preventable causes of cancer – Flashcards
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number of deaths averted from 1991 to 2011
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1.5 million
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primary prevention
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prevent onset of condition -smoking cessation -HPV vaccine
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secondary prevention
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detect and treat disease early to prevent morbidity and mortality -screening for cervical cancer
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tertiary prevention
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treat established disease, preventing deterioration and reducing complications -chemotherapy, surgery
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number 1 cause of preventable cancer deaths
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tobacco
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is nicotine carcinogenic
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no, tobacco and its 4,000 chemicals are
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tobacco related cancers
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lung oral cavity larynx pharynx bladder kidneys esophagus pancreas stomach cervix
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the first surgeon general's report on tobacco and health was administered in what year
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1964 -steady decline -corresponding decline in cancer deaths occurred later, reflecting the delay time between exposure and the development of disease
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smoking from 2005-2011
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heavy smoking declined significantly -light smoking increased
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smoking prevalence in 2011
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22% among men 17% among women
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primary prevention of smoking at the individual level
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education to prevent uptake smoking cessation
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primary prevention of smoking at the population level
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clean air acts (restaurants, parks, bus stops) -taxes
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1/3 of cancer cases are related to these issues and could therefore mostly be prevented
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diet and exercise
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animal fat, red meat lead to these types of cancer
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colon, rectum, prostate -processing -iron may generate free radicals -cooking
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fat may increase these things in the body
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secondary bile acids testosterone levels (prostate)
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these are formed by cooking meat at high temps
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heterocyclic amines
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these are used in meat processing
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nitrates, nitrites and salt form nitrosamines
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alcohol may increase the risk of these cancers
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mouth, pharynx, larynx, esophagus, liver, breast -risk is dose related -5% of cancers
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whole grains
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lignans-inconsistent data
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broccoli
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phytochemicals
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spinach
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carotenoids
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fruits, vegetables, dry beans
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flavonoids
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antioxidants
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beta carotene (carrots) vitamin C, elegiac acid (strawberries) anthocyanin (blueberries)
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dietary recommendations for fruits and vegetables
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fruit: 1.5-2 cups vegetables: 2-3
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median consumption of fruits and vegetables among us adults in 2013
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fruits: 1 vegetables: 1.7
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US adults who met fruit and vegetable intake
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13% 9%
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KS adults who met fruit and vegetable intake
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10% 8%
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american cancer society recommends at least this many cups of fruits/vegetables a day for cancer prevention
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2.5 cups
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cancers associated with physical inactivity
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breast colon prostate endometrium
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physical inactivity reduces cancer risk by
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-controlling body weight -accelerating transit time for food -reducing estrogen exposure -reducing insulin and related growth factors
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physical activity recommendations
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150 minutes of moderate physical activity 75 minutes of vigorous physical activity each week
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% of us adults engaged in no leisure time physical activity
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26.3%
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% of us adults who were active for more than 150 minutes
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50%
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less frequent physical activity is associated with
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-lower educational attainment -lower income -hispanic ethnicity -black race -female gender
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obesity contributes to 1 out of how many cancer deaths
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1 out of 5
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obesity contributes to these cancers
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breast colon endometrium kidney esophagus (adenocarcinoma) pancreas
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waist circumference goals to prevent cancer
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31.5 women 37 men
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% of adults overweight or obese in every state
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55%
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cancer deaths annually from chemical, radiation exposures in the workplace
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20,000
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asbestos
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mining, manufacturing -contact in home, school or workplace -demolition, construction workers -risk for mesothelioma, lung cancer
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HPV causes these cancers
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anogenital, oropharyngeal
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men and women receiving HPV vaccines
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females: 60% (40% received all 3 doses) males: 40% (20% received all 3)
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hepatitis B leads to these types of cancer
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liver, non-hodgkin lymphoma -91% coverage -hep C also leads to liver cancer, but no vaccine exists
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Epstein barr virus thought to cause these cancers
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nasopharyngeal burkitt hodgkin, stomach
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HIV thought to cause
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kaposi sarcoma (human herpes virus 8) non-hodgkin lymphoma
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most commonly diagnosed type of cancer
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skin cancer -not included because majority are basal and squamous cell and are very treatable
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cases of non melanoma skin cancer
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3.5 million
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cases of melanoma
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74,000 (10,000 deaths)
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aims of cancer screening
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-reduce cancer-related mortality -reduce cancer-related morbidity -detect precursors or early disease
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when assessing a screening test, should consider the
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benefit/harm ratio
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gold standard of evidence for screening
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prospective randomized control trial
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explains why we use mortality instead of survival for screening tests
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lead time bias
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length bias
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refers to the concept that cancers diagnoses between scheduled screenings are more aggressive (faster growing and have a poorer prognosis) than those diagnosed at scheduled screenings -those diagnosed at the initial screening are the least aggressive of all
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this is indicative of overdiagnosis
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if screening is detecting more cases, but not preventing death
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this is an independent panel of non-federal experts in prevention and evidence based medicine
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USPSTF -united states preventive services task force
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the USPSTF recommends these services
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grade A and B
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grade A
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high certainty that the net benefit is substantial
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grade B
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high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
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USPSTF recommends selectively offering or providing this service
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grade C
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grade C
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recommends to individual patients based on professional judgement and patient preferences -at least moderate certainty that the net benefit is small
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the USPSTF recommends against this service
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grade D
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grade D
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moderate or high certainty that the service has no benefit or that the harms outweigh the benefits
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I statement (grade)
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current evidence is insufficient to assess balance of benefits and harms of service -evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined
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recommended cancer screening tests
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breast colon cervical lung
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breast screening tests
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mammography, clinical breast exam
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colon screening tests
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stool blood testing, sigmoidoscopy, colonoscopy
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cervical screening tests
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pap, visual screening
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lung cancer screening
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(for high risk): lose dose spiral CT
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biennial mammography for 50-74 grade
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B
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biennial mammography for 40-49 grade
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C -decision should be made by individual
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colon cancer screening grade
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A
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colon cancer screening methods
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fecal occult blood testing (annually) or sigmoid every 5, FOBT every 3 or colonoscopy every 10
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ethnicities that are less likely to be screened
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hispanic, asian, black
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cervical screening grade
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A 21-65 years
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cervical screening mechanism
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cytology (pap smear) every 3 years 30-65 -screening with cytology plus HPV testing every 5
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heavy smoking means how many pack years
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30 pack years
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lung cancer screening grade
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B -55-80
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lung cancer screening mechanism
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annual screening with lose dose CT -30 pack year smoking history and currently smoke (or quit within past 15 years)
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% of lung cancer cases attributable to smoking
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85%
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lung cancer screening is estimated to apply to how many americans
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7 million
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grade for prostate-specific antigen based screening (PSA)
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D -less than 75
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informed decision making
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occurs when a man -understands the risks, benefits and alternatives of screening -participates in the decision to be screened or not at a level he desires -makes a decision consistent with his preferences and values
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benefits of a screening test
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reduce morbidity reduce mortality psychological reassurance health maintenance quality of life
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risks of screening test
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test itself -complications -radiation false positive results -work up testing and procedures -incorrect treament -psychological stress overdiagnosis -unnecessary treatment -psychological stress cost
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key modifiable targets in cancer prevention
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tobacco lifestyle -limit exposure to environmental toxins -physical activity -healthy weight -fruits and vegetables screening uptake
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