Wednesday, March 28, 2012

More than half of cancer is preventable now

The media release from the Washington University School of Medicine, yesterday, on our review of the potential to prevent cancer and barriers slowing our progress in acting on what we already know. (For article link here)
Colditz, Wolin, and Gehlert collaborate on a number of cancer prevention projects through Siteman Cancer Center Prevention and Control Program.

More than half of all cancer is preventable, and society has the knowledge to act on this information today, according to Washington University public health researchers at the Siteman Cancer Center in St. Louis.
In a review article published in Science Translational Medicine March 28, the investigators outline obstacles they say stand in the way of making a huge dent in the cancer burden in the United States and around the world.
“We actually have an enormous amount of data about the causes and preventability of cancer,” says epidemiologist Graham A. Colditz, MD, DrPH, the Niess-Gain Professor at the School of Medicine and associate director of prevention and control at the Siteman Cancer Center. “It’s time we made an investment in implementing what we know.”
What we know, according to Colditz and his co-authors, is that lifestyle choices people make and that society can influence in a number of ways — from tobacco use to diet and exercise — play a significant role in causing cancer. Specifically, the researchers cite data demonstrating that smoking alone is responsible for a third of all cancer cases in the United States. Excess body weight and obesity account for another 20 percent.
But beyond individual habits, they argue that the structure of society itself — from medical research funding to building design and food subsidies — influences the extent of the cancer burden and can be changed to reduce it.
The obstacles to implementing broad cancer prevention strategies are:
  • Skepticism that cancer can be prevented. Smoking rates in different states demonstrate that 75 percent of lung cancer in the United States could be prevented with elimination of cigarette smoking.
  • The short-term focus of cancer research. Benefits of prevention may be underestimated because they take decades to show up, and research funding often spans five years or less.
  • Intervening too late in life to prevent cancer. Strategies like vaccination against cancer-causing viruses, such as the human papilloma virus that causes cervical cancer, work best when begun early, in this case before young people begin sexual activity.
  • Research focuses on treatment, not prevention. Treatments focus only on a single organ after diagnosis but behavioral changes reduce cancer and death rates from many chronic diseases.
  • Debate among scientists. They say health experts have a moral responsibility to highlight cancer risk factors even without knowing the biological mechanism by which they cause cancer.
  • Societal factors that affect health. Tobacco policy and government subsidies don’t do enough to discourage unhealthy behavior, and in some cases they make the unhealthy options more accessible, especially in low-income communities.
  • Lack of collaboration across disciplines. Scientists and health experts must work together to learn what causes cancer, communicate that to the public and work with community leaders to implement policies that help people lead healthier lives, they say.
  • The complexity of implementing broad changes. With so many players involved, from health-care providers to government regulators to individuals, it will be difficult to implement broad change over the long term.
According to the American Cancer Society, an estimated 1,638,910 new cancer cases will be diagnosed this year in the United States. Also this year, 577,190 Americans are expected to die of cancer. Only heart disease kills more people in this country. And Colditz’s research has shown that these cancer prevention strategies would reduce the burden of heart disease and other chronic conditions as well.
Despite the obstacles, Colditz and his colleagues point to some successes that they say demonstrate that broad change is possible. One example is the relatively quick elimination of unhealthy trans fats from the national diet. And the National Cancer Institute (NCI) has reported that lung cancer rates are declining in both men and women, supporting the benefits of tighter tobacco control policy.
“After working in public health for 25 years, I’ve learned that if we want to change health, we need to change policy,” says co-author Sarah J. Gehlert, PhD, the E. Desmond Lee Professor of Racial and Ethnic Diversity at the Brown School of Social Work and the School of Medicine. “Stricter tobacco policy is a good example. But we can’t make policy change on our own. We can tell the story, but it requires a critical mass of people to talk more forcefully about the need for change.” 

Preventing Colon Cancer Now.

As we complete April, colon cancer awareness month, the topic of strategies to improve our population risk profile and reduce the cancer burden in our families, our workplaces, our communities and our state, I am reminded of many times we have written and talked on this topic. We have written on physical activity and colon cancer prevention from many angles (1-6) and used titles such as “walk away from colon cancer” or at the Eat and Run conference in Sydney Australia, 2002, we concluded that what we don’t know is how best to conduct community based interventions to reduce weight gain through increased physical activity.

It remains clear that higher levels of exercise protects against colon cancer, most likely through insulin pathways (7, 8). While further research may refine this understanding and identify potential points for intervention – keeping active through adolescent and adult years reduces risk of many chronic conditions including heart disease and diabetes. The pay-off for wellness is clear.

Writing in the American Journal of Public Health in 2001, I emphasized the need for action to implement our understanding of sun exposure as a cause of the epidemic of melanoma we are currently experiencing in the US. The messages for cancer prevention from this time over a decade ago, apply just the same today as we work to prevent colon and other major cancers. “It is time to implement existing cancer prevention strategies through providers, regulatory changes, and programs focused on individuals: programs to encourage smoking cessation and counter trends in youth smoking initiation as well as programs that encourage people to eat a healthy diet, avoid weight gain, be physically active, drink in moderation if at all, practice safe sex, and avoid sunburns and excessive sun exposure”(9). We can act on our understanding of the power of prevention and bring healthier life to our country reducing health expenditures in the future as an added benefit.

For tips and strategies on how to adopt a healthier lifestyle for you, your family, and your community go to:Your Disease Risk

See the Community Action button for strategies to promote wellness and prevent cancer in your community.

Literature cited

Friday, March 23, 2012

Prevention of Colon Cancer: time for action is now

Recent updated evidence from the United States National Health And Nutrition Survey (NHANES) show that the majority of US adults have more than one modifiable risk factor for colon cancer that needs attention (see article). While screening is advocated for prevention of colon cancer and supported by evidence from randomized controlled trials (1), we have shown that even after screening, those with poor risk profiles remain at elevated risk of colon cancer (2). In particular, and analyzing data from the Nurses’ Health Study, Wei and colleagues show that lack of physical activity, red meat consumption and high alcohol intake and lack of regular aspirin use, leave women who have been screened for colon cancer at substantially elevated risk of cancer in subsequent years.

What do we know about the US population and primary prevention of colon cancer?
Analyzing the NHANES data, Joshu and colleagues tracked colon cancer risk factors form 1999 to 2008 (3). Obesity, physical inactivity, red meat consumption, and alcohol intake, together account for more than 70% of colon cancer (4). Over this decade of repeated surveys the adult US population remained largely unchanged in their poor risk profile for colon cancer. 4 out of 5 US adults had one or more risk factors that could be modified. This was true for men and women, for White, Black, and Hispanic populations, and for each age group from 20 to 69. Almost 20% of adults have 3 or more modifiable risk factors. Thus they could take action now to lower their risk of colon cancer.

Why lower your risk?
Lifestyle changes significantly lower risk of colon cancer. 
It is time to act on what we know and reduce the population burden of colon cancer - a leading cause of cancer mortality. In fact, treatment of colon cancer accounted or 11% of all US cancer care expenditures in 2010. That is some 14 billion dollars spent on treating a cancer that is highly preventable. 

We can all take action now that will reduce the number of cases diagnosed over the coming years and the suffering that goes with this disease; save unnecessary expenditures; and improve quality of life. 

For help identifying risk factors you can work on today, visit our award winning web site your disease risk .

Related posts

Web resources
Your Disease Risk

Literature cited

Wednesday, March 21, 2012

Smoking cessation reduces lung cancer mortality

A new rigorous analysis funded by the National Cancer Institute is published this month in the JNCI. Moolgavkar and colleagues (see report) now estimate that over 790,000 lung cancer deaths have been avoided by cessation from cigarette smoking since the 1964 Surgeon General's first Report on Smoking and Health was released. This represents only a fraction of all deaths that can be avoided by more comprehensive implementation of what we know works for tobacco control. 

A detailed report from the CDC estimates that each year cigarette smoking and exposure to second hand smoke cause over 400,000 or 1 in 5 deaths. See Tobacco Control State Highlights 2010 for a detailed break down by state. This report highlights how substantial the range of implementation of effective and proven programs is, even within the US, where policies and practice vary enormously from one state to the next. 

Implementing programs that we know work can reduce the burden of not just lung cancer, but many other chronic diseases which drive up costs of health care in this country. To see how much risk is reduced for individuals who stop smoking, go to our web site Your Disease Risk. More details are also provided in our Prevention Snapshot accessed through the tab above.

Wednesday, March 14, 2012

"Your Disease Risk" to be Featured in NCI Webinar on Risk Assessment Tools

Don't miss out.  Our award-winning website Your Disease Risk ( will be a featured part of next week's NCI webinar: "Communication Science and Online Risk Assessment Tools."

Launched in January 2000, Your Disease Risk has been a steady and trust-worthy source of personalized estimates of disease risk and tips for prevention. Drs Graham Colditz and Erika Waters will review the history, science, and theory behind the site's long-term success in their presentation: "Your Disease Risk: The Culmination of 17 Years of Transdisciplinary Research."

Webinar details:
Communication Science and Online Risk Assessment Tools
March 22, 1:00pm - 4:00pm EDT.
Registration day-of @ 1:00pm EDT - limited to first 250

Friday, March 9, 2012

You Can Prevent Colorectal Cancer

Colorectal cancer kills over 50,000 Americans each year. Lung cancer is the only cancer that kills more people. Both men and women can get colorectal cancer, and it usually strikes those over the age of 50.

The good news: Colorectal cancer is one of the most preventable cancers. No matter what your age, there is a lot you can do to lower your risk of getting the disease - from getting regular screening tests to making 
healthy changes to your lifestyle. 

Use this guide to decide which changes you should make. Start with a few. Then move on to the others. Remember to talk to a health care professional before making any big changes in your lifestyle.

The best way to prevent colorectal cancer is to get screening tests on a regular basis after age 50. These tests can find non-cancerous tumors, called polyps, that sometimes turn into cancer. By finding polyps early and having them removed, you can prevent cancer from starting.

The screening tests aren’t as uncomfortable as you might think, and the benefits make them well worth it.

Talk to a health care professional about which screening test might be right for you. If you are at increased risk for colorectal cancer, you may start screening earlier than most people.

Start getting screened at age 50, using one of the following:
  • Home fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year
  • Flexible sigmoidoscopy every 5 years
  • Barium enema every 5 years
  • Virtual colonoscopy every 5 years
  • Colonoscopy every 10 years
  • Stool DNA test (ask doctor how often)

Get at least 30 minutes of physical activity every day

A lot of things count as physical activity. Try walking, jogging or dancing—whatever you enjoy! In general, the more activity you get, the better. And any amount is better than none.

Maintain a healthy weight
The best way to maintain a healthy weight is to be physically active and make healthy food choices. Body mass index is a good way to gauge how you’re doing with your weight. Visit this link to see where you fall: BMI calculator.

Eat no more than 2 to 3 servings of red meat a week
The less red meat you eat, the better. Choose chicken, fish, or beans instead of beef, pork, lamb, or veal. A serving of cooked meat is 3 ounces—the size of a deck of cards.

Take a multivitamin with folate every day
Taking a multivitamin with folate (also called folic acid) can give you added protection against colorectal cancer.

Have no more than one alcoholic drink a day
Drinking alcohol increases your risk of colorectal cancer, but it can have positive and
negative effects on your health. Talk to a health care professional about how alcohol may affect you.

Get your calcium every day
Low-fat dairy products, like milk and yogurt, are the best sources of calcium.Daily calcium supplements, calcium-fortified foods like orange juice, and darkgreen leafy vegetables are good too. Try to get about 1,000 – 1,200 mg a day.

Get your vitamin D every day
In addition to being good for bone health, vitamin D can help lower the risk of colon cancer. Supplements are usually the best choice since not many food are rich in the vitamin. Try to get about 1,000 mg a day.
A note on aspirin: Long term daily use of a single aspirin (325mg) can lower the risk of colorectal cancer. Aspirin can also have some serious side effects for some people. Talk to a health care professional before you start taking it regularly.