HOW TO PREVENT CANCERS

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Benefits of the Acai Berry Good For prevention of cancer

Tuesday, December 3, 2013 0 comments

Benefits of the Acai Berry Good For prevention of cancer, premature aging and to maintain health. Fruit acai berry as one of the fruits that have anti-aging and weight loss. Even some companies use acai berries in cosmetics and beauty products

Acai fruit contains several compounds called anthocyanins and flavonoids. Anthocyanins are responsible for the substance elements of red, purple, and blue as the colors in fruits, vegetables, and flowers. Food that contains anthocyanins - such as blueberries, red grapes, red wine, and acai - it has a very strong color, ranging from dark purple to black.

Anthocyanins and flavonoids are powerful antioxidants that help defend the body against life's stressors days. They also have an important role in pencegahaan system cells. Free radicals are harmful byproducts produced by the body. Eating foods rich in antioxidants associated with aging and disease process by neutralizing free radicals.
By lessening the destructive power of free radicals, antioxidants may help reduce the risk of some diseases, such as heart disease and cancer.

Acai Berry Smoothie recepes
1 cup boiling water
2 Lipton® Purple Acai with Blueberry Green Tea Bags
1 cup fresh blueberries
1 cup ice cubes (about 5 to 6)
1/2 cup low fat or nonfat vanilla yogurt
1 Tbsp. honey
Nutrition Facts
Calories 130
Calories from Fat
Total Fat 1g     2%
Saturated Fat 0.5g     3%
Cholesterol less than 5 mg     2%
Sodium 45mg     2%
Total Carbohydrate 28g     9%
Dietary Fiber 2g     8%
Sugars 24g
Protein 4g
Vitamin A     2%
Vitamin C     15%
Calcium     10%
Iron     2%

Healthy Eating: Focus on Every Day, not Thanksgiving Day

Thursday, November 15, 2012 0 comments

Tara Parker-Pope wrote an interesting post yesterday on the New York Times' Thanksgiving Help Line about the commonly thrown around stat that the average person consumes 4500 calories in the course of Thanksgiving Day. In the piece, she works at length itemizing what 4500 calories would actually look like – choosing many fat and sugar-laden calorie bombs – and although she was able to reach the 4500 calorie count, it took some doing, and would, she concludes, if actually consumed likely leave most people nauseous and gaseous and reaching for a full pack of antacids.

The take away was that while some people certainly pack in the calories on Thanksgiving, it’s likely not to such an extreme as has become lore. The vilification of Thanksgiving as a diet-killing, weight-packing annual affair may be undeserved. Yet, the day does serve to highlight what most health and nutrition experts can agree upon: it’s not one meal, or one day, that’s important. It’s how we eat on all the other days that matters.

For many of us, everyday has become a lot like Thanksgiving Day when it comes to how much we eat. We’re surrounded by so many cues to eat – and so few avenues to activity – that we consistently eat more than we burn off, and the result is the creeping weight gain we see over time.

Certainly, the holidays don’t help, with the numerous parties and meals and other celebrations that span the time between Thanksgiving and New Years , but the other eleven months of the year matter even more. And, unfortunately, it takes a lot of effort to keep those external cues at bay, and our internal motivation up, but it’s something we can all do – maybe not overnight but certainly in the long run.

Over the holidays and throughout the rest of the year, try these healthy eating and lifestyle tips :

Exercise, exercise, exercise. Being active is one of the best ways of controlling weight.
Go Mediterranean. A diet rich in fruits, vegetables, whole grains, and healthy oils (like olive oil) can make you feel full, help regulate your appetite, and actually taste really good
Choose smaller portions and eat more slowly. Slow down and give your body a chance to feel full before you move on to seconds.
Be a mindful eater. Food is big business, and their main goal is to get you to eat. Try to listen to what your body is telling you, not what the food business wants you to hear.

How You Can Prevent Uterine Cancer

Saturday, October 27, 2012 0 comments

By Lauren Streicher, MD

Most women assume that ovarian cancer is the most common gynecologic cancer. They are surprised when I tell them that uterine cancer – also known as endometrial cancer – is actually the most common gynecologic malignancy and the fourth most common cancer in women.

The reason uterine cancer is not the first to come to mind is that, unlike ovarian cancer, most uterine cancer is diagnosed in its early stages so relatively few women die from it. The five-year survival rate for women diagnosed when their cancer is still in stage I is 96%. That’s why it is so important to evaluate abnormal bleeding sooner rather than later so that if a cancer is present it will be diagnosed in its earliest, most curable stage.

In a premenopausal or perimenopausal woman, abnormal bleeding is anything that varies from a normal monthly flow. Heavy bleeding, constant spotting or irregular cycles may all indicate a problem. Any bleeding in a postmenopausal woman should be evaluated. The overwhelming majority of abnormal bleeding is not an indication of uterine cancer, but still needs to be checked out.

The only thing better than early detection of uterine cancer is to prevent it from developing in the first place. Since most uterine cancer is caused by an excess of estrogen compared to progestin, this is a potentially preventable cancer. Here are five steps that may dramatically reduce your risk:

1. A Pill a Day…
The use of birth control pills for at least 12 months decreases the risk of uterine cancer by a whopping 50-80 percent. This protection lasts for 15 years after pill use is discontinued.

2. Choose an IUD
You may be familiar with an intrauterine device as a method of contraception, but the progestin in the Mirena ™ IUD also has a number of non-contraceptive benefits. A little known fact is that the Mirena ™ IUD decreases the risk of hyperplasia (an abnormal thickening of the uterine lining), which in many cases is a precursor to uterine cancer.

3. Question Your Kin
If you have multiple family members with colon cancer and/or uterine cancer, genetic testing could be lifesaving, not only for you, but also for your entire family. Carriers of hereditary nonpolyposis colorectal cancer, known as Lynch syndrome, have a 27-71% chance of developing uterine cancer as opposed to the 3% in the general population.

4. Lower Your Weight to Lower Your Risk
Fat cells produce estrogen, so obese women are at an increased risk for uterine and breast cancer. Higher BMI not only increases the rate of developing endometrial cancer, but is associated with an increased death rate as well.

5. Pick Your Progestin
It has been known since the 1970s that taking estrogen therapy without adequate progestin increases the risk of uterine cancer almost tenfold. If you are taking estrogen for relief of menopausal symptoms (and have a uterus), it is crucial to take an appropriate progestin to protect the lining of the uterus. “Bioidentical” progestin creams have not been shown to offer adequate protection in spite of claims by compounding pharmacies. The progestin molecule is too large to be absorbed through the skin, which is why all the FDA-approved progestins are in pill form. (Note: A progestin is not necessary if you are using vaginal estrogen.)

Added to Women's Health, Anatomy, Smart Patient, Illness Prevention, Gynecology on Sun 11/20/2011

Source: The Dr. Oz Show
Image: Find Feeling

Uterine Cancer Screening & Prevention

Tuesday, October 16, 2012 0 comments

Information about the prevention of cancer and the science of screening appropriate individuals at high-risk of developing cancer is gaining interest. Physicians and individuals alike recognize that the best “treatment” of cancer is preventing its occurrence in the first place or detecting it early when it may be most treatable.

Uterine (endometrial) cancer is the most common invasive gynecologic cancer in women, with 36,100 new cases each year. This incidence would be higher if it weren’t for the relatively large number of hysterectomies performed for non-cancerous reasons. It is estimated that approximately 6,500 women will die of uterine cancer in the United States each year. The lifetime risk of developing uterine cancer for an American woman is 2%.

There has been an increase in the incidence of, but not mortality from, uterine cancer since the mid 1970s, which has been attributed to the use of hormone replacement therapy for treatment of menopausal symptoms. Studies show that the most common type of uterine cancer, endometroid adenocarcinoma, develops from the overgrowth of cells lining the uterus in the setting of excessive or prolonged exposure to the female hormone estrogen. Other less common uterine cancers, such as serous carcinoma, do not seem to be related to estrogen levels in the body.

The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait, while a non-genetic factor is a variable in a person’s environment, which can often be changed. Non-genetic factors may include diet, exercise, or exposure to other substances present in our surroundings. These non-genetic factors are often referred to as environmental factors. Some non-genetic factors play a role in facilitating the process of healthy cells turning cancerous (i.e. the correlation between smoking and lung cancer) while other cancers have no known environmental correlation but are known to have a genetic predisposition, meaning a person may be at higher risk for a certain cancer if a family member has that type of cancer.

Heredity or Genetic Factors

Women with a family history of uterine cancer are twice as likely to develop uterine cancer than women without a family history. Women who have a family history of hereditary nonpolyposis colon cancer (HNPCC) have an increased risk for carrying the HNPCC genetic abnormality. Studies suggest that women who carry this genetic abnormality have a 10-fold increased risk of uterine cancer and a 20% incidence of uterine cancer by the age of 70. Women with a family history of uterine cancer may wish to discuss genetic testing with their physician. For more information about genetic testing, please refer to the section Genetic Testing.

Environmental or Non-Genetic Factors

Factors associated with an increased risk of developing uterine cancer include obesity, a high-fat diet and a prolonged exposure to the female hormone, estrogen. Women who begin to menstruate early in life, experience a late menopause and/or have no children have the longest exposure to estrogen, and are thus, at the highest risk. Completion of at least one pregnancy appears to lower the risk of uterine cancer by 50%, as after the birth of the first child, the risk of developing uterine cancer appears to decrease with increasing age. The risk also decreases in proportion to the number of induced abortions. Women who take oral contraceptives also appear to have a reduction in the incidence of uterine cancer.

Hormone Replacement and Uterine Cancer: Women who take estrogen replacement therapy to control menopausal symptoms have a 4 to 8-fold increase in the risk of developing uterine cancer. This risk increases with the duration of use. For example, after 5 or more years of estrogen use, the risk of developing uterine cancer increases to 10 to 30-fold. The risk appears to last for 10 years or more after discontinuation of estrogen replacement therapy. When this information was made public, there was a decline in the use of estrogen replacement and a decline in the incidence of uterine cancer. However, women need to consider all risks and benefits before discontinuing hormone replacement for treatment of menopause because the benefits of hormone replacement therapy may outweigh the risk of cancer.

There is some evidence that adding progesterone to estrogen for the treatment of menopausal symptoms can decrease the risk of uterine cancer that is presented by estrogen; however, there is also evidence that this strategy increases the risk of breast cancer. The main issue for women taking hormone replacement is to have periodic gynecologic evaluations to detect early uterine cancer. With this strategy, women can both achieve the benefits of hormone therapy and detect uterine cancer early when it is small and curable.

Tamoxifen and Uterine Cancer: Tamoxifen is a chemopreventive drug that blocks estrogen from entering the cells. Tamoxifen and other anti-estrogens are commonly used in the treatment of breast cancer, but have also proven successful in the prevention of breast cancer in women at high-risk.

One uncommon complication of tamoxifen therapy is uterine cancer. Several clinical studies around the world have evaluated the risks and benefits of tamoxifen. The results of the National Cancer Institute clinical study evaluating tamoxifen were presented in 1998. During this study, 13,388 women at high risk of developing breast cancer were treated with either tamoxifen or placebo for 5 years. While the results indicated a 45% reduction in the development of breast cancer, they also showed an increase in the risk of uterine cancer, as 33 women treated with tamoxifen developed uterine cancer, compared with only 14 women in the placebo group. All of the uterine cancers occurring in the tamoxifen group were early stage I cancers.

Since the majority of uterine cancers will be detected at an early stage when they are highly curable, the overall benefit of anti-estrogen treatment in breast cancer patients probably outweighs the risk of uterine cancer. All women who have a uterus and are receiving anti-estrogen therapy should undergo regular gynecologic examinations.

Furthermore, in response to the risks posed by tamoxifen, newer anti-estrogens have emerged. Selective estrogen receptor modulators (SERM) are believed to have positive effects on bones as well as anti-estrogen effects on breast cancer without increasing the risk of uterine cancer. For more information, please refer to the section Hormonal Therapy.

Prevention of Uterine Cancer

Cancer is largely a preventable illness. Two-thirds of cancer deaths in the U.S. can be linked to tobacco use, poor diet, obesity, and lack of exercise. All of these factors can be modified. Nevertheless, an awareness of the opportunity to prevent cancer through changes in lifestyle is still under-appreciated.

Decreasing body weight and reducing exposure to estrogen may decrease the risk of developing uterine cancer. The addition of progesterone to estrogen may also decrease the risk of developing uterine cancer in women taking hormone replacement for menopausal symptoms. There is evidence to suggest that the use of combined hormone therapy in the form of oral contraceptives can also reduce the risk of uterine cancer by up to 40% if used for at least a year.

Diet: Diet is a fertile area for immediate individual and societal intervention to decrease the risk of developing certain cancers. Numerous studies have provided a wealth of often-contradictory information about the detrimental and protective factors of different foods.

There is convincing evidence that excess body fat substantially increases the risk for many types of cancer. While much of the cancer-related nutrition information cautions against a high-fat diet, the real culprit may be an excess of calories. Studies indicate that there is little, if any, relationship between body fat and fat composition of the diet. These studies show that excessive caloric intake from both fats and carbohydrates lead to the same result of excess body fat. The ideal way to avoid excess body fat is to limit caloric intake and/or balance caloric intake with ample exercise.

It is still important, however, to limit fat intake, as evidence still supports a relationship between cancer and polyunsaturated, saturated and animal fats. Specifically, studies show that high consumption of red meat and dairy products can increase the risk of certain cancers. One strategy for positive dietary change is to replace red meat with chicken, fish, nuts and legumes.

High fruit and vegetable consumption has been associated with a reduced risk for developing at least 10 different cancers. This may be a result of potentially protective factors such as carotenoids, folic acid, vitamin C, flavonoids, phytoestrogens and isothiocyanates. These are often referred to as antioxidants.

There is strong evidence that moderate to high alcohol consumption also increases the risk of certain cancers. One reason for this relationship may be that alcohol interferes with the availability of folic acid. Alcohol in combination with tobacco creates an even greater risk of certain types of cancer.

Exercise: Higher levels of physical activity may reduce the incidence of some cancers. According to researchers at Harvard, if the entire population increased their level of physical activity by 30 minutes of brisk walking per day (or the equivalent energy expenditure in other activities), we would observe a 15% reduction in the incidence of colon cancer. The association between exercise and uterine cancer is not as well defined.

Screening and Early Detection of Uterine Cancer

For many types of cancer, progress in the areas of cancer screening and treatment has offered promise for earlier detection and higher cure rates. The term screening refers to the regular use of certain examinations or tests in persons who do not have any symptoms of a cancer but are at high-risk for that cancer. When individuals are at high-risk for a type of cancer, this means that they have certain characteristics or exposures, called risk factors that make them more likely to develop that type of cancer than those who do not have these risk factors. The risk factors are different for different types of cancer. An awareness of these risk factors is important because 1) some risk factors can be changed (such as smoking or dietary intake), thus decreasing the risk for developing the associated cancer; and 2) persons who are at high-risk for developing a cancer can often undergo regular screening measures that are recommended for that cancer type. Researchers continue to study which characteristics or exposures are associated with an increased risk for various cancers, allowing for the use of more effective prevention, early detection, and treatment strategies.

Periodic gynecologic evaluation is crucial for the early detection of uterine cancer. All women should undergo regular physical examinations and patients on hormone replacement therapy or tamoxifen might consider monitoring with transvaginal sonography (ultrasound examination) and hysteroscopy (endoscopic evaluation of the uterus). The ability to detect abnormalities in the uterus may be improved with a test called sonohysterograpy, where a salt-water solution is infused into the uterus before the transvaginal sonography is performed. This is a safe and inexpensive improvement over conventional ultrasound examinations.

For women taking tamoxifen, annual examinations beginning 2-3 years after the start of treatment are currently advised. Abnormal bleeding or undiagnosed postmenopausal bleeding warrants immediate evaluation with endometrial biopsy. Ultrasound performed through the vagina for the evaluation of bleeding can also be used in some patients instead of immediate biopsy.

Strategies to Improve Screening and Prevention

The potential for earlier detection and higher cure rates increases with the advent of more refined screening techniques. In an effort to provide more screening options and perhaps more effective prevention strategies, researchers continue to explore new techniques for the screening and early detection of cancer.

Predictive Genetic Testing: The identification of the cancer susceptibility genes has led to predictive genetic testing for these genes. Since most uterine cancers are not the result of known inherited mutations, not all women would benefit from genetic testing. However, women who have a family history of hereditary nonpolyposis colon cancer (HNPCC) have an increased risk for carrying the HNPCC genetic abnormality. These women may benefit from undergoing a test to determine if they do carry the HNPCC genetic abnormality. An accurate genetic test can reveal a genetic mutation, but cannot guarantee that cancer will or will not develop. At this point, genetic tests are used to identify individuals who are at an increased risk of developing cancer, so that these individuals may have the option of taking preventive measures. For more information about genetic testing, please refer to the section Genetic Testing.

Copyright © 2012 Omni Health Media Uterine Cancer Information Center. All Rights Reserved.

Source: National Foundation for Cancer Research
Image 1: http://www.presstv.ir/detail/211664.html
Image 2: http://www.wellwomanblog.com/50226711/woman_abandoning_tamoxifen_after_side_effects.php
Image 3: http://pyournutrition.com/the-top-seven-musts-to-design-a-healthy-diet-plan/

Transdisciplinary Energetics and Cancer (TREC)

Thursday, January 26, 2012 0 comments

Obesity and cancer?

Why are we meeting in Philadelphia?

These are question not commonly asked on our CNiC blog. Let me explain a little of our new center on obesity and cancer, and link you to our related resources.

NCI convened the first meeting of funded centers working together on issues relating energy balance, obesity, and cancer. My role at this meeting with Sarah Gehlert, leading our TREC at Washington University in St. Louis was to provide an overview of our Center and the projects we have embarked upon to address obesity and cancer, with a particular focus on translating our findings to the burden of cancer in Missouri. See our web site.

Our 5-year funding sets us in motion to bring faculty together across our university and with neighbors across our state to move forward counteracting the burden of cancer due to obesity. We have previously written on just how great this is for our nation.(see Obesity and Cancer. Wolin, et al. 2010.) Now we are linked to colleagues in other centers to learn from our collective efforts.

The quick summary of our center is available through this link. "Transdisciplinary Center Approach to Examine Multilevel and Multigenerational Associations Between Obesity and Cancer".

Over the coming months we will add updates on progress as we expand our research and translation to practice to address obesity and prevent cancer.

Meat: Not for Dinner Tonight

Friday, January 13, 2012 0 comments

This week was full of news about meat. The week started with news from the Department of Agriculture that US red meat consumption is expected to be lower in 2012 than it was in 2007. Of course, global meat consumption isn't down, which means the US is continuing the trend we started with tobacco of exporting our bad habits abroad. As Mark Bittman noted in his New York Times OpEd, Americans are choosing to eat less meat, not just because of price changes, but because of the negative health and environmental effects of eating red meat.

Which is good news, since the week is ending with more research on the carcinogenic effects of red meat consumption. We've talked a lot on CNiC about how red meat consumption increases risk of colon cancer. This week, a meta-analysis (i.e., a study of studies) in the British Journal of Cancer reports consumption of red and processed meats significantly increase pancreatic cancer risk. They found a 30% increase in pancreatic cancer risk with red meat consumption in men.

This is exactly the kind of science that is the foundation of the 8 ways to prevent cancer. If you want to learn more about your personal risk for pancreatic cancer, head over to Your Disease Risk.

(Video) 8 Ways to Prevent Cancer (and A Bunch of Other Diseases)

Monday, January 9, 2012 0 comments

As part of our 8 Ways to Prevent Cancer campaign, the Siteman Cancer Center and the Cancer News in Context team produced a series of videos focusing on practical information and useful tips about each "way."

This is the first in the series, featuring CNiC's Dr. Kate Wolin.

Simple tips. Big benefits.

6 Ways to Prevent Breast Cancer

Thursday, October 6, 2011 0 comments

Ask women what they think is the biggest threat to their health, and most will answer “breast cancer.” And even though lung cancer and heart disease kill more women each year, their concern is well placed.

Breast cancer is the most common cancer among women in the US -- about 230,000 American women are diagnosed with the disease each year -- and it is the leading killer of women in midlife (ages 30 – 55). And despite thousands of studies on the causes of breast cancer, not many lifestyle factors have been linked to the disease, leaving many women frustrated that there’s not more they than can do to try to lower their risk.

Yet, looked at as a whole, there are a number of important steps women can take to try to prevent breast cancer. Not every one applies to every woman, but together than can have a big impact on risk:

Six Ways to Prevent Breast Cancer

1) Keep weight in check

No surprise here. Women who maintain a healthy weight have a lower risk of breast cancer, especially when they’re post-menopausal. One reason for this is that fat tissue produces hormones that increase the risk of breast cancer. The less fat tissue, the lower the hormone levels, and the lower the risk of breast cancer.

2) Be physically active

Exercise is as close to a silver bullet for health as there is. People who are physically active for at least 30 minutes a day have a lower risk of breast cancer, possibly because exercise has a positive effect on the levels of hormone and other growth factors in the body. Being physically active is also one of the best ways to help keep weight in check.

3) Avoid too much alcohol

Yes, alcohol can be good for your heart, but when it comes to cancer there’s not too much good about it. Even moderate amounts increase the risk of colon cancer and breast cancer. And studies show that women who have less than one drink a day have a lower risk of breast cancer than those who drink more.

If you do drink moderately, there’s evidence that the vitamin folate - in the amount found in most 100 % DV multivitamins and B-complex vitamins – may help protect against the increased risk associated with alcohol.

In general, if you drink moderately (no more than 1 drink a day for women) the overall health benefit of drinking outweigh the risks. But if you don’t drink, don’t feel that you need to start. If you have any concerns, talk to a doctor about how alcohol may affect your health.

4) Breastfeed, if possible

OK, this only applies to women who are still having children, but there is very good evidence that breastfeeding has real benefits for mother and child. When it comes to breast cancer, women who breastfeed for a total of one year or more (combined for all children) have a lower risk of the disease. Why? Breastfeeding can cause changes both in hormone levels and in the breast tissue itself that help protect the cells from becoming cancerous. Women who regularly breast feed also have a lower risk of ovarian cancer.

5) Avoid birth control pills, particularly after age 35 or if you smoke

As many women know, birth control pills have real, practical benefits. But, they can have some downsides, too. Women currently on birth control pills have an increased risk of breast cancer as well as a higher risk of stroke and heart attack – particularly if they smoke. Since their long term use, though, can lower the risk of colon cancer, uterine cancer and ovarian cancer – not to mention unwanted pregnancy - there’s also a lot in their favor. If you’re particularly concerned about breast cancer risk, avoiding birth control pills can lower your risk. Even if you take birth control pills, though, risk only seems to be increased during the time you’re actively on them.

6) Avoid post-menopausal hormones

Even if you’ve wanted to, it’s been hard to avoid the topic of post-menopausal hormones the past number of years, the way it’s swept the health news, confusing thousands along the way. In a nutshell, here’s what you need to know about how they can affect the risk of breast cancer and other important diseases.

When all the evidence is looked at together it’s clear that post-menopausal hormones shouldn’t be taken long term to prevent chronic diseases, like osteoporosis and heart disease. Estrogen-only hormones don’t lower the risk of heart disease, and actually increase the risk of breast cancer and stroke. And estrogen plus progestin hormones—the type of hormones taken most often by women with a uterus—raise the risk of breast cancer, heart disease, stroke, and blood clots. While both types of hormones lower the risk of osteoporosis, this benefit is usually offset by their risks, especially since there are many other options for combating bone loss and fractures.

Whether women should take post-menopausal hormones in the short term to treat menopausal symptoms like hot flashes is a personal decision. Hormones can bring significant relief from unpleasant, irritating, and sometimes severe symptoms, and the risks are relatively small from 1- 2 years of hormone use, especially for estrogen-alone in women without a uterus. If women do take hormones, it should be for the shortest time possible. As always, the best person to talk to about the risks and benefits of post-menopausal hormones is a doctor.

Tamoxifen and Raloxifene

Allthough not really a “healthy behavior” as most would describe it, if you’re at high risk of breast cancer, taking the prescription drugs tamoxifen and raloxifene can significantly lower your risk. They are powerful drugs, though, and can also have serious side effects, so are not right for everyone and can only be prescribed by a doctor. If you think you’re at high risk, talk to your doctor to see if these drugs may be right for you.

What about Soy?

No doubt you’ve heard a lot about soy in recent years as a way to boost your health, and there is growing evidence that a high-soy diet is both safe to eat and could help lower the risk of breast cancer. The amount of soy that seems to bring benefits, though, is much higher than even big soy eaters in the US typically consume. So, it’s unclear how realistic it is for most women to eat enough to begin to see breast health benefits.

Importance of Screening

Despite recent news storms on breast cancer screening, it remains the single best way to protect yourself from the disease. Though it doesn’t help prevent cancer, it can help find cancer early when it’s most treatable.

All women over the age of 20 should get screened regularly for breast cancer. The right screening tests mainly depend on a woman's age:

If you are between ages 20 and 39: Get a clinical breast exam every 1 - 3 years.

If you age 40 or older: Get a mammogram and clinical breast exam every year.

If you’re at high risk, you may need to have mammograms more often and begin them at an earlier age. You may also need to have some different types of screening tests.

And don't rely on finding breast cancer yourself with self-exams. Though it’s OK to do breast self-exams, they don't take the place of mammograms and clinical breast exams.

Estimating Your Breast Cancer Risk

Online tools for estimating breast cancer risk abound, and many of these sites can be useful guides for opening a dialog with doctors or other health professionals about your cancer risk and health choices.

Not all risk assessment sites, though, are created equal, and it’s good to do some research before using them. As with most health information on the Internet, it’s best to start with sites from known reputable organizations, such as universities, large health organizations, and the federal government. When seeking out cancer risk assessment tools, it’s also very important to look for information showing that developers of the site have experience in the field. While it’s easy to put up a cancer risk quiz on the web, it’s much harder to get it right. 

Two of the best-established cancer risk estimation sites are the National Cancer Institute’s “Breast Cancer Risk Assessment Tool” and our “Your Disease Risk” site at Washington University School of Medicine,” which offers estimates of 12 different cancers, including breast cancer. Unlike many tools available on the Web, these have been scientifically validated in published studies.

Web Resources

Washington University School of Medicine

Your Disease Risk

Twitter Feed - Your Disease Risk

8 Ways to Stay Healthy and Prevent Cancer (PDF)

Cancer Survivor's 8 Ways to Stay Healthy After Cancer (PDF)

Others

Harvard School of Public Health – Nutrition Source

National Cancer Institute

American Cancer Society

National Library of Medicine – PubMed

Obesity increases risk of multiple myeloma – overwhelming evidence.

Wednesday, September 7, 2011 0 comments

In our Prevention Snapshot we refer to data from a thorough analysis reported by Renehan who combined prospective cohort data separately for men (7 studies) and women (6 studies) and observed a significant increase in relative risk of 1.11 for a 5 unit increase in BMI for men 1. This meta-analysis also reported no meaningful variation in the results among the studies evaluating BMI and multiple myeloma.

A subsequent updated analysis reported in full this summer by Wallin and Larsson 2 also summarize the prospective studies evaluating the association of body mass index and the risk of being diagnosed with multiple myeloma. For this study the authors searched for and identified published studies through January 26, 2011. A total of 20 studies (15 on incidence of multiple myeloma and 5 on risk of mortality) were included. Compared to individuals in the normal weight category, the risk of multiple myeloma was statistically significant for the overweight (RR, 1.12; CI, 1.07-1.18) giving a 12 percent increase, and for obese men and women (RR, 1.21; CI, 1.08-1.35), a 21 percent increase in risk compared to average weight adults. The risk estimates for mortality from myeloma were somewhat higher.

Why does this matter?
As I recently noted, 30 years ago when Doll and Peto reviewed the evidence on causes of cancer 3, and considered overweight under the category of nutrition (over-nutrition), they did not separate out any clear link to specific cancers or a percentage of all cancers that could be avoided through healthy weight maintenance. In the past 30 years the study of weight, weight gain, overweight obesity and cancer has refined our understanding of how much cancer is caused by excess gain in weight over adult years.

The association between cancer and obesity is now well established in the literature. The 2002 IARC report on Prevention Report on Weight Control and Physical Activity listed obesity and lack of physical activity as causes of cancer incidence and mortality 4. Specifically, obesity was described as a cause of esophageal, colon, uterine, kidney and post-menopausal breast cancer. Data from the ACS Cancer Prevention Study II, which followed more than 1 million men and women for an average of 16 years, showed an additional link to cancers of the prostate and pancreas, as well as to non-Hodgkin lymphoma and myeloma 5. That study concluded that 16–20% of cancer deaths among women and 14% of cancer deaths among men were attributable to obesity. Furthermore, the IARC monograph also reported that there was sufficient evidence to conclude that lack of physical activity increased the risk of breast and colon cancer — two of the most cancers in the US.

Since that report, numerous additional studies have been published and the synthesis by Wallin brings the data into sharp focus for myeloma.

We can now be confident in understanding that obesity causes many cancers (see our report on obesity and cancer. We note that the evidence is consistent across many studies, conducted in the US, Europe, Australia, and Asia. As we note in our Knol on Obesity, many chronic conditions are caused by excess weight and the burden to society is substantial. Myeloma is now yet another malignancy that is caused by excess weight. Our quick tips for keeping weight in check can help us all moving forward.

Obesity, Diabetes, and Cancer

Obesity: Disturbing Rates Even if Trends Show a Glimmer of Hope

Obesity Causes Lymphoma and Myeloma

Literature Cited

1. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. Feb 16 2008;371:569-578.

2. Wallin A, Larsson SC. Body mass index and risk of multiple myeloma: A meta-analysis of prospective studies. Eur J Cancer. 2011;47:1606-15.

3. Doll R, Peto R. The Causes of Cancer: Quantitative Estimates of Avoidable Risks of Cancer in the United States Today. New York: Oxford University Press; 1981.

4. International Agency for Research on Cancer. Weight Control and Physical Activity. Vol 6. Lyon: International Agency for Research on Cancer; 2002.

5. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. Apr 24 2003;348(17):1625-1638.

Colorectal Cancer: Screening Rates Up; New Cases and Mortality Down

Wednesday, July 6, 2011 0 comments

A new federal report out yesterday may put some wind in the sails of those who work in the field of cancer prevention. The July 5 issue of CDC's Morbidity and Mortality Weekly Report shows that rates of screening for colorectal cancer have been climbing steadily between 2002 and 2010, with a related drop in rates of new cases and mortality from the disease (report). Over that eight year period, the percentage of people between ages 50 - 75 who got recommended screening tests rose from 52 percent to 65 percent. Rates of new cases (incidence rate) and death from colorectal cancer over that period declined by three percent each year (see figure).

Unlike screening for some other cancers, screening for colon cancer can both find the disease early when its most treatable and prevent the disease by finding and removing pre-cancerous growths. For more on screening and lowering the risk of colorectal cancer, visit Your Disease Risk (www.yourdiseaserisk.wustl.edu).

The figure above shows declines in colorectal cancer (CRC) incidence from 59.5 per 100,000 population in 1975 to 44.7 in 2007 and in the CRC death rate from 28.6 per 100,000 population in 1976 to 16.7 in 2007 and the corresponding Healthy People 2020 targets of 38.6 per 100,000 and 14.5, respectively. Source CDC MMWR, July 5, 2011 (Fig 3)

Preventing Disease, Saving Billions of Dollars

Thursday, April 14, 2011 0 comments

In the New York Times this week, Mark Bittman highlights the magnitude of our chronic disease burden and the potential for prevention to save our future federal budget billions of dollars (see story). A small change in diet to reduce heart disease by 10% would save 100 billion dollars. And this is all easy to achieve. Many suggestions are out there and Bittman provides a nice summary of some of the current leading strategies.

In a related new study form the American Cancer Society, McCullough and colleagues report on the benefits of following a healthy lifestyle – in accordance with ACS recommendations (see report). Focusing on non-smokers since they account for the vast majority of the US population, McCullough followed over 110,000 men and women for 14 years. Some 10,000 men Andover 6500 women died during follow-up. Those who followed ACS cancer prevention guidelines at the beginning of the study: health weight throughout life, limiting alcohol consumption, adequate physical activity, and healthy diet, had 50% reduction in death from cardiovascular disease and 30 percent reduction in death from cancer. So being in the normal weight range (BMI less than 25), being active at the level of one hour per day for at least 5 days per week, drinking no more than one drink per day (for women) or two drinks per day (for men), and eating a healthy diet including higher intake of whole grants and limiting red meat intake gave the greatest benefit.

Following healthy lifestyle will save us billions in health care costs as our population ages and the burden of chronic diseases increases. Its time for everyone to eat well and keep moving!

Which Screening Tests and When? Two Nice Tools Cover This and More

Friday, April 8, 2011 0 comments

I was on the Preventive Services Task Force website yesterday to read some new screening recommendations, and I came across a couple neat little widgets that personalize the Task Force's prevention-related guidelines. One is intended for the public and provides very nice, straightforward recommendations based on a person's gender and age. The other is intended for doctors and other health professionals but could be of interest to other people interested in delving deeper into things. It not only summarizes the recommendations but also provides the level of evidence behind the recommendations and other background information.

On the face, these are simple little tools - and I guess they are - but they do a very good job summarizing a lot of important information and in a way not often seen.

For the public:

For doctors and other health professionals:

Taking a Step Back to Find Prevention's Place

Monday, March 7, 2011 0 comments

As a spin-off of our recent 7-Minute Abs post, I've spent part of the past week working on a journal article about the evidence and rationale behind our 8 Ways to Stay Healthy and Prevent Cancer (8 Ways link). And one of the things that the process of reviewing the science and writing the paper reminded me of what just how straightforward the major cancer prevention recommendations are, especially given the huge benefits they can hold. Things like maintaining a healthy weight, not smoking, and getting regular excercise and screening tests could eliminate half of all cancers and three quarters of some specific ones.

Public health has always had this type of focus, choosing the straightforward, broad-based approach with proven benefits whenever possible. Yet, as Sean Palfrey writes in a new Perspective piece in the New England Journal of Medicine this approach towards health is becoming more and more endangered in the high-tech era where more medical tests and more health care are generally equated with better health care.

He argues that medical education and medical care in general needs to take a step back and rely more on good clinical decision-making, rather than knee-jerk testing that may result in more test data but not necessarily any better outcomes. "Our time and attention," he writes, "have been diverted to the the task of sorting out data instead of sorting out what is important to our patients, their families, and the community at large."

An extension of this, which Palfrey hints at but doesn't explicitly state, is to broaden the clinical reach to include whole-hearted efforts at prevention. This will take a big reordering of priorities, given that prevention is often relegated to a lower rung on the medical education ladder, but it is far from hopeless. The new health care reform bill has a number of prevention-related provisions that should, if not spotlight prevention, make it an important behind-the-scenes player in the nation's health.

Time will tell where things fall. But with the science of prevention showing the large health benefits possible with behaviors we can all do, it makes little sense to not take a hard look at the current paradigm and try to get back in touch with the basics of clinical care. And what could be more basic than a healthy lifetyle?

Primary prevention of colon cancer, time to act is now!

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In this short update we draw attention to the strength of evidence that colon cancer is largely preventable with what we already know. While we have provided more extensive summaries of the overall evidence in the past ¹, and have reported in detail on specific lifestyle habits and colon cancer ^2,3, our goal here is to provide a quick update to help readers see just how strong the evidence is. For each lifestyle factor we provide a short summary of the evidence.

Data from US based cohorts show that more than 90% of adults have one or more lifestyle factors that they could change to reduce their risk of colon cancer ⁴ and other chronic diseases like diabetes ⁵ and heart disease.⁶ We conclude that if Americans modify the behavioral factors that we summarize here, with changes at an early enough age to reverse risk, then more than 80% of colon cancers could be prevented in the long term ⁴. While risk reduction strategies can be evaluated either individually or in combination showing substantial benefits for the population ⁷, we do not yet have community wide studies showing this benefit in real time – some of the challenge is the time lag from change in a health behavior to subsequent development of genetic changes, growth of tumor, and diagnosis of cancer.⁸

Table Summary of relative risk, as well as the prevalence, of each of the modifiable and no-modifiable factors related to colon cancer.

*Lifestyle factor*	*Relative risk*	*Reference*	*Population percentage who can change behavior*
Modifiable			Women	Men
Physical activity (>3 hours per week)	0.75	Wolin ²	80%	80%
Meat >7 servings per week	1.5	WCRF ⁹	25%	25%
Obesity Per 5kg/m2	1.24	Renehan ¹⁰	40%	35%
Alcohol >4 drinks per day vs. never	1.5	Fedirko ¹¹	5%	10%
Cigarette smoking	1.4	Tsoi ¹² Liang ¹³	20%	20%
Aspirin use Daily for 5 years	0.5	Flossmann ¹⁴ Rothwell ¹⁵	80%	70%
Calcium 1200 mg/day	0.80	Baron ¹⁶ Cho ¹⁷	20%	25%
Estrogen use	0.80	Grodstein ¹⁸	~	n/a
Oral contraceptive use	0.80	Martinez ¹⁹ Bosetti ²⁰	~	n/a
Non modifiable
Family history Parent or sibling	1.8	Fuchs ²¹	5%	5%
Height Per 6 inches	1.2	Wei ⁷	~	~
Screening
Colonoscopy	0.5	Frazier ²²	Approx 50% total population up to date & screened
Sigmoidoscopy	0.5	Atkin ²³	Approx 50% total population up to date & screened

The factors are listed based on the strength of the scientific evidence that a particular factor affects colon cancer risk. We also note that the majority of modifiable risk factors also contribute to other health benefits if changes are made to reduce colon cancer risk.

For example, the observational data on physical activity and colon cancer are very consistent ², the benefits of physical activity for cardiovascular and bone health are well-established ²⁴, and the adverse consequences of physical activity are minimal if it is done sensibly. Furthermore the level of inactivity in the population suggests that the vast majority of Americans could gain health benefits form increasing their level of activity.

Notably, the majority of the population is not engaging in the behaviors known to be most protective against colon cancer: 80% of adults are active less than 3 hours a week ²⁵ and 25% consume more than 7 servings of meat a week. The observational data on red meat consumption and colon cancer are only a little less consistent ⁹, there may be cardiovascular benefits to restricting red meat consumption, and the adverse consequences are almost entirely cultural and economic.

The data on obesity and colon cancer are rigorously combined by Renehan and show consistent direct relation between increasing Body Mass Index (BMI) and risk of colon cancer. ¹⁰

Calcium supplementation reduces risk of colorectal polyps and colon cancer. A randomized trial shows the does of 1200 mg per day reduces risk of polyps by 20% ¹⁶ and that this benefit persists for many years after stopping therapy. ²⁶ In addition, combined data from prospective cohort studies shows this level of calcium intake (1200mg per day) is sufficient for protection against colon cancer and that there is little added benefit from higher intakes. ¹⁷ Importantly, the lack of benefit in the randomized trial component of the Women’s Health Initiative that evaluated calcium and vitamin D in relation to colon cancer risk had the mean intake at randomization already at the 1200 mg per day for women in the trial. Thus there was likely little room for benefit in terms of reduction in risk with even high intakes during the trial. ²⁷

Alcohol is a known carcinogen causing cancer of the mouth and throat as well as breast and colon. Data on colon cancer have been combined from 27 cohort studies and 34 case-control studies.¹¹ In the combined analysis risk for colorectal cancer increased with the amount of alcohol consumed. Compared to non-drinkers, those consuming 50 grams per day (4 drinks) had a relative risk of 1.38 (95% confidence interval 1.28 to 1.50). ¹¹ Risk was present in men and women.

For aspirin, it is now clear that eicosanoids and the COX pathway play a role in neoplasia. However, there is no certain knowledge about dose and regimen, and the side effects of gastrointestinal and cerebral bleeding are well known. Evidence from several randomized trials suggests that a daily does of 75 mg is sufficient to obtain the benefit of reduce colon cancer with no added benefit form higher doses. ¹⁵ Importantly, data show that the benefit accrues some years after starting daily aspirin. ¹⁵ Furthermore, when dose and duration are taken into account the data from randomized trials and the prospective cohort studies show equivalent benefits from use of aspirin. ¹⁴ In sum, the data from randomized trials for prevention of cardiovascular disease agree with observational data when dose and duration are considered together ^14,15,28. Five years of use gives approximately 50 percent reduction in risk of death from colon cancer through 20 years of follow-up.

Cigarette smoking is a cause of many cancers. Colon cancer has been added to the list of sites where smoking now is directly related to increased risk of cancer. Combining data from 28 prospective cohort studies Tsoi and colleagues reported that current smokers had an increased risk of colorectal cancer (RR 1.20) and that the risk was stronger among men (RR=1.38). Longer duration of smoking and number of cigarettes smoked per day also increased risk of colorectal cancer. ¹²

Among women use of oral contraceptives is related to reduced risk of colorectal cancer. ^19,20 In addition, among postmenopausal women, those who currently use hormone therapy have reduced risk of colon cancer. ¹⁸

Family History

Strong evidence shows that this common malignancy has an inherited component. Those with family history gain added benefit from changing lifestyle factors and from screening. Recommendations for screening now indicate that hose with a family history should begin screening at a younger age. Obviously you need to let your health care providers know about your family history if they are to order screening tests at the appropriate age.

Given that most Americans are not engaging in behaviors known to prevent development of malignancy, early detection of polyps and colon cancer must become routine and commonplace.

Screening

For most diseases, screening is considered ‘secondary prevention’ because it detects early forms of cancer, but does not prevent the actual development of disease.

However, colon cancer screening can be considered either primary prevention or secondary prevention because the tests have the ability to detect, and often remove, both precancerous polyps and carcinomas. Approaches to colon cancer screening are cost-effective²² and are now widely integrated into primary care. Primary prevention via screening involves the removal of precancerous polyps that may have progressed to carcinoma if left undetected. Evidence suggests that removal of polyps in a population does lead to a significant reduction in the incidence of colon cancer. ²³ A randomized trial of flexible sigmoidoscopy included 113,195 people assigned to the control group and 57,237 assigned to flexible sigmoidoscopy. ²³ During follow-up of 11 years colon cancer incidence was significantly reduced in the screened group (23 percent reduction compared to that in the unscreened group). Mortality from colon cancer was reduced by 31 percent. Both reductions were statistically significant providing further support for recommendations that screening reduced incidence and mortality form this cancer.

Related CNiC posts

Colon Cancer Screening - Just a (great) first step

Literature cited

1. Tomeo C, Colditz G, Willett W, et al. Harvard report on cancer prevention Volume 3: Prevention of colon cancer in the United States. Cancer Causes and Control. 1999;10:167-180.

2. Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer. Feb 24 2009;100(4):611-616.

3. Colditz G, Cannuscio C, Frazier A. Physical activity and colon cancer. Cancer Causes Control. 1997;8.

4. Platz E, Willett W, Colditz G, Rimm E, Spiegelman D, Giovannucci E. Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control. 2000;11:579-588.

5. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifetsyle, and risk of type 2 diabetes mellitus in women. N Eng J Med. 2001;345:790-797.

6. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle. N Engl J Med. July 6, 2000 2000;343(1):16-22.

7. Wei EK, Colditz GA, Giovannucci EL, Fuchs CS, Rosner BA. Cumulative Risk of Colon Cancer up to Age 70 Years by Risk Factor Status Using Data From the Nurses' Health Study. Am J Epidemiol. Sep 1 2009.

8. Wei EK, Wolin KY, Colditz GA. Time course of risk factors in cancer etiology and progression. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. Sep 10 2010;28(26):4052-4057.

9. World Cancer Research Fund. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR; 2007.

10. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. Feb 16 2008;371(9612):569-578.

11. Fedirko V, Tramacere I, Bagnardi V, et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. Feb 9 2011.

12. Tsoi KK, Pau CY, Wu WK, Chan FK, Griffiths S, Sung JJ. Cigarette smoking and the risk of colorectal cancer: a meta-analysis of prospective cohort studies. Clin Gastroenterol Hepatol. Jun 2009;7(6):682-688 e681-685.

13. Liang PS, Chen TY, Giovannucci E. Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis. Int J Cancer. May 15 2009;124(10):2406-2415.

14. Flossmann E, Rothwell PM. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomised and observational studies. Lancet. May 12 2007;369(9573):1603-1613.

15. Rothwell PM, Wilson M, Elwin CE, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet. Nov 20 2010;376(9754):1741-1750.

16. Baron J, Beach M, Mandel J, et al. Calcium supplements for the prevention of colorectal adenomas.

Calcium Polyp Prevention Study Group. N Engl J Med. 1999;340:101-107.

17. Cho E, Smith-Warner SA, Spiegelman D, et al. Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst. Jul 7 2004;96(13):1015-1022.

18. Grodstein F, Newcomb PA, Stampfer MJ. Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. Am J Med. May 1999;106(5):574-582.

19. Martinez M, Grodstein F, Giovannucci E, et al. A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomarker Prev. 1997;6:1-5.

20. Bosetti C, Bravi F, Negri E, La Vecchia C. Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis. Hum Reprod Update. Sep-Oct 2009;15(5):489-498.

21. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Speizer FE, Willett WC. A prospective study of family history and the risk of colorectal cancer. N Engl J Med. 1994;331:1669-1674.

22. Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. Oct 18 2000;284(15):1954-1961.

23. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. May 8 2010;375(9726):1624-1633.

24. U.S. Department of Health and Human Services. Physical activity and health: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.; 1996 1996.

25. U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, The President's Council on Physical Fitness and Sports. Physical Activity and Health: A Report of the Surgeon General. Washington, DC: Office of the Surgeon General;1996.

26. Grau MV, Baron JA, Sandler RS, et al. Prolonged effect of calcium supplementation on risk of colorectal adenomas in a randomized trial. J Natl Cancer Inst. Jan 17 2007;99(2):129-136.

27. Martinez ME, Marshall JR, Giovannucci E. Diet and cancer prevention: the roles of observation and experimentation. Nat Rev Cancer. Aug 7 2008.

28. Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet. Jan 1 2011;377(9759):31-41.

Heredity or Genetic Factors

Environmental or Non-Genetic Factors

Prevention of Uterine Cancer

Screening and Early Detection of Uterine Cancer

Strategies to Improve Screening and Prevention

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