Cancer Prevention-- Robert A. Wascher, MD, FACS, FSSO Chief, Department of Surgery Director, Comprehensive Breast Cancer Program Cancer Treatment Centers of America-- Hispanic Chamber of Commerce 2013 - final
Cancer Prevention-- Robert A. Wascher, MD, FACS, FSSO Chief, Department of Surgery Director, Comprehensive Breast Cancer Program Cancer Treatment Centers of America-- Hispanic Chamber of Commerce 2013 - finalPresentation Transcript
CANCER PREVENTIONRobert A. Wascher, MD, FACS, FSSOChief, Department of SurgeryDirector, Comprehensive Breast Cancer ProgramCancer Treatment Centers of AmericaGoodyear, AZClinical Professor of SurgeryUniversity of Arizona College of Medicine - Phoenix
Cancer Treatment Centers of America®A national network of dedicated comprehensivecancer care centers specializing in advanced andcomplex cancersWe provide patient-centered, multidisciplinary, team-based care to patients with cancerCANCER PREVENTION
60 to 65% of cancerpatients will be aliveand cancer-free in 5years (“cured”)….50 to 60% of all cancercases are potentiallypreventable withlifestyle modification….CANCER PREVENTION
Few Diagnoses Cause as Much Fear or Concern asCancer…CANCER PREVENTION
Cancer as a Public Health Issue in the United StatesCANCER PREVENTION
• 1,660,000 new cancer cases in 2013• 580,000 cancer deaths in 2013• ~14 million living cancer patients• ~1:2 men will develop cancer• ~1:3 women will develop cancerCancer Facts & Figures; American Cancer Society, 2013Cancer as a Public Health Issue in the United StatesCANCER PREVENTION
CANCER PREVENTION• Current 5-year overall cancer survival: ~65%• Overall annual cancer-associated deaths have modestly decreasedover the past 15 years• Cancer-associated death rates have increased for cancers of theesophagus, pancreas, bladder, and liver• Regional differences in cancer death rate trends: rate ofimprovement in death rates more modest in South and Midwest• Gender differences persist: lung cancer rates in men improving,but just barely leveling-off for women
CANCER PREVENTION• Cancer incidence predicted to rise by 45% between 2010 and 2030• U.S. population is getting older, more obese, and more ethnicallydiverse (all are known risk factors for cancer)• Among the elderly, cancer incidence to rise by 67% (2010 to 2030)• Among ethnic minority populations (which are also aging andbecoming more obese), predicted 99% increase in cancer incidence(2010 to 2030)Smith BD, et al. J Clin Oncol 2009; 27:2745-2746SEER Cancer Statistics review, 1975 - 2005
CANCER PREVENTIONLifestyle-AssociatedCancer Risk Factors(Risk Factors ThatYou Can Change!)
At least 50% of all cancer cases linked to modifiable lifestyle factors• Tobacco (20% all cancer cases; 30% of all cancer deaths)• Diet (↑ meat, ↑ salt, ↓ fruit, ↓ vegetables, ↓ whole grains)• Overweight & Obesity• Alcohol• Occupation• UV Radiation (sun & tanning beds)• Infections• Ionizing Radiation (medical X-rays)• Sedentary Lifestyle (lack of exercise)• Reproductive (late or absent childbearing, no breastfeeding, exposure to HPVand other oncogenic viruses, hormone replacement therapy)Br J Cancer. 2011; 105: S77–S81CANCER PREVENTION
Br J Cancer. 2011; 105: S77–S81CANCER PREVENTION
CANCER PREVENTIONTobacco• 19% of U.S. population still smokes…• #1 cause of preventable cancers => 1 out of 5 of all cancer cases;30% of all cancer deaths (~175,000 deaths/ year)• #1 cause of preventable death => 1 in 5 deaths (~450,000/ year)
CANCER PREVENTIONExposure to Inhaled Carcinogens• Tobacco => 90 to 95% of all lung cancer cases; and cancers ofthe nasal cavity, larynx, esophagus, stomach, colon, rectum, liver,pancreas, breast, ovary, cervix, prostate, bladder, and leukemia• Diesel exhaust => lung cancerDiet• Red meat and processed meats• Other animal-based foods• Salt• High glycemic-index foods (sugar & carbs)• Alcohol
CANCER PREVENTIONChronic Diseases• Obesity• Diabetes• Infection with viruses and bacteria (HBV, HCV, HIV, HPV,H. pylori)Medications• Hormone replacement therapy (especially combination HRT)Ionizing Radiation• Medical x-rays (IOM => at least 2% of all cancers)• Radon gas (5 to 8% of lung cancer cases)Sedentary Lifestyle (exercise more!)
CANCER PREVENTIONObesityBMI > 25 is estimated to cause at least 100,500 new cases of cancerevery year in the United States (5 to 7% of all cases), including:49% of endometrial (uterus) cancers (20,700 cases/year)35% of esophageal cancers ( 5,800 cases/year)28% of pancreatic cancers (11,900 cases/year)24% of kidney cancers (13,900 cases/year)21% of gallbladder cancers ( 2,000 cases/year)17 % of breast cancers (33,000 cases/year)9% of colorectal cancers (13,200 cases/year)American Institute for Cancer research/WCRFs Policy and Action for Cancer Prevention, 2009;Cancer Facts and Figures 2009, American Cancer Society
CANCER PREVENTIONDiabetes• Nurses’ Health Study (~120,000 women, 30 to 55 years of age):• 43% increase (RR) in colon cancer & 11% increase (RR) inrectal cancer.• Other studies: 50% increase in pancreatic cancer risk; andincreased risk of cancers of the breast, liver, kidney, and uterusHu F, et al. JNCI 1999; 17:542-547.Gioavannucci E, Michaud D. Gastroenterology 2007; 132:2208-2225.
Alcohol & Cancer• ~4% of all cancer cases in the U.S. (5% in men, 2% in women)• #8 overall cause of cancer (#4 cause among top 11 lifestyle-associated causes)• 4 to 6% of cancer deaths => 23,000 to 34,000 deaths/year(33,000 MVA fatalities/year; 16,000 homicides/year)Sci Transl Med. 2012;4:127rv4Br J Cancer. 2011; 105: S77–S81Am J Public Health. 2013; 103:641-648Int J. Cancer. 2006; 119: 884-7CANCER PREVENTION
Cancer Types Most Closely Linked With Alcohol• Breast• Esophagus• Stomach• Colon• Rectum• Pancreas• Liver• Alcohol + Tobacco: Lung, Oral Cavity, Pharynx, LarynxCANCER PREVENTION
CANCER PREVENTIONCancer Prevention Lifestyle: Diet & Nutrition
CANCER PREVENTIONLifestyle & Dietary Factors: Diet• European Prospective Investigation into Cancer and Nutrition-Potsdam Study (EPIC-P) (n >23,000 healthy volunteers; 35 to 65years of age average follow-up >8 years)• Just 4 factors were associated with a 40% reduction in cancerrisk, 93% reduction in diabetes risk, 81% reduction in risk ofheart attack, 50% reduction in risk of stroke, 78% overalldecrease in risk of all chronic serious diseases:• BMI <30• Moderate exercise (≥ 3.5 hours/week)• Diet rich in whole grains, fresh fruits & vegetables, andlow in meat & other animal-source foods• Abstention from tobaccoFord ES, et al. Archives of Internal Medicine 2009; 169:1355-1362.
CANCER PREVENTIONLifestyle & Dietary Factors: Diet• “Mediterranean Diet:” Fresh fruits and vegetables, nuts, fish& healthy cooking oils (canola oil and olive oil); substitutes herbsand spices for salt; minimal amounts of red meat & processedmeats• 12% overall reduction in cancer risk, and a 50% reductionin GI cancer risk• Reduced risk of cancers of the lung, esophagus, breast,stomach, colon, and rectumKant AK, et al. J Nutrition 2009; 139:1374-1380.La Vecchia C, Boestti C. Public Health Nutrition 2006; 9:1077-1082.
CANCER PREVENTIONEating more fish (and less meat) reduces cancer risk!