Did you know that up to 50 percent of cancer cases in the United States could have been prevented? Learn strategies you can implement in your life to significantly reduce your risk of getting cancer. Light refreshments will be served. Presenter(s): Melissa Berlin, MD, Family Medicine Practitioner; Constance Gore, RN-APN, Oncologist; Christina Lavner, RD, Oncologist

1. Simple Ways to Reduce
Your Cancer Risk
Presented by:
Melissa Berlin, MD, Family Medicine
Christina Lavner, RD, Nutrition Services
Constance Gore, RN-APN, Genetic Counseling
Montclair Public Library
May 18, 2019

2. Simple Ways to Reduce
Your Cancer Risk
Presented by: Melissa Berlin, MD, Family Medicine

3. Biography
• Born and raised in Ottawa, Canada
• Moved to NYC for Residency
• Completed a Family Medicine Residency at
Montefiore Medical Center in the Bronx
• Joined Summit Medical Group in October 2018 after
practicing in a few other practices in Boston
and Bergen County
• Mom to 4 amazing kids (ages 7,7,4,1)

5. My Office:
230 Sherman Avenue
Glen Ridge, NJ
973-743-2321

6. In memory of one of my best friends:
Lyle Goldsmith
who lost his fight with colon cancer
on May 16, 2018 at the age of 40.

8. 1. Aside from smoking, research has shown
which of these to be a major cause of
cancer?
• Hormones in beef
• Obesity
• Artificial Sweeteners
• Genetically Modified Foods
• Cell Phones

9. 1. Aside from smoking, research has shown
which of these to be a major cause of
cancer?
• Hormones in beef
• Obesity
• Artificial Sweeteners
• Genetically Modified Foods
• Cell Phones

10. 2.TRUE OR FALSE:
Coffee increases cancer risk
• True
• False

11. 2.TRUE OR FALSE:
Coffee increases cancer risk
• True
• False
Coffee has actually been linked to
lower risks of endometrial cancers
and might play a protective role
in other cancer as well.

12. 3.Diets high in ____ may increase risk
of colorectal cancer.
• Fats
• Carbohydrates
• Red Meat
• Artificial Sweeteners

13. 3.Diets high in ____ may increase
cancer risk.
• Fats
• Carbohydrates
• Red Meat
• Artificial Sweeteners
• Eating high amounts of red meat – over 18 ounces a week – linked to
increased risk of colorectal cancer.

14. 4.True or False:
Physical activity lowers cancer risk
• True
• False

15. 4.True or False:
Physical activity lowers cancer risk
• True
• False
• Physical activity has been shown to lower risk
of colorectal cancer as well as post-
menopausal breast and endometrial cancer.

16. 5.Which of the following increases
a woman's risk of breast cancer?
• Stress
• Alcohol
• Soy
• Food Additives

17. 5.Which of the following increases
a woman's risk of breast cancer?
• Stress
• Alcohol
• Soy
• Food Additives
Alcohol, obesity and sedentary lifestyle have been
shown to increase breast cancer risk.

18. Reducing Your Cancer Risk
1. Lifestyle recommendations from
the World Cancer Research
Fund International
2. Recommended Screening

19. Click to add text
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20. BMI = Body Mass Index
Ratio of Height to Weight
Ideal: 18.5 - 24.9
Overweight: 25-29
Obese: 30+
Eg/ A woman who is 5'4 should
be between 108 - 145 lbs.
Be a Healthy Weight
The evidence linking obesity to cancer is
overwhelming and has grown stronger
over the past decade.
The new findings show strong evidence
that being overweight or obese is a
cause of 12 cancers.

21. 150 minutes/ week
moderate-intensity
(2 hours and 30 minutes)
or
75 minutes / week
vigorous-intensity
(1 hour and 15 minutes)
Even higher levels of activity
provide even more benefit.
Be Physically Active
Physical activity can help protect you
directly from 3 cancers and also helps you
maintain a healthy weight, which reduces
your cancer risk even more.

22. Diet: Eat More Of:

23. Diet: Eat Less Of:

24. Limit as much as possible:
MAX: 1 drink/day women
2 drinks/day men
A drink =
-12 ounces of regular beer
-5 ounces of wine
-1.5 ounces of 80-proof
distilled spirits
Alcohol
But for cancer prevention, the evidence is
clear and convincing: alcohol in any form
is a potent carcinogen. It's linked to 6
different cancers.
The best advice for those concerned about
cancer is not to drink at all.

25. For most people, it is possible to obtain adequate
nutrition from a healthy diet that includes the right
foods and drinks.
Research cautions against expecting any dietary
supplement to lower cancer risk as well as a healthy
diet can.
Supplements?

26. There is strong evidence that breastfeeding helps protect
against breast cancer in the mother.
Breastfeeding

27. Environment
Not smoking and avoiding other exposure to
tobacco and excess sun are also important in
reducing cancer risk.

28. Cancer Screening
The U.S. Preventive Services Task Force is an independent, volunteer panel
of national experts in disease prevention and evidence-based medicine.
The Task Force works to improve the health of all Americans by making
evidence-based recommendations about clinical preventive services.
https://www.uspreventiveservicestaskforce.org

29. Screening:
Cervical Cancer
Women aged 21-29: pap every 3 years
Women aged 30 - 65 years: pap every 3 years or every 5 years with
high-risk human papillomavirus HPV testing and pap combined
GARDASIL HPV Vaccine given to children at age 11-12 but can be
given up to age 45 has been to shown to dramatically reduce the rates
of cervical cancer.

30. Screening:
Breast Cancer
Women aged 50 to 74 years: mammogram every 1-2 years
There are some higher risk women who would benefit starting
mammogram at age 40 or 45 but it's a decision with your doctor.
If at increased risk because of family history: discuss options with your
physician.

31. Screening:
Colorectal
Best test is colonoscopy every 5-10 years.
Begin screening of average risk individuals at age 50. For African Americans,
consider beginning at age 45.
After age 75, individualize based on life expectancy
First tier for colon cancer prevention: colonoscopy every 10 years.
First tier for early detection of cancer: colonoscopy every 10 years or FIT annually.
Other options:
Flexible sigmoidoscopy every 3 to 5 years
Combination FIT and DNA stool testing every three years.
*These recommendations are based on the two definitive groups in the USA:
US Preventative services task force 2016(USPSTF);
and the US Multi-society task force on Colorectal cancer 2019 (USMSTF).

32. Screening:
Lung
Lung cancer screening for people who smoke or have a significant
smoking history:
Annual low-dose CT Scan of the lungs in adults aged 55 to 80 years
• CURRENT or FORMER smoker who quit within the past 15 years
• Smoked at least 30 pack-years
1 pack per day for at least 30 years
2 packs per day for 15 years
3 packs per day for 10 years

33. Screening:
Prostate
Men ages 55-69: The decision to undergo PSA blood test screening for
prostate cancer should be an individual one: discuss with your doctor
about risks/benefits.

34. Screening:
Other Cancers?
Routine screening for: ovarian, pancreatic, prostate, testicular, and
thyroid cancers has not been shown to reduce deaths from those
cancers.

35. Cancer Prevention
Nutrition Recommendations
Presented by: Christina Lavner, RD

36. Overall Eating Patterns have been found
to be more important then focusing on
one food or nutrient. It is not the one meal
that is important but the consistency of
what you do over time.
 Weight & Weight Gain
 Dietary Patterns
 A lifestyle with regular physical activity=
Move more, Sit less!!

37. #1 Be a healthy weight
Keep your weight within
the healthy range
and
avoid weight gain in
adult life.

38. #2 Be physically active
Be physically
active as part
of EVERYDAY life.
Our bodies are
meant to MOVE!!

39. #3 Eat a diet rich in whole grains,
vegetables, fruits & beans
Make whole grains,
vegetables, fruits
and pulses (legumes)
such as
beans and lentils a major part
of your usual daily diet.

40. #4 Limit consumption of
“fast foods”
& other processed foods high in fat,
starches or sugars.
Limiting these foods helps
control calorie
intake and maintain
a healthy weight

41. #5 Limit consumption of red
& processed meats
Eat no more than moderate
amounts of red meat,
such as beef, pork and lamb.
Eat little, if any,
processed meats.

42. #6 Limited consumption
of sugar-sweetened drinks
Drink mostly water
& unsweetened drinks

43. #7 Limit alcohol consumption
For cancer prevention, it’s best
not to drink alcohol

44. #8 Do not use supplements for
cancer prevention
Aim to meet nutritional needs
through diet alone.

45. #9 For mother: breastfeed
your baby, if you can
Breastfeeding is
good for both
mother & baby

46. #10 After a cancer diagnosis:
follow above recommendations if
you can
Check with your health
professional about what is right
for you

49. Family History:
Role in Cancer Risk Assessment
Presented by: Connie Gore, RN, MA, ACNP-BC AOCNP
Nurse Practitioner

50. Family History: Role in cancer
risk assessment
• Red flags
• Genetic testing
• Implications

51. Family History: Role in cancer
risk assessment
• Red flags
 Early onset of common cancers, e.g.
breast, prostate, colon <50
 Rare cancers, e.g. ovary, pancreas at any
age
 Multiple cancers in same patient
 Multiple cancers on same side of family
 Ashkenazi Jewish ethnicity 1:40 vs 1:200

52. Genetic Testing
• Can be done on blood or saliva
• Not always covered by insurance
• OOP cost from 1500-2500$ for panel on
index relative; subsequent testing for
affected relatives 3-400$
• Results take 3-4 weeks
• Ancestry/23&me; require confirmatory
testing if + for cancer risk

53. HBOC: Hereditary Breast and
Ovarian Cancer Syndrome
• BRCA1/BRCA2; associated cancers
 Early onset breast cancer; extraordinary
lifetime risk approaching 80% vs.10%
 Ovarian cancer: 30-50% vs.1%
 Prostate cancer: 11% general population
 Pancreas cancer: 1% general population
 Male breast cancer: 0.5% general
population

54. HBOC: Hereditary Breast and
Ovarian Cancer Syndrome
• Benefits to unaffected patient if +:
 Personalized screening/surveillance
recommendations
• Add MRI to annual screening for high risk
profile
• Consider prophylactic bilateral mastectomy
• Consider prophylactic bilateral
salpingoopherectomy (PBSO); removal of
fallopian tubes and ovaries

55. HBOC: Hereditary Breast and
Ovarian Cancer Syndrome
• Benefit to affected patient if +
 Assist in surgical decision making; e.g.
bilateral mastectomy vs. lumpectomy
 PARP inhibitors as option for management
of metastatic disease/maintenance of
remission; evolving use in
pancreas/prostate cancers
 Characterize risk for offspring/siblings

56. Next generation sequencing:
Beyond BRCA1/2
BRCA1/2 sequenced in 1994 and
commercially tested since 1999
Expanded testing now includes other genes
which contribute variably to risk for breast
and other cancers
Screening and surveillance
recommendations may be escalated if +
If you were tested >5 years ago consider
update testing

57. Implications for relatives
• Carriers of cancer genetic mutations
have elevated risks for cancer(s)
• Their offspring and siblings have a
50:50 chance of having inherited the
same mutation
• Mutations occur at the time of
conception and are carried in all cells

58. Take Home Message
Ask about your family history!
It’s uncommon to have a genetic
mutation, but common to get cancer if you
have one. Only 10-15% of cancers are
thought to be hereditary.
Knowledge is power!

59. QUESTIONS?