Friday, September 2, 2016

Back to School Vaccinations: Don't Forget the HPV Vaccine

by Katy Henke

With Labor Day weekend bringing summer vacation to a close, parents are putting the finishing touches on preparation for the impending school year. In addition to school supplies and new clothing, parents should also be vaccinating their children prior to school starting. Vaccinations help prevent possible future infections and diseases. Prevention through vaccines is one of the best ways to help your child stay healthy during their lifetime and is recommended by multiple health organizations, such as the Centers for Disease Control and Prevention, the World Health Organization, and the National Cancer Institute.

Some of the more common vaccines parents may have heard of, and that some schools in the United States require, include Tdap, which protects against diphtheria and tetanus; IPV, which protects against polio; and MMR, which protects against measles, mumps, and rubella. These diseases have decreased in children and young adults throughout the years thanks to the use of vaccines. Influenza (flu) is another common virus that can help be reduced and infection prevented when children, teens, and adults receive the flu vaccine. Research continues to show that vaccines are important, safe, and effective for children and teens, and should be administered at appropriate ages. The CDC offers a quick vaccine guide for parents based on a child’s age.

A more recent vaccine, and one that’s often overlooked by many parents and doctors, is the human papillomavirus (HPV) vaccine. This vaccine protects against a specific strand of viruses that can cause cancer. The HPV virus affects one in four people. It’s estimated that 14 million people each year contract the HPV virus, which can lead to cervical and vaginal cancer in women, and penile cancer in men. More than 90 percent of sexually active men and 80 percent of sexually active women will contract a form of HPV at some point in their lives. Most HPV infections do go away on their own, but some don’t. The HPV vaccine helps protect and reduce these infection rates

The HPV vaccine series is recommended to both preteen boys and girls beginning around age 11 or 12, prior to when they would contract the HPV virus. This vaccine is a three-part series for both girls and boys, with the second shot given at one to two months after the first shot, and the final third shot given around six months after the first shot. Teenagers and young adults can also receive the vaccine up until age 26, so talk with your doctor today. The HPV vaccine will be most effective when the person being vaccinated receives all three shots.

Research continues to show that the HPV vaccine should very successfully prevent later adult cancers in preteens and young adults. Close to 100 percent of people who receive the vaccine will be protected against the types of HPV targeted by the vaccine. And studies have found that vaccination cuts the risk of cervical pre-cancer in about half.

The HPV vaccine is a safe and effective way to reduce the risk of cancer, yet vaccination rates are still low due in part to lack of knowledge and other barriers. Talk with your child’s doctor or your doctor today to learn if the HPV vaccine may help reduce their risk for cancer in the future.

Thursday, August 25, 2016

Dr. Graham Colditz Discusses Broad-Based Strategies for Cancer Prevention (Video)

Cancer News in Context's Dr. Graham Colditz speaks with ecancertv at the International Agency for Research on Cancer (IARC) 50th Anniversary Scientific Conference 2016 about the social and legislative surroundings of modern strategies in cancer prevention.

Wednesday, August 24, 2016

Weighty Evidence: New Report Further Highlights Importance of Overweight and Cancer Risk

A new international report released today further highlights the important role that overweight and obesity play in the development of cancer.  Produced by the International Agency for Research on Cancer (IARC) and released in the New England Journal of Medicine, the report, Body Fatness and Cancer — Viewpoint of the IARC Working Group, finds that approximately 4.5 million deaths worldwide are caused each year by cancers related to overweight and obesity.

For thirteen cancers, there was "sufficient" evidence to conclude that excess weight significantly increased risk of developing the disease. This was eight more cancers than was included in the similar IARC report published in 2002. Esophageal (adenocarcinoma) and uterine (corpus uteri) cancers had the highest risks.  Comparing the highest body mass index (BMI) category with the normal category, there was a nearly 5 times increased risk for developing esophageal cancer, and just over 7 times increased risk for uterine cancer.  Risk increases for other cancers ranged between a 10 percent increase in risk to a 80 percent increase in risk, and included cancers ranging from ovarian and breast cancer to pancreatic cancer and multiple myeloma.  

Cancer News in Context's Graham Colditz chaired the IARC working group that developed the statement.  In a Washington University School of Medicine media release about the findings of the working group, he stated:
“Significant numbers of the U.S. and the world’s population are overweight. This is another wake-up call. It’s time to take our health and our diets seriously.” 
Looking at the data as a whole, the report concludes that maintaining a healthy weight can lower cancer risk, and though solid evidence in humans is still developing -  that losing excess weight likely can as well.

Battling weight is a lifelong struggle for most people, and the US and global obesity epidemic has complex and multiple origins. To make real progress against the epidemic, we need to create a society that enables and fosters healthy activity and food choices.  Individual choice is just one part of the larger approach.  The Obesity Prevention Sourcedeveloped by our colleagues at the Harvard School of Public Health, provides a guidebook for tackling these broader issues, targeting policy makers, health professionals, and motivated citizens.

For those looking for help getting started with personal healthy choices for weight control, the federal site, Nutrition.gov, is a good place to begin - as is our own post: Some Simple Tips for Keeping Weight in Check.

Some Simple Tips for Keeping Weight in Check

Although keeping weight in check can be a tall order in this day of dollar menus and smartphones, it’s well worth the effort.  The cancer benefits alone are huge.  When the impact on heart disease, diabetes, blood pressure, and good old-fashioned quality of life are added, the benefits become enormous.  Try these simple steps:
  • Exercise, exercise, exercise. Being active is one of the best ways of controlling weight.
  • Watch the calories. It sounds simple, but it’s worth saying: calories matter when in comes to weight gain and weight loss. When you sit down for a snack or meal, take some time to think about how much you’re eating and when you’ve had enough.
  • Weigh yourself – every day. Weighing yourself regularly can help you keep on track with your weight goals.
  • Go Mediterranean. A diet rich in fruits, vegetables, whole grains, and healthy oils (like olive oil) can make you feel full, help regulate your appetite, and actually taste really good.
  • Choose smaller portions and eat more slowly. Slow down and give your body a chance to feel full before you move on to seconds.
  • Be a mindful eater. Food is big business, its main goal is to get you to eat.  Try to listen to what your body is telling you, not what the food business wants you to hear.

Tuesday, July 26, 2016

Cloudy Evidence on Skin Cancer Screening Shines Light on Prevention

The U.S. Preventive Services Task Force (USPSTF) reported today in the journal, JAMA, that there is not enough evidence to recommend that adults get screened for skin cancer. Though some professional medical organizations recommend physician-performed visual checks for skin cancer -- and many physicians carry them out -- the USPSTF found no solid evidence that "early detection of skin cancer through visual skin examination by a clinician reduces morbidity or mortality." Essentially, screening was not found to save lives.

On top of this, skin cancer screening itself is not without some risks. Though the Task Force concluded that was not enough evidence to fully explore the potential harms related to screening, it is likely to lead to unnecessary biopsies and other follow up tests as well as increased stress and worry in patients told they have a suspicious mole or other lesion.

On balance, the evidence was just too sparse and too ambiguous on potential harms and benefits for the Task Force to recommend skin cancer screening.

While research on screening continues to develops, these current conclusions point to the importance of also working to control skin cancer through a greater focus on prevention -- a point made in an accompanying editorial in JAMA Internal Medicine by Eleni Linos, Kenneth Katz, and CNiC's Graham Colditz. In addition to educating individuals about UV-safe behaviors (figure), policy approaches need to focus on areas such as limiting youth access to indoor tanning, promoting comprehensive campaigns that help change social norms related to tanning, and developing infrastructure that supports UV-safe behaviors, like shade structures and sunscreen dispensers.

Admittedly, it can be hard to believe that skin cancer screening has not been found to be a net health benefit.  It seems such a simple and common sense way to save lives.  Unfortunately, cancer is a very complex disease and not all screening exams have been proven to be effective tools to help prevent disease and lower mortality.  In fact, there are only a handful of cancers with recommended screening tests -- breast, colon, cervical, and lung cancer.

As the science develops, skin cancer may be added to that list, but right now efforts to combat skin cancer through prevention are key. As Linos and colleagues conclude: "we should...fully implement skin cancer primary prevention by eliminating indoor tanning exposure, especially among youths, and increasing the use of sun-protection strategies that work."




Tuesday, July 19, 2016

2nd Rural Cancer Disparities Partnership Retreat, July 15, 2016 (Photos)

Photos from Friday's very successful 2nd Rural Cancer Disparities Retreat at Washington University School of Medicine in collaboration with Southern Illinois University School of Medicine.

The P20 leadership team: from left: Sonya Izadi, WUSM project coordinator; Dr. Wiley Jenkins, SIU; Dr. Graham Colditz, WUSM; Dr. David Steward, SIU; Dr. Aimee James, WUSM; and Amanda Fogleman

Dr. Graham Colditz speaking on the goals of the Rural Cancer Disparities Partnership.

Dr. David Steward of SIU speaking on the cancer burden across Illinois.

Dr. David Steward of SIU speaking on the cancer burden across Illinois (con't).

Thursday, July 14, 2016

Genetic Risk of Breast Cancer and Your Options

Cancer News in Context is excited to publish four posts this week on high-risk breast and ovarian cancer.  These posts will provide insight for women (and their families) from Washington University School of Medicine physicians on unique aspects of high-risk disease -- from genetic testing and treatment to prevention and risk management.  
July 11 - Overview: High-Risk Breast Cancer - Prevention and Risk Management
July 12 - High-Risk Ovarian Cancer: Identifying, Preventing, and Managing Risk
July 13 - Treating and Managing Future Risk in Women with Hereditary Breast Cancer
July 14 - Genetic Risk of Breast Cancer and Your Options
--      --     --

by
Elizabeth B. Odom, MD 
Resident/Clinical Trainee, Division of Plastic & Reconstructive Surgery, Department of Surgery
Jennifer Yu, MD 
Resident, Division of Plastic & Reconstructive Surgery, Department of Surgery

Genes are the code that are passed down from ancestors that determine everything about us – hair color, eye color, body type, and every other characteristic that makes you an individual. These codes also determine our risk for certain types of cancer, and certain changes or mutations in the gene can change the risk of cancer developing over your lifetime. 

One gene that has been studied extensively is the BRCA gene mutation that has been linked to a high risk for breast cancer. Under one percent of women have this genetic mutation. The average chance of an American woman developing breast cancer in her lifetime is around 12 percent, and the risk of having cancer in both breasts is rare.(1) However, without treatment, women with the BRCA gene mutation have a lifetime risk of breast cancer development of over 50 percent with a higher likelihood of breast cancer occurring in both breasts.(2) 

There is no proven way to prevent breast cancer, but generally, exercise, healthy weight, a diet full of fruits and vegetables, and the avoidance of tobacco leads to lower rates of disease. Breastfeeding has also been found to be somewhat protective in the development of breast cancer. However, for all women, not just those genetically susceptible, breast cancer screening is key. All women should get an annual mammogram after the age of 45, then every 2 years after the age of 55 if no cancer has developed. Screening may start earlier if there is a history of early breast cancer in the patient’s family. 

Women with a strong family history of breast cancer in relatives before the age of 50, or those who have a male relative with breast cancer may be tested for the BRCA mutation through a blood test. They may also begin having mammograms as early as 25 years old. If the test is positive, due to the high risk for cancer, women are referred to a breast specialist to discuss their treatment options. 

In 2014, there was a study published that found women with the BRCA mutation who undergo removal of both breasts (bilateral mastectomy) at the time of breast cancer treatment had half the lifetime risk of dying from breast cancer than those who underwent removal of just the breast affected by cancer.(3) Furthermore, because of the increased risk, women such as actress Angelina Jolie, may choose to have both breasts removed to prevent the development of breast cancer. This has been shown to reduce the incidence of breast cancer significantly.(4) This decision is highly individual and options for continued screening or surgical intervention should be discussed thoroughly between the patient, family members, and the treating physician. 

However, preventative mastectomy is becoming an increasingly popular option, especially with the availability of breast reconstructive procedures using either your own tissue or implant devices. Women who elect to undergo a bilateral mastectomy to treat or prevent cancer are usually referred to a plastic surgeon to discuss the best reconstructive option for them. In many cases, the breasts may be reconstructed the same day as the mastectomy procedure. 

There is some increased risk of operative complications when having both breasts removed, however, after bilateral mastectomy and reconstruction, women no longer need to undergo annual mammogram screening, have less anxiety about the development of breast cancer, and are satisfied with the way their breasts look, particularly with clothing.(5) If you or someone you know is concerned about their risk of breast cancer, discuss this with your physician. There are well-known strategies of early detection and prevention, and the treatment options today are better than ever. 

References
1. Howlader N NA, Krapcho M, et al. (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/ , based on November 2013 SEER data submission, posted to the SEER web site, April 2014. 
2. Levy-Lahad E, Friedman E. Cancer risks among BRCA1 and BRCA2 mutation carriers. Br J Cancer. 2007;96(1):11-5. Epub 2007/01/11. doi: 10.1038/sj.bjc.6603535. PubMed PMID: 17213823; PMCID: PMC2360226. 
3. Metcalfe K, Gershman S, Ghadirian P, Lynch HT, Snyder C, Tung N, Kim-Sing C, Eisen A, Foulkes WD, Rosen B, Sun P, Narod SA. Contralateral mastectomy and survival after breast cancer in carriers of BRCA1 and BRCA2 mutations: retrospective analysis. BMJ. 2014;348:g226. Epub 2014/02/13. doi: 10.1136/bmj.g226. PubMed PMID: 24519767; PMCID: PMC3921438. 
4. Lostumbo L, Carbine N, Wallace J, Ezzo J. Prophylactic mastectomy for the prevention of breast cancer. The Cochrane database of systematic reviews. 2004(4):CD002748. Epub 2004/10/21. doi: 10.1002/14651858.CD002748.pub2. PubMed PMID: 15495033. 
5. Koslow S, Pharmer LA, Scott AM, Stempel M, Morrow M, Pusic AL, King TA. Long-term patient-reported satisfaction after contralateral prophylactic mastectomy and implant reconstruction. Annals of surgical oncology. 2013;20(11):3422-9. Epub 2013/05/31. doi: 10.1245/s10434-013-3026-2. PubMed PMID: 23720070.