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On the Web - Concept 22

Web22-01: Cancer Trends Over Time

Web 22-02: Self Exam Screening for Breast Cancer

Web22-03: Colon-Rectal Cancer

Web22-04: Lung Cancer

Web22-05: Prostate Cancer

Web22-06: Uterine and Ovarian Cancers

Web22-07: Skin Cancer

Web22-08: Treating Cancer

Web22-09: Hormone Replacement Therapy

Web22-10: Health Risks of Diabetes

Web22-11: Oral Glucose Tolerance Tests

Web22-12: Physical Activity and Mental Health

Web22-13: Web Resources

Web22-14: Supplemental Readings

Web22-15: Self-Exam Screening for Testicular Cancer

Web 22-16: Self Exam Screening for Breast Cancer

Web22-01: Cancer Trends Over Time

Rates of death from most cancers have decreased in the past 50-60 years. This is due to better diagnoses and treatments as well as some improvements in lifestyle. Lung cancer rates rose dramatically in the 60's to 80's (likely due to the prevalence of cigarette smoking). In the past 10-20 years, the rates of tobacco use began to decrease and the rates of lung cancer also started dropping. The recent trends for various cancers are shown for both men and women below. See the American Cancer Society website (www.cancer.org) for more details on cancer trends and risks. The National Cancer Institute (NCI) has recently posted information with maps on the prevalence of cancers in different regions. Visit the Atlas on Cancer website for more details (http://www.nci.nih.gov/atlas/).

Web 22-02: Self Exam Screening for Breast Cancer

Because cancer can be most effectively treated if it is detected early it is important to conduct periodic self-exams. If you identify anything out of the ordinary, you should be checked by a physician. The procedures described below are for females to check for early signs of breast cancer.

Web22-03: Colon-Rectal Cancer

Along with regular screening, prevention is another important tool in the fight against colo-rectal cancer. The American Cancer Society lists five major categories that people should focus on to help prevent the development of colo-rectal cancer.

1. Diet and Exercise: The diet should include fruits, vegetables, whole grains, and limit high fat foods. Physical activity should be performed for at least 30 minutes most days of the week, and by increasing the activity to 45 minutes or more of moderate or vigorous activity you can reduce your risk of developing both colo-rectal and breast cancer even more. Being overweight also increases a person's risk, so weight loss should also be considered.
2. Vitamins, Calcium, and Magnesium: A daily multivitamin with folic acid has been shown in some studies to reduce a person's risk. Calcium, magnesium, and vitamin D have also been shown to help reduce risk.
3. Non-steroidal anti-inflammatory drugs (NSAIDs): Aspirin and NSAIDs have been shown to reduce a person's risk for developing polyps but these medications can also lead to serious stomach problems, so these medications may not be recommended as a cancer treatment prevention for everyone.
4. Female Hormones: Hormone replacement therapy (HRT) may reduce a post-menopausal woman's risk for developing colo-rectal cancer. Unfortunately, women who are on HRT replacement that do develop colo-rectal cancer seem to have the fastest growing form of the cancer. Therefore, HRT may not be recommended for everyone.
5. Other Factors: Some factors such as genetics or family history of the disease cannot be prevented. But knowing your family history can encourage you to begin your screenings at an earlier age.

The following websites provide valuable information on colo-rectal cancer:

Colo-rectal Cancer Awareness: This website provides information about colo-rectal cancer awareness month that takes place in March. It is also a good resource for general information on this cancer.

Colo-rectal Cancer Network: This website provides valuable information about colon and rectal cancers as well as providing a support network for those afflicted with the disease and their friends and family.

Web22-04: Lung Cancer

There are two major types of lung cancer, and the type of cancer a person develops depends on the type of cells that are affected.

1. Non-Small Cell Lung Cancer (NSCLC): This is the most common form of lung cancer and it can be classified into 3 subtypes (squamous cell carcinoma, adenocarcinoma, and large cell undifferentiated carcinoma)
   Staging is used to determine how far along the cancer has developed. For NSCLC, the TNM staging system is used. The "T" describes the tumor, the "N" describes the spreading of the cancer to the lymph nodes, and the "M" stands for metastasis or spreading of the cancer to other parts of the body.
2. Small Cell Lung Cancer (SCLC): This type of lung cancer is less common and is sometime referred to as oat cell cancer, small cell undifferentiated carcinoma, or poorly differentiated neuroendocrine carcinoma).
   A simpler 2 stage system is used for this type of lung cancer. The first type is "limited stage" or the cancer has only affected one lung and/or the lymph nodes on that same side. The second type is "extensive stage" or the cancer is affecting both lungs, and/or the lymph nodes on both sides of the chest, or has spread to other parts of the body as well.

For more information concerning lung cancer, visit the National Comprehensive Cancer Network.

Web22-05: Prostate Cancer

The prostate gland is found in men and its function is to produce some of the seminal fluid that nourishes sperm. Testosterone influences the health of the prostate gland. Prostate cancer begins from cells in the prostate gland. It is usually a slow growing cancer. Generally prostate cancer is detected in its early stages through a prostate-specific antigen (PSA) test or a digital rectal exam (DRE).

For more information on prostate cancer, visit the National Comprehensive Cancer Network.

Web22-06: Uterine and Ovarian Cancers

The American Cancer Society provides the following recommendations to offer the best chance to find reproductive cancers early, when treatments are most effective.

• Women at average risk should talk with their doctors about the need for periodic, thorough pelvic exams to look for signs of ovarian, cervical, and uterine (endometrial) cancer. In general, the risk for these cancers increases with age. The risk for ovarian cancer doesn't peak until a woman is in her late 70s.
• Women should also stay aware of their bodies. Early ovarian cancer may not produce any noticeable symptoms, but if there is anything unusual or different, women should report it to a doctor right away.
• Be alert for the possible symptoms of ovarian cancer listed below, but remember they are often signs of something else, too.

• Swelling of the stomach
• Persistent problems such as gas, bloating, stomach pain, or indigestion
• Bleeding between menstrual cycles (periods) or after menopause
• Pelvic, leg, or back pain
• Feeling of pressure in the pelvis
• Unexplained weight loss or gain
• Shortness of breath
• Unusual fatigue

Women with a higher risk of developing ovarian cancer, such as those with a strong family history of this disease, should talk with a doctor about specific medical tests that look for early signs of the disease and about measures that may help reduce the risk for ovarian cancer.

Web22-07: Skin Cancer

The FDA recently approved a new type of sunscreen that is more effective than those previously available. The new sunscreen contains an agent (ecamsule or NME) that is especially effective in blocking UVA rays that contribute most to the type of skin and eye damage that leads to skin cancer. It will be marketed in the United States in a product called Anthelios SX. The product will also contain the previously approved avobenzone and octocrylene. Ingredients in previously approved sunscreens are effective in blocking UVB rays that cause sunburns, but not as effective in blocking UVA rays that penetrate into deeper skin layers. Sunscreen containing the new ingredient has a longer lasting effect, and for this reason does not have to be applied as often. Experts caution consumers not to assume that any sunscreen, including sunscreen with the new ingredient, is 100% effective in protecting the skin. They encourage all people to cover the skin, avoid exposure to the sun during the middle of the day, wear sunglasses, and take other established steps to protect the eyes and skin.

Click here for the whole press release by the FDA.

Web22-08: Treating Cancer

When dealing with cancer treatment, the patient and family need to be able to ask important questions regarding the disease and treatment. It is often hard to ask the right questions during this difficult time. The American Cancer Society recommends asking the following questions at a minimum:

• Would you please write down the exact kind of cancer I have.
• Where is my cancer located?
• Has it spread beyond the place where it began?
• What is the stage of my cancer, and what does that mean in my case?
• What treatment choices do I have?
• What treatment do you suggest and why?
• What is the goal of this treatment?
• What risks or side effects are there to the treatments you suggest?
• If I lose my hair, what can I do about it?
• What are the chances my cancer will come back with this treatment plan?
• What are my chances of survival, based on my cancer as you see it?
• What should I do to be ready for treatment?
• Should I follow a special diet?

Go to the following link for more information from the American Cancer Society about treatment decision tools.

Web22-09: Hormone Replacement Therapy

There are two main forms of hormone replacement in women after menopause. Estrogen Replacement Therapy (ERT) provides synthetic estrogen to the women while Hormone Replacement Therapy (HRT) uses both estrogen and progestin. There are risks associated with the use of both of these forms of hormone replacement. Visit the American Cancer Society for more information on these risks.

Who can benefit from hormone replacement therapy? Although risks of hormone replacement therapy have been shown in some women, there are still women that can benefit from HRT. The following issues should be discussed with your doctor:

1. Hot Flashes: HRT is the most effective treatment for hot flashes and night sweats.
2. Vaginal Discomfort: HRT can relieve dryness, burning, discomfort, and itching.
3. Osteoporosis: HRT can be used when other osteoporosis medications are not an appropriate option for a patient.

Web22-10: Health Risks of Diabetes

Approximately 15.7 million people in the United States have diabetes. One third of these are undiagnosed. Diabetes is a disease that prevents the body from producing insulin in quantities that are either enough or not at all. Diabetes is usually diagnosed by identifying elevated blood glucose levels (see Web24-03). The American Diabetes Association (ADA) provides a Diabetes risk test to help people determine if they may be at risk

Diabetes can cause many different disabling and life-threatening conditions. The ADA web site provides the following facts about the problems associated with diabetes:

• Blindness. Diabetes is the leading cause of new cases of blindness in people ages 20-74.
• Kidney Disease. Diabetes is the leading cause of end-stage renal disease, accounting for about 40% of new cases.
• Nerve Disease and Amputations. About 60-70 percent of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations.
• Heart Disease and Stroke. People with diabetes are 2 to 4 times more likely to have heart disease which is present in 75 percent of diabetes-related deaths. And, they are 2 to 4 times more likely to suffer a stroke.

For more information on diabetes check the following references:

CDC's Diabetes Public Health Resource
http://www.cdc.gov/diabetes/

American Diabetes Association
http://www.diabetes.org/

Web22-11: Oral Glucose Tolerance Tests

Diabetes is typically diagnosed with a glucose tolerance test. This test evaluates the ability of the body to effectively metabolize and process a concentrated glucose "load" (e.g. a sugar drink). The observed changes in the levels of blood sugar over time are used as an indicator of the bodies sensitivity and responsiveness to insulin. When a normal fasting person ingests 1 gram of glucose per kilogram of body weight, the blood glucose level rises from around 90 mg/dl to 130 mg/dl and then falls back into normal ranges in about 2 hours. When a diabetic person ingests 1 gram of glucose per kilogram of body weight, the blood glucose level rises considerably higher than that of a normal person, to about 200+ mg/dl. A diabetic also typically has a higher than average fasting blood glucose level, about 100 -120 mg/dl. These responses indicate a poor response to the glucose load and the presence of (or potential risk for) diabetes.

The graph below indicates the normal and abnormal (diabetic) patterns observed from an oral glucose tolerance test. The values refer to the changes in blood glucose concentration (mg/dl) over a time span of 5 hours.

Web22-12: Physical Activity and Mental Health

Mental health conditions such as depression exert a significant influence on health and negatively impact quality of life. Greater awareness and acceptance of depression within the medical community and the society at large have helped lead to improvements in the diagnosis and treatment of depression. While the etiology of depression is complex, there is considerable evidence suggesting that individuals who are physically active are less likely to be depressed. It is not clear if this effect is due to the physical, physiological or psychological effects of exercise. It is possible that all of these factors contribute to the effect. Because of these effects, most psychiatrists now commonly prescribe physical activity for many of their depressed patients.

In one study (1), a sample of 82 adults participated in a 12 week aerobic exercise program to examine the effects of exercise on psychological outcomes. At the end of the study, the exercise group had significant psychological improvement compared with a control group that didn't exercise. At 1 year follow-up, the changes were still significant.

A recent population study in Finland (2) on over 3400 participants found that individuals who exercised at least two to three times a week experienced significantly less depression, anger, cynical distrust, and stress than those exercising less frequently or not at all.

Collectively, these studies support the consistent associations between physical activity and enhanced psychological well-being and mental health.

Sources:

(1) DiLorenzo, T.M., Bargman, E.P., Stucky-Ropp, R., Brassington, G.S., Frensch, P.A., and LaFontaine, T. (2000). Long-term effects of aerobic exercise on psychological outcomes. Preventive Medicine, 28, 75-85

(2) Hassmen, P. Koivula, N., and Uutela, A. (2000). Physical exercise and psychological well-being: A population study in Finland. Preventive Medicine, 30, 17-25.

Depression-Screening Test
If you think you are experiencing symptoms of clinical depression complete the depression-screening test developed by the National Mental Health Association. This will help you decide if you need to seek professional help.

Web22-13: Web Resources

American Cancer Society - www.cancer.org

American Diabetes Association - www.diabetes.org

Environmental Protection Agency - www.epa.gov

Healthy People 2010- www.health.gov/healthypeople

National Cancer Institute - www.nci.nih.gov

National Center for Environmental Health (NCEH) - http://www.cdc.gov/nceh

National Center for Health Statistics – www.cdc.gov/nchs

National Institute of Mental Health – www.nimh.nih.gov

Web22-14: Supplemental Readings

References new to 7e/14e:

American Diabetes Association. 2006. Diabetes by the numbers for 2006. Available at www.diabetes.org.

Carney, P. A. et al. 2005. Utilization of screening mammography in New Hampshire. Cancer. 104(8):1726-1732.

Edwards, B. K. et al. 2005. Annual report to the nation on the status of cancer. Journal of the National Cancer Institute. 97(19):1407-1427.

Hahn, D. B. et al. 2007. Focus on Health (8^th ed.). New York: McGraw-Hill Higher Education, Chapter 11.

Hamann, B. P. 2007. Disease: Identification, Prevention and Control (3^rd. ed.). New York: McGraw-Hill Higher Education.

Hewitt, M. et al. 2006. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: National Academies Press. www.nap.edu

Hoyert, D. L., Kung, H., and B. L. Smith. 2005. Deaths: Preliminary Data for 2003. National Vital Statistics Reports 53(15): 1-32.

National Cancer Institute. 2005. Cancer Trends Progress Report—2005 Update. Washington, DC: National Cancer Institute. Available at http://progressreport.cancer.gov/highlights.asp

Pisano, E. et al. 2006. Utilization of screening mammography in New Hampshire. Cancer. 104 (8):1726 – 1732.

Rubin, R. 2005. Vaccine prevents cervical cancer. USA Today. October 7.

Stefanick, M. L. et al. 2006. Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. Journal of American Medical Association. 295(14): 1647-1657.

Thompson, I. M. t al. 2005.Operating characteristics of prostate-specific antigen in men with an initial PSA Level of 3.0 ng/mL or lower. Journal of the American Medical Association. 294(9):66-70.

U.S. Preventive Services Task Force. 2006. Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. Annals of Internal Medicine. 143(5):355-361.

Wang, X. et al. 2005. Autoantibody signatures in prostate cancer. New England Journal of Medicine. 353(12):1224-1235.

References from Past Editions:

• American Cancer Society. Cancer Facts and Figures—1997. New York: The American Cancer Society, 1998.
• American Heart Association. 1997 Heart Facts Reference Sheet. Dallas: American Heart Association, 1997.
• Blair, S.N., & A. Oberman. "Epidemiological Analysis of Coronary Heart Disease." Cardiology Clinics 5(1987):271.
• Bruess, C., & G. Richardson. Decisions for Health. 4th ed. Dubuque, IA: Wm. C. Brown Publishers, 1995.
• Campaigne, B. N. Exercise and Type I Diabetes. ACSM's Health and FitnessJournal. 2(4)(1998):35.
• CDC. The Cost Effectivenss of Screening for Type II Diabetes. Journal of the American Medical Association. 280(20)(1999):1957.
• Corbin, C. B. & R. P. Pangrazi. (ed.) Towards a Better Understanding of Physical Fitness and Activity. Scottsdale, AZ: Holcomb-Hathaway, 1999, Chapters 9, 10, 11.
• Eddy, D.M., et al. "The Value of Mammography Screening in Women under 50 Years." Journal of the American Medical Association 259(1988):187.
• Ekoe, J. "Overview of Diabetes Mellitus and Exercise." Medicine and Science in Sports and Exercise 21(1989):353.
• Erickson, S. M. & T. L. Sevier. Osteoporosis in Active Women. Physician and Sports Medicine. 25(11)(1997):61.
• Frisch, R.E., et al. "Lower Lifetime Occurrence of Breast Cancer and Cancers of the Reproductive System Among Former College Athletes." American Journal of Clinical Nutrition 45(1987):328.
• Gorman, M., et al. "Position of the American Dietetic Association: Health Implications of Dietary Fiber." Journal of the American Dietetics Association 88(1988):216.
• Ike, R.W. "Arthritis and Aerobic Exercise: A Review." Physician and Sportsmedicine 17(1989):128.
• Katz, W. A. & C. Sherman. Exercise for Osteoporosis. Physician and Sports Medicine. 26(2)(1998):43.
• Katz, W. A. & C. Sherman. Osteoporosis: The Role of Exercise in Optimal Management. Physician and Sports Medicine. 26(2)(1998):33.
• Klerman, G.L. "Clinical Epidemiology of Suicide." Journal of Clinical Psychiatry 48(1987):33.
• Koss, L.G. "The Papanicolaou Test for Cervical Cancer Detection: A Triumph and a Tragedy." Journal of the American Medical Association 261(1989):737.
• Lee, I. "Exercise and Physical Health: Cancer and Immune Function." Research Quarterly for Exercise and Sport 66(1995):286.
• Lee, I., et al. "Physical Activity and Risk of Developing Colorectal Cancer Among College Alumni." Journal of the National Cancer Institute 83(1991):1324.
• Lerman, C. "Reducing Avoidable Cancer through Prevention and Early Detection Regimens." Cancer Research 49(1989):4955.
• Monahan, T. "Exercise and Depression: Swapping Sweat for Serenity." Physician and Sportsmedicine 14(1986):192.
• Morbidity and Mortality Weekly Reports. Published Weekly by the Centers for Disease Control and Prevention, Provides Updated Information on Health, Available on the WEB at www.cdc.gov.epo/mmwr/mmwr.html.
• National Center for Health Statistics. Health, United States, 1998: With Socioeconomic Statistics and Health Chartbook. Hyattsville, MD: National Center for Health Statistics, 1998.
• Paffenbarger, R.S., et al. "Physical Activity and Incidence of Cancer in Diverse Populations: A Preliminary Report." American Journal of Clinical Nutrition 45(1987):312.
• Payne, W. A. & D. B. Hahn. Understanding Your Health (5^th Ed.). St. Louis: WCB/McGraw-Hill, 1998, Chapters10, 11, 12, 19 and 20.
• Shaffers, D., et al. Prevention in Child and Adolescent Psychiatry: The Reduction of Risk of Mental Disorders. Washington, DC: American Academy of Child and Adolescent Psychiatry, 1990.
• Simon, H.B. "Exercise and Infection." Physician and Sportsmedicine 15(1987):135.
• Storms, W. W. and D. M. Joyner. Update on Exercise-Induced Asthma. The Physician and Sports Medicine, 25(3)(1997):45.

· U.S. Department of Health and Human Services. Healthy People 2010 Objectives: Draft for Comment. Washington, DC: U.S. Department of Health and Human Services, 1998, Objectives Chapters 5, 7, 8, 17, 18, 19, 20, 23, and 24.

Web22-15: Self-Exam Screening for Testicular Cancer

Because cancer can be most effectively treated if it is detected early it is important to conduct periodic self-exams. If you identify anything out of the ordinary, you should be checked by a physician. The procedures described below are for males to check for early signs of testicular cancer.

Web 22-16: Self Exam Screening for Breast Cancer

Because cancer can be most effectively treated if it is detected early it is important to conduct periodic self-exams. If you identify anything out of the ordinary, you should be checked by a physician. The procedures described below are for females to check for early signs of breast cancer.