Thursday, October 29, 2015

Practical Steps to Prevent Breast Cancer: Day 9 - If High Risk: Consider Risk-Reducing Medications

It's the final day in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
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If High Risk: Consider Risk-Reducing Medications
Although not commonly thought of as a “healthy behavior,” taking prescription risk-reducing medications – such as, tamoxifen, raloxifene, and possibly exemestane – can significantly lower the risk of breast cancer in women at high risk of the disease. They can also have important side effects, so they aren’t right for everyone.

“High risk” is specifically defined as a woman with a five-year risk of breast cancer of 1.67 percent or higher, typically calculated by the National Cancer Institute’s Breast Cancer Risk Assessment Tool. If you think you’re at high risk, either after estimating your risk or for some other reason, it’s important to talk to a doctor. Together, you can decide if risk-reducing medication or other steps to lower or manage your risk may be right for you.

Tips and Tricks – Tamoxifen and Raloxifine

Talk to a doctor about your risk and your options. Many women who feel they’re at high risk are likely not. And some who feel they aren’t, likely are. So it’s important to talk to a doctor or other qualified health professional about your risk of breast cancer. If you are at high risk, together you can talk about your options for managing that risk and decide which option is likely best for you.

Review the possible benefits and risks of risk-reducing medication. For many high-risk women, tamoxifen, raloxifene, and possibly exemestane are good choices for managing their risk. Though each does have potential side effects, these can be dramatically offset by their ability to cut the risk of breast cancer in half. Talk to a doctor about how these might balance out for you. A huge percentage of women in the United States who stand to benefit greatly from risk-reducing medications choose not to take them – and not always for accurate reasons (more).

Next Steps – Tamoxifen and Raloxifene

American Cancer Society

National Cancer Institute

Your Disease Risk

Wednesday, October 28, 2015

Practical Steps to Prevent Breast Cancer: Day 8 - Find Out Your Family History

It's day eight in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
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Day 8 - Find Out Your Family History

Women with a strong family history of breast cancer can take special steps to protect themselves, so it’s important for women to know their family history of breast and other cancers. You may be at high risk of breast cancer if you have a mother or sister who developed breast or ovarian cancer (especially at an early age) or if you have multiple family members (including males) who developed breast, ovarian and/or prostate cancer. A doctor or genetic counselor can help you understand your family history of the disease.  A doctor is also the best source of information on ways to lower or manage your breast cancer risk.

Tips and Tricks – Family History

Learn your family history. Most women will have a general idea of their family history of breast cancer, but it’s a good idea to spend a little time to get a more detailed idea of your cancer history, especially if it’s pretty clear that breast or other cancers run in your family.  A doctor or genetic counselor can help.

Keep things in perspective. Most women with a family history of breast cancer are not at high risk of the disease. In most instances, family history behaves on par with many other breast cancer risk factors. Of course, women with a very strong family history (multiple family members with cancer or inherited BRCA1 or BRCA2 mutations) have a very strong risk of breast cancer. But even these situations don’t guarantee a woman will develop the disease.

Next Steps – Family History

Looking for more in-depth information on family history? Here are some good sources:

US Surgeon General

Centers for Disease Control and Prevention

Tuesday, October 27, 2015

Practical Steps to Prevent Breast Cancer: Day 7 - Avoid Postmenopausal Hormones

It's day seven in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
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Day 7 - Avoid Postmenopausal Hormones

The issue still comes up in the news, and study results still get parsed and discussed, but in the end, the basic conclusion about postmenopausal hormones and breast cancer remains the same: While postmenopausal hormones can effectively treat moderate to severe symptoms of menopause, when it comes to breast cancer, it’s best to avoid them long term.

If women choose to take postmenopausal hormones to relieve menopausal symptoms (like night sweats, hot flashes, and vaginal dryness), it should be for the shortest period of time possible – not more than 1 – 3 years. And they shouldn’t be taken long term with the intent of lowering the risk of chronic diseases like heart disease or osteoporosis.

The best person to talk to about the risks and benefits of postmenopausal hormones is your doctor.

Tips and Tricks – Postmenopausal hormones

Try to deal with menopausal symptoms without postmenopausal hormones. Menopausal symptoms are no fun – to put it mildly. And finding relief from them is key. It’s best, though, to look past postmenopausal hormones and try to find relief in other ways. Physical activity, for example, can help with mood swings, troubled sleep, and forgetfulness. Identifying triggers (and then avoiding them) can help deal with hot flashes, as can some non-hormonal medications. Over-the-counter lubricants can help with vaginal dryness. At a certain point, symptoms may be so bad that it makes sense to consider postmenopausal hormones. Talk to your doctor about the best approach.

Next Steps – Postmenopausal hormones

Looking for more in-depth information on postmenopausal hormones? Here is a good source:

Monday, October 26, 2015

Practical Steps to Prevent Breast Cancer: Day 6 - Avoid Birth Control Pills - Particularly After Age 35 or If You Smoke

It's day six in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
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Day 6 - Avoid Birth Control Pills - Particularly After Age 35 or If You Smoke

There’s no denying that birth control pills have been a fantastic innovation – empowering women by putting them in charge of their own reproductive planning. But, like any medication, no matter how great the benefits, there are some risks that go along with them. For standard birth control pills, the most notable side effects are an increased risk of breast cancer, as well as of stroke and heart attack, particularly if a woman smokes and is over age 35. The good news is that the increase in breast cancer risk is temporary; about 10 years after stopping, risk drops to near that of a woman who has never taken the pill.

Because most women who take birth control pills are young and healthy, the risks linked to their use are usually outweighed in most women’s minds by the benefits – which in addition to preventing unwanted pregnancy also include a lower risk of ovarian, uterine, and colon cancer.

For a small group of women, though, who may be at high risk of breast cancer or simply concerned about breast cancer, avoiding birth control pills is one option to lower risk. The best source of information about the risks and benefits of birth control pills is a health care provider.

Tips and Tricks – Birth Control Pills

Don’t worry too much. For most women, the risks of birth control pills are outweighed by their benefits. Talk to a health care provider to find out how birth control pills may impact your health.

Next Steps – Birth Control Pills

Looking for more in-depth information on birth control pills? Here are some good sources:

National Cancer Institute

Susan G. Komen

American Congress of Obstetricians and Gynecologists

Planned Parenthood

Sunday, October 25, 2015

Practical Steps to Prevent Breast Cancer: Day 5 - Breastfeed, If Possible

It's day five in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
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Day 5 - Breastfeed, If Possible

Breastfeeding for a total of one year or more (combined for all children) lowers the risk of breast cancer. It also has great health benefits for the child. Unfortunately, as natural a thing as breastfeeding is, it doesn’t always naturally fit into today’s modern society. While things are certainly better than they were -- with more understanding workplaces and day care providers -- moms still often need to work hard to make it work.

Tips and Tricks – Breastfeeding

Start early and ask for help. Breastfeeding has the best chance of success when it’s started early, and this usually means beginning an hour or less after the baby is born. Many hospitals help mothers initiate breastfeeding, but it’s also best to let the delivery nurses know your desire to breastfeed your baby. If you have questions, ask. If you have problems, ask. Many hospitals offer great support for new moms who want to breastfeed – not only in the hours after birth, but the days, weeks, and months after as well.

Don’t be shy. Even though there are still a few vocal opponents to breastfeeding in public, put them at the back your mind, and charge forward and breastfeed when and where you need to. Job interviews and work meetings may not be the best venues to do so, but most other places are just fine.

Coordinate with your workplace and day care provider. Going back to work is just a fact of life for most new moms, and balancing work and breastfeeding can be a real challenge. A large percentage of new moms are interested in breastfeeding their children, and employers and day cares have taken note, offering much better resources than they used to. If you’re unsure about the resources available to you, ask. The human resources office is a good place to start.

Next Steps – Breastfeeding

Looking for more in-depth information on breastfeeding? Here are some good sources:

La Leche League

United States Department of Labor

National Conference of State Legislatures

Saturday, October 24, 2015

Practical Steps to Prevent Breast Cancer: Day 4 - Don’t Smoke, and Avoid Other People’s Smoke, Too

It's day four in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days  
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Day 4 - Don’t Smoke, and Avoid Other People’s Smoke, Too

This really goes without saying: Don’t smoke, and avoid other people’s smoke, too. 

Smokers and non-smokers alike know how bad smoking (and secondhand smoke) is to their health. On top of lowering quality of life and increasing the risk of heart disease, stroke, and at least 15 cancers – including breast cancer – it also causes smelly breath, bad teeth, and wrinkles. Now that’s motivation to stay smoke-free or quickly get smoke-free. 

Though electronic cigarettes can seem like safe alternatives to standard cigarettes, so much is unknown about their risks and benefits that it’s important to avoid them as well. For help quitting smoking, there are many FDA-approved nicotine-replacement options that have been shown to be safe and to double chances of success.

Tips and Tricks – Smoking

It’s hard to quit, so keep trying. If there’s one thing we all know about quitting smoking, it’s that it’s hard. It takes most people six or seven tries before they quit for good. So, if at first you don’t succeed, try try again. Don’t give up. Over a thousand Americans successfully quit smoking every day.

Talk to a health-care provider. Seeing a doctor or other health care professional may not be the first thing you think of when thinking about ways to quit smoking, but they can be fabulous sources of information and cessation aids that can help you kick the habit. Studies show that seeing a doctor for help quitting can double your chances of success.

Visit Whether you are just thinking about quitting, want help quitting, or are looking for information about quitting for a friend of family member, the federal website is the place for you. They also host the innovative text message cessation program, smokefreetxt, and sites focused on specific groups: smokefreeVET. smokefreewomen, smokefreeteen, and the Spanish-language smokefreeespanol.

Call 1-800-QUIT-NOW. Similar to the federal, 1-800-QUIT-NOW (1-800-784-8669) will connect you to cessation information and resources in your state.

Talk to your kids about smoking. If you have kids – or grandkids or nieces and nephews – it’s important to with talk them from a young age about the dangers of tobacco and the need to stay away from cigarettes and other tobacco products.

Next Steps – Smoking

Looking for more in-depth information on smoking? Here are some good sources:

American Cancer Society

The Truth Campaign

Friday, October 23, 2015

Practical Steps to Prevent Breast Cancer: Day 3 - Avoid Too Much Alcohol

It's day three in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
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Day 3 - Avoid Too Much Alcohol

Alcohol can be good for the heart, but when it comes to cancer, there is, unfortunately, nothing really good about it. Even modest amounts increase the risk of breast cancer. In general, if you drink moderately (no more than one drink a day for women) the overall health benefits of drinking outweigh the risks. But if you’re particularly concerned about breast cancer, you may want to choose not to drink.

Tips and Tricks - Alcohol

Choose non-alcoholic beverages at meals and parties. If you’re trying to cut back on alcohol, meals and parties can be tough occasions since so many of them center around alcohol. Yet, more than ever, there are good non-alcohol choices. And if you want to be sure to have a non-alcoholic choice that you like, don’t be afraid to bring it along with you.

Avoid occasions centered around alcohol. There’s no reason to avoid alcohol completely, but if you’re trying to cut back to a healthier level and having trouble keeping to the new program, it can be good to avoid occasions or establishments centered around alcohol. Unfortunately, this can mean your favorite watering hole or restaurant, but just keep in mind your bigger goal and maybe you’ll miss it a bit less.

Talk to a health care professional if you feel you have a problem with alcohol. Alcoholism and problem drinking are major problems in the United States. By some estimates, close to 20 percent of the population have abused alcohol at some point in their lives 46. If you feel you have a problem with alcohol – or want to cut back drinking but can’t – talk to a health care provider. They can help.

Discuss the risk and dangers of alcohol use with your children. It’s almost never too early to begin an age-appropriate healthy dialogue with your kids and grandkids about drugs and alcohol use. A health care professional or school counselor can help. For breast cancer, this discussion can be particularly important since alcohol intake in youth and young adulthood can have an important influence on breast cancer risk later in life.

Next Steps – Alcohol

Looking for more in-depth information on alcohol? Here are some good sources:

Centers for Disease Control

National Library of Medicine

Thursday, October 22, 2015

Practical Steps to Prevent Breast Cancer: Day 2 - Be Physically Active

It's day two in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.  
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Day 2 - Be Physically Active

Exercise is as close to a silver bullet for overall good health as there is, and those benefits certainly extend to breast cancer. Women who are physically active for at least 30 minutes a day have a significantly lower risk of the disease than those who don’t. Regular exercise is also one of the best ways to help keep weight in check.

Tips and Tricks – Physical Activity

Choose activities you enjoy. When thinking about physical activity, it’s easy to conjure up unpleasant images: pained faces at the end of a marathon or grunting athletes at the gym. It’s no wonder exercise gets a bad rap. But, in reality, exercise can be really enjoyable. It’s just a matter of picking the right activity. Whatever gets you moving at a hard enough effort, counts towards your 30 minutes a day. The talk test is the best way to know if you’re going hard enough. If you can talk while you’re exercising, but can’t sing, that’s perfect. And there are a lot of activities that can put you right in that sweet spot - walking, cycling, dancing, playing tennis, even certain types of gardening and housework.

Make exercise a habit. There are good habits and bad habits. And if you’re like most folks, you have a mix of both. One thing that all types of habits share, though, is power. No matter how busy we get, or how crazy life is, we can almost always fit in our habits day in and day out. Making an effort to turn exercise into a habit can be a powerful tool in the fight against breast cancer and other serious diseases. So how do you do that? The best way is through consistency. Try going to the gym each day at lunchtime or taking a walk regularly after dinner. You may not always feel like doing it, but by doing it nevertheless, it’ll become ingrained into your day. Before you know it, a day won’t feel normal if you didn’t get in your walk, run, or trip to the gym.

Stay motivated by exercising with someone. Friends, family, and workout partners keep you honest. So one of the best ways to make sure you fit in your regular physical activity is to have a standing date to work out together a few days each week. It can be a lunchtime walk, a spin class, or a ballroom dancing class. The most important thing is to set the date and keep it. If you don’t, you’re likely to hear about it.

Get a pedometer and shoot for 10,000 steps each day. If you’re looking for a great way to stay motivated, it’s hard to go wrong with setting a goal of getting 10,000 steps each day. This has become a standard for a healthy activity level and includes all the steps you take – at work, at home, at the park, at the grocery store. To get started, all you need to do is buy an inexpensive pedometer (good ones start at $10), put it on at the beginning of each day, and keep moving until is ticks over 10,000. You’ll be surprised how that simple little plastic pedometer can keep you on track with your exercise goals.

Do healthy activities with your kids. Life with little kids can be exhausting and leave very little time for regular exercise. One of the best ways around this is to do healthy, activities with your kids. Whether it’s riding bikes together, going for a run with them in the jog stroller, or just playing tag at the park – the important thing is that you get your exercise, and the kids do, too. Together, you build a fantastic family habit of activity and exercise.

Next Steps – Physical Activity

Looking for more in-depth information on physical activity? Here are some good sources:

National Heart, Lung, and Blood Institute

Wednesday, October 21, 2015

9 Days of Practical Steps to Prevent Breast Cancer: Day 1 - Keep Weight in Check

We know. You've been awash in pink for the past three weeks.  So you're forgiven if you're a bit tired of reading about breast cancer and Breast Cancer Awareness Month.  But, we at Cancer News in Context hope to help you work past any late October doldrums by closing the month out with an engaging series that emphasizes the very positive message that breast cancer is preventable -- and with pretty simple behaviors.

For the next nine days, we'll highlight key steps and practical tips that can help women lower their risk of the disease.   It may be hard to believe, but evidence shows that half or more of all breast cancers could be avoided by things like exercising, keeping weight in check, and avoiding too much alcohol.  

This series will be your practical guide to putting these behaviors into practice and boosting your overall breast health.  So, let's get started. 

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Day 1 - Keep Weight in Check

OK. This message is easy to tune out because it gets said so often, but maintaining a healthy weight is a great goal for everyone. Two-thirds of all women in the United States are either overweight or obese. And excess weight is a key contributor not only to breast cancer risk but also to the risk of heart disease, stroke, and diabetes.

So, what should be your weight goal? The first goal should always be to maintain your weight – to keep it steady. Weight gain can be sneaky. It creeps up on most people. One pound here, another pound there. Then you step on the scale and suddenly realize you’ve put on 20 pounds over the past 10 years. This happens to a lot of people, so the best thing you can do is try to keep from gaining weight. This applies pretty much to all women, no matter what their current weight.

If you’re overweight, the next goal is to try to lose weight. Losing just 5 – 10 pounds and keeping it off can significantly lower the risk of breast cancer, and it’s a very realistic goal. Ideally, the next goal is bringing your weight down to a BMI between 18.5 – 23 (BMI calculator). For a woman who is 5’ 5”, that’s a weight between 111 – 138 pounds.

Losing weight isn’t always easy, but it’s far from impossible, and some practical tips can really help you succeed.

Tips and Tricks - Weight

Be physically active every 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. 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. On to top of this, there’s growing evidence that plant-based food can help lower breast cancer risk, outside of their influence on weight. Shoot for at least three servings of whole grains a day, five servings of fruits and vegetables, and keep red meat to a minimum.

Choose smaller portions, and eat more slowly. It can seem unlikely that eating food slowly and choosing smaller portions can help people eat less, but there are actually data to back this up. At the most basic level, eating slowly gives our stomachs time to tell our brain when we’ve had enough food. As competitive hot dog eaters will tell you, it takes about 10 - 20 minutes 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.

Choose water and keep sugary drinks to a minimum. Sugary drinks – like, sodas and energy drinks – can sure taste good, but they really do nothing good for you. They have little or no nutritional value, are packed with calories, and have been shown to increase the risk of obesity and weight gain. The best choice is to avoid sugary drinks completely and choose water instead. It can be a tough transition, but you don’t need to do it all at once. Each week, slowly cut back on sodas and energy drinks, and before you know it, you’ll be down to zero and likely not missing them at all. Keeping a water bottle handy wherever you go can really help. And be sure to keep 100 percent fruit juice in check as well. Though it’s healthier than sugary sodas, 100 percent juice is still packed with calories. Whole fruit is always a better choice. If you do drink 100 percent fruit juice, keep it to just 4 – 6 ounces a day.

Step on the scale every day. Yes. Every day. It may sound like a nightmare – confronting those pounds every morning – but research shows that your bathroom scale can be a great tool when it comes to losing weight and keeping it off. Weighing yourself regularly helps you avoid being surprised by creeping annual weight gain and can help you make necessary adjustments to stay on track to losing or maintaining weight. Perhaps surprisingly, weighing yourself every day can also let you know if you’re losing weight too quickly. Healthy weight loss is around a pound or two a week. Losing weight quicker than this – while initially exciting – can make it harder to keep weight off over time.

Find people who support you. You may be a rugged individual with a deep streak of independence, but when it comes to losing weight and keeping it off there’s some pretty good evidence that you may just want to surround yourself with people who support your efforts. It can be family, friends, or a weight loss discussion group, but the key is to find people who can not only provide practical support for weight loss – with recipes and other tips – but also emotional support and encouragement that help keep you on track and heading toward your goals. Many hospitals, medical centers, and recreation departments host weight loss support groups. Some commercial weight loss programs – like Weight Watchers – also have programs with support components. Online options exist as well.

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Mindful weight loss

Stop. Read this. Now read this slowly. S l o w l y. Now take a slow deep breath in and count “one.” Take a slow breath out and count “two.” Now repeat this three times. S l o w l y.

You’ve just had a mindful moment. It’s a real rarity in today’s busy, smartphone-obsessed world. And that’s a problem according to some health experts, because there’s growing evidence that adding more mindful moments to our lives may be good for overall health by helping us eat better and keep our weight in check.

While mindfulness may sound somewhat mystical, it’s really just the practice of slowing down, turning off as many distractions as possible, and focusing on the thing that is happening in front of us right at that moment. By doing this we’re able to more deeply appreciate each experience in our lives and to be more in tune with both our mind and body.

Applying mindfulness to the way we eat can have many benefits. It can put us in better touch with our hunger cues, so we’re better able to realize when we’re actually hungry. It can help us know during a meal when it’s time to put the fork down because we’ve had enough. And it can even allow us to better appreciate healthy foods by focusing on the benefits they provide us.

Overall, mindfulness has a lot of potential to help people make better food and eating choices. And it’s really quite easy to get started. Begin with the mindful eating tips below. If these spur you on, and you’re interested in exploring things more in-depth, there are a number of mindful eating books by reputable doctors and researchers.

  • When you eat, just eat. Whether you’re eating alone or sitting down as a family, make sure all other distractions are limited. Turn off the television. Turn off the radio. Turn off the iPod. And definitely, get out of the car. This helps you to focus on the food and your experience of eating it. You’ll find you appreciate your food more and may actually feel like eating less of it.
  • Take a moment. When you sit down to a meal – wherever you are – take some time to just be silent before you start eating. You don’t need to do anything. You don’t need to think anything. All you need to do is sit quietly. Whether it’s for five seconds or 60 seconds, taking that little bit of time can be a great way to rest your mind and focus on the food you’re about to enjoy.
  • Eat slowly. Meals are meant to be savored – not rushed through. So slow down and enjoy your food; give your mind the chance to tell your stomach when it’s had enough.
  • Choose smaller portions. Part of being mindful is appreciating what’s in front of us. When we do this with our food, you may find that you get as much satisfaction from a plate of smaller portions than a plate (or two) of larger portions.
  • Appreciate water. There’s little in life that is more simple and straightforward than a glass of water. Take a long look at your next glass full and really appreciate it – what it looks like, what it tastes like, even what it feels like. It’s the healthiest thing you can drink and should be your main beverage choice every day. 

Next Steps - Weight

Looking for more in-depth information on weight? Here are some good sources:

National Heart, Lung, and Blood Institute

The Nutrition Source

Choose My Plate

Centers for Disease Control

Obesity Prevention Source

Monday, October 19, 2015

Room for Improvement: Most Breast Cancer Risk Sites Fall Short in Readability

by Katy Henke

Breast cancer is one of the most well known cancers as well as the leading cause of cancer death in women worldwide (1). In an effort to educate and prevent future breast cancer cases and deaths, online health assessment tools have been created to help women understand their risk for developing breast cancer as well as learn how to reduce or manage their risk. These tools allow individuals to input their own health history and family health history into a calculator that then estimates the risk for developing breast cancer.

A recent publication by faculty members at Washington University School of Medicine highlights that many online tools may not be understandable for all users. In the study, 42 online assessment tools were analyzed using specific suitability and readability criteria, and only 21 percent of websites received a superior rating. In rating the tools, the study looked at website content, writing style, context, layout, subheadings and model behavior. Additionally, all websites were rated based on their readability. Overall, the sites had an average of a 12th grade reading level. The recommended reading level for patient-directed health information is 5th or 6th grade (2).

With these findings, the authors recommended future online assessment tools take into account the broader audience who may be utilizing the online health tools. Over a third of the United States population has limited health literacy (3). And these numbers can vary greatly by income, education, and race/ethnicity. Taking steps to improve the readability and usability of online breast health assessment sites would mean that a broader audience would have the possibility of benefitting from their important messages.

What can be done to improve these assessment tools? The study concluded each tool should feature an overview of the assessment tool and explain its purpose to users, what the user’s cancer risk is, and what the user can do to reduce it. Each online assessment tool should also be written at a 5th grade reading level. This would allow the majority of United States population to understand the content. Additionally, vocabulary should include common words, shorter sentences, and words with fewer syllables. The authors also suggested illustrations and graphics that are friendly and inviting when portraying relevant health information.

To help improve risk communication and reduce the health literacy barrier, breast cancer assessment tools can be reformatted in a more user friendly way. Ideally this will help individuals understand their own breast cancer risk as well as ways to reduce and prevent breast cancer.

For a list of assessment tools rated as “superior,” see table below.

From Table 1; Cortez et al, 2015

  1. Center for Disease Control and Prevention. Breast Cancer Statistics. 2015 Aug 20. 
  2. Friedman D.B., & Hoffman Goetz L. 2006 Jun. A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Education and Behavior. 33(3): 352-373. DOI: 10.1177/1090198105277329.
  3. The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. 2006 Sep. U.S. Department of Education. National Center for Education Statistics, Washington, D.C.

Monday, October 12, 2015

Progress on Vaccine to Prevent Stomach Cancer

When it comes to news stories about infections and cancer, HPV (human papillomavirus) has dominated the headlines the past few years.  For the most part, this has been great. HPV causes nearly all cases of cervical cancer and increases the risk of multiple other cancers.  And there is an effective vaccine to protect against HPV, use of which has been slowly but steadily increasing in the United States.

Outside of HPV, though, there are many other important infections that can increase the risk of certain cancers. One of these in an infection with a bacterium called Helicobacter pylori - or H pylori for short - which is a main cause of stomach cancer.  Stomach cancer is the 15th most common cancer in the United States, but it is the 5th most common cancer globally and the 3rd leading cause of cancer death.

H pylori infections are actually quite common, generally occur early in life, and can persist lifelong.  And while the link between H pylori and cancer has been known for decades, development of an effective vaccine has been elusive.

A new study published in The Lancet last week, though, shows we may finally be making solid progress on that front.  The study, done in China with approximately 4,500 children ages 6 - 15 years old, found that a 3-dose oral vaccine could reduce early life infections with H pylori by around 70 percent in the year after vaccination.

The results, of course, weren't perfect.  Although 70 percent effectiveness is very good compared to that found in previous H pylori vaccine studies, it's still not as high as many would prefer.  And the effectiveness appeared to wane with time - dropping to around 55 percent just two years after vaccination.  Still, for an infection so common and so closely linked to an important global cancer, these results show promise that someday in the not-to-distant future there may be an effective, easy-to-administer vaccine for H pylori that could help prevent stomach cancer.

Many questions remain, however, about the potential benefits and drawbacks of such a vaccine; this recent study, though, will hopefully help move us closer to getting some of the answers.

Thursday, October 8, 2015

The Importance of Shared Decision Making in Lung Cancer Screening

by Mary C Politi, PhD and Sydney Philpott

More people in the United States die from lung cancer than any other type of cancer. Patients and providers want and need ways to find lung cancer early when it is more easily treated. Recently, the Centers for Medicare and Medicaid Services (CMS) approved yearly lung cancer screening through low-dose CT (LDCT) scans as one possible way to find lung cancer early. Screening can save lives among people who are at high risk for developing lung cancer. However, the decision to get yearly lung cancer screening is not as clear-cut as it sounds.

CMS requires counseling through a process called shared decision making to help patients decide whether yearly lung cancer screening with LDCT is right for them. Shared decision making is a process through which patients and their providers make health care decisions together. It helps patients learn the scientific evidence about options, think about the pros and cons of options, and encourages them to consider what is important to them so they can make an informed, personal choice. Decision aids that present information in a balanced way can be used to add to conversations patients have with their providers about health choices.

To think about yearly lung cancer screening with LDCT, first patients need to learn whether they are eligible and likely to benefit from screening. Patients who are 55-80 years old and have a smoking history of 30 pack years or more (click here to calculate your smoking history in pack years) are eligible to be screened. Next, patients need to weigh the pros and cons of screening.

Screening through yearly LDCT can find lung cancer earlier than waiting until a patient has symptoms. But it can also find “false alarms,” or abnormalities that look concerning but might not be cancer. These false alarms could lead to unnecessary tests or biopsies. Several of us at Washington University and Siteman Cancer Center have developed a tool to help patients think about whether yearly lung cancer screening through LDCT is right for them.

If patients smoke, quitting smoking is a core part of the conversation about lung cancer screening. Quitting smoking lowers the risk of getting lung cancer and other diseases of the lungs, heart, blood, and brain. Smokers can get a free “quit plan” online or contact the Smoking Cessation Program at Washington University (314-362-7844) for help quitting.

Shared decision making is an important part of making medical decisions. Engaging in this process can help patients feel more informed and confident in their health choices. When thinking about lung cancer screening, requiring shared decision making helps patients and providers talk about screening in a collaborative way and truly puts patients’ values at the forefront of medical decisions.


"Lung Cancer Statistics." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Aug. 2015. Web. 7 Oct. 2015.

"What Is Shared Decision Making?" Informed Medical Decisions Foundation. Web. 7 Oct. 2015.