Riva L. Rahl, M.D. Cooper Clinic Preventive Medicine Physician Medical Director, Cooper Wellness Program Cancer: Beating the Odds

Cancer U.S. 1.4 million Cancer Deaths/year Cancer screening is available for many types Lifestyle choices can alter your risk Screening vs. Prevention Cancer

2009 Estimated US Cancer Cases* *Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder. Source: American Cancer Society, Men 766,130 Women 713,220 27%Breast 14%Lung & bronchus 10%Colon & rectum 6%Uterine corpus 4%Non-Hodgkin lymphoma 4% Melanoma of skin 4% Thyroid 3%Kidney & renal pelvis 3%Ovary 3%Pancreas 22%All Other Sites Prostate25% Lung & bronchus15% Colon & rectum10% Urinary bladder7% Melanoma of skin5% Non-Hodgkin5% lymphoma Kidney & renal pelvis5% Leukemia 3% Oral cavity3% Pancreas3% All Other Sites19% 2009 Estimated US Cancer Cases*

2009 Estimated US Cancer Deaths* ONS=Other nervous system. Source: American Cancer Society, Men 292,540 Women 269,800 26%Lung & bronchus 15%Breast 9%Colon & rectum 6%Pancreas 5%Ovary 4%Non-Hodgkin lymphoma 3%Leukemia 3%Uterine corpus 2%Liver & intrahepatic bile duct 2%Brain/ONS 25% All other sites Lung & bronchus30% Prostate9% Colon & rectum 9% Pancreas6% Leukemia4% Liver & intrahepatic4% bile duct Esophagus4% Urinary bladder3% Non-Hodgkin 3% lymphoma Kidney & renal pelvis3% All other sites 25% 2009 Estimated US Cancer Deaths*

Cancer in Women Breast cancer is the highest incidence Lung cancer is the highest mortality Cancer in Women

Cancer in Men Prostate cancer has the highest incidence Mortality from lung cancer is the highest –Followed by colorectal cancer –Prostate cancer is less lethal Cancer in Men

Cancer: Role of Genetics Some genes have been identified –BRCA1 and BRCA2 –ATM –CHEK-2 Heredity –Colon Cancer –Ovarian Cancer –Ashkenazi-Jew Cancer: Role of Genetics

Cancer Screening Goals –Early stage –Better chance at cure –Pre-cancerous prevention Cancer Screening

Different organizations have different guidelines –U.S. Preventive Services Task Force –American Cancer Society –American College of Obstet./Gynec. –American Medical Association –Medicare! Cancer Screening

Breast –ACS: Annual mammography 40+ –Breast self-exam –Clinical breast exam every 1-3 years 20+ Cervical –ACS: Pap test annually 18+/sexual onset –After 3 normal Paps, may do less frequently Ovarian –No organization currently recommends screening Cancer Screening

Prostate –ACS and AUA: annual PSA and digital rectal exam for 50+ –No other organization recommends routine prostate cancer screening (AMA/ACP/USPSTF/AAFP) Cancer Screening

Colorectal cancer Several options for screening –Annual FOBT plus Flex. Sig. every 3-5 years –Annual FOBT plus Barium Enema every 5-10 years –Colonoscopy every 10 years Cancer Screening

Lung cancer No consensus recommendation for screening Japanese study suggests: –Based on smoking history (pack-years) –High-res. lung CT scan Chest X-rays are not effective screen Cancer Screening

Special at-Risk Populations Family History Occupational Exposure Tobacco Use Other Diseases Special at-Risk Populations

Cancer: Prevention Know your risks! Start early Lead a healthy lifestyle Avoid tobacco (30% of all cancer deaths) Cancer: Prevention

Lung Cancer: Prevention DON’T SMOKE!!! Check your home’s radon levels Avoid asbestos Avoid marijuana If you smoke, avoid high doses vitamin A (87%) Lung Cancer: Prevention

Breast Cancer: Prevention Protective –Multiple pregnancies/births –Breastfeeding –Exercise Harmful –Obesity –Alcohol Hormone-replacement therapy Breast Cancer: Prevention

Prostate Cancer: Prevention Protective –Diet high in fruits and vegetables (lycopene, selenium, vitamin E) Harmful –Saturated fats –Being overweight Prostate Cancer: Prevention

Colon Cancer: Prevention Protective –Healthy weight –Exercise –Fruits/vegetables –whole grains Harmful –Alcohol –Smoking –Saturated fat Colon Cancer: Prevention

Protective –Oral contraceptive use –Pregnancy/breastfeeding –Tubal ligation/hysterectomy Harmful –Hormone-replacement therapy –HPV infection –Smoking Female Reproductive Cancer: Prevention

Brain Cancer: Prevention Cell phone use –Three case-control studies found no link Swedish National Cancer Institute American Health Foundation Brain Cancer: Prevention

Oral Cancer: Prevention Don’t smoke Smokeless tobacco Avoid excess alcohol Oral Cancer: Prevention

Skin Cancer: Prevention Sunscreen/Sunblock –SPF 15 or greater –Apply and re-apply Avoid sun exposure Avoid UV exposure Skin Cancer: Prevention

Liver Cancer: Prevention Avoid Alcohol Avoid Hepatitis B/C infection Liver Cancer: Prevention

GI Cancers: Prevention Protective –Fruits and vegetables Harmful –Nitrites –Cigarettes –Alcohol –H. Pylori infection GI Cancers: Prevention

Other Cancers: Prevention  Maintain a healthy weight  Avoid tobacco  Avoid excess of alcohol  Eat plenty of fruits and vegetables  Avoid environmental toxins Other Cancers: Prevention

What Can I Do? Know your risks Get age appropriate screening tests Be aware of your body and talk to your doctor if something is concerning Avoid carcinogens Exercise, eat healthy diet What Can I Do?

What Tests Do I Need? Under Age 40 –Skin Examination –Monthly Self Examination Breast Testicular –Consider baseline mammogram at 35 What Tests Do I Need?

Under Age 40 –Skin Examination –Monthly Self Examination Breast Testicular –Consider baseline mammogram at 35 What Tests Do I Need?

Age –Continue Self-Examination –Skin Examination –Annual Mammogram –Annual Pap Smear –Consider Flex. Sigmoidoscopy or Barium Enema every 3-5 years –Baseline Lung CT if >15 pack year smoker What Tests Do I Need?

Age –Continue Self-Examination –Skin Examination –Annual Mammogram –Annual Pap Smear –Consider Flex. Sigmoidoscopy or Barium Enema every 3-5 years –Baseline Lung CT if >15 pack year smoker What Tests Do I Need?

Age 50+ –Continue Self-Examinations –Skin Examination –Annual Mammogram/Pap Smear (stop at 70 years old?) –Annual DRE and consider PSA –Flex. Sigmoidoscopy or Barium Enema every 3-5 years or Colonoscopy every 5-10 years –Annual FOBT –Periodic Lung CT if >15 pack year smoker –Oral Examination What Tests Do I Need?

Age 50+ –Continue Self-Examinations –Skin Examination –Annual Mammogram/Pap Smear (stop at 70 years old?) –Annual DRE and consider PSA –Flex. Sigmoidoscopy or Barium Enema every 3-5 years or Colonoscopy every 5-10 years –Annual FOBT –Periodic Lung CT if >15 pack year smoker –Oral Examination What Tests Do I Need?

Questions?