Recently in Cancer Prevention Category

If you're a woman or a spouse or loved one of a woman -- and that likely covers most people we know -- you may be struggling with how to interpret some new guidelines on breast cancer screenings that were issued today by the U.S. Preventive Services Task Force. You're probably very surprised to read their recommendations to push back initial mammograms to age 50 and conduct follow-ups every two years.

Thanks to the efforts of the American Cancer Society, Komen for the Cure, Avon, many other advocacy groups and even M. D. Anderson's own Public Education Office, it's likely that most women and their physicians would answer "40 years old" to the question: At what age should you get your first mammogram? Furthermore, we'd expect to hear "every year" in response to the question of how often to have this test.

Based on practices in our Cancer Prevention Center and the risk-based guidelines for breast cancer screenings, M. D. Anderson is standing by those recommendations.  

If you're of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren't sure how to assess your risk, we recommend setting up time with your physician.

"We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40," says Therese Bevers, M.D., professor and director of M. D. Anderson's Cancer Prevention Center.

M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation.   

Ongoing dialog and research on this topic are very important in the lives of many women. We'll assess these findings and others in the annual evaluation of our guidelines in March 2010.

The task force, and M. D. Anderson, are united in our emphasis on developing risk-based,  specific breast cancer screening guidelines. We'll continue to seek evidence that benefits women by catching this disease in its earliest stages.

"Doctors need to have more discussion about the risks and limitations of breast cancer screening with patients so they can participate in decision-making," Bevers says. "There have been huge successes in teaching American women about the benefits of screening mammography, but women have not been educated about the limitations of screening -- which is why many women believe that there is no harm in screening and if one test is good, two tests are better and more frequent testing with both is the best."

Read more about this discussion on twitter hashtag - #mammogram40

http://tweetchat.com/room/mammogram40

Transcript from Houston Chronicle MedBlog Live Chat Event
 

By Deborah Thomas, Staff Writer

The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.




Deborah Scott, of the Native American Health Care Coalition, says, "In the native community breast cancer is a big problem, because many women are diagnosed late." According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American Indian/Alaska Native women have the lowest incidence of breast cancer yet have the poorest five-year survival rates.

Event Sponsors:
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition
M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of... Wellness

M. D. Anderson recently updated its cancer screening recommendations. While the new guidelines focus on a person's chances of developing cancer, they also reveal when screening may no longer necessary. 

What's great about screening exams are that they have the potential to find cancer at its earliest stage, when the disease is most likely to be cured. For most of us, the benefits of getting a cancer screening exam outweigh the risks. However, there are some who may not benefit from having these tests. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains more.



Visit our website to review our cancer screening guidelines. To make an appointment in the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings simply fill out our patient self referral form. 

Do you get tests to check for cancer, such as a mammogram or colonoscopy? What do you think about cancer screening?

Cancer screening examinations are medical tests performed when you're healthy and you don't have any symptoms. They help ensure that any existing cancers are identified at their earliest, most treatable stages.

By Bayan Raji, Staff Writer

Continuing their quests for that bronze "summer" look into the fall and winter, many people walk away from the beaches and into indoor tanning salons when sweater weather rolls around.
    
While tanning beds may seem like a no-risk alternative to the sun, they carry many similar dangers.

UV rays are harmful   
Tanning beds do their job with ultraviolet (UV) radiation. While these rays may not cause sunburn, they can thin the skin and make it less able to heal. This may increase previous skin damage caused by the sun.

"Tanning beds are dangerous," says Carol Drucker, M.D., associate professor in the Department of Dermatology at M. D. Anderson. "Advertising may make them seem like a safe alternative to tanning, but they're not."

Beds increase cancer risk
Skin cancer is the most common type of cancer in the United States, according to the American Cancer Society (ACS), and melanoma is the most dangerous form of skin cancer. More than 59,000 people in this country are diagnosed with melanoma each year, and 7,000 people die because of it.

The ACS found women who use tanning beds more than once a month are:

•    55% more likely to develop malignant melanoma
•    75% more likely to develop melanoma if they use tanning beds before age 35

Occasional use of tanning beds almost tripled the risk of developing melanoma.

Don't buy vitamin D claims
Some tanning salons try to counteract negative views of tanning beds by saying the UV rays can help increase the body's production of vitamin D. Vitamin D is necessary for strong bones and a healthy immune system.

"While it may be true that you get vitamin D from the UV rays in tanning beds, the danger far outweighs the positive aspects," Drucker says. "It's preferable not to get your vitamin D through a carcinogen. You can get vitamin D from much safer sources, including fortified milk, orange juice or cereals, or oral supplements."

Self-tanning products can give you the same look, without the negative effects. But, remember, most of them do not include sun protection. Be sure to wear sunscreen when you are outside. 

M. D. Anderson resources:

Melanoma

Department of Dermatology


Additional resources:

Tanning Beds Cause Serious Cancer Risk, Agency Says (American Cancer Society)

How Do I Protect Myself from UV? (American Cancer Society)

Can Melanoma Be Prevented?(American Cancer Society)

Melanoma (National Cancer Institute)

 

Co- Authors: Jerah Thomas, M.P.H., Peiying Yang, Ph.D.

Omega-3 and omega-6 essential fatty acids are necessary for normal human growth and development. However, the human body can't produce these "essential" fatty acids. The amounts found in our bodies are a direct result of the content in the food we eat.

Omega-3
There are three major omega-3 fatty acids: Alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA is primarily found in certain nuts and vegetable oils, while EPA and DHA are found in dietary fish and fish oil products. Sources include, but are not limited to:
•    Fish and fish oils
•    Vegetable oils (flaxseed, canola, soybean and olive oils)
•    Green vegetables
•    Grass-fed livestock and poultry (dairy products and eggs from grass-fed animals)

There's some evidence suggesting omega-3s may prevent and treat diseases of the heart and blood vessels: heart disease, heart attacks, atherosclerosis and blood pressure. Additionally, EPA and DHA specifically may reduce blood triglyceride levels, protect organ transplant patients from cyclosporine toxicity, and improve symptoms related to rheumatoid arthritis. In fact, the U.S. Food and Drug Administration has approved fish oil-derived omega-3s for the reduction of blood triglyceride levels.

As the benefits of omega-3s are unfolding, researchers are evaluating their unique role as anti-inflammatory and antiproliferative activities, both of which are critical mechanisms in cancer prevention and tumor growth. M. D. Anderson faculty are investigating the role of omega-3s in cancer prevention.

Omega-6
Omega−6 fatty acids (popularly referred to as ω−6 fatty acids or omega-6 fatty acids) are another family of essential fatty acids that have in common a final carbon-carbon double bond in the n−6 position. Omega-6s are important for maintaining human health because they provide energy and are also components of nerve cells, cellular membranes, and are converted to hormone-like substances known as prostaglandins. Excessive amounts of omega-6 fatty acids have been linked to promotion of various diseases, such as cardiovascular disease, cancer, inflammation and autoimmune disease. Sources include, but are not limited to:  
•    Vegetable oils (corn, soybean, sunflower and evening primrose oils)
•    Hydrogenated (trans) fat
•    Margarine
•    Meat, egg and dairy products (from animals with diets consisting of grains, corn, soy or wheat)

Balance of omega-6 and omega-3
Certain foods that are part of the western diet have had a dramatic increase in the amount of omega-6s relative to the amount of omega 3s (15-20:1 current from closer to 1:1 prior to 1960) (Simopoulos, A.P, Exp Biol Med 233:674-688, 2008). This can lead to an increase in inflammation, which is potentially problematic for many chronic diseases including cancer. It's vital that we purposefully evaluate what we eat and select food items that promote health and wellness. While fatty acids are essential, it's imperative that we choose to integrate the healthy promoting, omega-3 fatty acids to our daily diets and ensure a proper balance (4 to 1 or lower) between omega-6 and omega-3 fatty acids.

African-Americans die of cancer at much higher rates than any other racial or ethnic group in the United States. Cancer's toll on African-Americans is particularly high for cancers of the lung, colon and rectum, female breast, prostate and cervix.

The American Cancer Society estimates that about 152,900 new cancer cases will be diagnosed and 62,780 cancer deaths will occur among African-Americans annually. In Texas, African-Americans' cancer mortality rates are 38% higher for men and 22% higher for women, compared to non-Hispanic Whites.

The reasons behind African-Americans' higher rates of cancer occurrence and death are still largely unknown. Large cancer prevention studies, which can help identify specific risks for different populations, often have very low participation from minority communities. This limits the ability of researchers to understand whether the risks that are found for the entire population are the same for specific groups, such as African-Americans.

To reduce the burden of cancer in the African-American community, researchers and the community need to join forces to conduct focused research and to promote activities that will reduce cancer risks. Effective cancer prevention activities for African-Americans need to take into account not just their social situation and the environment they live in, but also their life priorities and concerns.

The African-American Cancer Prevention Project (AACPP) is a collaborative study between the Department of Health Disparities Research and Windsor Village United Methodist Church in Houston, home to the largest African-American Methodist congregation in the United States. This type of study, known as a cohort study, follows healthy individuals over time to see how behavioral, social and environmental factors (such as weight management, cigarette smoking, cancer screening, health care, work and financial issues, neighborhood environment and mental health), contribute to cancer risk for African-Americans.

To date, 1,500 individuals have been enrolled in the study and they will be followed for three years, receiving periodic health assessments, as well as programs and services designed to address concerns such as stress, smoking, and exercise and fitness. Participants also receive help to navigate health and cancer screening and treatment services.  

Open and continuous communications, a lengthy history of community support and the full backing of church leaders have enabled the study to successfully reach its recruiting goals on time. Information gathered from the study will help to increase our understanding and ability to assess cancer risks in African-Americans, as well as identify areas that both M. D. Anderson and the community can focus on to reduce the burden of cancer for African-Americans.

Other Resources
Minorities and Health Disparities (CDC)

African American Health (MedlinePlus)

By Mary Brolley, Staff Writer
Recently, the Public Education Office at M. D. Anderson hosted an event on healthful cooking featuring Scott Uehlein, corporate chef at the Canyon Ranch Health Resorts. For those who missed it, "Cooking Healthy: An Evening with Canyon Ranch Chef Scott Uehlein" is now available online.

For 30 years, the chefs and nutritionists at Canyon Ranch have created tempting dishes to nourish body and soul. So Uehlein, in collaboration with Rachel Murphy, R.D., senior clinical dietitian in the Department of Clinical Nutrition at M. D. Anderson, provided the tools and inspiration to create delicious, healthy recipes. He cooked, using recipes from his new book, "Canyon Ranch Nourish," now available in stores and online.

The goal was to educate attendees on how their diets can help prevent cancer.

Topics included plant-based diets, low-fat cooking, reducing trans and saturated fats, and the importance of fruits and vegetables in a healthful diet.

Tune in to watch Uehlein and Murphy demonstrate how to cook healthier meals or download the event on iTunes University.

By Michael M. Frumovitz, M. D., M.P.H. Assistant Professor, Department of Gynecologic Oncology

There will be almost 11,000 cases of cervical cancer and over 330,000 cases of high-grade cervical dysplasia (or "precancer") in the United States this year. Almost every one of these cases will be a result of exposure to the human papilloma virus or HPV. The health industry will spend almost $4 billion this year to treat HPV and HPV-associated diseases, a huge amount of money not mentioned often in the current health care debate.

There are currently two HPV vaccines manufactured. Both vaccines are virtually 100% effective in preventing HPV transmission if administered prior to exposure to the virus. Cervarix (GlaxoSmithKline) is a bivalent vaccine that prevents cervical dysplasia and cancers caused by the HPV subtypes 16 and 18. These two are the most common high-risk or "oncogenic" subtypes and account for almost 70% of all high-grade dysplasia and cervical cancers. Gardasil (Merck) is a quadrivalent vaccine that also prevents HPV 16 and 18 infections as well as infections with HPV 6 and 11, the two subtypes that account for almost 90% of benign genital warts.

By Bayan Raji, Staff Writer

Cancer among elderly people and minority groups is expected to increase dramatically over the next 30 years, precipitating a need for increased research in two groups that often are under-represented in clinical trials.

The study by researchers at M. D. Anderson, published in the June issue of Journal of Clinical Oncology, predicts cancer diagnoses over the next 30 years.

Population, cancer cases will grow

To conduct their research, the team looked at U.S. Census Bureau statistics, updated in 2008 to project population growth through 2050, and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database.

They found:
•    The U.S. population is expected to grow from 305 million in 2010 to 365 million in 2030
•    The total number of cancer diagnoses per year will increase from 1.6 million in 2010 to 2.3 million in 2030
•    In 2030, 70% of cancers will be diagnosed in the elderly
•    In 2030, 28% of cancers will be diagnosed in minorities

The study highlighted three important issues:
•    Clinical trial participation
•    Increasing cost of cancer care
•    Expected shortage of oncologists

Groups face challenges

From 2010 to 2030, the rate of cancer is predicted to increase:

•    65% in elderly people
•    100% percent in non-white people

These groups are under-represented in clinical studies and are vulnerable to sub-optimal cancer treatment.

"The fact that these two groups have been under-represented in clinical research participation, combined with the groups' rapid growth in cancer diagnoses, reflects the need for clinical trials of new therapies to be more inclusive and to address issues that are relevant to both populations," says Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology and the study's senior author.

Screening, prevention crucial

Cancer rates will increase by:

•    31% in whites
•    64% in blacks
•    76% in American Indian-Alaska Natives
•    101% in multi-racial people
•    132% in Asian-Pacific Islanders
•    142% in Hispanics

Screening and prevention will become essential tools to help prevent a similar growth in cancer deaths. However, no easy answer exists, according to Smith.
"There's no doubt the increasing incidence of cancer is a very important societal issue," Smith says. "There will not be one solution to this problem, but many different issues that must be addressed to prepare for these changes."
Changes take toll on system

The cost of cancer care continues to grow at a rate that's not sustainable for patients.

"As we design clinical trials, we need to seek not only the treatment that will prolong survival, but prolong survival at a reasonable cost to patients," Smith says. "These are two issues that oncologists need to be much more concerned about and attuned to."

A shortage of medical oncologists will have an impact on the health care system by 2020, according to the American Society for Clinical Oncology (ASCO).  

Smith says ASCO and other professional medical organizations beyond oncology are aware of the problem and are trying to increase the number of physicians, nurse practitioners and physician assistants.

More research needed

Unless specific prevention and treatment strategies are discovered, cancer death rates will increase dramatically, according to Smith.

"It's alarming that a number of the types of cancers expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates," he says.

M. D. Anderson resources

Audio Interview with Dr. Smith about Cancer Rate Growth (Cancer Newsline)

Cancer Incidence Rates Among Minorities Expected to Increase (David Wetter, Ph.D)

Division of Radiation Oncology


Other resources

Cancer Health Disparities (National Cancer Institute)

By Mary Brolley, Staff Writer

Acai berries come from the acai palm tree (Euterpe oleracea) found in Central and South America. The acai berry has been used by native Central and South Americans for centuries -- it makes up 42% of the region's total food intake. 

A relative of the blueberry and cranberry, the acai berry has become popular in the United States because it's believed to have tremendous health benefits. It's touted as the latest "super fruit" due to high antioxidant levels. An antioxidant is a substance that protects the body's cells from damage caused by unstable molecules known as free radicals.

How do you discuss a topic that most people hope they never have to think about, and that is about as appealing as a fuzzy brown Chinese gooseberry or a bug-eyed Patagonian toothfish? Like the wildly successful re-marketing of the popular Kiwi fruit (formerly Chinese gooseberry) and the Chilean sea bass (formerly Patagonian toothfish), the key to talking about cancer clinical trials is framing the issue in ways that are relevant and meaningful to the audience.  
                        
In Texas, 70% of cancer patients are white, even though the white population makes up only 48% of the population of Texas. Hispanics make up 37% of the population, but only 17% of new cancer cases. This surprising statistic is largely due to the fact that while minorities experience higher cancer rates in general, there are fewer minorities currently diagnosed with cancer. Minorities as a group -- in particular Hispanics -- are younger than the white population, and age is a significant risk factor for cancer. The older you are, the more your risk for cancer increases. In Texas, 70% of people older than 70 are white.
To reach healthier, younger people -- in particular Asians and Latinos -- we talk about cancer preparedness as a tool to maintain and protect their health and that of their families.

Residents of the Texas Gulf Coast are very familiar with the concept of hurricane preparedness. Every hurricane season, meteorologists are the most visible people on TV, as they share the latest news about potential hurricanes forming, and communicate messages of awareness, preparation and appropriate action. The annual rituals of stocking batteries and canned foods, filling the tub with water and the tank with gas become matter-of-fact behaviors, and not reasons for fear or distress. Certainly we hope that the hurricane does not head our way, but if it does, we will know what to do and how to do it.

Cancer preparedness takes the same approach. Health education specialists in the Minority & Women Clinical Trials Recruitment Program promote cancer awareness, prevention and screening with Hispanic and Asian audiences. They provide information about treatment options, including clinical trials, as resources that audiences can use to help themselves, their parents and elders decide the most appropriate course of action, for optimal survival and outcome, should the hurricane of cancer enter their lives.