LECTURE 1. Opening and introduction to course

NOTES Oncology and Public Health

LECTURE 1. Opening and introduction to course

Mostly done cancer tests: breast, cervix, and colon cancers.

The incidence of cancer is rising with 3000 patients per year. During COVID fewer diagnoses, because people didn’t show up to their GP.

• Men: prostate, skin, lung, bowel. In the beginning, more men had lung cancer, but

now also women, because they started smoking later.

- Women: breast, skin, lung, bowel, lymph node and leukaemia.

• Woman started smoking later -> therefore they also started to get lung cancer

later. Hence, lung cancer is now an upcoming cancer type in women.

Survival rate (5-year survival) = W 70%, M 66%.

20 year prevalence: in 2032, 1 in 13 will have (a history of) cancer.

Oncology is a public health issue, oncology is the leading cause of death.

1/3 of all cancer types is due to behavioural and dietary risks:

• High BMI.
• Low fruit and vegetable intake.
• Lack of physical activity.
• Tobacco use.
• Alcohol use.

Public health: the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society.Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.

- The focus of oncology and public health is on:

• Prevention.
• Increasing health care capacity.
• Making the organization of health care more efficient.
• Digitalization.
• Supporting the needs of patients and survivors.
• Increasing the quality of life and quality of end-of-life.

Answers to the quiz:

• More men than women are diagnosed with cancer in the Netherlands; probably

because diagnosis happen less in women – not that there are less women with cancer.

• The incidence of cancer in the Netherlands in 2019 was about 119.000; the

prevalence is way higher.

• Breast cancer screening is an example of secondary prevention = early detection/

diagnosis; with secondary prevention the disease is already present– primary screening is when the individual takes steps to prevent a disease from happening.

• 40-50% of new cancers causes are diagnosed during the working age (18-65) – for

instance because people are working until a later age. 1 / 4

• More than 85% of all cancer types can be considered ‘rare’ cancer types.
• Most prevalent cancer type in women is breast cancer
• Most prevalent cancer types in men is prostate cancer
• In the Netherlands people usually get screened for colon cancer at the age of 55.
• In the Netherlands people usually get screened for breast cancer at the age of 50.
• In the Netherlands people usually get screened for cervical cancer at the age of 35.
• 1/3 of all cancer are caused by an unhealthy lifestyle
• 5-10% of all cancer have a genetical component
• Palliative care and intense life prolonging therapy can be combined.
• The prevalence of distress in patient with cancer is 1/3 of all patient.
• Colorectal cancer is the type of screening program that has the highest uptake rates

in the Netherlands together with breast cancer.

• Cannabis can be used to relieve pain in patients with cancer.

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LECTURE 2. Introduction in public health

X Definition of public health The science and art of (1) preventing disease, (2) prolonging life and (3) promoting health in the public through organized efforts and informed choices of society.

- Society: organizations, public and private, communities, and individuals.

- Public: communities, countries, or global health.

→ collective action to improve population health.

3 most important goals (3Ps):

• Preventing disease
• Prolonging life
• Promoting health

X Public health application

Three fields of public health research:

• Epidemiology and community diagnosis.

o Epidemiology: the branch of medicine which deals with the incidence,

distribution, and possible control of diseases and other factors relating to health.

o Community diagnosis: a quantitative and qualitative description of the health

of citizens and the factors which influence their health.

• Collective prevention and health promotion.
• Screening and information.
• Health care organization and performance
• How is health care (in a city) organized, how is health provided? How is the

access to health organizations (GP/ hospital) distributed? Is it accessible for everyone?

Public health vs medical science:

• Public health and cancer: trying to decrease the risk factors – through screening.
• But also through environmental control.

- Populations: From local areas to the world population.

• Causes of diseases (causes of causes): From behaviours to broader environment.
• Advertisements for smoking banned, taxes for cigarettes - because it causes

smoking. 3 / 4

• Why do people smoke? Why do people keep smoking?

- Prevention of disease: From individual patients to national policies.

• What can the government do to prevent it? What can the society do to

prevent disease?

• Smoking behaviour.

- General health outcomes: From quality of life to healthy life expectancy.

• Where do we get our gains, what can you do to improve this? is living longer

always better or quality of life?

X Public health function

- Assessment and monitoring:

• At a population level – how many people get cancer or how many are healthy?
• To identify health problems and priorities in risk populations.

▪ Mesothelioma risk with asbestos? Relation asbestos and mesothelioma = 1 on 1. Working with asbestos has a huge latency period (can be 40 years) before mesothelioma occurs. 500-600 people are dying of mesothelioma.

- Formulation of public policies:

• What kind of policy should be considered in the disease situation? What is

necessary to improve public health.▪ What kind of policy should be used in asbestos, ban on asbestos?

- Access to appropriate and cost-effective care:

• Assure that all populations have access to health care.

▪ Including health promotion and diseases prevention services.

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