Cancer Risk in Women

September 15, 2017

Cancers that most affect women are breast, colon, endometrial, lung, cervical, skin, & ovarian.

Doing what you can day to day to prevent cancer is your best defense. Knowing about cancer & what you can do to reduce your risk can help save your life.  Another key is early detection. Finding cancer early, before it has spread, gives you the best chance to do something about it.  You can take control of your health & reduce your cancer risk by doing the following:

  • Stay away from tobacco.
  • Get to and stay at a healthy weight.
  • Get moving with regular physical activity.
  • Eat healthy with plenty of fruits and vegetables.
  • Limit how much alcohol you drink (if you drink at all).
  • Protect your skin.
  • Know yourself, your family history, and your risks.
  • Get regular check-ups and cancer screening tests.

 

Breast cancer is the most common cancer that women face in their lifetime (except for skin cancer). It can occur at any age, but risk goes up as you age. Because of certain factors, some women may have a greater chance of having breast cancer than others. Every woman should know about breast cancer, their personal an&d family risks, and what can be done about it.

The best defense is to find breast cancer early: called ‘early detection’.  All women should perform routine self-breast exam and should be familiar with the benefits, limitations, and potential harms linked to breast cancer screening. Women should be familiar with how their breasts normally look & feel and report any changes to a healthcare provider immediately. Women ages 40-54 should have a yearly clinical breast exam, and a mammogram every 1-2 years.  The frequency of mammograms should depend on careful discussion with your doctor. Women 55 and older can switch to mammograms every 2 years, along with yearly clinical breast exam. Screening should continue as long as a woman is in good health and is expected to live at least 10 or more years. Women at high risk for breast cancer should be screened with MRIs along with mammograms. Talk with your doctor about your risk for breast cancer and the best screening plan for you.

 

Colon Cancer.  Most colon cancer (cancers of the colon or rectum) are found in people age 50 or older. People with a personal or family history, or who have polyps in their colon or rectum, or those with inflammatory bowel disease are more likely to have colon cancer. Also, being overweight, eating a diet mostly of high-fat foods, smoking & being inactive can increase risk.

Colon cancer almost always starts with a polyp – a small growth on the lining of the colon or rectum. Screening can help save lives by finding polyps before they become cancer. If pre-cancerous polyps are removed, cancer can be prevented. People should have one of the following tests, starting at age 50:

  • Colonoscopy every 10 years, or
  • CT colonography (virtual colonoscopy) every 5 years (if positive, a colonoscopy should be done)
  • Flexible sigmoidoscopy every 5 years (if positive, a colonoscopy should be done)
  • Double-contrast barium enema every 5 years (if positive, a colonoscopy should be done)

If you are at high risk of colon cancer based on family history or other factors, you may need to start testing at a younger age. Talk to your doctor about your risk for colon cancer to know when you should start testing.

 

Endometrial cancer (cancer of the lining of the uterus) occurs most often in women age 55 and older. Taking estrogen without progesterone and taking tamoxifen for breast cancer treatment or to lower breast cancer risk can increase risk. Having an early onset of menstrual periods, late menopause, a history of infertility, or not having children can increase risk, too. Women with a personal or family history of hereditary non-polyposis colon cancer (HNPCC) or polycystic ovary syndrome (PCOS), or those who are obese are also more likely to have endometrial cancer.

Women should watch for symptoms, such as unusual spotting or bleeding not related to menstrual periods, and report these to your doctor. It is also recommended that women who have or are likely to have HNPCC be offered yearly testing with an endometrial biopsy by age 35.

 

Lung cancer:  Eight out of 10 lung cancer deaths result from smoking. But people who don’t smoke can also have lung cancer.

Lung cancer is one of the few cancers that can often be prevented by not smoking.  If you are a smoker, ask your doctor to help you quit. If you don’t smoke, don’t start, and avoid breathing in other people’s smoke. Certain women at high risk for lung cancer may want to talk to a healthcare provider about whether getting yearly low-dose CT scans to test for early lung cancer is right for them. Testing may benefit adults who are current or former smokers ages 55-74 who are in good health and who have a 30 pack-year or more smoking history (A pack-year is 1 pack of cigarettes per day per year). You should discuss the benefits, limitations, and risks of lung cancer testing with your doctor.

 

Cervical cancer can affect any woman who is or has been sexually active. It results from the human papilloma virus (HPV). This virus is acquired during sex. Cervical cancer is also more likely in women who smoke, have HIV or AIDS, have poor nutrition, and who do not get regular Paps. A Pap smear can find changes in the cervix that can be treated before they become cancer. The following is recommended:

  • Cervical cancer screening starting at age 21. Women under age 21 should not be tested.
  • Women ages 21-29 should have a Pap every 3 years. HPV testing should not be used unless it’s needed after an abnormal Pap.
  • Women ages 30-65should have a Pap plus HPV testing (co-testing) every 5 years. This is the preferred approach, but it’s OK to have a Pap alone every 3 years.
  • Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested for cervical cancer. Women with a history of a cervical pre-cancer should continue testing for 20 years after the diagnosis, even if testing continues past age 65.
  • A woman who has had a hysterectomy (removal of uterus and cervix) for reasons not related to cervical cancer & who has no history of cervical cancer or pre-cancer should not be tested.
  • If vaccinated against HPV, you should still follow screening recommendations for your age group.

Some women (because of their history) may need testing more often. You should talk to your doctor about your history.

 

Skin cancer.  Anyone who spends time in the sun can get skin cancer. People with fair skin, especially those with blond or red hair, are more likely to get skin cancer than people with darker coloring. People who have had a close family member with melanoma & those who had bad sunburns as children are more likely to get skin cancer.

Most skin cancers can be prevented by limiting exposure to ultraviolet (UV) rays. When outside, try to stay in the shade, especially midday. If you are going to be in the sun, wear hats with brims, long-sleeve shirts, sunglasses, and use broad-spectrum sunscreen with SPF 30 or higher. If you have children, protect them from the sun and don’t let them get sunburned. Do not use tanning beds or lamps.  Be aware of moles and spots on your skin, and report any changes to your doctor immediately. Have a skin exam done during routine wellness check.

 

Ovarian cancer is more likely to occur as women age. Women who have never had children, who have unexplained infertility, or who had their first child after age 30 are at increased risk. Women with a personal or family history of HNPCC, ovarian cancer, or breast cancer are more likely to have this disease. Women who don’t have any of these conditions can still get ovarian cancer.

There are no good tests for finding ovarian cancer early. A pelvic exam should be part of a woman’s regular health exam. Also, talk to a healthcare provider about your risk for ovarian cancer and whether there are tests that may be right for you. You should talk to your doctor right away if you have any of these symptoms for more than a few weeks:

  • Abdominal (belly) swelling
  • Digestive problems (including gas, loss of appetite, and bloating)
  • Abdominal or pelvic pain
  • Feeling like you need to urinate (pee) all the time

 

Research shows poor diet and not being active are two key factors that increase cancer risk. Twenty percent of cancers are related to obesity, physical inactivity, excess alcohol, and/or poor nutrition. Besides quitting smoking, you can help reduce your cancer risk by: (1) get to and stay at a healthy weight, (2) be physically active and (3) make healthy food choices.

Getting to and staying at a healthy weight reduces risk of cancer and other chronic diseases, such as heart disease and diabetes. Excess weight causes the body to produce and circulate more estrogen and insulin, hormones that can stimulate cancer growth. When trying to control weight, watch portion size, especially of foods high in calories, fat, and added sugars. Also, limit intake of high-calorie foods and drinks. Try writing down what and how much you eat & drink to see where you can cut down on portion sizes and cut back on unhealthy foods and drinks.  Losing even a small amount of weight has health benefits.

Next, increase your physically activity. Being active helps improve weight, and it can help improve hormone levels and the way your immune system works. The recommendation for adults is at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week. This is over and above usual daily activities like using the stairs instead of the elevator at your office or doing housework. For kids, the recommendation is at least 60 minutes of moderate or vigorous intensity activity each day, with vigorous intensity activity occurring at least 3 days each week. Moderate activities are those that make you breathe as hard as you would during a brisk walk. Vigorous activities make you use large muscle groups and make your heart beat faster, make you breathe faster and deeper, and also make you sweat. It’s also important to limit sedentary behavior such as sitting, lying down, watching television, or other forms of screen-based entertainment.

Eating well is an important part of improving your health and reducing cancer risk. Read food labels to become more aware of portion sizes and calories. Low-fat or non-fat does not necessarily mean low-calorie. Eat smaller portions when eating high-calorie foods. Choose vegetables, whole fruit, legumes such as peas and beans, and other low-calorie foods instead of calorie-dense foods such as French fries, potato and other chips, ice cream, donuts, and other sweets. Limit your intake of sugar-sweetened beverages such as soft drinks, sports drinks, and fruit-flavored drinks. When you eat away from home, choose food low in calories, fat, and added sugar, and avoid eating large portion sizes. Limit how much processed meat and red meat you eat. Eat at least 2½ cups of vegetables and fruits each day. Choose whole grains instead of refined grain products. If you drink alcohol, limit intake to 2 drinks per day for men and 1 drink per day for women. The recommended limit is lower for women because of their smaller body size and slower breakdown of alcohol. A drink of alcohol is defined as 12 ounces of beer, 5 ounces of wine, or 1½ ounces of 80-proof distilled spirits (hard liquor).

It has been shown that people who experience high levels of psychological stress or who experience stress repeatedly over a long time may develop health problems (mental and/or physical).

The body responds to physical, mental, or emotional pressure by releasing stress that increase blood pressure, speed heart rate & raise blood sugar levels. Research shows that people who experience intense and chronic stress can have digestive problems, fertility problems, urinary problems, and a weakened immune system. Chronic stress makes people more prone to viral infections such as the flu or common cold and to have headaches, sleep trouble, depression, and anxiety. Although stress can cause a number of physical health problems, the evidence that it causes cancer is weak. Apparent links between psychological stress and cancer could arise in several ways. For example, people under stress may develop certain behaviors, such as smoking, overeating, or drinking alcohol, which increase a person’s risk for cancer. People who have cancer may find the physical, emotional, and social effects of the disease to be stressful. Those who attempt to manage their stress with risky behaviors such as smoking or drinking alcohol or who become more sedentary may have a poorer quality of life after cancer treatment. In contrast, people who are able to use effective coping strategies to deal with stress, such as relaxation and stress management techniques, have been shown to have lower levels of depression, anxiety, and symptoms related to the cancer and its treatment. People who have cancer who are under increased stress have poorer outcomes. Patients can develop a sense of helplessness or hopelessness when stress becomes overwhelming. This response is associated with higher rates of death, although the mechanism for this outcome is unclear. It may be that people who feel helpless or hopeless do not seek treatment when they become ill, give up prematurely on or fail to adhere to potentially helpful therapy, engage in risky behaviors such as drug use, or do not maintain a healthy lifestyle, resulting in premature death. Despite this, there is no evidence that successful stress management improves cancer survival.

Emotional & social support can help patients cope with psychological stress. Support can reduce depression, anxiety, and disease- and treatment-related symptoms. Approaches can include:

  • Training in relaxation,meditation or stress management
  • Counseling or talk therapy
  • Cancer education sessions
  • Social support in a group setting
  • Medications for depression or anxiety
  • Exercise

Hereditary Cancer Testing

September 5, 2017

Why Genetic Testing?

 

You’ve heard the phrase, “it runs in the family”? Whether it be an obvious family resemblance to a not-so-obvious inherited trait, much of who we are comes from our DNA.  We have about 20,000 genes, which are our blueprints.  All cancers are caused by mutations, or changes in DNA. Most mutations occur by chance and are usually automatically repaired by the body.  Sometimes, however, the mutation is not repaired and is passed on when the cell divides. If the mutation is harmful and interferes with a critical function, the mutation can make the cells cancer-like. If enough mutations occur, cancer may result. Mutations can also be part of our genetic makeup from birth. These mutations are inherited and are passed from generation to generation. Mutations in genes passed one generation to the next can drastically increase our risk of disease, including many cancers.

 

Most cancers develop from random mutations, but up to 10% are inherited, or hereditary. Certain inherited genetic mutations make it more likely that we will get cancer, as well as develop cancer earlier or even develop multiple cancers in a lifetime.  If you carry an inherited mutation that has been linked to cancer, knowing your risk can help you and your doctor make better, more informed decisions about your healthcare. If you have a mutation that puts you at increased risk of cancer, you and your doctor can take action to reduce your risk. Once the risk of cancer is identified, you and your doctor can choose the best way to delay, or even prevent, the cancer. There are also effective options to help lower your risk of cancer such as earlier and more intensive screening, preventive medications and risk-reducing surgeries.

 

Having information about your cancer risk can help improve health and quality of life. Hereditary cancer testing has helped millions of people make more informed choices. Testing is available for several inherited cancers including breast, ovarian, colon, skin (melanoma), uterine (endometrial), pancreatic, gastric and prostate cancer.  These tests provide vital information to help people with a strong personal or family history of cancer understand their own risk of developing the disease. With this information, they can take steps to potentially prevent cancer, delay the onset of the disease or catch it at an earlier stage when outcomes and survival rates are better.

 

When talking about your genetic family history, the only family members who matter are your biological relatives.  To learn more about your biological inheritance, talk to your relatives, gather information on their health history and fill out a family tree. If you find that certain illnesses, such as breast or ovarian cancer, have appeared in more than one relative, you should talk with your doctor and discuss the possibility of a hereditary cancer.  Just as an increased risk of cancer can run in families, some inherited conditions are more likely to occur in certain populations. People in these groups can inherit a specific genetic makeup from their ancestors. If the genes that are common to a group include a genetic mutation that cause disease, that disease can occur more frequently in that group. For example, hereditary breast and ovarian cancer is more common in people of Ashkenazi, or Eastern European Jewish, ancestry.

 

The goals of genetic testing are to:

  • Provide valuable information for use in customizing medical management plans;
  • Determine whether you have genetic mutations that increases your risk for inherited cancers;
  • Help your doctor make a timely and accurate diagnosis;
  • Enable your doctor to better predict disease aggressiveness to help make more informed treatment decisions;
  • Assist you and your doctor in making important decisions about disease management.

 

If you have had cancer at a young age, a rare cancer or if cancer occurs frequently in your family, genetic testing may be recommended. If a greater than average risk of cancer is found, there are a number of things you and your doctor can do to manage that risk:

  • More frequent monitoring to help detect cancer at an earlier, more treatable stage and improve survival.
  • Preventive strategies, including risk-reducing medications or surgeries, that may reduce your risk of developing cancer.
  • Make more informed decisions on your treatment options.
  • Can help your relatives learn more about their inherited risk and how it may affect them.

 

Common questions:

Q. I already know I have a family history of cancer. Why should I get tested?

A. Testing for a hereditary cancer risk helps you and your doctor understand your risk so you can make the best medical decisions. Knowing family history is important, but testing can give a more accurate picture of your risk.

Q. I already have cancer. Why should I get tested?

A. Testing for a hereditary cancer could help identify your risk for developing a second primary cancer.

Q. Is testing recommended for everyone?

A. Only people who have cancer in their family or a personal history of disease need to be tested.

Q. How do I get tested?

A. Ask your doctor if testing is right for you. Most testing can be done right in the office.

Q. How long does it take to get the test results?

A. It may be as soon as two weeks from the date your test is performed.

Q. Does a positive test result mean that I have cancer?

A. No. Genetic testing does not tell you if you have cancer. Results tell your inherited risk of developing cancer in the future.

Q. Does a positive test result mean that I will definitely develop cancer?

A. No. A positive test result simply tells you that you have an increased risk of cancer.