Monday, August 31, 2015

Bottom Line of New Study: Colon Cancer is Quite Preventable

A large proportion of colon cancer is preventable with healthy lifestyle choices, even without taking into account the benefits of screening.  That's the finding in a new analysis from the large Nurses' Health Study released in print last week in Cancer Causes & Control.  The analysis, done by researchers from Stanford and Harvard Universities, calculated the percentage of colon cancers in women that could be attributable to a combination of lifestyle choices that have been found in previous research to be established risk factors for the disease: overweight/obesity, lack of physical activity, alcohol intake, smoking, low multivitamin use, and low calcium intake.

Comparing women who had only one or none of these risk factors with women having two or more, the researchers found that 37 percent of colon cancer cases in women could be avoided through healthy lifestyle choices.  This proportion was even higher when aspirin use was considered.  Though not a lifestyle choice, per se, long term aspirin use has been shown in many well-designed studies to lower the risk of colon cancer.  When aspirin use of just twice a week for six years or more was added to the analysis, the percentage of cancers estimated as preventable rose to 43 percent.

These percentages are quite significant and do not even take into account the further benefit of colon cancer screening, which in addition to catching cancer early can also prevent the disease by finding (and removing) pre-cancerous growths.

Though some other analyses have estimated even greater proportions of cases potentially preventable, these new findings still demonstrate that colon cancer is a very preventable cancer - and with lifestyle choices that many women can follow.  Key steps for lowering the risk of colon cancer include:

  • Getting screened, beginning at age 50, or earlier if you have a family history.  Talk to a doctor about which screening test is right for you and when you should start screening.  
  • Keeping weight in check
  • Not smoking
  • Being physically active
  • Drinking only moderately, if at all
  • Limiting red meat, especially processed meat
  • Getting enough calcium and vitamin D
  • Considering a multivitamin

Regular aspirin use has also been found to lower the risk of colon cancer, but it has some important risks as well (such as serious bleeding). One recent analysis, though, suggests that regular aspirin use may have overall health benefits for some older adults. However, it's important that anyone considering taking aspirin regularly talk to a doctor about the potential risks and benefits before doing so.   

For more on screening and other steps to prevent colon cancer, see 8IGHT WAYS to Prevent Colon Cancer (PDF version).

Top photo: Flickr/thomasletholsen

Thursday, August 13, 2015

Making Strides in HPV Vaccination but Still a Long Way to Go

Photo: Melissa P
A federal report released at the end of July shows promising trends in rates of HPV vaccination in United States adolescents, but rates varied greatly between certain regions and left much room for improvement overall, especially for boys.

The recommended schedule for HPV (human papillomavirus) vaccination, which protects against cervical and other cancers, is three doses preferably beginning in early adolescence.   
Between 2013 and 2014, the report found that the number of girls ages 13 - 17 receiving all three doses of the vaccine increased around three full percentage points, from 37 percent to close to 40 percent.  Boys aged 13 – 17 increased by an even greater amount – 8 percentage points – but remained low compared to girls – at around 22 percent.   

Washington DC was the state with the highest rates of girls receiving three full doses, at 57 percent, with Tennessee having the lowest rate, at 20 percent.

The report goes on to highlight that most regions with increases in rates of vaccination developed and put in place multifaceted strategies specifically intended to improve use of the vaccine.  Among other efforts, these included approaches like, provider education, public outreach, automated vaccination reminders, and integration of vaccination goals into cancer control plans. 

Overall, these latest numbers are heartening but show that there is still a great deal that needs to be done.  Only 20 percent of adolescent boys and 40 percent of adolescent girls in the United States are getting the full protection from the HPV vaccine.  Given that HPV is a common infection and the primary cause of cervical cancer – as well as a risk factor for vaginal, penile, anal, and oropharyngeal cancers – it’s a great missed opportunity for prevention. 

Coverage of other standard vaccinations in these age groups in the United States can reach as high as 88 percent.  And that type of coverage should be possible with the HPV vaccine, for both boys and girls.  It will, however, take a concerted effort to do so.  These new numbers show it will most likely be worth it.


Tuesday, August 4, 2015

More Than Zero: New Evidence That Any Amount of Physical Activity is Better Than None

Results from a large analysis released yesterday further confirm that getting even small amounts of physical activity is better than getting none if your goal is to live longer.

In the new paper, which combined results from nine cohort studies, researchers focussed on the possible mortality benefits of varying levels of physical activity in people age 60 and older. With over 120,000 participants followed an average of 10 years, the analysis found that compared to older adults getting zero exercise, those getting about 75 minutes a week of moderate-to-vigorous activity had a 22 percent lower risk of premature death.  Though it's unclear exactly why, women showed a greater reduction (32 percent) for this same activity level compared to men (14 percent).

What is notable about these findings is that 75 minutes a week of activity (15 minutes a day) is half the amount recommended by most exercise guidelines focussed on health.  And there are an increasing number of studies demonstrating the benefits of getting even just small amounts of physical activity on a regular basis - as long as it's more than zero.  We even posted a story in 2010 about a study that found that cycling just 5 minutes a day could significantly help with weight control.

Of course, reaching recommended levels of physical activity - and even going beyond them - has an even greater impact on health, well-being, and weight control.  In the current analysis in older adults, for example, the risk of dying further dropped to 28 percent in those getting recommended levels of activity of 150 minutes per week, with risk dropping 35 percent for those in the highest level of activity.

So, getting 150 minutes per week or more of moderate activity remains an important goal. But, to many people, especially those who've been sedentary for a long time or have health issues, 150 minutes per week can feel daunting.  Add to this the intimidating images we're exposed to on social media and television of sculpted Crossfit bodies and featherweight marathoners, and it can feel like fitness is an unattainable goal.   But what this study and others like it now show is that there is real benefit when someone simply moves from doing nothing to doing something.  And that's something almost everyone can do.  And it's a great place to start.

Photo: Creative Common License; Flickr/Nimo_ji

The full analysis appeared early online in the British Journal of Sports Medicine.

Friday, July 17, 2015

A Day in the Life: Working with Communities to Improve Health and Lessen Cancer Disparities

by Ashley Housten, OTD, OTR/L, MSCI, MPA

The Siteman Cancer Center Program for the Elimination of Cancer Disparities (PECaD) hosted a Community Health Education Day in East St. Louis, Illinois on July 11, 2015. Partnering with the East Side Health District and other community organizations, community health workers, citizens, and cancer survivors came together to discuss cancer risk and health. With approximately 25 in attendance at the East St Louis Community College Center, PECaD and the Division of Public Health staff led workshops on 8IGHT WAYS to Prevent Cancer, Colon Health, Exercise and Nutrition, Cancer Survivorship, and Understanding Research. This was the first Community Health Outreach Day hosted by PECaD in Illinois and proved to be an exciting event for staff and participants. 

During the event, participants were able to walk through a large, inflatable model of a colon and see examples of conditions that can increase the risk of colon cancer. Saffiyah Muhammad, MPH, the PECaD program coordinator explained how the inflatable colon is an important learning tool:
“Participants are able to see the differences between a healthy colon, early stages, and advanced colon cancer. This visual facilitates discussion and helps our participants understand what colon cancer looks like in the body.” 
With this innovative teaching tool, participants are immersed in the educational experience and are compelled to engage in meaningful conversations about screening, cancer, and survivorship.

Community Health Education events are just one part of PECaD. The primary goal of the Program is to work through community partnerships to develop outreach and education, quality improvement and research, and training strategies that will foster healthy communities and environments less burdened by cancer disparities. By working with community organizations, cancer survivors, clinicians, researchers and advocates to enhance education and awareness about cancer risk and prevention we aim to reduce cancer disparities.

Developing partnerships in St. Louis and the surrounding communities provide the opportunity to increase outreach and engagement with community members. Through community partnerships, education, and outreach we plan to continue hosting health education events. 

Visit the PECaD website to learn more about our community events and how to get involved. Keep an eye out for the inflatable colon model.  It's a must see! 

Related resources:

Tuesday, June 23, 2015

Larger Than We've Ever Been: New Data on the Nation's Weight Problem

In blunt terms: we're larger than we've ever been.  That's the essential conclusion of new research published online yesterday in JAMA Internal Medicine by CNiC's Dr. Graham Colditz and Dr. Lin Yang.  In the analysis, which looked at a nationally representative sample of Americans from 2007 - 2012, the authors found that 75 percent of men, and 67 percent of women age 25 and older were either overweight or obese.  This is a significant increase from rates seen 20 years ago, when 63 percent of men and 55 percent of women were either overweight of obese.

With overweight and obesity linked to cancer, heart disease, diabetes, lower quality of life, and premature death, these new numbers are likely to translate to huge medical and financial burdens both for the nation, and for individuals and families.  They also point to the need to make large-scale meaningful efforts in combatting our nation's weight problem.

While weight is in many ways an intensely individual issue, it's difficult to overestimate the impact that our social and physical surroundings have on the choices we make.  It's harder to be physically active, for example, when there are no nearby sidewalks, bike paths, or affordable gyms.  It's harder to make healthy food choices when our friends only like fast-food, and there are no good grocery stores in our neighborhoods.

To truly combat the weight issue, therefore, we need to make changes at all levels of society - from the individual on up to the federal government - changes that foster healthy choices, healthy attitudes, and sustainable approaches to weight, physical activity, and healthy eating.

As Yang and Colditz conclude: "Population-based strategies helping to reduce modifiable risk factors such as physical environmental interventions, enhancing primary care efforts to prevent and treat obesity, and altering societal norms of behavior are required."

Friday, June 12, 2015

New eBook: TOGETHER - Every Woman's Guide to Preventing Breast Cancer

After posting a handful of excerpts over the past year, we're excited to announce the official launch this week of the e-book: TOGETHER - Every Woman's Guide to Preventing Breast Cancer.

Written by CNiC's Graham Colditz, MD, DrPH and Hank Dart, MS, along with noted Washington University School of Medicine researcher Katherine Weilbaecher, MD, TOGETHER takes a generational approach to breast health and cancer prevention, with practical tips and useful messages that apply as early as childhood and remain important throughout life.

 In TOGETHER, you'll discover that:
  • Over half of all breast cancers can be prevented. 
  • You can lower your risk with many healthy behaviors you already know about – and some you don’t. 
  • Simple tips can help your daughters and granddaughters improve their breast health and lower their adult breast cancer risk. 
  • Women at high risk of breast cancer can take important steps to lower their risk and protect their health. 
  • It’s important for all of us to work together to improve the health of our families and our communities. 
  • A few key rules can help you make sense of confusing health news. 
  • Simple recommendations can help you lead a healthy life as a cancer survivor.
TOGETHER can be dowloaded for free in three e-book formats (epub, mobi, and pdf) and will soon be available through Apple iBooks.

Tuesday, June 2, 2015

Do You Stand for 2 - 4 Hours During the Work Day? New Recommendations Suggest You Should

It's said that sitting is the new smoking.  And while this is an exaggeration of sorts, there is certainly something to it.  Sedentary lifestyles have been linked to heart disease, diabetes, certain cancers, and premature death.  And like smoking, sitting too much has health risks even for those who are a healthy weight and who exercise regularly.

But the good news is that it takes very little effort to counteract the effects of being too sedentary.  Standing -- surprise, surprise -- works well.  A saunter will work, too.  The key is to simply take regular breaks from sitting throughout the day.  It can take some time to make these standing breaks a habit, but once you get into the groove, you realize that many of the things you do sitting, you can also do standing, with some minor adjustments.

For many people, the lion's share of sitting takes place at work.  This makes the workplace a perfect target for battling our too-sedentary lifestyles, which happens to also be the conclusion of a new statement out of the U.K. by Public Health England and the Active Working Community Interest Company.   For those who work primarily at desk-based jobs, the report recommends two hours of accumulated standing or light activity throughout the day, working up to a total of four hours each day.  Much of this can be done taking short walking breaks or working standing up, using "sit-stand" workstations, which have been shown in early studies to significantly increase work-day standing time.  These workstations offer options for working while standing or working while sitting, and they are becoming increasingly common choices in workplaces and home offices.

In a prepared statement, specific recommendations from the report include:
  • 2 hours daily of standing and light activity (light walking) during working hours, eventually progressing to a total of 4 hours for all office workers whose jobs are predominantly desk based 
  • Regularly breaking up seated based work with standing based work, with the use of adjustable sit-stand desks/work stations 
  • Avoidance of prolonged static standing, which may be as harmful as prolonged sitting 
  • Altering posture/light walking to alleviate possible musculoskeletal pain and fatigue as part of the adaptive process 
  • As well as encouraging staff to embrace other healthy behaviours, such as cutting down on drinking and smoking, eating a nutritious diet, and alleviating stress, employers should also warn their staff about the potential dangers of too much time spent sitting down either at work or at home
Of course, the last thing many of us want to hear is one more health recommendation about physical activity, especially when most of us don't exercise enough as is.  But, really, the recommendations to avoid extended sitting can be really easy to put into practice.  You don't get sweaty.  You don't need special shoes or clothes.  And you don't need to go anywhere to do it.

All you really need to do is take a stand from time to time.

Photo: Flickr/Ahmed Hashim, Creative Commons License