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. 
  • Keep sugary drinks, like sodas, fruit drinks, and energy drinks to a minimum.
  • 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.

Friday, 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.

While modernization has many important benefits, it is also directly driving up the risk of breast cancer. Globally, one in every four new cancers diagnosed in women is breast cancer, and over 1.7 million new cases are diagnosed each year.

We need a global breast cancer prevention strategy - now.

We currently understand how the longer interval from first menstrual period (menarche) to first baby increases lifetime risk for beast cancer. This interval has expanded over centuries in Western Europe following the Industrial Revolution, and - in dramatic fashion - over just a few decades in Asian countries. Data from China and Korea show a rapid decline in age at first menstrual period since World War II, as well as a decline in number of children, which has accelerated. The age women have their first babies is now above the Organization for Economic Cooperation and Development (OECD) average of 28 years old. This means that a typical woman has 16 or more years between her first period and her first baby (first birth at 28 minus first period at 12 years of age). In 1950 in China, this interval was just three years (first birth at 19 minus first period at 16).

Given these social movements, are there approaches early in life that can help mitigate the impact of these changes in reproductive factors? It appears so.

We, and others, have studied diet and physical activity as two key aspects of lifestyle, and then alcohol intake in later adolescence and early adult life.
  • Eating a diet high in fiber and vegetable protein is related to significantly lower risk of both premalignant breast lesions and breast cancer.
  • Being more physicaly active from ages 12 to 22 is powerfully protective against breast cancer.
  • Avoiding alcohol before first pregnancy is strongly protective against both benign breast lesions and invasive breast cancer.
Together, we need to work to improve diet in children, adolescents, and young adults – fostering access to, and consumption of, fruits, vegetables, and whole grains – as well as reducing alcohol intake among women under age. Especially for high school- and college-aged women, we must create an environment that encourages less alcohol intake. Also important is sustaining physically active lifestyles through the adolescent and early adult years, which has both immediate and long-term benefits.

Multifaceted approaches are needed to achieve such behaviors across a broad set of the population, but doing so will have lasting benefits, not only for breast cancer but also colon cancer, heart disease, stroke, as well as mental health. Momentum in this direction can take time to gather, but is achievable and important, and can have a positive impact for generations to come.

Related posts

Tuesday, September 23, 2014

PALB2 Mutation: A "New" Gene That Greatly Increases Breast Cancer Risk

Photo: Flickr/Micahb37
by Sarah Cortez

There’s been a recent surge in women asking for genetic testing for breast cancer, due in large part to Angelina Jolie’s public decision last year to get a prophylactic mastectomy after discovering she had a mutation in the BRCA1 gene. These days, another breast cancer gene has been making headlines, a gene called PALB2.

Mutations in BRCA1, and its related gene, BRCA2, are the two most important known genetic links to breast cancer risk. Well, new findings on PALB2 have some describing it as the “third gene” to be linked with breast cancer.

Previous studies have found that mutations in PALB2 combined with mutations in the BRCA genes increased the risk of breast cancer. PALB2 is even short for Partner and Localizer of BRCA2. What we didn’t know was how much the risk of breast cancer increased with a PALB2 mutation alone – that is without a related BRCA mutation.

In August, the New England Journal of Medicine published a study that characterized patients with only a PALB2 mutation. To do this, researchers identified patients who did not have a BRCA1/2 mutation but who had a history of breast cancer in at least one family member. These patients were then tested for the PALB2 mutation.

So, what did they find?

The results showed that a PALB2 mutation by itself increased the risk of breast cancer 9.5 times compared to the general population. They also showed that, for those with a mutation in PALB2, the risk of developing breast cancer by age 70 was about 33%, as compared to a 12% lifetime risk in the general population. Furthermore, for those with a PALB2 mutation who also had two first-degree relatives (like your mom and your sister) with breast cancer, the risk of developing breast cancer by age 70 increased to more than 50%. For comparison, a BRCA1 mutation increases your risk of developing breast cancer, by age 70, to 55-65%. So BRCA mutations are still considered more risky.

So what does all this new information mean to you?

Just like with the BRCA genes, it would only be recommended that you get screened for PALB2 mutation if you have a strong history of breast or ovarian cancer in your family, such as:
  • Breast cancer in more than one family member
  • Breast cancer diagnosed before the age of 50
  • Breast cancer diagnosed in both breasts (bilateral breast cancer)
  • Male breast cancer
  • Breast cancer plus ovarian or pancreatic cancer
  • Ashkenazi Jewish ethnicity
Many women at low risk for gene mutations are needlessly tested every year, which can cause a great deal of unnecessary anxiety.

If a woman tests positive for a BRCA mutation, we offer increased cancer screening, risk-reducing medications, prophylactic mastectomy, or some combination of these. While it’s likely such approaches will also help protect women with a PALB2 mutation, there is currently no evidence that they have benefit. More research is needed.

Genetic mutations like BRCA1/2 and PALB2 are frightening because they increase the risk of breast cancer by such a great degree. But it’s important to also keep in mind that they are rare. Around one in 400 women in the United States have a BRCA mutation, which translates to 0.25 percent of American women. And even women who have such mutations are not guaranteed to develop the disease.

For the large majority of women, the most important things they can do to improve their health and lower the risk of breast cancer is to focus on living an overall healthy lifestyle that includes: being physically active for at least 30 minutes a day, keeping weight in check, and drinking alcohol only moderately, if at all.

Antonis C. Antoniou, Ph.D., Silvia Casadei, Ph.D., Tuomas Heikkinen, Ph.D., Daniel Barrowdale, B.Sc., Katri Pylkäs, Ph.D., et al. Breast-Cancer Risk in Families with Mutations in PALB2. N Engl J Med 2014; 371:497-506.

Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance. Journal of Clinical Oncology 2007; 25(11):1329–1333.

Tuesday, September 2, 2014

Hormonal IUDs and Breast Cancer: Is There a Link?

by Sarah Cortez

It certainly goes without saying that birth control has been a major news story the past couple of months. Much of this coverage, of course, has revolved around the recent Supreme Court ruling and reactions to it. Outside of that media storm, there have been some other health-related birth control stories as well, a number of which have focused on the potential of a specific type of IUD - the levonorgestrel IUD - to increase breast cancer risk. 

Photo: Flickr/Theilr
So what do the data actually say about this link? Let’s take a look.

In case you are unfamiliar with the levonorgestrel IUD (brand name Mirena or Skyla), it is a small, plastic, T-shaped device that is inserted into your uterus by a healthcare provider, usually your gynecologist. It prevents pregnancy by releasing a hormone called levonorgestrel and can be left in your uterus for up to five years.

Much of this recent interest in levonorgestrel-releasing IUDs was sparked by a study published in Obstetrics & Gynecology that looked at the records of all 30-49 year old women in Finland who used a levonorgestrel IUD to treat menorrhagia (heavy periods).

The study reports finding that the Finnish women who used the levonorgestrel IUD for 5 years had a 19% increased rate of breast cancer compared to the general Finnish population. That’s bad, right? Well, hold on.

The study also reports that, for these women, ovarian cancer was decreased by 40% and endometrial (uterine) cancer was decreased by 54%. Seeing if the IUD could decrease the risk for, or prevent, endometrial (uterine) cancer was the actual goal of the study.

Remember, these women were receiving a levonogrestrel IUD to treat very heavy periods. Periods, which if caused by endometrial hyperplasia (overgrowth of the uterine lining), put them at increased risk for endometrial cancer. So the study showed that it helped prevent endometrial (uterine) cancer in women who used it to treat very heavy periods.

But, what about the increase in breast cancer?

The authors of the study advised not being too quick to assume that this increase in breast cancer is real. Prior studies have never found an association between levonogrestrel IUD use and breast cancer. So, the finding could just be an outlier or something else could be going on. We don’t know, for example, whether a group of women with very heavy periods has the same breast cancer risk as the general population.

Exactly how this finding translates from Finnish women to American women is also unclear, since the IUDs available in Finland are not exactly the same as those available in the United States

So before you decide to get rid of your IUD because of concerns about breast cancer risk, have an in-depth talk to your doctor. Discuss your family-planning goals, your family history, and your personal risk for breast, endometrial, and ovarian cancer. If your overall risk for breast cancer is low, the levonogrestrel IUD isn’t likely to put you in the high-risk category.

The three most important things women of child-bearing age can do to prevent breast cancer are: be physically active, stay at a healthy weight, and drink only moderate amounts of alcohol – if at all.


Soini T, Hurskainen R, Grenman S, Maenpaa J, Paavonen J, Pukkala E. Cancer Risk in Women Using the Levonorgestrel-Releasing Intrauterine System in Finland. Obstet Gynecol 2014;124:292-299.

Friday, August 15, 2014

New Study Confirms Weight is a Major Cancer Risk Factor

Photo: Flickr/Kizette
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.


That's simple.  Overweight really is one of the most important health issues of our time, and much like tobacco in the middle part of the last century - unless we make some big strides against today's weight problem, generations will experience a greatly decreased quality of life and greatly increased rates of conditions like heart disease, diabetes, stroke, and cancer.  By keeping the issue upfront in articles, journals, and on social media, we can help push for policy changes and shifts in public attitude that will help address the obesity epidemic - much like we did with tobacco.  We've seen some very small positive steps recently on the obesity front, but we need to keep up - and expand on - these efforts.  

A study out today further confirms why.  Building on results from previous studies, researchers with the London School of Hygiene and Tropical Medicine published an analysis in The Lancet showing that increases in weight raise the risk of 11 different cancer, including esophageal, colon, liver, gallbladder, pancreatic, breast (post-menopause), cervical, uterine, ovarian, and kidney cancers, as well as leukemia.  Even for those in the healthy weight range (BMI of 18.5 - 24.9; or someone 5' 9" weighing 125 - 168 pounds), an increase of just one BMI point, say from 23 up to 24, was linked to an increased risk of cancer.

The researchers also calculated the percent of specific cancers likely caused by being obese or overweight (figure).  Five percent of all breast cancers diagnosed after menopause were linked to weight, as well as 11 percent of all colon cancers.  Each of these cancers is quite common.  Less common - but still very important - cancers had much greater percentages linked to weight.

In an accompanying editorial, titled Obesity: a certain and avoidable cause of cancer, Peter Campbell of the American Cancer Society concludes:
"We have sufficient evidence that obesity is an important cause of unnecessary suffering and death from many forms of cancer, in addition to the well recognised increased risks of mortality and morbidity from many other causes. More research is not needed to justify, or even demand, policy changes aimed at curbing overweight and obesity."
We certainly agree.  It's time to act more forcefully for prevention.  Yet, even though disease prevention is increasingly listed as a public health priority, funding and political backing for prevention programs still often lag behind fields like treatment and diagnosis. If we are to truly make headway in the fight against obesity and other key risk factors, prevention needs funding and political will commensurate with its large potential to reduce future disease burden.

Tuesday, August 12, 2014

Evolution of the Science on Aspirin Use and Colon Cancer Prevention

Yesterday, we posted about a new analysis suggesting that long term aspirin use is likely to have an overall health benefit in the general population even when its side effects are taken into account.  At risk of being wonky, we wanted to follow up on that with a figure that shows the general evolution of the science on aspirin use and colon cancer prevention.  

Though it's the cardiovascular benefits that come to most people's minds when they think of reasons to take a daily aspirin, the Cuzick et al analysis shows that most of the benefits from regular aspirin use don't come from the prevention of heart attack and ischemic stroke, they actually come from the prevention of cancer - including colorectal, esophageal, and stomach cancer, and possibly breast, prostate, and lung cancer.  Of these, colorectal cancer is the most important, making up about a third of the total cancer and cardiovascular disease benefits of aspirin use.  

The figure below (full size PDF) shows the evolution of the evidence on aspirin and colon cancer prevention.  Though the science has taken a while to develop, the findings of a number of early positive studies have been confirmed in later studies, and it seems we're finally reaching a point where broad recommendations for daily aspirin use to prevent cardiovascular disease as well as cancer may become a reality.

Monday, August 11, 2014

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

Photo: Flickr/JenR
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

While the heart attack and stroke benefits of aspirin use, especially in those at high risk of such events, has been accepted for years, the cancer prevention benefits have been slower to catch on - even though the evidence for colon cancer prevention alone has been quite convincing.

This new analysis confirms the cardiovascular benefits of aspirin use while solidifying its benefits in both preventing and lowering mortality for colorectal, esophageal, and stomach cancer - and possibly for breast, prostate, and lung cancer.

Bleeding is the main concern with regular aspirin use, and the analysis found - not surprisingly - that the risks of events such as bleeding strokes (hemorrhagic strokes) and GI (gastrointestinal) bleeding go up with regular use.

However, after looking at all the benefits and risks together, the researchers found that use of a daily 75 - 325 mg aspirin for 5 or more years starting between ages 50 - 65 years had overall positive benefits.

After 10 years of use, risk of cancer, heart attack, and stroke was 9 percent lower in men and 7 percent lower in women after 15 years. Lower rates of cancer made up the large majority of this benefit, with colon cancer by itself making up about a third of the total benefit from aspirin use. Taking the risks of bleeding events into account, the overall health benefit dropped to about 6 percent for men and women. Lower but still overall positive.

Of course there are still many unanswered questions about the best approach to aspirin use. Because risk of bleeding goes up with age, it's unclear at what age people should stop taking aspirin because the risks outweigh the benefits. Figuring out the best way to identify people at risk of bleeding issues is another important topic, as is the best dose to use. While there's good evidence that a low-dose baby aspirin provides most if not all the benefits of, and likely has fewer risks than, a higher dose 325 mg aspirin, there are not yet definitive studies that have looked at the issue.

While anyone interested in starting on daily aspirin should first talk with his or her doctor, the data are now clearer than they've ever been that such use is likely to have real and lasting health benefits for most people.

Related post: Evolution of the Science on Aspirin Use and Colon Cancer Prevention

Tuesday, July 29, 2014

Missed Opportunities to Prevent Cervical Cancer: Use of HPV Vaccine Still Low

Photo: Flickr/Melissa Wiese 
To work in the field of cancer prevention one has to be an optimist at heart.  In the science, in the statistics, and in the news, you see not only the broad burden of cancer but also the vast opportunities that exist to lower risk and prevent the disease.

At the same time, we understand that shifting environments, attitudes, and behaviors in positive directions can take years, and most likely decades.  We didn't overnight become a nation where two-thirds of us are overweight/obese and half of us get little or no activity.  So it follows that shifting the pendulum in the other direction won't happen overnight either.  Such issues take daily efforts year after year to address both on a personal level and on a societal level.  There are no magic bullets.

Yet, however optimistic, there are two issues that leave many in the public health and medical professions scratching their heads over: the underuse of two relatively simple medical strategies that have vast potential for preventing cancer.

We've written at length about both of these strategies here in CNiC: the use of medications to prevent breast cancer in those at high risk of the disease (posts), and the use of the HPV vaccine to prevent cervical cancer (posts).

Of these two, the low use of the medications tamoxifen and raloxifene is perhaps the hardest to understand, given the large demonstrated benefits they have in preventing breast cancer in high risk women and the yawning gap between the number of women who likely stand to benefit from taking them (well over 2 million) and the number who actually do take them (just 117,000).

While new data on the HPV vaccine show there's been some progress in its use, the numbers also fall well short of what should be possible based on the use of other standard childhood vaccines. The vaccine is recommended for all girls and boys ages 11 or 12, given in a three dose course.  Its safety has been well-documented. Yet, only 57% of girls and 35% of boys get one or more doses of the vaccine.  Count only those who've received the full three doses, and the numbers fall to 38% for girls and 14% for boys.  Based on the number of children in this age-group cohort who receive other vaccines at their standard health care visits, and these percentages could realistically be as high as 91%.

The primary reasons parents give for not vaccinating their children were similar for both girls and boys, including the vaccine not being recommended by the health care provider, concerns about safety, and lack of knowledge of the vaccine or feeling it wasn't needed.

Both of these cases -  low use of the HPV vaccine and of tamoxifen/raloxifene - demonstrate just how important broad-based efforts at education are. It is not enough to demonstrate cancer prevention benefits - even benefits from activities as relatively simple as getting a vaccine or taking a pill.  Concerns of patients, parents, and health care providers must be appropriately addressed while we also move ahead fostering knowledge of, and demand for, the benefits the vaccine and preventive medications provide.

The trend in HPV vaccination show's we're making some progress on that front.  We have to be happy with that, but as usually, we'll keep striving for more.

Thursday, July 3, 2014

Alcohol and Health: Three New Studies and What They Mean for Youth and Young Adults

Photo: Flickr/Tim RT
It's been a big week in the news for alcohol and health. Three separate studies were released that helped shed light on a key issue we often discuss here at Cancer News in Context: the important impact that drinking has on cancer risk - particularly when started early in life.

The first report, which appeared in the online journal Preventing Chronic Disease, details the impact that drinking has on both disease risk and lifespan.  In the overall population, excessive drinking was found to cause over 87,000 deaths each year, resulting in 2.5 million years of life lost.  Acute causes - like car crashes, suicide/homicide, and falls - accounted for a little over half of these deaths, while chronic diseases - like stroke, cancer, and liver diseases - accounted for the rest.  Among working age adults (20 - 64 years), 10 percent of all deaths each year could be attributed to alcohol.

In those under age 21, alcohol accounted for about 4,300 deaths each year and a total of 249,727 years of life lost.  Not surprisingly, the most important contributors to these deaths were more immediate causes - car crashes and suicides/homicides -  rather than chronic diseases.  

Yet, just because the full chronic disease effect of excessive drinking doesn't show itself until later in life, this doesn't mean that drinking in youth doesn't have an important impact on later risk.  This seems especially so for breast cancer, where there is now good evidence that drinking in youth and young adulthood has a pronounced influence on later-life breast cancer risk.  Unlike most other organs in the body, the breasts continue to develop until a woman has her first child, and up until then, breast tissue appears more susceptible to harmful risk factors, like alcohol.  

This makes the results of another study released this week particularly concerning.  This study, released in the Journal of the American Medical Association - Psychiatry, found that younger generations of Australian women now drink much more excessively than did their mothers when they were the same age.  One primary reason for this is, simply, that women today are more likely to delay childbirth, deciding to have children later in life than their mothers did.  Without obligations of children and family there is greater opportunity for, and fewer drawbacks to, drinking.  

This new pattern  - which is likely mimicked across multiple nations - can have important implications for breast cancer for the reasons discussed above related to breast development.  Not only are women drinking more, they're doing so during the key period in breast development between first having a period and having a first child.   

Finding effective ways to help adolescents and college-aged women understand these risks and avoid alcohol - or at a minimum avoid excessive amounts of alcohol - will be a challenge for health professionals moving forward.  

Another paper released in the journal Nature this week could eventually help with this (related NPR story).  Researchers looked at various characteristics of 700 European 14 year olds - from family history, to personality traits, to brain anatomy - to see if any patterns emerged that predicted drinking at age 16.  They found that life experiences, personality, and certain aspects of brain anatomy could predict with decent accuracy who would go on to become problem drinkers.  While using such an algorithm is a long way off from practical application, it does show that it may be possible in the future to identify in the health care setting which youth may be more likely to put their health at risk with early life drinking.  Interventions could then be better targeted and would hopefully be more effective at curbing youth drinking.

Despite the depictions in magazine, TV, and website ads, drinking is a major minefield for adolescents and young adults.  There's the very immediate dangers of car crashes, injuries, and unsafe sex, and the longer-term dangers of alcoholism, cancer, and other chronic diseases.  Forming effective channels to reach out to youth with such messages needs to be a continued priority for public health.

Friday, June 27, 2014

Time on the Side: New Analysis Finds That to Eat Less - Eat Slower

Photo: Flickr/thomashawk

It probably comes as no surprise, but mom was right: We really shouldn't eat so fast.

Apart from the noise and the mess and the ill-effects on dinner table conversation, wolfing down food may have ill-effects on health as well.

A detailed new analysis in the American Journal of Clinical Nutrition shows that taking your time when you eat can substantially cut down on how much you eat.  And in today's world, where at least two thirds of the nation struggles with weight, this can have important implications.

The researchers performing the analysis combined the results from 22 separate studies looking at speed of eating and the amount of food eaten.  What they found was that those who ate their food slower ate less overall than those who ate their food faster, and apparently without feeling deprived.  Eating speed - fast or slow - had no effect on feelings of hunger, either right after a meal or three and half hours later.

We live in a society that often works against us when it comes to choosing healthy food and getting physical activity.  This can make it tough to lose weight, or even stay at the same weight. Yet, there are some simple steps we've promoted for a long time that can help with cutting back on calories and burning more calories through exercise.  Eating more slowly is one of these.  It may take some re-training of eating habits but in the end, its a pretty simple step  - just sit back, enjoy your food, and let time do the hard work.  In the end, we're likely to have eaten less - and to feel just as satisfied.

Try this and other tips to help keep weight in check: 

Choose smaller portions, and eat more slowly.  At the most basic level, eating slowly gives our stomachs time to tell our brain when we’ve had enough food.  As competitors at the Nathan’s Hot Dog eating contest will tell you, it takes about 8 minutes or so for the brain to register when the stomach’s full.  If you eat too quickly, you can down a plate of food, grab more, and then down that before your brain knows what hit it.  By then, you may have had twice as much food as you needed or even really wanted.  So why not slow down and enjoy your food.  You won’t even miss the extra food you’re not eating and that you didn’t even really want.

Fit physical activity and movement into your life each day.  Regular activity is one of the best ways to keep weight in check.  Choose things you enjoy that get you moving and shoot for at least 30 minutes a day.  And studies show that 60 minutes or more is even better for weight loss. 

Limit time in front of the TV and computer.  Screen time – the phrase given to time spent with our TVs, computers, phones, and tablets – is a double whammy when it comes to weight and health. Not only does it up the amount of time we spend each day in complete inactivity, but it also makes it more likely that we’ll overeat (especially unhealthy foods) while we’re sitting in front of those screens.  Shoot for under two hours of non-work screen time each day.  Less is even better.  Zero is ideal.  

Eat a diet rich in fruits, vegetables, and whole grains.  Eating a lot of plant-based foods can help keep appetite and weight in check.  Not only are they very filling but they also keep at bay wild swings in blood sugar that make you want to eat – even if you’ve just had a big meal.  Shoot for at least 3 servings of whole grains a day, 5 serving of fruits and vegetables, and keep red meat to a minimum.

Wednesday, June 25, 2014

New Study: Tanning Bed Use Brings Skin Cancer Risks - and Brings Them Early

Photo: Flickr/whatshername
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 medical journal Pediatrics, the study compared the history of indoor tanning in a group of 25 - 50 years old participants, 657 who'd been diagnosed with a type of skin cancer called basal cell carcinoma and 452 who did not have cancer.

The researchers found that any indoor tanning was linked to a 60 percent increased risk of early-onset basal cell carcinoma, and all types of tanning devices carried risks, from tanning lamps to tanning booths to tanning beds, which carried the most harm - doubling the risk of cancer. Beginning tanning before age 20 was linked to greater risk than tanning starting later in life. And cancer risk increased 10 percent for each year under the age of 24 that participants first indoor tanned.

These results are part of a disturbing trend in the United States - both in the popularity of indoor tanning by youth and in growing rates of skin cancer. And although basal cell carcinoma is not as serious a skin cancer as the much more deadly melanoma, it is not to be taken lightly. If not treated early, basal cell carcinoma can result in significant scars and other cosmetic damage. If it returns after initial treatment, it can be more complicated to treat.

Melanoma skin cancer is the most deadly type of the disease, and is also tightly linked with indoor tanning. A 2012 analysis of over 25 studies found that having ever used a tanning bed raised the risk of melanoma by 20 percent compared to those who had never used a tanning bed. Use in early life boosted risk even more. Using a tanning bed before age 35 raised the risk of melanoma nearly 90 percent.

Rates of melanoma have been rising steadily over the past 30 years. And a recent analysis found that indoor tanning use has also been increasing and is responsible for over 400,000 cases of skin cancer each year in the United States.

Despite such troubling numbers, full scale regulation of the tanning industry is slow to catch on. While there have been positive moves by state governments in recent years, it still still too easy for minors to access indoor tanning facilities. A 2014 analysis of 2012 data found that numerous states had no regulations in place at all that restricted youth access and many others had lax enforcement of regulations.

The dangers of indoor tanning, though, is a subject that is finally beginning to gain traction, moving states that once had no regulations to finally get some in the books. In June, for example, Missouri put into place legislation requiring minors to have parental consent to indoor tan. Though such a move is short of the outright ban on minors tanning supported by the American Academy of Dermatology, it is a move in the right direction and, along with similar legislation in other states, should help garner further support for indoor tanning protections across the nation.

More and more evidence is showing that youth and young adulthood are key times in determining cancer risk in later adulthood. We need to do everything we can to help our children, grandchildren, nieces, and nephews be as healthy as they can throughout life. This means helping them to eat well, to be active, to not smoke, to protect themselves from the sun, and to avoid indoor tanning.

Monday, June 23, 2014

Data Show More Support Warranted for Worksite Wellness Programs

Photo: Flickr/abraj
This week I had the privilege of addressing the American Cancer Society CEOs Against Cancer at their annual meeting that this year was held at Washington University in St. Louis. As a member of the panel addressing worksite wellness, I was able to briefly summarize the strong evidence that worksite wellness programs can generate substantial savings. For example, in a critical meta-analysis of the literature on costs and savings associated with workplace disease prevention and wellness programs, Baicker, Cutler and Song (2009), show that medical costs fall by about $3.27 for every dollar spent on wellness programs. In addition, absenteeism costs fall by about $2.73 for every dollar spent.

Others have summarized the evidence on worksite physical activity and nutrition programs. A systematic review and meta-analysis of 18 programs shows that physical activity and nutrition programs are effective in reducing body weight when compared to usual care (van Dongen et al., 2012).

Even more impressive are the benefits of smoking cessation. Halpern and colleagues (2007) show savings in terms of reduced healthcare costs. The savings per smoker range from $350-$582 at 10 years, with internal rate of return ranging from 39% to 60% at 10 years. In addition, as noted in the 50th anniversary Surgeon General’s Report on Smoking and Health (2014) after stopping smoking, former smokers experience an increase in their quality of life. Never smokers have the lowest health care costs in the age range of 45 to 64. Smokers have a loss of productivity in the workplace through absenteeism and also incur more hospitalization and medical charges as a result of outpatient visits. It is the sum of these benefits of quitting smoking, over several years, that drives the benefits of worksite wellness.

A rigorous evaluation by investigators at RAND evaluating a worksite wellness program that included prevention services as well as navigation and support for those with chronic conditions also shows substantial savings (Liu et al 2013). Disease management interventions reduce costs per employee per month significantly. The prevention interventions also substantially reduced costs. While such a program has expenses in the first year, savings are visible in 3 to 5 years after implementing a worksite wellness program.

In sum, worksite wellness programs save employers in terms of health care costs and increase productivity of the workforce. It is hard to see why we don’t have even more support for these programs across all workplaces.

Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff. 2010;29:304-311.

DeVol R, Bedroussian A. An Unhealthy America: The Economic Burden of Chronic Disease. Santa Monica, CA: Milken Institute. 2007. 

Halpern, MT, Dirani, R, and Schmier, JK. Impacts of a Smoking Cessation Benefit Among Employed Populations. J Occup Environ Med. 2007;49:11–21. 

Liu, H, et al. Effect of an Employer-Sponsored Health and Wellness Program on Medical Cost and Utilization. Population Health Management. 2013;16:1–6.

U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014. 

van Dongen, JM, et al. A systematic review of the cost-effectiveness of worksite physical activity and/or nutrition programs. Scand J Work Environ Health, 2012. 38:393-408.

Wednesday, June 18, 2014

The Ongoing Challenge to Secure Resources for Cancer Prevention

The ongoing challenge of garnering appropriate resources and recognition for cancer prevention was highlighted yet again by a recently released paper in the Journal of Cancer Policy titled Cancer economics, policy and politics: What informs the debate? Perspectives from the EU, Canada and US.

The overall goal of this paper was to assess the factors that are informing and influencing the political debate on cancer economics in the United States, Canada, and Europe.  That the analysis focuses on cancer diagnosis and treatment isn't surprising.  What is surprising, however, is that a paper on the economics of the burden of cancer and cancer care almost completely ignores prevention.

If there is one thing that has become clear over the past decade it is that cancer is a problem we will not be able to treat our way out of.  With the aging population, prevalence of the disease is increasing so much, and the disease itself is simply so diverse, that therapies are very unlikely to have a major impact on cancer burden population-wide in the foreseeable future.

We know enough today, however, to prevent at least half of all cancer cases.  Yet, the word "prevention" appears exactly once in this paper, and the concept of prevention appears only in passing in a handful of places throughout.

Of course, this single paper isn't responsible for cancer prevention not receiving its due attention.  It is, however, an example of many cancer-related policy papers that don't fully acknowledge the potential of prevention in reducing population-wide cancer burden.

As CNiC's Graham Colditz stated in his recent paper: Carpe Diem: Time to Seize the Opportunity for Cancer Prevention:
"What is currently lacking is the political will to allocate resources, prioritize incentives and rewards, and implement regulations that reinforce behaviors that will prevent cancer. Given that we know today that 50% or more of cancer is preventable, gathering political support for prevention should be our highest priority. One likely reason for its current limited support is simply the nature of prevention. Its success is marked by silent victories. Those who do not get cancer do not have compelling stories of survival that often accompany cancer treatment. And the understated approach of prevention—putting into practice the knowledge we already have—does not garner the same political and research excitement associated with newer technologies and the hunt for undiscovered and unproven cancer risk factors. 
Of course, research across the full spectrum of cancer is essential and needs to continue. Cancer prevention, however, must be funded in proportion to its potential effect. If we do not act, with the aging United States population, the number of new cancer cases diagnosed annually will double within 35 years."
To make true headway against the burden of cancer - especially in the face of economic realities - it's time for such a vision for prevention to become reality.