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					October 2011




                                       Perspectives
                                       Supporting Queenslanders affected by cancer




Genetics and cancer                                                                Contents
Genes: The role of genes               External factors such as exposure to        2 Claire’s letter
Humans are thought to possess          environmental toxins (e.g. asbestos or
over 30,000 genes, which are           infection with some specific viruses)       4 What is Genetic
contained in the cells of the body.    can increase the risk of damage               Health Queensland?
Many people know about the role        to the genes, as can tobacco use
of genes in determining a person’s     and excessive alcohol intake. The           5 Maria Kyriacou’s
physical characteristics such as       combined impact of all these factors          cancer blog
eye colour, hair colour and facial     makes cancer more common in an
                                       aging population.                           6 Decision aids
features. These are some of the
visible inherited characteristics
for which genes are responsible.
                                       What is cancer?                             8 Cancer Council
However, genes have a much             Some genetic mutations may have               Queensland
more extensive role than this. They    no effect, whereas others may cause           accommodation
provide the instructions for all the   changes to the way the cells grow             and support lodges
thousands of basic processes           and function. Cancer results when
going on inside the cells of our       the cells stop paying attention to the      9 Dietary fibre explained
bodies that support life.              normal signals that tell them to grow,
                                       stop growing or even to die. Cancer         11 Q and A from the
Cell division
                                       cells still share many of the properties       Cancer Council
Cells in the body are continually      of normal cells but they no longer
dying and being replaced.                                                             Helpline
                                       respond to the controls that make
For example, cells in the skin,        these processes function smoothly.
intestines and liver are replaced      There are many different factors that
                                                                                   12 We’re moving online
every few weeks.                       may affect this process of cell change.
Cell division is the process by        That is why it is usually not possible
which new cells are created. This      to determine the exact cause of an
process is continuous during our       individual’s cancer.
lifetime. An existing cell, known      Cancer is actually a general term
as the parent cell, divides into two   that describes a large group of
daughter cells. In order to maintain   related diseases. Every case of
the correct working of the body the
same genes need to be passed
                                       cancer is unique with its own set
                                       of genetic changes and growth
                                                                                    Thank you…
onto the new cells. However, each
                                       characteristics. Some cancers grow           to everyone who completed the
time this process of cell division
                                       quickly while others can take years          Reader’s Survey in the previous
takes place it is possible a mistake
                                       before they present a significant risk       edition of Perspectives. Your
may be made in how the genetic
                                       to the patient. The many differences         feedback is invaluable to
material is copied to the new
                                       between cases of cancer, even of             improving the quality of this
cells. These mistakes are called
                                       the same organ (i.e. different cases
genetic mutations. The older we                                                     newsletter. The lucky winner
                                       of breast cancer), is one of the main
get the more often the process                                                      of the $50 SunSmart voucher
of cell division has occurred and      reasons that treatment for some
                                                                                    was W Clarke, Minyama.
therefore the more likely it is that   cancers remains a challenge.
mutations may also have occurred.                            continued on page 3


Cancer Council Helpline 13 11 20
www.cancerqld.org.au
Perspectives | October 2011




                                         Dear readers
                                         Welcome to the Spring 2011
                                         edition of Perspectives
Claire Kelly, Executive Manager
Cancer Support and Information
Cancer Council Queensland

In our last edition (June), we asked     to learn about Maria’s blog and read        Many readers of this newsletter may
our readers to take part in our          Barry’s poems. It is such a privilege       have been confronted with difficult
Reader’s Survey. We received some        that we are permitted to share these        decisions that have arisen from a
invaluable feedback and support from     individual stories and we hope they         cancer diagnosis and/or treatment
this survey and I would like to thank    provide some inspiration for each of        and many would know that it can be
each of you who took the time to let     you, our valued readers.                    extremely challenging deciding on
your voice be heard. You may notice                                                  the best plan of action when given
                                         The word ‘genetics’ appears to be
that we have implemented a few                                                       a range of options to choose from.
                                         increasingly mentioned in media
of these suggestions in this edition                                                 Of course, staff providing treatment
                                         coverage, cancer literature and
and as always, we welcome your                                                       and care will assist and support in
                                         sometimes even hospital cancer
feedback on these changes and any                                                    the decision-making process, but
                                         treatment clinics, but it is a relatively
future suggestions that you may have                                                 the individual’s choice is paramount
                                         new word in our everyday language
to improve this newsletter.                                                          too. The article on decision support
                                         and may sound a bit scientific. Do we
                                                                                     outlines a system that can be used to
This edition addresses many              really need to know about genetics          assist in identifying the best care plan
cancer-related issues from a range       and is it really complicated? The           for an individual.
of perspectives. Cancer Council          article in this edition of Perspectives
Queensland is always delighted when      begins to explain some of the mystery       Now it’s time to grab yourself a
people contact us to share their own     behind this word and explains how           cuppa, find a quiet, shady spot
stories and we encourage you to get      genetics can relate to cancer. We also      outside and make the most of this
in touch if you have a story to share.   find out about the service available        beautiful spring season as you read
We know that sharing experiences         in Queensland for those of us who           this informative and inspirational
and writing about them can be a          would like to know what to do if we         edition of Perspectives.
positive experience for some people      suspect a cancer may be common to           Best wishes,
and in this edition we are delighted     our family.                                 Claire Kelly




                                            Pink ribbon day
                                                filler ad


Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                       2
Perspectives | October 2011




Genetics and cancer
continued from page 1

The following information is
generously provided by Cancer
Council South Australia. For more
information, visit http://www.
cancersa.org.au/aspx/familial_
cancer.aspx

Familial cancer
What is a family history of cancer?
Cancer is common - many people
have someone in their family who
currently has or has had cancer. It
is not uncommon for more than one
member of a family to have cancer.
Cancer can occur in families:
•   Just by chance, which is most
    often the case.
                                            There may be a familial basis for         Why is it important to know about
•   Because family members have             other cancers such as prostate            familial cancer?
    environmental and lifestyle             cancer, melanoma and testicular
    influences in common, e.g. too                                                    Knowing you are at increased risk of
                                            cancer, but the particular genes          developing cancer is useful because:
    much sun or smoking.                    responsible for this haven’t been
                                                                                      •   Your risk of cancer may be able to
•   Because there is an inherited faulty    identified yet.
                                                                                          be reduced.
    gene leading to an increased risk
                                            How can I tell if my family has           •   A cancer may be diagnosed at an
    of cancer, which is uncommon.
                                            a history of cancer?                          early stage, increasing the chance
Only a small percentage of certain                                                        that it can be cured.
                                            Look at the family history on both
cancers (up to five per cent) are due
                                            your father’s and your mother’s side      Where do I find out more about
to a faulty gene inherited from either
                                            of the family. The clues that cancers     familial cancer?
the father or mother. This is what          in the family may be due to an
we call a familial or family cancer.        inherited faulty gene include:            •   Talk to your doctor if you are
This can also be referred to as an                                                        concerned about cancer in
inherited predisposition to cancer.         •   The number of blood relatives (e.g.       your family.
The faulty gene increases the risk              mother, grandmother, brother,
                                                sister - not related by marriage)
                                                                                      •   Your GP can refer you (if there
of cancer, but even then it does                                                          is a suggestion of a familial
not mean every family member will               who have had cancer.
                                                                                          cancer) to the Familial Cancer
develop the cancer.                         •   Cancer developing at a younger            Service in Queensland for further
                                                age than is usual in the community.       assessment, advice, and (in some
Are some cancers more likely                                                              cases) genetic testing.
                                            •   Pattern of cancer in the family.
to be familial than others?
                                                Families may develop the same         •   Call the Cancer Council Helpline on
In general, the great majority of               cancer, or several cancers,               13 11 20 to talk about your concerns.
cancers are not familial.                       depending on which faulty gene
                                                is involved.                          Other useful websites
•   Some breast, ovarian, endometrial
    and bowel cancers can be due to an      The more clues that are present,          http://www.cancer.net/patient/
    inherited mutation, but most are not.   the more likely it is that there is an    All+About+Cancer/Genetics/
                                            inherited faulty gene in the family       The+Genetics+of+Cancer
•   Others such as lung cancer,
                                            causing a higher than usual chance        http://www.cancerquest.org/cancer-
    leukemia and cervical cancer are
                                            of cancer. However, it is not definite.   genes-overview
    rarely due to an inherited mutation.
                                            Some people who inherit a faulty gene
•   Some rare cancers have a familial       which causes an increased risk of
    tendency.                               cancer never go on to develop cancer.


Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                           3
Perspectives | October 2011




What is Genetic Health Queensland?
By Julie White, Senior Genetic Counsellor,   Reasons why your doctor may                 After your appointment, both you
Genetic Health Queensland.
                                             refer you to the Family Cancer              and your doctors will receive a letter
Genetic Health Queensland (GHQ)              Clinic at GHQ                               summarising your consultation,
is a statewide super-specialty                                                           including any recommendations
                                             Individuals with multiple family
service that provides genetics                                                           made and follow-up appointments
                                             members with a specific type of
services across Queensland. Our                                                          are arranged as required.
                                             cancer, such as breast, ovarian or
team of specialist health-care
                                             bowel cancer or individuals with            How do I organise an appointment,
professionals sees individuals and
their families with a suspected              cancers diagnosed at an unusually           and is there a cost involved?
or known inherited or genetic                young age can be referred to GHQ.
                                                                                         GHQ is a specialist service and so it
condition. A major component of              A genetic counselling appointment           does require a written referral from
our work relates to cancer family            can provide information to individuals      your doctor. It is a public health
history, risk assessment and in              with a significant personal and/or          service provided by Queensland
some cases genetic testing.                  family history of cancer. This may          Health, so there are no out-of-pockets
A team of medical specialists (clinical      include:                                    expenses.
geneticists) and genetic counsellors         •   Individual risk of developing cancer    Referrals can be mailed or faxed to
work together at GHQ to look
                                             •   Likelihood of inheriting a hereditary   the address or number below:
after patients and families all over
Queensland. Regular clinics are held             cancer syndrome                         Dr Rachel Susman
in Brisbane, at the Royal Brisbane &         •   Screening recommendations               Genetic Health Queensland
Women’s Hospital, Redcliffe Hospital                                                     C/- Royal Brisbane
                                             •   Cancer risk reduction options
and Princess Alexandra Hospital.                                                         & Women’s Hospital
In regional areas, clinics are held in       Genetic testing may also be provided        Herston Road, Brisbane QLD 4029
Gold Coast, Ipswich, Toowoomba,              where appropriate.
                                                                                         Telephone: 07 3636 1686
Nambour, Gympie, Hervey Bay,
Bundaberg, Rockhampton, Mackay,              What does an appointment                    Fax: 07 3636 1987
Townsville, Cairns and Mt Isa.               at GHQ involve?
                                                                                         Email: ghq@health.qld.gov.au
Telemedicine clinics may also be             Prior to your appointment a Cancer
                                                                                         Web: www.health.qld.gov.au
offered to other remote area sites.          History Medical Questionnaire will be
The Queensland Familial Bowel                sent to you by mail to help us provide      For more information about GHQ and
Cancer Registry (QFBCR) is also              the most accurate diagnostic and            details about making an appointment
based within GHQ.                            counselling information. This includes      please contact our main office or
                                             information about the person who            the genetic counsellor at one of our
                                             has been referred as well as their          regional centres.
                                             family. On return of the questionnaire      Royal Brisbane
                                             a genetic counsellor will usually           & Women’s Hospital
                                             contact you by telephone to clarify         (main office)            07 3636 1686
                                             information about cancer diagnoses
                                                                                         Cairns and Mackay        07 4226 6247
                                             in your family. This may include
                                             sending consent forms to you to             Gold Coast               07 5519 8741
                                             discuss with relatives.                     Bundaberg, Hervey Bay
                                             At your appointment, you will be seen       and Rockhampton       07 4150 2794
                                             by a clinical geneticist, a genetic         Nambour and Gympie 07 5441 7167
                                             counsellor or both. An assessment           Toowoomba
                                             of cancer risk will be made for you         and Ipswich              07 4616 6995
                                             and/or your family. In some cases
                                             genetic testing for a hereditary cancer     Townsville and Mt Isa    07 4796 1463
                                             syndrome may be offered.                    Office hours are 8am to 5pm




Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                              4
Perspectives | October 2011




Maria Kyriacou’s cancer blog
                                             Since my breast reconstruction, I’ve          this monumental change, not that you
                                             taken up Restorative Yoga which has           have much of a choice. My mother
                                             been another revelation. My teacher           told me of her 42-year-old friend
                                             does a wonderful mix of holding long          who is anxious about having to have
                                             poses, meditation and chanting (yes           her ovaries removed. I immediately
                                             chanting!!). As with Pilates, it’s a joy      wanted to call this woman and let
                                             to find yourself in a yogic position          her know it’s not as scary as she
                                             you thought you couldn’t achieve.             might think. I plan on having an
                                             Judging from the awkward little ‘oms’         oophorectomy down the track and
                                             I hear from newbies to our class, it          have been told it’s a simple one-day
                                             seems most people find the chanting           laparoscopic procedure.
                                             confronting but I’ve grown to love            In my experience, the dread
                                             it and now chant boldly. You feel             of menopause lies more in the
                                             such a connectedness to everyone              psychological, as it casts women into
                                             around you when you ‘ommmmm’ in               the realm of the ‘next phase’ of their
Maria Kyriacou
                                             unison. Sitting in stillness, chanting,       lives. Prematurely in some cases,
                                             can lead you into a state where you           which is unfair and feels unnatural in
Om Shanti Shanti
                                             feel your body vibrate from the inside        a way, but there are advantages.
One of the things cancer can do is           out. Our teacher always says to feel
rob you of control and confidence            the vibration you’ve created once the         I thought I’d feel old and unattractive
in your body. You can feel that your         chanting has stopped and then to              but I’m here to tell you life goes on!
body has let you down and I often            bring it out and share it with the world.     Aside from the hot flushes I don’t feel
experienced a strong disconnect.                                                           much of a change, perhaps because
                                             The beautiful thing about this focus          I have a young family with a busy life.
Throughout my treatment and                  (and this is also true of meditation) is
recovery I’ve always maintained                                                            I’ve always been a bit ditzy so I can’t
                                             that it’s a much needed escape from           blame menopause for my memory
some sort of exercise, even if it was        all the needles, stitches and anxiety
walking 20 minutes a day. Aside from                                                       lapses. I’ve been trying to walk
                                             that come with the dreaded cancer.            daily and keep up with my Pilates
awakening your bed weary muscles,            I find that to focus entirely on your
walking lifts your mood, which I                                                           and yoga so I haven’t put on any
                                             breath awakens you to living mindfully        extra kilos. I had joint pain initially
believe is key in living with a cancer       and simply within the moment.
diagnosis.                                                                                 which is common but it’s gone now.
                                             Good morning hot stuff!                       Things are also surprisingly fine with
Pilates was my saviour through the                                                         my husband in the intimacy sphere
dark chemo days, and often shocked           When I was 20 I hosted a radio show           thank you very much!
me into waking up from my chemo              called ‘Wake Up with a Headache’,
                                             playing heavy industrial and alternative      So essentially, for better or worse
stupor. The beauty of Pilates is that
                                             music. I remembered this because my           I’m still me. These days I just inhabit
it feels like you’re not actually doing
                                             motto these days is ‘Wake Up with a           an oestrogen-deprived body which
very much, but you feel its effects
                                             Hot Flush’. The 36-year-old me thinks         I hope in turn translates to a cancer
later. This is fantastic if your brain has
                                             both these methods of                         free body.
succeeded in convincing you your
body is a weak failure, because the          waking up are awful but
stretches seem so easy when you’re           I’d obviously choose the
doing them.                                  slamming headache!
                                             I’m so used to waking
                                                                           RAISING
The elation of feeling that you have
                                             in a sweat now, and
                                                                           MONEY AND
the ability to influence how your body                                     AWARENESS FOR
                                             compared to the
feels can be intoxicating, probably
                                             monster that is cancer
                                                                           WOMEN’S
because I think your consciousness
                                             the onset of early            CANCERS
follows suit. I believe this is
particularly true when your treatment        menopause is more like
                                             an irritating little dog
is so invasive that it leaves you feeling                                  Register or donate at girlsnightin.com.au or call 1300 65 65 85
                                             yapping at my heels.
like a poked and prodded rag doll.
I found it to be the best way of taking      I realise lately how                                                           FOLLOW
                                                                                                                              US ON
back some control.                           easily I’ve accepted

Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                                         5
Perspectives | October 2011




Decision aids
A diagnosis of cancer
may result in the need to
make a number of difficult
decisions. These may
include choosing between
treatments, if and when
to return to work, how to
involve or care for family
members and how to
manage finances.
Difficult decisions are often
made harder if there is more
than one option to choose
from, and each option brings
a different set of issues to
consider.
Decision aids are designed
to help people understand
the options, to consider
the personal importance of
possible benefits and risks,
and to participate in decision
making. They can be used
when there is more than one
reasonable option, when no
option has a clear advantage
in terms of outcomes and
each has benefits and risks
that people value differently.
On the right is a sample of
a decision aid you may wish
to use. To receive further
information or support in
your decision making, call
the Cancer Council Helpline
on 13 11 20, where trained
staff can guide you through
the process.

Useful websites:
Ottawa Personal
Decision Guide:
http://decisionaid.ohri.ca/
index.html
Information on patient
decision aids:
http://decisionaid.ohri.ca/
AZinvent.php




Cancer Council Helpline 13 11 20
www.cancerqld.org.au               6
Perspectives | October 2011




Cancer Council Helpline 13 11 20
www.cancerqld.org.au               7
Perspectives | October 2011




Cancer Council Queensland
accommodation and support lodges
Cancer Council Queensland’s               the radiation that followed. Luckily,   The Lodge
accommodation and support                 they think they have it all so it all   I beat the bugger, yes I did,
lodges provide a home-away-               looks good. The thing I miss most is    that dreaded thing caller cancer.
from-home, at no cost, for                not my hearing, as I had expected;
regional cancer patients and their        it’s my teeth I miss the most because   Now all the doctors want to know,
carers having to travel away from         it’s so hard to eat with no teeth.      just what’s the bloody answer.
home to receive cancer treatment.         Hurry up false ones!”                   To how and why and when we get it,
Our accommodation and support                                                     and how to stop that thing.
lodges are crucial to cancer              The R.B.W.H
                                                                                  But one thing is important,
survival in Queensland, enabling          O here I am in hospital,                the support different people bring.
regional patients to access life-         a sure and sorry sight.
saving services.                                                                  The Lodge you know is a mighty place,
                                          Cancer’s what they cut out,             It boards us country yokels.
Currently, Cancer Council Queensland      I hope they did it right.
operates facilities in Brisbane, Cairns                                           The staff they are fantastic,
                                          I shouldn’t really say that,
(recently opened), Townsville and                                                 as are the volunteer locals.
                                          the experts they have here.
Rockhampton and preparations are                                                  They take you shopping once a week,
well underway to open a new facility      The doctors are a mighty bunch,
                                                                                  and will show you round their city.
in Toowoomba by the end of the year.      not trim and taught and proper.
By the end of 2011, we will have five                                             Patients getting treatment,
                                          They tell it as it really is,
lodges operating across the State,                                                they don’t want anyone’s pity.
                                          so that you don’t come a cropper.
providing a combined 73,000 bed           This is the R.B.W.H,                    The Lodge’s chat room’s a popular place,
nights per year to patients and carers,   a hospital that trains.                 with patients and those that care.
at no cost, easing the financial strain                                           They sit and chat and have a laugh,
that many patients experience.            Where even the newest student nurse,
                                          will have to use their brains.          no-one’s treatment is that rare.
Barry Cornelius was recently
                                          Let’s get back to the medics here,      The Queensland Cancer Council,
a resident at Cancer Council
                                          they work in different teams.           is the one that supports this place.
Queensland’s Charles Wanstall Apex
Lodge in Brisbane. He has written         One to remove the nasties,              State and Federal governments,
about his cancer experiences in a         the other to replace the seams.         don’t enter in this race.
series of poems, the first two of which   They call the first the ENT,            It’s the public that donate to this,
are printed below. The first describes    the others known as plastics.           needy, grateful group.
his experience at the Charles Wanstall
                                          But team them with the nurses,          So keep the dollars coming,
Apex Lodge in Brisbane, while the
                                          and call them all fantastic.            ’you’ could end up in this loop.
second describes his time at the
Royal Brisbane Women’s Hospital.
Barry provided the following brief
details about himself.
“I have lived on a property in Central
Queensland as a boreman-mechanic
for nearly 22 years. Mid-January this
year I was diagnosed with cancer
around the left side of my face
including the left ear. Mid-February
they operated removing the whole
ear – ear drum included. Also, all of
my teeth were pulled because of



Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                     8
Perspectives | October 2011




Dietary fibre explained
                                                                                   risk of developing cancers of the
                                                                                   colon, breast (in post-menopausal
                                                                                   women), endometrium, kidney and
                                                                                   oesophagus (adenocarcinoma).
                                                                                   Some studies have also found links
                                                                                   between obesity and cancers of the
                                                                                   gallbladder, ovaries and pancreas
                                                                                   (Vainio and Bianchini 2002).

                                                                                   Soluble vs. insoluble fibre
                                                                                   There are two broad categories of
                                                                                   fibre – soluble and insoluble. Most
                                                                                   plant foods contain a combination of
                                                                                   both but may be higher in one type.
                                                                                   Soluble fibre is able to dissolve in
                                                                                   water, while insoluble fibre ferments
                                                                                   in the large bowel. Examples of
Bridget Kehoe, Nutritionist              How does fibre work?                      insoluble fibre include pectin and oat
Cancer Council Queensland                                                          bran. Insoluble fibre is usually found
                                         Dietary fibre is not digested or
                                                                                   in the skins of fruits and vegetables,
What is fibre?                           absorbed in the small bowel; instead,
                                                                                   wholegrain wheat, wheat bran,
                                         it is completely or partially fermented
Fibre is the indigestible portion of                                               corn, wholegrain rice and fibrous
                                         by colonic flora in the large bowel.
edible plants, found in plant cell                                                 vegetables. Soluble fibre is found in
                                         When fibre is fermented it produces
walls. Foods containing fibre include:                                             oats, barley, rye, legumes and peeled
                                         butyrate, which is a type of fatty        fruits and vegetables. Insoluble fibre
wholegrain cereals and breads,           acid. There is convincing evidence
fruits and vegetables, beans, dried                                                is more likely to speed up bowel
                                         that eating foods containing dietary      transit time while soluble fibre can
peas, legumes, nuts and seeds.           fibre can decrease your risk of
The majority of fibre is contained                                                 help to slow down a bowel motion.
                                         developing colorectal cancer and it is    Insoluble fibre can help people
in the outer layer of grains and         thought that butyrate helps to do this    who are suffering from constipation
therefore can be removed by refining     by maintaining the integrity of the       and soluble fibre may help reduce
processes. This means that products      DNA in colonocytes (cells that line       diarrhoea and prevent leakage.
made with white flour tend be            the bowel) and maintaining normal
much lower in fibre than their whole     cell differentiation (the process of      Constipation
meal or wholegrain counterparts.         simple cells changing into different      There are several reasons that
Processing can also reduce the           specialised cells). Fibre is also a       people diagnosed with cancer
amount of fibre in a product. For        major controller of faecal bulk and       may experience problems with
example, apple juice contains nearly     decreases colonic transit time or the     constipation. Some of these may
no fibre while whole apples have a       time it takes for a bowel motion to       be directly related to the disease
much higher fibre content.               pass through. This means that there       or may be as a result of treatment
Australians generally have diets low     is reduced contact between the cells      or medications, for example pain
in fibre, with most people consuming     lining the colon wall and potential       medications. Constipation can also
between 12 and 20g/day. There            carcinogens.                              be caused or exacerbated by lifestyle
is no official recommendation for        Eating a diet high in fibre helps to      factors such as living a sedentary
the amount of fibre that should          reduce the energy density of your         lifestyle, having a low overall food
be consumed but it is generally          diet and promotes greater satiety         intake or having a diet low in fibre.
accepted that you should aim for         (fullness). Several studies (Slavin       While it may not be possible to
around 25g-30g of fibre per day.         2005; Bes-Rastrollo et al 2006;           change factors related to your cancer,
This can be achieved by eating           Anderson et al 2009) have shown           treatment or medications, some of
wholegrain cereals and meeting the       that people who eat a diet high in        the lifestyle factors are modifiable
recommendations for two serves of        fibre are less likely to be overweight    and may have an impact on
fruit and five serves of vegetables      or obese. There is some evidence          improving your constipation.
per day.                                 that obesity is linked to an increased                         continued on page 10

Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                      9
Perspectives | October 2011


Dietary fibre explained
continued from page 9

                                                                                          Fibre supplements
  MOST laxative
                                          •   WHEAT                                       Fibre supplements may be an option
                                                                                          for people who are not experiencing
                                          •   FRUIT AND VEGETABLES
                                                                                          improvement through dietary change
                                          •   PLANT GUMS (Found in cell walls             alone. Soluble fibre supplements can
                                              and often used as a thickener in the        help to control loose bowel motions,
                                              food industry. Examples include gum         however, they do not work for
                                              arabic, sterculia and tragacanth)
                                                                                          everyone and may increase diarrhoea
                                          •   OATS                                        in some people. There are many
                                                                                          commercial supplements available
                                          •   LEGUMES                                     from supermarkets, pharmacies or
                                          •   PECTIN (Found in cell walls, particularly   health food stores. A few commonly
                                              in fruits such as apples, pears, and        known ones include: Metamucil
  LEAST laxative                              citrus and used in jam making)              (Psyllium), Benefiber (Wheat Dextrin),
                                                                                          Normafibe (Sterculia), Dulcofibre
Figure 1: Laxative effect of different fibre sources                                      (Glucomannan) and Bonvit (Psyllium).
                                                                                          Some people may experience
                                                                                          bloating, gas or abdominal pain
Different types of fibre have different       Increasing fibre                            when they first begin taking fibre
levels of laxative activity (shown            It is important to gradually increase       supplements. These symptoms may
in figure 1), so some may be more             the amount of fibre in your diet as a       be minimised by introducing fibre
effective at increasing gut transit           sudden increase may lead to bloating        supplements gradually, starting with
time and helping you to pass a                and gas. In severe cases it can lead        small amounts and increasing slowly
bowel motion if you are struggling            to cramps or a bowel obstruction.           over a few weeks. It is also important
to do so. If you are having trouble           Too much fibre can lead to reduced          to drink an adequate amount of water
with constipation you should speak            absorption of some minerals, such           when taking a fibre supplement to
to your doctor or dietitian about             as iron.
whether changing your diet may                                                            ensure bowel motions can be passed
help to alleviate this problem.               Some tips for increasing fibre:             easily. If you are considering taking a
                                              •   Increase wholegrain bread/cereal        fibre supplement your dietitian, GP or
Diarrhoea                                         intake to meet recommendations          continence advisor can advise you in
People diagnosed with cancer                      for your gender/age (the exact          choosing a suitable fibre supplement
may experience problems with                      number of serves can be found           for your needs.
diarrhoea due to a number of different            in the Dietary Guidelines for
                                                                                          References
reasons. This may include treatment,              all Australians available at
medications or anxiety. If you are                www.nhmrc.gov.au).                      Anderson, J., Baird, P., Davis, R.,
having radiation to the pelvic area you       •   Eat wholegrain or whole meal            Ferreri, S., Knudtson, M., Koraym.,
may experience radiation induced                  bread and cereal products.              A., Waters, V., and C. Williams. 2006.
diarrhoea, however this often does not                                                    “Health benefits of dietary fiber”.
improve with dietary changes. If you          •   Increase fruit and vegetable intake     Nutrition Reviews 67 (4): 188-205.
experience diarrhoea as a result of               to two serves of fruit and five
                                                  serves of vegetables each day.          Bes-Rastrollo, M., Martinez-Gonzalez,
other factors dietary changes may be
                                                                                          M., Sanchez-Villegas, A., de la Fuente
able to help alleviate some symptoms.         •   Incorporate legumes into meals.
If diarrhoea is a problem you may look                                                    Arrillaga, C., and J. Martinez. 2006.
                                                  For example peas, beans and
at reducing the amount of fibre in your                                                   “Association of fiber intake and fruit/
                                                  lentils can be added to soups or
diet by replacing wholegrain breads                                                       vegetable consumption with weight
                                                  casseroles (Note: Legumes can
and cereals with white versions,                  cause gas in some people).              gain in a Mediterranean population.”
removing the skins and seeds from                                                         Journal of Nutrition 22: 504-511.
                                              •   Try to limit low fibre foods such as
fruit and vegetables, and cutting down                                                    Slavin, J. 2005. “Dietary fiber and
                                                  fruit juice, fatty foods, take-away
on the amount of legumes, nuts and                                                        body weight”. Journal of Nutrition
                                                  and refined cereal products made
seeds that you consume. It is also                                                        21: 411-418.
                                                  from white flour.
important to make sure you consume
an adequate amount of fluid. If your          •   When eating out ask for whole           Vainio, H., and F. Bianchini. 2002.
diarrhoea persists you should consult             meal rolls, choose a side salad         IARC handbooks of cancer prevention
your doctor so that the cause can be              and vegetables or include fruit         volume 6: Weight control and physical
determined.                                       for dessert.                            activity. Lyon: IARC Press.

Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                            10
Perspectives | October 2011




Q and A from the
Cancer Council Helpline
Question                                This may lead to a false sense of
                                        security among users.
Recently I read that sunscreen
with an SPF50+ will become              For best protection, we recommend
available in Australia. How does        a combination of sun protection
sunscreen with an SPF50+ rating         measures:
compare with sunscreen with             •   Slip on some sun-protective
an SPF30+?                                  clothing – that covers as much
                                            skin as possible.
Answer
                                        •   Slop on broad spectrum, water
Messages regarding sunscreen can            resistant SPF30+ sunscreen.
leave consumers confused regarding          Put it on 20 minutes before you
the safety and effectiveness of             go outdoors and every two hours
available products. The introduction        afterwards. Sunscreen should
of sunscreens with an SPF50+ may            never be used to extend the time
add to this confusion.                      you spend in the sun.
Cancer Council does not oppose          •   Slap on a broad-brimmed hat
SPF50+ sunscreen as a product,              that protects your face, head,
however, it is concerned that it will       neck and ears.
be marketed as offering more
significant protection, while it does
                                        •   Seek shade, especially between
                                            10am and 3pm when UV levels
in fact provide only a negligible
                                            are at their most extreme.
                                                                                         For information
improvement in protection with                                                          and support, call
SPF30+ sunscreen providing 96.7 per     •   Slide on some sunglasses –
cent protection and SPF50+ sunscreen        make sure they meet Australian              Monday to Friday
providing 98 per cent protection.           Standards.




                                                                 Help Cancer Council Queensland raise
                                                                 funds for skin cancer research and
                                                                 encourage everyone you know to slip on a
                                                                 shirt, slop on 30+ sunscreen, slap on a hat,
                                                                 seek shade and slide on some sunnies.
                                                                 Jump online to www.qldsunsmartday.org.au
                                                                 or phone 1300 65 65 85 to register and
                 Friday, November 12, 2010                       receive your Queensland SunSmart Day kit.




                                                                                                    Major sponsor




Cancer Council Helpline 13 11 20
www.cancerqld.org.au                                                                                                11
Perspectives | October 2011




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