Can We Prevent Cancer? - Dr. Goodwin


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Dr. Jerry Goodwin, chief medical officer of Sylvester Comprehensive Cancer Center/UMHC, presented "Can Cancer Be Prevented?" at the 2011 WellBeingWell Conference in Miami.

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Can We Prevent Cancer? - Dr. Goodwin

  1. 1. W. Jarrard Goodwin, M.D., F.A.C.S.Chief Medical Officer, Sylvester Comprehensive Cancer Center <br />Can We Prevent Cancer?<br />
  2. 2. Cancer in America<br />1.44 million Americans will be diagnosed in 2008<br />570,000 deaths annually (1 in 4)<br />1,500 deaths daily<br />Lifetime risk <br />1 in 2 men <br />1 in 3 women<br />These figures exclude non-melanoma skin cancer<br />Age-adjusted death rate is decreasing<br />Lots of good news<br />
  3. 3. Impact of Total Eradication<br />Impact of Total Eradication<br />Life expectancy of general population ↑ 2.5 years<br />For the approx 25% who would have died - ↑ 10 – 15 years<br />↓ Suffering for patients, friends and family<br />Economic costs 1990<br />Direct $27 billion<br />Indirect $69 billion<br />Total $96 billion <br />
  4. 4. Carcinogenesis<br />Multiple genetic mutations<br />Germline – 20%<br />Spontaneous<br />Abnormal proteins<br />Cell cycle<br />Cell surface<br />Malignant phenotype<br />Cell proliferation > apoptosis<br />Loss of contact inhibition, invasion<br />Escape immune surveillance<br />Angiogenesis<br />
  5. 5. Nature vs. Nurture<br />Environment more important<br />Inhibitors<br />Diet <br />Micronutrients<br />Exercise<br />Anti-inflammatory agents<br />Hormone inhibitors<br />Carcinogens<br />Tobacco/Alcohol<br />Obesity <br />Radiation<br />Stress<br />Chemicals<br />Viruses<br />Gene Pool<br />less<br />
  6. 6. 50% of Deaths are Preventable<br />Tobacco/Alcohol<br />Screening<br />Prevention<br />Early Detection<br />Lifestyle<br />Diet<br />Exercise<br />Stress/frustration<br />Depression<br />Social support<br />Viruses<br />Sun exposure +/-<br />Drugs/Micronutrients<br />Hormone agonists<br />Vitamins, antioxidants<br />Anti-inflammatory drugs –aspirin, NSAs<br />
  7. 7. Socialand Behavioral Issues<br />Socialand Behavioral Issues<br />Personal freedoms vs. good of society<br />Medical economics – focus on treatment, sick care vs. well care<br />Knowledge/education<br />Individual fears / cultural factors<br />Ignore symptoms and signs<br />Disregard screening guidelines<br />Disparities – minority and medically underserved bare an unequal burden<br />
  8. 8. Tobacco<br />Cancer of the lung<br />Mouth and throat cancer<br />Kidney cancer<br />Bladder cancer<br />Pancreatic cancer<br />Esophageal cancer<br />Breast cancer?<br />
  9. 9. Tobacco Prevalence<br />Problems- low income, low education, minorities, stable since 2004<br />
  10. 10. Second Hand Smoke<br />3,400 deaths from lung cancer<br />35,000 deaths from heart disease<br />Occupational exposure<br />Family exposure<br />Legislation and litigation helping<br />
  11. 11. Industry Marketing<br />1998 2005<br /> $6.7 B $13.1 B<br />Discounting strategies<br />
  12. 12. Quitting<br />Quitting<br />Behavioral interventions<br />Pharmaceutical treatment<br />Social initiatives<br />Legislative – taxes/pricing, clean air<br />Judicial<br />ACS quitline in Florida <br />Success rate 16%<br />200 calls/month to 400/day<br />
  13. 13. Excess Alcohol<br />Excess Alcohol<br />Mouth and throat<br />Esophagus<br />Liver<br />Breast<br />
  14. 14. Screening<br />Screening<br />Breast<br />Prostate<br />Colon<br />Lung - controversial<br />Uterine cervix <br />Skin<br />Mouth<br />Esophagus<br />Prevention<br />Early detection<br />
  15. 15. Diet<br />Diet<br />Calories<br />Fruits and Vegetables<br />Animal Fat<br />Fiber<br />Bioactive Micronutrients<br />Preservatives vs. Organic<br />
  16. 16. Exercise<br />Exercise<br />25-50% reduction in breast and colon cancer<br />Effects on fat distribution and metabolism<br />Reduced stress<br />Immune enhancement <br />Hormones <br />Reduced estrogen levels<br />Reduced insulin growth factors<br />Anti-angiogenesis <br />
  17. 17. Exercise and Breast Cancer<br />Exercise and Breast Cancer<br />Moderate levels of exercise – walking 2.9 mph for 1 hr.<br /><ul><li>Reduces incidence
  18. 18. Improves survival after diagnosis
  19. 19. Exercise prior to diagnosis or at any time after diagnosis</li></li></ul><li>Mind/Body Factors<br />Mind/Body Factors<br />Cancer Incidence<br />Progression<br /><ul><li>Chronic stress
  20. 20. Frustration
  21. 21. Depression 
  22. 22. Social isolation</li></li></ul><li>Neural Stress Pathways<br />M. Antoni, et al<br />Nature Medicine 2006<br />
  23. 23. Effect on the Tumor<br />
  24. 24. Infections<br />Viruses<br />HPV, Hepatitis B & C, EBV, HIV&HHV-8<br />Bacteria<br />Helicobacter pylori<br />Immunization, antivirals, antibiotics<br />Gardasil – HPV types 16, 18 - FDA approved in 9-26 year old females<br />
  25. 25. Environmental Carcinogens<br />Environmental Carcinogens<br />5-10% of deaths?<br />Ionizing Radiation<br />Radon: 15 – 20,000 lung cancer deaths annually<br />Sun<br />Occupational exposures – now regulated<br />Pesticides – skin contact<br />Pollutants <br />– second hand smoke<br />
  26. 26. Gastro-esophageal Reflux<br />Gastro-esophageal Reflux<br />Millions of Americans<br />Barrett’s esophagus – approximately 10%, annual screening<br />Esophageal cancer – 3-4/100,000 overall, 3-8% of Barrett’s patients, .5%/year<br />Treatment <br />Lifestyle changes<br />Medications<br />Surgery<br />
  27. 27. Inhibitors of Carcinogenesis<br />Inhibitors of Carcinogenesis<br />Antioxidants<br />BHT, BHA, selenium<br />Red wine, chocolate, garlic, herbals<br />Vitamins A, B12, C, D and E<br />Retinoids, beta carotene, lycopene<br />Anti-inflammatory drugs<br />Aspirin<br />Cox 2 inhibitors<br />Estrogen and androgen inhibitors<br />
  28. 28. American Cancer Society<br />American Cancer Society<br />Don’t smoke – or be around anyone who does!<br />Choose most foods from plant sources<br />Five servings of fruits and vegetables a day<br />Cereal and grains<br />Limit high fat foods – especially from animal sources<br />Be physically active – at least 30 minutes daily<br />Maintain a healthy body weight<br />Limit alcohol intake <br />Follow screening guidelines<br />Know the danger signals<br />
  29. 29. CDC/HHS/NCI<br />CDC/HHS/NCI<br /><br />
  30. 30. ACS Screening Guidelines<br />ACS Screening Guidelines<br />Breast Cancer<br />Yearly mammogram starting at age 40<br />Annual MRI if lifetime risk > 20%<br />Colon Cancer – beginning at age 50<br />Annual stool test (occult blood, DNA)<br />Every 5 years – sigmoidoscopy/colonoscopy<br />
  31. 31. ACS Screening Guidelines<br />ACS Screening Guidelines<br />Cervical cancer<br />Annual Pap test beginning at 21 years<br />Less frequent if 3 normal tests in a row and may stop at age 70 years<br />Prostate cancer<br />Annual PSA and digital exam beginning at age 40 - 50 years depending on risk<br />
  32. 32. Individual Issues & Choices<br />Individual Issues & Choices<br />Know your own risk, but don’t obsess about it.<br />Manage stress and especially frustration<br />Invest time in family and friends<br />Should you take:<br />Aspirin?<br />Vitamin D?<br />Selenium?<br />Estrogen replacement therapy?<br />Red wine, chocolate, garlic, herbals?<br />Avoid gastroesophogeal acid reflux<br />Include laughter in every day <br />
  33. 33. Future<br />Future<br />Better public education <br />Personalized messaging<br />Behavioral research <br />Choices <br />Coping<br />Early detection <br />Imaging<br />Genetic and protein screening<br />Inhibitors<br />Vaccination<br />Public Policy / legislation<br />Research<br />Cures<br />Cancer<br />