Monday, January 12, 2015

Preventing Skin Cancer: Tanning Beds Still Alluring, Still Very Risky

Photo: Flickr/whatshername, Creative Commons Lic.
There was a nice piece in the New York Times this weekend on the risks of indoor tanning, particularly in youth. Focussing on the personal experiences of a handful of young women and their  parents, it does a very good job highlighting the well-established risks of skin cancer and deadly melanoma, the continued allure of tanning, and some promising advances in tanning salon regulation and rates of tanning by youth.

We've written a number of posts over the years here on Cancer New in Context (see below) about the dangers of tanning beds and the need for better policies to curb their use and protect youth. So, it's good to see the topic continuing to gain traction both in terms of awareness and in the willingness of state and federal government to take important tax and regulatory action to try to maintain the recent downward trend in tanning bed use.

In many ways, it's similar to the concerted efforts that have helped curb tobacco use over the past 50 years, a similarity not lost on 22 year-old Westfield State University student, Elizabeth LaBak, who was highlighted in the Times article:
“The tanning thing is like the smoking thing,” she said. “Everyone used to smoke. And then they said, ‘You’ll die of lung cancer.’ That’s what’s happening to tanning.”
As this quote sums up,  there's a lot more than "bad luck" involved when it comes to developing skin cancer risk.  In fact, skin cancer - including deadly melanoma - is a prime example of the importance of prevention.  Protecting yourself from the sun and staying away from indoor tanning can significantly lower risk.

Of course, attitudes to tan skin and tanning can be slow-to-change, especially since they are so intertwined with other complex issues of appearance and body image. But the multi-faceted approaches that have been used so far have a great chance of success.  For real progress, though, they need to be extended to more states and expanded in approach.  The blistering truth is that we still have a long way to go.

Other Cancer News in Context articles on tanning and skin cancer risk:
New Study: Tanning Bed Use Brings Skin Cancer RisksJun 25, 2014
A new study out this week further confirms the dangers of indoor tanning, finding that use of tanning beds and other UV tanning devices is strongly linked to developing skin cancer early in life. Published early online in the ... 
Tanning Industry Fights the Blistering Truth: That Tanning Beds Raise the Risk of Melanoma and Other Skin CancersJan 07, 2013
A recent article in MedPage Today highlighted the birth of a new tanning salon industry-sponsored group that has the sole intent of refuting well-established and peer-reviewed science showing the dangers of tanning bed use ... 
With Spring in the Air, New Sun-Safe, UV-Safe Recommendations from the American Academy of PediatricsMar 29, 2011
The statement, published in the journal Pediatrics (link), refreshes and reinforces what many of us know - that unprotected sun exposure and tanning bed use are unhealthy activities for everyone, but particularly so for youth. 
Mother/Daughter Tanning and the Dual Nature of Family HistoryDec 29, 2010
We've dedicated a number of posts over the past year on the policy and health pitfalls of indoor tanning - from the potential benefits of the "tanning tax" (post) to surprisingly high rates of tanning by some youth (post). 
Tanning Beds, Addiction, and TaxesApr 20, 2010
A new study in this month's Archives of Dermatology suggests that indoor tanning can be addicting in young adults (study) (1). While the study was relatively small, with just over 400 participants surveyed, the results seem to ... 
More Blistering Truths About Tanning Bed Use By YouthApr 05, 2010
A new study published online last week in the British Medical Journal on tanning bed use by youth in the United Kingdom has raised concerns well beyond its shores (full study) (1). The study surveyed over 9,000 children ...

Thursday, January 8, 2015

Setting the Record Straight on Cancer Prevention: Lifestyle Trumps "Bad Luck"

While the paper by Tomasetti and Vogelstein is certainly intriguing and will help guide future research on targeting prevention and early detection efforts, it is still a preliminary finding and does not reverse the long-term conclusion that is supported by decades of well-designed research in people:  that cancer is largely preventable.
-     -     -     - 

It's been hard to avoid the headlines this past week touting the conclusions of a new study in the journal Science that cancer is a disease largely caused by "bad luck."  Some of these headlines have been sensationalized; some have been more measured.  Together, they've seemed nearly ubiquitous.  And in some ways that's been positive, demonstrating that cancer - and its causes and prevention - remain an important topic to both the public and the media.

Unfortunately, the conclusions of the paper - and the subsequent coverage they've received - seem to reach well beyond what the actually findings of the study support, and in doing so, have incorrectly called into question what decades of overwhelming evidence shows:  that over half of all cancers - and up to three quarters of some cancers - could be prevented by regular screening and healthy lifestyle choices.

The new study by Johns Hopkins researchers Cristian Tomasetti and Bert Vogelstein gathered data on the number of stem cell divisions that occur in various tissues in the body and compared these data to annual incidence rates of cancers in those tissues.  Stem cells divide to replace cells in tissue that die or are lost.  This maintains the tissue.  Some tissues need a lot of cell divisions for maintenance.  Others need less.  When cells divide, the DNA in cells also replicate and divide, opening up the chance for random mutations that could eventually lead to cancer.

The researchers found a strong correlation between tissues' number of stem cell divisions and cancer in those tissues, attributing 65% of cancers to these divisions, and the random DNA mutations that can occur with them.

While the study is well-designed and executed, it also has some key limitations that don't fully support its overarching conclusions.

First, the study was not done directly in humans.  It correlated data on cancer rates with tissue cell division data generated from cell analyses done in labs.  It is essentially a laboratory-based study, and lab studies in general are fantastic ways to generate hypotheses on cancer causes but bad ways to generate conclusive evidence on actual causes of cancer in humans.  The research world is littered with promising findings in petri dishes and mice that were never proved in actual people.

Second, many of the cancers included in the study are those already known to have few, if any, known lifestyle risk factors.  And while the study included two common preventable cancers, lung and colorectal, it also did not include two other major cancers with key lifestyle factors - breast and prostate cancer.  Together, lung, colorectal, breast, and prostate cancers account for approximately half of newly diagnosed cancers in the United States, a number much higher than the   other serious cancers included in the study.  The study itself even showed that colorectal cancers and lung cancers (in smokers) were less due to "bad luck" mutations than most others in the study. Other analyses based on long-term studies in humans have found that up to 75 percent of lung and colon cancers could be prevented, as well as at least half of breast cancers.

Finally, simply because there is a correlation between stem cell division and rates of cancer does not mean that random DNA mutations are the precipitating cause of cancer.  Multiple cell divisions could accelerate the cancer-causing effects of lifestyle factors. And many lifestyle factors  - from obesity to smoking - are thought to increase the risk of cancer by fostering cell division and DNA changes that begin the cascade to cancer.  So what is described as random "bad luck" may actually have its genesis in lifestyle choices.

While the paper by Tomasetti and Vogelstein is certainly intriguing and will help guide future research on targeting prevention and early detection efforts, it is still a preliminary finding and does not reverse the long-term conclusion that is supported by decades of well-designed research in people:  that cancer is largely preventable.  In our own 2012 paper that also appeared in a Science publication - Science Translational Medicine - we conclude that over half of the 572,000 deaths from cancer in the United States in 2011 were caused by key modifiable risk factors, such as smoking, obesity, and lack of physical activity.

Of course, "bad luck" plays a role in any cancer - any disease, for that matter.  We know people who smoke and drink and weigh more than they should who live until their 90s, and we know the healthiest people in the world who are struck down by disease early in life.  Healthy choices, though, can greatly increase our odds of living longer and healthier lives.  It's no guarantee, but it helps to stack the deck in our favor.

For more on the preventability of cancer, see our page: Preventing Cancer - Today

Monday, January 5, 2015

New Study Shows Being Sedentary is Bad for Physical and Fiscal Health

Creative Commons photo (cropped): Flickr/hjl
There is no magic bullet that will guarantee good health.  That's just an unfortunate fact of life.  But there is something that can help stave off heart disease, diabetes, cancer, osteoporosis, and depression, while also helping us maintain a higher quality of life as we get older.  And it's largely free and accessible to just about everyone: physical activity.

We've written a lot over the years here on Cancer News in Context about the benefits of being active, but not very much about the economic costs of being inactive - both for individuals and for the nation as a whole.  Yet, with the nation growing older and health care costs continuing to accelerate, there's a fantastic need to highlight effective and simple approaches to address such issues. And a new study out this month in Progress in Cardiovascular Diseases highlights just how important regular physical activity is to the physical and economic health of the nation.

Wednesday, December 31, 2014

Healthy "Hoppin' John" to Welcome 2015 (Recipe)

Creative Commons photo: Flickr/Robert S. Donovan (cropped)
The holidays are filled with great-tasting but less-than-healthy food.  And that's OK.  We all deserve some time to celebrate with our family and friends and enjoy food without worrying about its sodium, fat, and whole grain content.  As long as we don't go too crazy and get back to our healthy habits the rest of the year - there's really no harm done.

To begin the transition back to our regular lives and to usher in the coming year, we searched for a great-tasting, healthy recipe for New Year's Day and came up with a version of the already-pretty-healthy traditional dish - Hoppin' John.  With Southern origins, it's now eaten all across the country and is said to bring good luck throughout the year.

This recipe - from Let's Move - is simple, meatless, big on flavor, and quite healthy.  It has the traditional black-eyed peas and brown rice, collard greens, and smoked paprika in place of bacon or ham-hock. Enjoy.

Happy New Year

Let's Move - Holiday's All Over - Hoppin' John (recipe)

2014's Top Posts on Cancer News in Context

Amidst the crush of year-end top ten lists filling your news feeds this week, we present our own: the top posts of 2014 from Cancer News in Context. Covering topics from aspirin to healthy eating to the importance of starting healthy behaviors in childhood, these posts show the prominent place that cancer prevention has had in the news this past year - and the key role it must continue to play in the nation's health moving forward.

So why not take a break from the year's best albums, books, movies, and cat videos and catch up on some highlights from the year in cancer prevention?

Happy New Year from the Team at Cancer News in Context.

December 10, 2014

The Power of Youth: Beginning Breast Cancer Prevention in Childhood

We've written a lot recently about the importance of breast cancer prevention starting early in life, both here on Cancer News in Context and in a guest post on the American Association for Cancer Research blog, Cancer Research Catalyst. Though most breast cancer research focusses on women in midlife and older, more and more evidence supports the years between early adolescence and when a woman has her first child as key to laying down risk for breast cancer later in life. Breast tissue in these years appears to be particularly vulnerable to certain risk factors that can have a durable influence on risk. Continue...

April 23, 2014

Setting the Record Straight: The Impact of Diet on Cancer Risk

An article posted earlier this week on the New York Times website stated that the link between diet and cancer risk was, in essence, a "myth." And while links between diet and cancer are not as strong as those with some other chronic diseases, like heart disease, the article's conclusions demonstrate a lack of understanding of the science. Continue...

October 10, 2014

Breast Cancer Prevention Now

By Graham A. Colditz, MD, DrPH

It is time to bring our focus back to lowering the risk or reducing the onset of new cases of breast cancer at all ages. Worldwide incidence of the disease is rising as societies across the globe modernize, which brings with it higher rates of breast cancer risk factors, such as overweight, lack of physical activity, and key reproductive factors like beginning families later in life and have fewer children. Continue...

August 15, 2014

New Study Confirms Weight is a Major Cancer Risk Factor

The subjects of weight gain, the obesity epidemic, and their major impact on health are brought up so much these days that they're easy to tune out. So, if a few articles and news reports here and there pass you by - on accident or on purpose - we understand. But we won't let that keep us from continuing to write regularly about the topic because it's something we're passionate about here at CNiC. Continue...

August 13, 2014

An Aspirin a Day...May Have Overall Health Benefits

The writing was on the wall a few years ago, but it seems that we may have finally reached a point where the scientific evidence points pretty convincingly to the potential health benefits of long-term regular aspirin use outweighing the potential risks for most people. That's the conclusion of a new analysis appearing last week in the Annals of Oncology. Continue...

February 4, 2014

Preventing Cancer Today. Over 50% of New Cancer Cases Can be Prevented by acting on What We Know Right Now

by Graham A. Colditz, MD, DrPH

Much attention is being placed today on the global burden of cancer and the power for prevention to have an enormous benefit for the world through reducing cancer incidence, diagnosis, treatment, pain, and suffering. A reminder on numbers that have been around for some time – more than half of cancer is diagnosed in low and middle income countries, where access to care is often limited. Data from the World Health Organization for 2012 (1) show that an estimated 14 million new cases of cancer were diagnosed, and the number is rising every year. The most common cancers diagnosed were those of the:
  • lung (1.8 million cases, 13.0% of the total)
  • breast (1.7 million, 11.9%)
  • colorectal cancer (1.4 million, 9.7%)

October 31, 2014

Infographic: Breast Cancer Prevention - The Numbers

Wednesday, December 10, 2014

The Power of Youth: Beginning Breast Cancer Prevention in Childhood

Creative Commons photo: Flickr/CatDancing (cropped)
We've written a lot recently about the importance of breast cancer prevention starting early in life, both here on Cancer News in Context and in a guest post on the American Association for Cancer Research blog, Cancer Research Catalyst.  Though most breast cancer research focusses on women in midlife and older, more and more evidence supports the years between early adolescence and when a woman has her first child as key to laying down risk for breast cancer later in life.  Breast tissue in these years appears to be particularly vulnerable to certain risk factors that can have a durable influence on risk.

Diet and physical activity seem to be especially key in youth.  Eating foods rich in vegetable protein and low in animal products can help lower risk -- as can being physically active and keeping weight in check.  For teens and young adult women, avoiding alcohol - or at a minimum avoiding heavy drinking - is also important.

Our overarching message is that to optimize breast health a healthy diet, regular physical activity, and healthy weight are key habits that should begin in - and be fostered throughout - childhood and into adolescence and beyond.  Prevention is something that can almost never start too early.

A pie chart we use to illustrate the power of breast cancer prevention starting in childhood shows that healthy behaviors starting as early as age two years old could help avoid 68 percent of breast cancers (see figure).  The idea of beginning breast cancer prevention at two can seem extreme and has struck a chord with the media (see image).  And in many ways that is understandable, since breast cancer is a disease that seems so far off - striking most women much later in life - and breasts don't even fully develop until the teen and young adult years.

Yet, we know that healthy behaviors aren't easily turned on and off like spigots.  Healthy behaviors are learned over time, and the sooner in life they are set, the more likely they are to be carried on throughout childhood and into adulthood, and the more likely they are to have a positive impact on long term health.  This is why the Dietary Guidelines for Americans apply to everyone age two years old and over.  That breast tissue seems particularly vulnerable in youth and young adulthood adds even more reason to begin good breast health habits as early as possible.

For parents, the key is simply to help their children make healthy choices that they can follow throughout life.  This will not only help them lower their risk of breast cancer as adults, but also heart disease, stroke, diabetes, osteoporosis, and even depression.

See the excerpt below from our upcoming book on breast cancer prevention for breast health tips for the parents of young girls.

#     #     #

Young daughters (2 years – 10 years)

As challenging as the period between ages 2 years old and 10 years old can be as a parent, it does offer some sense of control and the ability to steer your children in positive directions.

Within reason, the food you put on the table is the food they will eat and likely come to enjoy – even if it can take some struggling, pouting, and tears along the way, from them, and you. Similarly, if you’re a family that plays at parks and goes for walks throughout the week, that’s something that will become ingrained in a child as well and something they’ll likely wind up doing throughout their lives and eventually with their own children.

With young daughters, there are three simple things to focus on: healthy activity, healthy food, and healthy weight. Pretty straightforward stuff, but in today’s busy world where both parents often work and have very little time to think about such things, they can be much easier said than done.

Luckily, creating a healthy environment for our children isn’t very complicated or time-consuming - with a little planning and a little effort.

Let little legs move

We can easily get caught up in all the detailed recommendations we read about physical activity. Moderate intensity. Vigorous intensity. Aerobic. Strength. X number of minutes a week. And, yes, those can be important, but when it comes to young kids, it’s really less about making our kids reach some time targets for activity than it is about simply giving kids the opportunity to be kids. Because being active is really their natural state.
  • Be physically active as a family, every day if possible. Go on walks, ride bikes, shoot hoops, dance – whatever gets everyone moving.
  • Encourage children to play outside (when it’s safe) and to take part in organized activities, including soccer, gymnastics and dancing. 
  • Walk or ride bikes with your kids to school in the morning. 
  • Find safe places for children to play when weather is really bad: indoor playgrounds, YMCA, shopping malls.

Freeze the screens

Children grow up as digital natives these days, but that doesn’t mean that all that screen time doesn’t have health repercussions. Too much screen time takes time away from physical activity and can promote unhealthy eating.
  • Limit TV, tablet, computer, and other screen time to under 2 hours a day. The less the better.
  • Keep TV, tablets, and smartphones out of children’s bedroom’s. 
  • Choose one day each week to go TV and tablet-free as a family. Board games and family book or cooking clubs are great screen-time alternatives.

Offer a lot of plant foods

When it comes to promoting breast health later in life, getting daughters to eat a lot of plant-based foods early in life is likely important. This means focusing on fruits, vegetables, nuts, whole grains, and eating less full-fat dairy and meat.

  • Make fruits and vegetables a part of every meal. Put fruit on cereal. Cut up vegetables as a snack. 
  • Dice vegetables into soups, sauces, even batters. It’s an easy – and tricky - way to add more veggies to meals. 
  • Keep fruit out where kids can see it: on the counter, on a desk, in a backpack. If they can see it, they’re more likely to eat it.
  • Offer whole-grain cereal, brown rice and whole-wheat bread over refined choices, like white rice and white bread. 
  • Try a meat-free week. The family just might like it.
  • Make dishes made with olive or canola oil, which are high in healthy fats. 
  • Cut back on full-fat dairy, fast food, and store-bought snacks (like cookies), which are often high in unhealthy fats.

Don’t obsess but keep track of weight

Weight is clearly a loaded issue, especially for girls. And it’s important not to create or perpetuate in your daughters – or any girls for that matter – unhealthy body image. In today’s world of Photoshopped models and selfies, females of all ages have a hard enough time comparing themselves to unreal expectations of beauty and body size.

At the same time, however, it’s important for parents to be aware of their daughter's weight and to know whether it may be too low, too high, or in the normal range. Surprisingly, studies show that many parents have trouble knowing if their child is an unhealthy weight or not. So, simply knowing can be a victory in itself.

A good place to start if you have questions about your child’s weight is the CDC’s BMI Calculator for Child and Teen. This tool uses a special calculation of weight, height, gender, and age to estimate whether a child is underweight, normal weight, overweight, or obese. Because children are still growing and developing, these labels are not always perfectly accurate, so it’s important to bring up any concerns about your child’s weight directly with a healthcare provider.

  • Keep track of your child’s weight and bring up any concerns with a health care provider.
  • Help your daughter focus on healthy food choices and healthy activities rather than on weight and body image.
  • Give your children the chance to be physically active every day.
  • Limit sweets and processed foods, which are often high in calories as well as carbohydrates that can stimulate hunger.
  • Limit TV, tablet, computer, and other screen time to under 2 hours a day. The less the better.
  • Help your children get enough sleep by setting a bed time and sticking to it every day. Keeping electronics out of the bedroom also helps with sleep.

Wednesday, November 5, 2014

HPV Vaccination Programs Shown Effective in Australia

Photo: Flickr/PAHOWHO
by Sarah Cortez

When given before the start of sexual activity, the HPV (human papillomavirus) vaccine prevents most cases of cervical cancer and genital warts. It can also lower the risk of oropharyngeal, penile and anal cancer.

HPV is a sexually transmitted infection, and we target the vaccine to 11-12 olds, as we expect children at this age to not be sexually active. This allows immunity to build up before any exposure to HPV occurs.

Though girls were the initial focus of the vaccine, it is now recommended that boys get vaccinated, too. Boys do not have cervices and, therefore, can’t get cervical cancer, but they certainly can get genital warts and the other rarer cancers linked to HPV. Importantly, males can also spread the cancer-causing virus to females.

As we have covered in previous posts, the use of the HPV vaccine has been slow to build in the US. But this is not the case in other countries.

A new study published in the open access journal PLOS ONE, details the effect of the Australian government’s national HPV vaccination program, using the Gardasil vaccine. Starting in 2007, the Australian government offered the HPV vaccine for free at school to all 11-12 year old girls on the standard schedule:

1. 1st dose at start
2. 2nd dose 1-2 months after 1st dose
3. 3rd dose 6 months after 1st dose

The Australian government also offered older schoolgirls (13-18 years old) and young adult women (18-26 year old) the vaccine for free through their general practitioners and community health clinics. This was referred to as the catch-up program due to the increased likelihood that patients were more likely to already be sexually active.

Preliminary results showed that by 2012, over 70% of all Australian girls had received the full 3 dose vaccine by age 15 and over 85% were vaccinated by the last year of high school. As a comparison, in 2012, the rates of 3-dose vaccination among adolescent girls in the US were only 35% by age 15 and 45% by age 17. 

So what resulted from this Australian vaccination program? Following its onset, the diagnosis of genital warts decreased by 93% among young women seen in the sexual health clinics. Additionally, the diagnoses of genital warts decreased by 82% among young heterosexual men. Remember, the vaccine was only free for girls, so the decrease in genital wart diagnoses for men who have sex with women was possibly due to something called “herd immunity,” where vaccination of a large percentage of a population (the “herd”) benefits even those who were not vaccinated.

The decrease in genital warts seen in the sexual health clinic is great, but the sexual health clinics see many fewer patients than general practitioners. So was the decrease in genital wart diagnoses also found in the general population?

To find out, the new study used data collected from over 11,000 Australian general practitioners who saw at least some Medicaid patients. Once a year since 1998, each general practitioner recorded 100 patient encounters. This method logged over 1 million patient encounters between 2000 and 2012.

What was the result? Did the general practitioners find the same decrease in genital warts after the start of the HPV vaccination program?

The answer is yes. Genital warts were found most often in 15-27 year old males and females. Following the vaccination program, genital wart management decreased by 61% among 15-27 year old females. As a comparison, they tracked the rate of other STDs like genital herpes. As expected, the diagnoses of other STDs did not decrease following the vaccination program.

There was no change in males or the 27+ age group, which did not receive the vaccination.

All in all, this is great news. The HPV vaccine works. It decreases genital warts among those who are vaccinated, and hopefully, in the future, we can replicate here in the United States the success Australia has seen. As for us at CNiC, we will continue to report the findings and outcomes of this important preventative health tool. 


Harrison C, Britt H, Garland S, Conway L, Stein A, Pirotta M, Fairly C. Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: Results from a nationally representative cross-sectional general practice study. PlosOne 2014; 9(9): e105967.

"Genital HPV Infection - Fact Sheet." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Mar. 2014. Web. 12 Oct. 2014.

"National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 30 Aug. 2013. Web. 13 Oct. 2014.