CANCER: RISK FACTORS, SYMPTOMS AND PREVENTION

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Nadia Malik, M.D

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Nuclear Medicine

CANCER RISK FACTORS, SYMPTOMS AND PREVENTION 

There were an estimated 12.7 million cancer cases and 7.6 million cancer deaths worldwide.

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Over half a million people die from cancer each year in the United States alone.

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One in five people will get cancer in their lifetime.

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Currently, cancer outranks cardiovascular disease as the number one cause of death in the United States.

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Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D, CA Cancer J Clin. 2011;61(2):69.

I will review:  Carcinogens around us Major modifiable cancer risk factors Different symptoms to identify the early signs  Prevention and screening. 

Established risks of Cancer: Gender  Female:

Cancer of thyroid, gallbladder, breast and meningiomas.

 Male:

Cancer of stomach, liver, lymphoma.

Percent of New Cancers by Age Group: All Cancer Sites SEER 18 2007-2011, All Races, Both Sexes National Cancer Institute website Posted April 2015

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Median age of a cancer diagnosis is 66 years

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For example, the median age at diagnosis is 61 years for breast cancer, 68 years for colorectal cancer, 70 years for lung cancer, and 66 years for prostate cancer.

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Bone cancer is most frequently diagnosed among people under age 20, with more than 1/4 of cases in this age group. And 10% of leukemias are diagnosed under 20 years of age. Only 1% of cancer overall is diagnosed in that age group.

FAMILY HISTORY

GENETICS Inherited genetic mutations play a major role in about 5 to 10% of all cancers passed from parent to child. Inherited mutations in the BRCA1 and BRCA2 genes are associated with hereditary breast and ovarian cancer syndrome, which is a disorder with an increased lifetime risk of cancers in women.

Over Weight/Obesity 'The roles of diet, physical activity, and body weight in cancer survivorship‘ Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ N Engl J Med. 2003;348(17):1625.

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Weight gain and obesity account for approximately 20% of all cancer cases.

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besity is quickly overtaking tobacco as the leading preventable cause of cancer. The risk of developing and dying from many common cancers is increased in obese individuals.

HIF FAT CONSUMPTION AND CANCER

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Obesity is also linked to poorer cancer outcomes, including increased risk of recurrence and of both cancerspecific and overall mortality.

In a large prospective study with a wide range of fatty food intake was directly associated with the risk of postmenopausal invasive breast cancer. Natl Cancer Inst. 2007;99(6):451.  A diet high in animal fat especially fat from red meat, may be an important factor in the development of prostate cancer. J Natl Cancer Inst. 1993;85(19):1571. 

Smoking 

Tobacco use is the most preventable cause of cancer and accounts for 21% of worldwide and approximately 30% of all cancer-related deaths in the US.

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It is the strongest risk factor for lung cancer, increasing risk 10 to 20-fold. It is also implicated as a causative factor for leukemia as well as cancers of the oral cavity, nasal cavity, sinuses, throat, esophagus, pancreas, liver, stomach, cervix, kidney, intestines, prostate and bladder.

Alcohol 

Alcohol increases the risk of multiple cancers. A prospective study of over one million women found that, at an average follow-up of 7.5 years, 10 g of alcohol (one drink) per day increased the risk for cancers of the oropharynx, esophagus, larynx, rectum, liver and breast . The overall risk for cancer was increased 6%.

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●It has been estimated that worldwide 3.6% of cancers are associated with alcohol.

Infections 

17% of all new cancers worldwide are due to infections.

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Multiple links between viral agents and cancer have been established:

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●Human papillomavirus (HPV) with cervical/pelvic cancers as well as squamous cell cancers of the head and neck

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●Hepatitis B (HBV) and C (HCV) with liver carcinoma

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●Human T-cell lymphotropic virus (HTLV-I) with adult T cell leukemia

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●Human immunodeficiency virus (HIV-I) with Kaposi sarcoma, non-Hodgkin lymphoma [15], and multiple non-AIDS defining malignancies

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●Human herpes virus 8 (HHV-8) with Kaposi sarcoma and primary effusion lymphoma [

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●Epstein-Barr virus (EBV) with Burkitt lymphoma

Diabetes 

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Patients with diabetes (Type 2) have a two-fold or greater risk of cancers of the liver, pancreas, and endometrium and a slightly lower but increased risk for cancers of the colon, breast and bladder; the risk of prostate cancer is decreased in patients with diabetes. Diabetes and cancer. AU Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R

SO Endocr Relat Cancer. 2009;16(4):1103.

Cellular telephones radiofrequency radiation 

After evaluating several studies on the possibility of a connection between cellphones and glioma and a noncancerous brain tumor known as acoustic neuroma, members of the International Agency for Research on Cancer (part of WHO) agreed that there's limited evidence that cellphone radiation is a cancer-causing agent in 2011. The group classified RFEM fields as a POSSIBLE carcinogenic to people.

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At this point, it's possible that too little time has passed to detect an increase in cancer rates directly attributable to cellphone use.

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If you are concerned about this issue and use cell phone extensively close to your head, consider limiting your use of cellphones, or use a speaker or hands-free device that places the cellphone away from your head. 

Is there any link between cellphones and cancer? Answers from Timothy J. Moynihan, M.D.

Ionizing Radiation 

Almost half of ionizing radiation exposure comes from medical imaging including x-rays(CT), gamma rays (nuclear medicine) and other forms of high-energy radiation therapies.

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Ask your doctor if you think you may be at risk for cancer if you were exposed to radiation. People considering CT scans should talk with their doctors about whether the procedure is necessary for them and about its risks and benefits. 

National Cancer Institute .

NCRP Sources of Radiation Exposure—2009 Reprinted from: NCRP Report No. 160, 2009, with permission of the National Council on Radiation Protection and Measurements, NCRPonline.org.

Ionizing Radiation 

Radon, a natural gas that escapes from the ground and surface water, is the most prominent source of environmental radioactivity.

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Exposure from radon is the second leading cause of lung cancer, after smoking. In the US, radon causes about 21,000 lung cancer deaths every year.

Sunlight/Non Ionizing radiation 

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Some forms of nonionizing radiation, for instance, too much ultraviolet (UV) light from the sun is known to cause some skin cancers. UV waves (sometimes called UV radiation) are emitted by lights used in tanning beds, black lights, and lights used to pasteurize fruit juices. 1 million cases of skin cancer, including basal cell and squamous cell carcinoma, are diagnosed each year. The American Cancer Society estimates over 68,000 cases of malignant melanoma in the US in 2010 . Cancer statistics, 2010. AU Jemal A, Siegel R, Xu J, Ward E SO CA Cancer J Clin. 2010;60(5):277.

INDOOR AIR POLLUTION 

Combustion sources – oil, gas, kerosene, coal and wood

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Tobacco products

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Wet / damp carpet or building materials

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Cabinetry or furniture made of certain pressed wood products

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Household cleaning products

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Personal care products

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Pesticides

OUTDOOR AIR POLLUTION

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The International Agency for Research on Cancer (IARC) has classified outdoor air pollution as a cancer causing agent, especially in industrializing countries with dense populations. It is concluded that outdoor air pollution causes lung caner and is also linked to an increased risk for bladder cancer.

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The predominant artificial sources of outdoor air pollution are transportation, stationary power generation, industrial and agricultural emissions, and residential heating and cooking.

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World Health Organization: Outdoor Air Pollution Causes Cancer. Article date: October 17, 2013

Chemical Pollutant/Asbestos 

Asbestos has been classified as a known human carcinogen. Asbestos exposure mostly occurs through inhalation of fibers in the working environment and through inhalation of air in the vicinity of sources such as factories handling asbestos ; or indoor air in houses and buildings containing asbestos.

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Today, about 125 million people worldwide are exposed to asbestos at their workplace. Asbestos inhalation causes lung cancer, mesothelioma, cancer of the larynx and ovary.

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Asbestos kills 12,000-15,000 people per year in the U.S. Cancer appears 30 to 50 years after exposure.

Environmental toxins 

Environmental factors have been associated with an increased risk for developing cancer. These include exposure to metals (arsenic, chromium, and nickel) and hydrocarbons such as coal or biofuels, pollution from power plants, industrial processes and vehicles, aluminum production, coal, iron and steel factories, oil extraction, wood burning, roofing, tar, road paving, chimney sweeping, etc.

COMMON USE PRODUCTS WITH FORMALDEHYDE 

Pressed-wood products, such as particleboard, plywood, and fiberboard

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Glues and adhesives

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Permanent-press fabrics

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Paper product coatings

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Insulation materials.

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Disinfectants

Bisphenol A (BPA), 

It is a building block of polycarbonate plastic, is one of the most widely produced chemicals in the world. It is used in hard plastics, food cans, drink cans, receipts, and dental sealants. CDC bio monitoring surveys indicate that more than 90% of Americans have the substance in their bodies. BPA is an endocrine disruptor linked to breast and prostate cancer.

Cosmetics and hair products: 

At least 11carconigens are currently used in personal care products: phenacetin, coal tar, benzene, Hydroquinone, ethylene oxide, Phthalates (Fragrance) Parabens, chromium, cadmium and its compounds, arsenic, and quartz, etc.

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http://www.ewg.org/skindeep/

CHEMICALS IN FOOD 

Diet: Diet is thought to be at least partly responsible for about 30% to 40% of all cancers.

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Nonorganic fruits and vegetables: pesticides, antibiotics, and hormones used on crops and livestock may cause an increase in cancer risk.

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Processed meats: sodium nitrite and sodium nitrate in cured meats, are known to significantly increase your risk of cancers of the brain, stomach, and intestines. Eating one hot dog each day raises your risk for colorectal cancer by 20% according to a study led by the American Institute of Cancer Research.

CHEMICALS IN FOOD 

Farmed Salmon: It is contaminated with chemicals, antibiotics, pesticides, and other known carcinogens. Microwave popcorn: Bags are lined with a chemical called perfluorooctanoic acid ( PFOA). This is a toxin you can find in Teflon also, it increases the risk of kidney, bladder, liver, pancreas and testicular cancers.

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GMO’s: Genetically modified organisms are modified by chemicals and grown with chemicals. Almost all grains, including soybeans, wheat, and corn, and potatoes have been grown via GMO’s. GMO’s do not have to be listed on food labels, so read carefully and look for labels that state the food is GMO free. Red Meat: In a study done over a 10 year period, eating red meat every day, even a small amount, by 22% and a woman’s chance by 20% with increased risk of breast, prostate, and colon cancer.

SIGNS AND SYMPTOMS OF CANCER 

Unexplained weight loss: An unexplained weight loss of 10 pounds or more may be the first sign of cancer.

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Night Sweats:

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Fever: Fever is very common with cancer, but it more often happens after cancer has spread from where it started. Almost all people with cancer will have fever at some time, especially if the cancer or its treatment affects the immune system. (This can make it harder for the body to fight infection.) Less often, fever may be an early sign of cancer, such as blood cancers like leukemia or lymphoma.

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Fatigue: Fatigue is extreme tiredness that doesn’t get better with rest.

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Pain: An unexplained pain or ache that lasts longer than four weeks

SIGNS AND SYMPTOMS 

Skin changes: Darker looking skin, Yellowish skin and eyes, Reddened skin, Itching, Excessive hair growth

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An new/enlarging lump or swelling anywhere on your body

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A change in the size, shape or color of a mole

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A sore that won’t heal or keeps coming back.

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A mouth or tongue ulcer that lasts longer than three weeks

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A cough or croaky voice that lasts longer than three weeks

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Persistent difficulty swallowing or indigestion

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Problems passing urine

SIGNS AND SYMPTOMS 

An unusual breast change: a lump, discharge, bleeding.

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Bleeding after menopause or between periods.

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Persistent bloating and increase in abdominal girth

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Blood in your bowel motions

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A change to more frequent bowel motions that lasts longer than four to six weeks

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Anorexia, nausea and vomiting, chronic pain, abdominal fullness, early satiety

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Breathlessness

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Coughing up blood

PREVENTION

(2:173) O ye who believe, eat of the good things we have provided for you, and render thanks to allah, if it is he who you worship.

Types of clinical prevention 

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There are four major types of clinical preventive care: Immunization: Hep B for HCC, HPV for cervical cancer. Screening Behavioral counseling (sometimes referred to as lifestyle changes) and Chemoprevention. It is the use of drugs to prevent disease. Tamoxifen for estrogen suppression in breast cancer.

PREVENTION: Modifiable variables 30-40% of cancer cases are preventable 

Maintain a healthy weight: By the right balance of diet and exercise.

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Exercising regularly: Participate in any amount of physical activity every day. Strive to get at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic physical activity.

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Eat nutritious food: Eat plenty of fruits and vegetables. Base your diet on fruits, vegetables and other foods from plant sources — such as whole grains and beans.

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Never smoke (or quit if you do smoke)

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Mayo Clinic

Exercise 

The relationship between physical activity and different types of cancer incidence has been extensively studied. These indicate that physically active women have a lower risk of developing breast cancer than inactive women (between 20 to 80 %).

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The risk of developing colon cancer is reduced by 30 to 40% relative to those who are sedentary regardless of body mass index (BMI).

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women who are physically active have a 20 to 40% reduced risk of endometrial cancer, with the greatest reduction in risk among those with the highest levels of physical activity. Risk does not appear to vary by age.

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National Cancer Institute

SCREENING: Identification of an asymptomatic disease, harmful condition, or risk factor 

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Breast Cancer: Routine screening at age 40 and every 2 years after that.

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Colon Cancer:

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Cervical cancer:

Screening begins at age 50 years by colonoscopy. Colorectal cancer is on the rise in asymptomatic average-risk people under the age of 50. For this reason, some physicians are recommending screening earlier. Initiated at age 21 in healthy and asymptomatic women by Pap testing followed by every three years.

Summary 

More people die from cancer than any other disease in the United States.

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30-40% of cancers are preventable through modifying our lifestyle.

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Maintain a healthy weight.

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Exercising regularly.

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Eat nutritious and organic food. Avoid processed and packaged food.

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Never smoke or quit if you smoke.

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Read food and product labels closely for carcinogen components of all products.

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Watch for early signs and symptoms of cancer. Best outcomes if detected early.

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Go to your doctor regularly and ask questions.

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Get age appropriate screening tests.

QUESTIONS