Cancer Awareness with Learning Disability Mental & Physical Disability Abuse Female Genital Mutilation (FGM) or cutting

A learning disability affects the way a person learns new things in any area of life, not just at school. This means they can have difficulty:   understanding new or complex information learning new skills  coping independently

A learning disability can be mild, moderate or severe A learning disability can be mild, moderate or severe. Some people with a mild learning disability can talk easily and look after themselves, but take a bit longer than usual to learn new skills. Others may not be able to communicate at all and have more than one disability.

Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 People with learning disabilities have a much greater propensity to develop health problems (both physical and mental) when compared with the general population. Research suggests people with learning disabilities are 58 times more likely to die before the age of 50.

http://whqlibdoc. who. int/publications/2008/9789241596442_eng. pdf http://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdf?ua=1

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4

Physical Disability

Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Physical disability is a major global concern Represents the commonest form of disability Disabilities can cause increased morbidity, mortality and healthcare need People with disabilities require access to healthcare- ? with specialist referral where necessary.

Consider- Impairment – physical and /or mental Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Consider- Impairment – physical and /or mental Mental capacity/ understanding/informed consent Physical environment Social environments - ? Smear test at home

High physical morbidity in patients with severe mental illness. Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 High physical morbidity in patients with severe mental illness. Severe mental illness is associated with behaviours that predispose an individual to an increased risk of some cancers, including lung and breast cancer. (Smoking, anti-psychotic medications, chaotic lifestyle, lack exercise, poor diet). Disparities in screening for cancer and with higher case- fatality rates (other medical comorbidity, drug interactions, lack of capacity, and difficulties in coping with the treatment regimen as a result of psychiatric symptoms).

Mental health Smoking rates are higher among those with mental health Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Mental health Smoking rates are higher among those with mental health problems. The presence of a neurotic disorder was found to double the chances of an individual being a smoker in a national study. Among those with schizophrenia smoking rates have been found to be as high as 80 per cent. McNeill, A. (2001) Smoking and Mental Health: A review of the literature London: SmokeFree London

Small steps… Health advice- stop smoking, diet Oral hygiene- higher risk oral cancers Weight, BMI Discuss & encourage screening programmes Observe & be aware- discuss with keyworker

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 http://ash.org.uk/files/documents/ASH_120.pdf http://www.cancerresearchuk.org/prod_consump/groups/cr_com mon/@nre/@pol/documents/generalcontent/crukmig_1000ast- 3344.pdf

Sexual Abuse There is a high prevalence of helicobacter pylori Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Sexual Abuse

How might it affect women in relation to smear tests?

Female Genital Mutilation Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Female Genital Mutilation

FGM There is a high prevalence of helicobacter pylori Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 FGM

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4

Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 WHO estimates that between 100 and 140 million girls and women worldwide have been subjected to one of the first three types of female genital mutilation. Most recent prevalence data indicate that 91,5 million girls and women above 9 years old in Africa are currently living with the consequences of female genital mutilation. An estimated 3 million girls in Africa at risk of undergoing female genital mutilation every year.

Not only abroad- reports occurring in UK. Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Awareness in surgery Travel vaccinations “Health Passport” Children UTI’s Not only abroad- reports occurring in UK.

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 http://www.rcn.org.uk/__data/assets/pdf_file/0004/547996/Tackling_F GM_in_the_UK_Intercollegiate_recommendations_for_identifying,_rec ording_and_reporting.pdf

There is a high prevalence of helicobacter pylori Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 The government has produced a statement opposing female genital mutilation in a leaflet, which is also known as a ‘health passport’. This is just pocket sized and states the law and the potential criminal penalties that can be used against those allowing FGM to happen. Raise awareness of this leaflet to all the professionals in your organisation, who are involved in providing care for people travelling abroad, for example giving travel vaccinations and medicines.   This leaflet can be used by families who do not want their children subjected to FGM, but still feel compelled by cultural and social norms when visiting family abroad. It is also used by older girls, who carry the document with them when they are visiting family abroad. Can you help us to make families and girls in the UK who may be at risk, aware that this leaflet is available to support them when travelling abroad?    

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 The government’s statement opposing female genital mutilation in a leaflet and ‘health passport’

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4  

Female Genital Mutilation: the facts leaflet Cancer Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 Female Genital Mutilation: the facts leaflet  https://www.gov.uk/government/publications/statement-opposing-female- genital-mutilation  To order copies of the statement leaflet just follow the instructions attached and then email or telephone you order. The leaflet covers those communities most at risk of practicing FGM, the signs that a girl may be at risk of FGM or has undergone FGM, what to do if you think someone is at risk of FGM and what to do if you are at risk. You can view the FGM: the facts leaflet at https://www.gov.uk/government/publications/female-genital-mutilation-leaflet  

, a class 1 carcinogen linked to stomach cancer, gastric ulcer and Overall, the incidence of deaths from cancer in the UK among people with learning disabilities is currently lower than the general population ( 12% - 18% vs 26%), although people with learning disabilities have proportionally higher rates of gastrointestinal cancer than the general population (48% 59% vs 25% of cancer deaths). 40 42 However, the incidence and pattern of cancer amongst people with learning disabilities is rapidly changing due, in part, to increased longevity. Children with Down’s syndrome are at particularly high risk of leukaemia compared to the ge neral population, although the risk of solid tumours, including breast cancer, is lower. 43 44 There is a high prevalence of helicobacter pylori , a class 1 carcinogen linked to stomach cancer, gastric ulcer and lymphoma, among people with learning disabilities. 4 You can view the FGM: the facts leaflet at https://www.gov.uk/government/publications/female-genital-mutilation-leaflet   To order copies of the facts leaflet just follow the above procedure for ordering the statement leaflets. The government has also produced a poster for girls and women to raise awareness of FGM and that it’s illegal in the UK. You can find this poster at https://www.gov.uk/government/publications/female-genital-mutilation-is- abuse-poster

https://www. mencap. org https://www.mencap.org.uk/sites/default/files/documents/Handout_ten_top_tips.pdf http://www.cancerscreening.nhs.uk/cervical/news/003.html http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer- questions/books-on-cancer-for-people-with-learning-disabilities#nhs https://www.mencap.org.uk/sites/default/files/documents/Handout_ten_top_t ips.pdf http://www.learningdisabilitytoday.co.uk/new-resource-about-cervical- screening-for-women-with-learning-disabilities.aspx http://www.cancerscreening.nhs.uk/cervical/publications/easy-guide-cervical- screening.html

http://a2anetwork.co.uk/wp-content/uploads/2010/01/Equal-Access-to- Breast-Cervical-Screening-for-Diabled-Women-NHS-Cancer-Screening- Programme.pdf http://www.fairadvice.org.uk/health-publications.php http://www.learningdisabilities.org.uk/help-information/learning- disability-a-z/h/health/ https://www.improvinghealthandlives.org.uk/uploads/doc/vid_7479_IHaL2 010-3HealthInequality2010.pdf http://www.bowelcanceruk.org.uk/media/171227/923_bcuk_scottish_b5. pdf