Cancer is the second leading cause of death in the United States. The risk of developing cancer rises dramatically with age. However, it can strike at any age. The exact pathways that cause cells to proliferate abnormally are still a subject of intense research. However, we have learned a tremendous amount about genetic and lifestyle factors that can contribute to cancer risk as well as ways to reduce our cancer risk.
Q: Roxanne, TX - I heard that being overweight can increase cancer risk. Is that true?
A: Dr. O'Neil - The answer is yes. More than half of Americans are considered overweight or obese. Several types of cancer have been shown to be associated with obesity. They include cancers of the breast in postmenopausal women, colon, kidney, and uterus.
Q: Sara, NJ - What causes cancer?
A: Dr. O'Neil - Normally the process that controls growth and development of cells is precisely regulated. There may be genetic (hereditary) or lifestyle factors (such as tobacco smoke, obesity, excessive sun exposure, viruses) that alter the cell. If the cell’s genetic material, called DNA, is damaged, the cell is more susceptible to the action of chemicals called “promoters” that can induce a tumor to form. Tumors can be benign such as fatty tumors called lipomas. Malignant tumors have the ability to invade other body tissues and to spread to other parts of the body.
Q: Jane, IL - what are ways to reduce our cancer risk?
A: Dr. O'Neil - Jane, I recommend measures that we have control over which includes diet, physical activity and healthy habits. I recommend a Mediterranean diet which is high in fruits and vegetable, fish and low in red meat. A regular physical activity program is important in order to keep weight under control. Don’t smoke and avoid exposure to second hand tobacco smoke. Excess alcohol is also considered a risk factor for cancer. Recent studies suggest that an adequate intake of vitamin D can reduce your risk for breast cancer. Also very important is to follow recommended screening practices for your age and gender.
Q: Jean, IL - What are the best sunscreen to use to prevent skin cancer?
A: Dr. O'Neil - The current recommendation is to use something with an SPF of 15 or greater.
Q: Judy, MA - How does one reduce the risk of breast cancer?
A: Dr. O'Neil - We can’t control genetics so if there is a strong family history appropriate screening and follow up is important. Close discussion with an expert in breast disease is important. However, we do know that certain lifestyle factors contribute to breast cancer risk. They can include prolonged estrogen use, high fat diet, excessive alcohol and age itself is a risk factor. Exposure to chest radiation can also be a risk factor. Women who did not have children and/or breast feed are at higher risk. Lack of physical activity is also a risk factor. There is no evidence that breast implants, bras and antiperspirants or even smoking increase breast cancer risk.
Q: Lindsay, IL - What foods should we eat every day to reduce our risk of cancer?
A: Dr. O'Neil - I recommend a Mediterranean-style diet not only to reduce cancer risk, but also to reduce the risk for heart disease, stroke, diabetes, and dementia. This diet is rich in fruits and vegetables, legumes such as beans and peas, whole grains, and fish. Red meat should be limited. Alcoholic beverages in moderation (one per day for women; two per day for men) may be consumed, but remember that as we get older, we are more likely to metabolize alcohol more slowly and there may be adverse reactions with prescription medications. Check with your doctor to determine what is right for you.
Q: Carol, OH - Do artificial sweeteners increase the risk of cancer?
A: Dr. O'Neil - No. Studies back in the 1970’s with rats suggested a higher risk of bladder cancer in those fed artificial sweeteners containing saccharin and cyclamate. However, no association with cancer has been found with artificial sweeteners in humans. Obesity, however, is a risk factor, so keep your weigh under control and continue to enjoy your artificial sweeteners.
Q: Judy, MA - How do you reduce your risk of ovarian cancer?
A: Dr. O'Neil - There are many theories about the causes of ovarian cancer. Some of what we know is based on things that modify the risk. Birth control pills, pregnancy, tubal ligation and hysterectomy lower the risk so it is thought that there may be a link between release of eggs and ovarian cancer risk. It is important to realize that having a risk factor does not mean you will get cancer. Some of the risk factors we know are age, obesity, and diet (especially high fat). Smoking and alcohol use have been found to increase the risk of one type of ovarian cancer.
Q: Mary, MA - If cancer runs in your family, what is your risk of getting it?
A: Dr. O'Neil - That is a great question Mary. We do know that family history plays a role in certain cancers such as breast, colon, ovaries, prostate and some forms of skin cancer such as melanoma. It is important to realize that family history does not mean you will get cancer. I recommend close monitoring by a physician and regular screening. Those with a family history may require closer monitoring and screening than is recommended for the general population.
Q: Leslie, ID - I heard there are drugs to prevent breast cancer. Can you tell me about that?
A: Dr. O'Neil - The Breast Cancer Prevention Project was funded by the National Cancer Institute which is part of the National Institutes of Health. A large number of women were studied over many years. The research showed that a drug called tamoxifen, which has been also used to treat breast cancer, can actually reduce the risk of breast cancer in women who are at higher risk for the disease (such as those with a positive family history). Tamoxifen was approved by the FDA for prevention of breast cancer in high-risk women in 1998. The results of another study called STAR (Study of Tamoxifen and Raloxifene) were published in 2006 and showed that tamoxifen and raloxifene (Evista) were equally effective in reducing breast cancer risk in high-risk women. In addition, there were fewer cases of uterine cancer and blood clots in women on raloxifene. In September 2007, the FDA approved raloxifene (which has been available since 1999 to treat osteoporosis) to reduce the risk in postmenopausal women at high risk for invasive breast cancer.
Q: Judy, MA - What is your risk of getting skin cancer if it runs in your family?
A: Dr. O'Neil - There is an increased risk if someone has a family history of melanoma. In addition those who have had family members with basal and squamous cell skin cancer should be extra cautious about sun exposure.
Q: Francis, MA - What is the cause of prostate cancer?
A: Dr. O'Neil - The underlying cause is unknown. It is felt to be a mixture of genetic and environmental factors. We know that prostate cancer is more common in African American men and in men with at brother or father who had prostate cancer. Lifestyle factors that increase risk are high fat diets, low intake of vegetable and conditions that lower our vitamin D levels such as lack of sun exposure. Protective factors include consumption of soy products, lycopene (found in cooked tomatoes), green tea and stress reduction.
Q: Sally, CA - Can calcium reduce cancer risk?
A: Calcium is important to bone health and is an essential nutrient. However, studies on the relationship of calcium intake to certain types of cancer have been inconsistent. Some research even suggests that a high calcium intake may increase the risk of prostate cancer. The National Cancer Institute does not recommend calcium supplements to reduce the risk of any type of cancer. However, your doctor may recommend a calcium supplement if you have osteoporosis or a low intake of calcium in your diet.
Q: Jessica, FL - Can cell phone use cause brain cancer?
A: Dr. O'Neil - We know that radiofrequency waves can heat brain tissue, but the radiofrequency energy emitted by cell phones is too low to cause significant heating of the tissue. So far, there is no consistent association between cell phone use and cancer. However, scientists feel that more research is needed before we can state categorically that there is no risk.
Q: Eric, WA - Is there any association of vasectomy with prostate cancer?
A: Dr. O'Neil - This has and is being studied. The association seems to be weak. Right now we can still recommend vasectomy to men as a method of birth control that is safe and carries minimal risk.
Q: Mary, MA - Do Pollops lead to cancer?
A: Dr. O'Neil - Polyps in yourself or a family member do confer an added risk. Most polyps are benign but some can become cancerous as they grow larger. People who have had polyps need regular colonoscopy follow up with a gastroenterologist. There are rare hereditary syndromes where numerous polyps are found in the colon. these syndromes are associated with a markedly increased colon cancer risk. Close monitoring by a gastroenterologist is essential.
Q: Cliff, IL - Is there a correlation between the drugs used with invetro fertilization and breast cancer?
A: Dr. O'Neil - There have been a number of studies on this but there has not been a strong association found between breast cancer and the use of fertility drugs. However it is recommended that women who have been on progesterone should be followed regularly.
Q: Sandy, FL - Why is cancer more common in older persons?
A: Dr. O'Neil - Research suggests that this is related to “senescence”—the aging of the immune system. The immune system is the body’s defense system against bacteria, viruses, and other invaders including cancer. The immune system normally recognizes these intruders as foreign and gets rid of them. With aging, the immune system is not as vigilant and may not be as effective at removing cancer cells. Many of the therapies directed at treating cancer are aimed at boosting the immune system. In the future, we may actually have vaccines that will protect us from some forms of cancer.
Q: Francis, MA - Can osteoporosis lead to cancer?
A: Dr. O'Neil - Osteoporosis does not increase cancer risk, in fact some of the drugs used to treat osteoporosis may be quite effective in reducing breast cancer risk as they have anti-estrogen effects.
Q: Ed, TX - Can eating red meat increase cancer risk?
A: Dr. O'Neil - Some interesting research has shown that cooking meats at high temperatures (such as barbecuing or frying) may increase the content of chemicals called heterocyclic amines which can potentially increase the risk of certain cancers. Researchers found that those who ate their beef medium-well or well-done had more than three times the risk of stomach cancer than those who ate their beef rare or medium-rare. They also found that people who ate beef four or more times a week had more than twice the risk of stomach cancer than those consuming beef less frequently. Additional studies have shown an increased risk of developing breast, colon, and pancreatic cancer with high intakes of well-done, fried, or barbequed meats.
Q: Judy, MA - Why does breast feeding reduce your risk of getting breast cancer?
A: Dr. O'Neil - Studies have shown that breast feeding does lower breast cancer risk especially if it lasts over a year or two. This is because it lowers total number of menstrual periods as does pregnancy.
Q: Mary, MA - Can fibroids lead to cancer?
A: Dr. O'Neil - Fibroids are benign muscular tumors of the uterus. Occasionally fibroids can undergo malignant degeneration. A gynecologist should monitor fibroid tumors. Fibroids that do not produce symptoms do not require intervention but if they produce pain or abnormal bleeding hysterectomy may need to be performed.
Q: Morgan, MA - Can heparin shots lead to blood clots or cancer?
A: Dr. O'Neil - I presume you are talking about heparin. This is an anti-coagulant (blood thinner). It is actually used to prevent blood clots so it would be unusual for it to cause them. There are rare syndromes where there can be diffuse coagulation, but this is rare. There is no known association of heparin with cancer.
Q: Judy, MA - Are hot flashes an indicator of a cancer risk?
A: Dr. O'Neil - Most commonly hot flashes occur in women during menopause when the ovaries reduce their production of the female hormone estrogen. This is considered normal and sometimes may need to be treated if symptoms are severe enough. There is a type of flushing that can occur with a relatively uncommon tumor called a carcinoid that is a gastrointestinal tumor. Night sweats can be associated with certain types of infections and cancers such as lymphoma. Night sweats should be evaluated by a physician.
Q: Mary, MA - What are symptoms of skin cancer?
A: Dr. O'Neil - Mary, if you notice a change in a mole or you notice a significant redness or scaling of the skin you need evaluation by your doctor. The American Cancer Society has good information on how to do a thorough self-examination including checking your back and between your toes. Any non-healing skin sore should be checked. A useful mnemonic for melanoma is ABCD, A for Asymmetry B- for irregular Borders, C for Color change and D is for Diameter (greater that 6 mm).
For more information go to: www.skincancer.org
Dr. O'Neil - I enjoyed being with you today, I hope these answers to these great questions helped you in your approach to wellness including reducing your cancer risk. I look forward to being with you again next month when we will discuss intimacy as we age.
Best wishes for an Optimum Life - Dr. Kevin.
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