Cancer Prevention and You

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Cancer Prevention and You

• Margaret Bell RN, BSN, MPH, CMPE
• Clinical Administrative Director,
• Cancer Prevention Center

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The Good News the Bad

• The good news
• Since 1991, cancer death rate has been steadily
  decreasing
• Improved treatments
• Cancer prevention activities
• The bad news
• Cancer is the 2cd leading cause of death in the
  United States

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Know Your Cancer Risk

• Age
• Predisposing conditions
• Hormone factors
• Personal history of cancer
• Family history of cancer

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Lifestyle risk factors you can do something about

• Nutrition
• Obesity
• Physical inactivity
• Alcohol
• Tobacco use
• Multiple sexual partners
• 2/3 of cancer can be prevented

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Breast Cancer Myths

• Injury
• Antiperspirants
• Underwire bras
• Induced abortion
• Environmental pollution
• Breast implants

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Risk Factors

• Age
• Family history of breast cancer
• Hormonal factors
• Proliferative breast disease
• Therapeutic radiation to breast region
• Personal history of malignancies
• Dietary and lifestyle factors

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Risk Factors

• Increasing age
• 75 have no risk other than age
• Hormonal factors
• Starting periods early (lt12 years)
• Stopping periods (gt55 years)
• Never having children
• Late age of first live birth (30 years)
• Oral contraceptives
• Hormone supplements

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Risk Factors

• Dietary and lifestyle factors
• High fat diet
• Adult weight gain, esp. postmenopausal
• Sedentary lifestyle
• Alcohol
• Higher education and socioeconomic status

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Symptoms of Breast Cancer

• Painless
• Hard
• Immobile
• Fixed to the chest wall
• Associated with skin changes redness,
  thickening, warmth, retraction
• NEW

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Evaluation Diagnosis

• Symptoms
• Physical examination
• Imaging studies
• Biopsy

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Types of Breast Cancer

• In-situ
• Ductal carcinoma in situ
• Infiltrating or Invasive
• Ductal
• lobular

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STAR Study Results

• A clinical trial to compare 2 drugs abilities to
  reduce the incidence of breast cancer in post
  menopausal women
• Raloxifene (Evista) a common osteoporosis drug,
  was shown to be as effective as Tomoxifen
  (Naolvadex)
• Both were equivalent in reducing the incidence of
  invasive breast cancer by about 50 but
  Raloxifene had fewer side effects
• Tamoxifen more effective in controlling the
  incidence of noninvasive breast cancers LCIS and
  DCIS
• Tamoxifen approved for pre and post menopausal
  women

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What is the most common and preventable cancer of
both men and women?

• Skin Cancers

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Hormone Therapy

• Estrogen and progesterone increase heart risk by
  23 and breast by 26
• If you have a uterus you need the progesterone to
  protect the uterus
• If your risk is 1 the the increased risk is
  1.26
• Estrogen alone does not seem to have a problem
  after 5 years doesnt help or hurt
• Hormones seen as a bridge (5-10 years) to
  menopause not long treatment

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Risk Factors
Age
Diet
Polyps
Personal history
Family history
Ulcerative colitis
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Colorectal Cancer Symptoms

• Change in bowel habits
• Diarrhea, constipation
• Blood in stool
• Narrow stools
• Fatigue
• Vomiting
• Unexplained weight loss
• Abdominal discomfort

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Reducing Colorectal Cancer Risk

• Maintain healthy diet and weight
• Increase fruit, vegetable and fiber intake
• Follow screening recommendations

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Types of Skin Cancer

• Nonmelanoma Basal Cell Carcinoma
• 90 of skin cancers
• Areas exposed to sun most at risk
• Small pearly nodules or bumps
• Slow growing, non spreading
• Can damage bone below lesion
• 95-99 cure with early detection

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Types of Skin Cancer

• Nonmelanoma Squamous Cell Carcinoma
• 6 of skin cancers
• Areas exposed to sun most at risk
• Crusty scaly patches
• Can spread internally if untreated
• 95 cure rate with early detection

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Types of Skin Cancer

• Malignant Melanoma
• Most serious skin cancer
• Can spread to other organs
• 4 of cases, 79 of cancer deaths
• Number of cases has doubled in last 20 years
• Close association with sun exposure

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Risk Factors
Cumulative sun exposure
Complexion type
History of sunburn
Environmental UV levels
Previous diagnosis
Many or atypical moles
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Nonmelanoma Symptoms

• Non-healing growth or sore
• Appearance small pearly bump,red lump, scaly
  patch, well defined outline
• Bleeds, crusts over
• Size increases

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The ABCDs

• Asymmetry one half does not match the other half
• Border Irregularity edges are ragged, notched or
  blurred
• Color pigmentation is not uniform
• Diameter mole is wider than a pencil eraser or
  is growing

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Reducing Risk

• Regular examination of skin
• Assessment of sore, mole, mark
• Sun protection
• Protective clothing
• Sunscreen higher than SPF 15
• Sunglasses
• Shade

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Cancer Promoter Obesity

• Endometrium
• Gall bladder
• Cervix
• Colon
• Kidney
• Post-menopausal breast

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Cancer Inhibitors Fruits and Vegetables

• Cancer risk colon, lung, stomach, esophagus,
  rectum, skin
• Protective factors dietary fiber, vitamins AC,
  several phytochemicals

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Pesticides

• Cancer concern
• Natural pesticides in food
• Organic claim
• Percent risks

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Reduce chemical Residues in Food

• No holes
• Wash well
• Remove outer leaves
• Organic veggies
• Eat a variety of foods

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Cancer Initiators alcohol

• Breast
• Colon
• Mouth
• Esophagus
• Larynx
• Pharynx
• Liver

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Cancer Initiators Alcohol

• Solvent to carcinogens
• Increases free radicals
• Immunosuppressive
• Usually associated with poor dietary intake

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Cancer Initiators salt/nitrite-cured, smoked and
charcoaled foods

• Nitrite and nitrate form nitrosamines in the
  stomach
• Nitrite/nitrates alter GI tract permeability to
  carcinogens
• Carcinogens formed during cooking and are
  deposited on the meat as charring

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Your prescription for Cancer Prevention

• Know your cancer risks
• Lead a healthy lifestyle
• Follow activity and nutrition guidelines
• Dont smoke
• Follow screening guidelines
• Have suspicious symptoms evaluated

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Cancer Promoter Dietary Fat

• Cancer risk Breast, colon, prostate
• Recommended 20-30 of daily calories from fat

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Services

• Risk assessment and counseling
• Genetic testing
• Classes weight, wellness
• Risk reduction
• Lifestyle modification counseling
• Chemoprevention
• Counseling on prophylactic strategies
• Cancer screening