What do we know about the prevention of cancer, in 2019?

1. Cancer
Prevention
and Screening
www.aboutcancer.com

2. 1.Overall prevention strategies (can you lower the
overall risk of getting any type of cancer?)
2.Specific cancers may have specific strategies
(breast, prostate, lung and colorectal)
3.Screening…where to find the best
advice

3. Key Web Sites for Cancer Prevention and Screening
www.aboutcancer.com Dr. Miller Site
cancer.gov/about-cancer/causes-prevention NCI prevention Site
www.cancer.gov/types NCI specific cancers
seer.cancer.gov/ Cancer Statistics
epss.ahrq.gov/PDA/index.jsp Screening Guidelines
www.nccn.org National Comprehensive
Cancer Network (NCCN)
Uptodate.com Current review article about all medicine
gis.cdc.gov/Cancer/USCS/DataViz.html CDC Cancer Risk Graphs
https://health.gov/dietaryguidelines/2015 Diet Guidelines

4. Despite improvements in screening and earlier diagnosis and better
treatments it was estimated that in 2019 in the US there would be over 1.7
million new cancer cases and over 600,000 deaths from cancer.
The probability of getting cancer during your life time based on data from
2013 to 2015 is 39.3% for men and 37.1% for women (not counting skin
cancers).

5. Site Men Woman
All 39.3% 37.7%
Breast 12.4%
Prostate 11.2%
Lung 6.7% 5.9%
Colorectal 4.4% 4.1%
Uterus 2.9%
Melanoma 3.7% 2.5%
Lymphoma 2.4% 1.9%
Kidney 2.1% 1.2%
Leukemia 1.8% 1.3%
Thyroid 0.6% 1.8%
Probability of Developing Invasive Cancer
(US 2013-2015)

6. The best approach would be to prevent cancer in the first
place. Some approaches are obvious and effective (e.g.
avoiding known carcinogens like smoking and asbestos or
excessive sun exposure to prevent skin cancer.)
Next best approach would be screening
(only if it’s been shown to be beneficial
and ? cost effective)

7. Prevention is defined as the reduction of cancer mortality via reduction in
the incidence of cancer. This can be accomplished by
• avoiding a carcinogen or altering its metabolism
• pursuing lifestyle or dietary practices that modify cancer-causing factors or
genetic predispositions
• medical interventions (e.g., chemoprevention) or risk-reducing surgical
procedures
• early detection strategies that can result in removal of precancerous
lesions, such as colonoscopy for colorectal polyps
cancer.gov/about-cancer/causes-prevention

8. It is estimated that 50 percent of cancer is preventable
In one study, nine modifiable risks were identified as the cause of 35 percent of cancer
deaths worldwide: smoking, alcohol use, diet low in fruit and vegetables, excess weight,
inactivity, unsafe sex, urban air pollution, use of solid fuels, and contaminated injections in
health care settings.
The International Agency for Research on Cancer (IARC) has identified and tabulated over
100 human carcinogens

9. Lifestyle factors have been linked to a variety of malignancies, including the most common
in the developed world: lung, colorectal, prostate, and breast cancer.
In a longitudinal study, participants who had all four lifestyle factors:
1. never smoking,
2. body mass index [BMI] <30,
3. physical activity >3.5 hours weekly,
4. prudent diet (high intake of fruits, vegetables, and whole-grain bread and low
meat consumption)
had approximately one-third lower risk of cancer compared with those who had none of
these factors
Ford ES. Arch Intern Med.
2009;169(15):1355.

10. Healthy living is the best revenge: findings from the European Prospective
Investigation Into Cancer and Nutrition-Potsdam study.
Ford ES. Arch Intern Med. 2009;169(15):1355.
23,153 German participants aged 35 to 65 years end points
included confirmed incident type 2 diabetes mellitus, myocardial
infarction, stroke, and cancer.
Risk of developing a chronic disease decreased progressively as
the number of healthy factors increased.
Participants with all 4 factors at baseline had a 78% lower risk of
developing a chronic disease:
- diabetes, 93%;
- myocardial infarction, 81%;
- stroke, 50%
- cancer, 36%
than participants without a healthy factor.

11. Healthy Life Style Can Overcome Bad
Genetics for Dementia
Lourida. JAMA July 14, 2019
• Study of 196,383
• 4 Healthy Life Styles (healthy diet,
proper exercise, no smoking,
moderate alcohol
• Included were polygenic factors
associated with Alzheimer disease
Lifestyle:
Favorable (3, or 4)
Intermediate (2)
Unfavorable (0, 1)
Risk of Getting Dementia

12. Risk Factors for Cancer
Age
Alcohol
Cancer-Causing Substances
Chronic Inflammation
Diet
Hormones
Immunosuppression
Infectious Agents
Obesity
Radiation
Sunlight
Tobacco

13. Probability of Developing Cancer During this
Age Interval (2013-2015)
Birth to 49 50 – 59 60 – 69 70 or older Lifetime
Male 3.4% 6.1% 13.2% 31.9% 39.3%
Female 5.6% 6.2% 10.0% 26.0% 37.7%
So 82% in men (31.9/39.3) and 69% in women (26/37.7) occur at 70+ (when screening may be stopped!)

14. Average Number of Deaths per Year and Age-Specific
Mortality Rates per 100,000 Population, UK, 2014-2016

15. Avoiding Old Age and Cancer…only solution die young!
Anne Frank 15
Ritchie Valens 17
Joan of Arc 19
Buddy Holly 22
River Phoenix 23
James Dean 24
Tupac Shakur 25
Kurt Cobain 27
Jim Morrison 27
Amy Winehouse 27
Janis Joplin 27
Jimi Hendrix 27
John Belushi 33
Mozart 35
Marilyn Monroe 36
George Gershwin 38
Chopin 39

16. There is a strong scientific consensus that alcohol drinking can
cause several types of cancer, an estimated 3.5% of cancer
deaths in the US are related to alcohol
Type of Cancer Increased Risk
Oral Cavity, Pharynx 1.8 X – 5 X
Larynx 2.6 X
Esophagus (squamous) 1.3 – 5X
Liver 2 X
Breast 1.04 (light) 1.23 (moderate) 1.6 X (heavy)
Colon, Rectal 1.2 – 1.5 X
According to the federal government’s Dietary Guidelines for Americans 2015-2020, individuals who do not drink alcohol
should not start drinking for any reason. It recommends that if alcohol is consumed, it should be done in moderation and
defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men. Heavy
alcohol drinking is defined as having 4 or more drinks on any day or 8 or more drinks per week for women and 5 or more
drinks on any day or 15 or more drinks per week for men

17. Drinking alcohol raises your risk of getting six kinds of cancer—mouth and throat, voice box
(larynx), esophagus, colon and rectum, liver, and breast (in women).

18. Cancer-Causing Substances in the Environment
Aflatoxins
Aristolochic Acids
Arsenic
Asbestos
Benzene
Benzidine
Beryllium
1,3-Butadiene
Cadmium
Coal Tar and Coal-Tar Pitch
Coke-Oven Emissions
Crystalline Silica (respirable size)
Erionite
Ethylene Oxide
Formaldehyde
Hexavalent Chromium Compounds
Indoor Emissions from the Household
Combustion of Coal
Mineral Oils: Untreated and Mildly Treated
Nickel Compounds
Radon
Secondhand Tobacco Smoke
(Environmental Tobacco Smoke)
Soot
Strong Inorganic Acid Mists Containing
Sulfuric Acid
Thorium
Trichloroethylene
Vinyl Chloride
Wood Dust

19. Chronic Inflammation
Chronic inflammation may be caused by infections that don’t go away, abnormal immune reactions to
normal tissues, or conditions such as obesity. Over time, chronic inflammation can cause DNA damage and
lead to cancer. For example, people with chronic inflammatory bowel diseases, such as ulcerative
colitis and Crohn disease, have an increased risk of colon cancer.
Many studies have investigated whether anti-inflammatory medications, such as aspirin or non-steroidal
anti-inflammatory drugs, reduce the risk of cancer. However, a clear answer is not yet available

21. Diet
With few exceptions, studies of human populations have not yet shown definitively that any dietary component
causes or protects against cancer.

22. Balanced, Low-Fat Diet Reduces Risk of Death From Breast Cancer in
Postmenopausal Women May 15, 2019
The federally funded Women’s Health Initiative (WHI) clinical trial of dietary modification This is the first large, randomized
clinical trial to show that diet can reduce the risk of dying from breast cancer.

23. The Importance of Dietary Fiber
Denis Parsons Burkitt , British surgeon
noted how rare colon cancer was in Africa
which he related to dietary fiber

24. Fiber — A number of laboratory, nutritional, and epidemiologic studies have identified a role for dietary fiber in the
pathogenesis of colorectal cancer.
●A decreased risk of colonic adenomas and CRC with higher intake of fiber was reported in five large epidemiologic studies.
●On the other hand, in the Nurses' Health study, no relationship was noted between fiber intake and the risk of CRC or
adenomas. Similarly, the Women's Health Initiative Trial found no protective effect of a modest low-fat, increased fiber, and
increased fruit and vegetable dietary intervention on CRC incidence.
●A pooled analysis of 13 prospective cohort studies (involving 725,628 men and women followed for 6 to 20 years) found
that dietary fiber intake was inversely associated with the risk of CRC, but the association was no longer apparent after
accounting for other dietary risk factors.
●A meta-analysis funded by the World Cancer Research Fund found that for every 10 g/day increase in dietary fiber
consumption, there was a significant reduction in the risk of CRC by 10 percent.
●In two randomized controlled studies from the United States as well as one from Australia, fiber supplementation had no
significant protective effect for the development of total colorectal adenomas.
●A systematic review of five studies involving a total of 4349 patients concluded that there was no definitive evidence that
increased dietary fiber reduces the incidence or recurrence of adenomatous polyps within a two- to four-year period.

25. A systematic review of 38 studies found that neither vitamin C nor vitamin E supplementation was beneficial for prevention of
the cancers evaluated . A 2006 National Institutes of Health (NIH) consensus conference panel concluded that "present
evidence is insufficient to recommend either for or against the use of multivitamin supplements by the American public to
prevent chronic disease“
A subsequent long-term randomized trial (mean 9.4 years treatment) in 8000 women found no evidence that
supplementation with vitamin C, E, or beta-carotene (singly or in combination) decreased cancer incidence or cancer
mortality.
Additionally, two long-term observational studies, one including over 160,000 women with follow-up of approximately eight
years and another including over 180,000 multiethnic participants with 11-year follow-up, found no association between
multivitamin use and risk of cancer. it has not been established that multivitamin and mineral supplements provide added
benefit to a balanced, healthful diet for most individuals
VITAMINS AND MICRONUTRIENTs

26. The Selenium and Vitamin E Cancer Prevention Trial (SELECT)
SELECT is a phase III randomized, placebo-controlled trial of selenium and/or vitamin E
supplementation for prostate cancer prevention. A total of 35,533 men were randomized from 427
sites in the U.S., Canada, and Puerto Rico achieving minority representation of 21% (15% African
Americans).
Primary results were reported early (planned futility analysis) indicating neither vitamin E nor
selenium supplements were associated with prevention of prostate cancer.
An updated analysis in 2011 showed a statistically significant increased risk of prostate cancer in the
vitamin E compared to placebo arms (hazard ratio 1.17,

27. Beta-carotene and lung cancer: a case study.
Am J Clin Nutr. 1999 Jun;69(6):1345S-1350S.
The conflicting evidence of the relation between beta-carotene and lung cancer in humans serves as a
poignant case study with respect to what types of evidence are sufficient to support or change a nutrition
recommendation
More than 30 case-control and cohort studies were conducted over many years in various populations and indicated that
people who eat more vegetables and fruit, foods rich in carotenoids, and carotenoids (beta-carotene in particular), as well
as those with higher blood beta-carotene concentrations, have a lower risk of lung cancer
In contrast, the intervention results from large, controlled trials of beta-carotene supplementation do not support the
observed beneficial associations or a role for supplemental beta-carotene in lung cancer prevention; instead, they provide
striking evidence for adverse effects (ie, excess lung cancer incidence and overall mortality) in smokers
One study of 29,000 male smokers (ATBC Trial) found an 18% increase in lung cancer in the group receiving 20 mg of beta-
carotene a day for 5 to 8 years. Another study of 18,000 (CARET Trial) people found 28% more lung cancers in people with
a history of smoking and/or asbestos exposure. These people took 30 mg of beta-carotene

28. Beta Carotene
No Beta Carotene
18% More Lung
Cancer
ATBC Trial
New Lung Cancer

29. CARET Trial…Beta Carotene and Vitamin A Prevention Trial
New Lung Cancer 28% Higher in those
taking Beta Carotene
and Vitamin A
N Engl J Med 1996; 334:1150-1155

30. Hormones
Taking combined menopausal hormone therapy (estrogen plus progestin, which is a synthetic version of the female
hormone progesterone) can increase a woman’s risk of breast cancer.
Menopausal hormone therapy with estrogen alone increases the risk of endometrial cancer and is used only in women
who have had a hysterectomy.
Studies have also shown that a woman’s risk of breast cancer is related to the estrogen and progesterone made by her
ovaries (known as endogenous estrogen and progesterone). Being exposed for a long time and/or to high levels of these
hormones has been linked to an increased risk of breast cancer. Increases in exposure can be caused by starting
menstruation early, going through menopause late, being older at first pregnancy, and never having given birth.
Conversely, having given birth is a protective factor for breast cancer.
Premarin is a mixture of the sodium salts of
estrogen conjugates found in the urine of
pregnant mares used since 1942

31. Immunosuppression
Many people who receive organ transplants take medications to suppress the immune system so the body won’t reject
the organ. These "immunosuppressive" drugs make the immune system less able to detect and destroy cancer cells or
fight off infections that cause cancer. Infection with HIV also weakens the immune system and increases the risk of certain
cancers.
transplant recipients are at increased risk of a large number of different cancers. Some of these cancers can be caused
by infectious agents, whereas others are not. The four most common cancers among transplant recipients and that occur
more commonly in these individuals than in the general population are non-Hodgkin lymphoma (NHL) and cancers of the
lung, kidney, and liver. NHL can be caused by Epstein-Barr virus (EBV) infection, and liver cancer by chronic infection with
the hepatitis B (HBV) and hepatitis C (HCV) viruses. Lung and kidney cancers are not generally thought to be associated
with infection.
People with HIV/AIDS also have increased risks of cancers that are caused by infectious agents, including EBV; human
herpesvirus 8, or Kaposi sarcoma-associated virus; HBV and HCV, which cause liver cancer; and human papillomavirus,
which causes cervical, anal, oropharyngeal, and other cancers. HIV infection is also associated with increased risks of
cancers that are not thought to be caused by infectious agents, such as lung cancer.

32. Infectious Agents
Certain infectious agents, including viruses, bacteria, and parasites, can cause cancer or increase the risk that cancer will
form. Most of the viruses that are linked to an increased risk of cancer can be passed from one person to another through
blood and/or other body fluids. As described below, you can lower your risk of infection by getting vaccinated, not having
unprotected sex, and not sharing needles.
Epstein-Barr Virus (EBV)
Hepatitis B Virus and Hepatitis C Virus (HBV and HCV)
Human Immunodeficiency Virus (HIV)
Human Papillomaviruses (HPVs)
Human T-Cell Leukemia/Lymphoma Virus Type 1 (HTLV-1)
Kaposi Sarcoma-Associated Herpesvirus (KSHV)
Merkel Cell Polyomavirus (MCPyV)
Helicobacter pylori (H. pylori)
Opisthorchis viverrini
Schistosoma hematobium

33. Human papillomavirus (HPV) causes most cervical cancers, as well as some cancers of
the vagina, vulva, penis, anus, and oropharynx (cancers of the back of the throat, including the base of
the tongue and tonsils).

34. Non-HPV = Yellow, HPV = blue
HPV Infections and Oropharynx Cancer

35. HPV Most Common
Smoking Less Common
Dramatic Rise in HPV + Tonsil Cancer

36. Obesity

37. There is sufficient evidence for an association between excess body fatness, including overweight, obesity, and weight gain,
and at least 13 cancers—adenocarcinoma of the esophagus; cancers of the adenocarcinoma of the esophagus; cancers of
the breast (in postmenopausal women); colon and rectum; endometrium (corpus uterus); gallbladder; gastric
cardia; kidney (renal cell); liver; ovary; pancreas; thyroid; meningioma; and multiple myeloma.

38. Obesity Trends in Adults in the US from 1985 to 2010
1985 2010

40. Radiation
Radiation of certain wavelengths, called ionizing radiation, has
enough energy to damage DNA and cause cancer.
Ionizing radiation includes radon, x-rays, gamma rays, and
other forms of high-energy radiation. Lower-energy, non-
ionizing forms of radiation, such as visible light and the energy
from cell phones and electromagnetic fields, do not damage
DNA and have not been found to cause cancer.

41. www.xrayrisk.com

42. Older man and one hip X-ray
will increase cancer risk by 1 in
37,189

43. Multiple PET scans in a child
increase the cancer risk by at least
1 in 42

44. Sunlight
The sun, sunlamps, and tanning booths all give off ultraviolet (UV)
radiation. Exposure to UV radiation causes early aging of the skin and
skin damage that can lead to skin cancer.
People of all ages and skin tones should limit the amount of time they
spend in the sun, especially between mid-morning and late
afternoon, and avoid other sources of UV radiation, such as tanning
beds.
It is important to keep in mind that UV radiation is reflected by sand,
water, snow, and ice and can go through windshields and windows.
Even though skin cancer is more common among people with a light
skin tone, people of all skin tones can develop skin cancer, including
those with dark skin

45. Cigarette Smoking
Smoking is the leading cause of premature, preventable death in this country.
Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature
deaths each year in the United States. Of those premature deaths, about 36% are from
cancer, 39% are from heart disease and stroke, and 24% are from lung
disease. Mortality rates among smokers are about three times higher than among people
who have never smoked.
Smoking harms nearly every bodily organ and organ system in the body and diminishes a
person’s overall health.
Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder,
liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia
Lauren Bacall

46. Tobacco smoke has at least 70 chemicals that cause cancer, also known as carcinogens. Smoking cigarettes can cause cancer
almost anywhere in your body, including in the bladder; blood (acute myeloid leukemia); cervix; colon and
rectum; esophagus; kidney and renal pelvis; liver; lungs, bronchi and trachea; mouth and throat; pancreas; stomach; voice
box (larynx). Additionally, the use of smokeless tobacco (snuff and chewing tobacco) causes cancers of the oral
cavity, pancreas and esophagus; cigar use causes cancers of the oral cavity, pharynx, esophagus, larynx, and lung; and
secondhand smoke exposure causes lung cancer.

47. Cigarette Consumption in the US and Health Events

48. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Smoking in the US
Humphrey Bogart
Dead at 57 from esophagus cancer in
1957

49. Smoking
Steep decline since 1950 - 60’s
Less dramatic decline in women
Time 1975-82 1982-91 91-2008 2008-15
Men + 1.5% -.5% -1.7% -2.9%
Women +5.6% +3.4% +.5% -1.5%
Lung Cancer Incidence

50. Lung cancer
mortality in men
starts declining
in the 1980’s
Doesn’t start
down in women
until the 2000’s

51. Percentage of adults aged ≥18 years who reported cigarette use “every day” or “some days,” by selected characteristics —
National Health Interview Survey, United States, 2017

52. Smoking by Level of
Education in 2017

53. Smoking by Income or
Health Insurance in 2017

54. Lung Cancer Mortality by County in the US in 2014

55. Smoking By State in 2018
Utah 8.9%
California 11.3%
New York 14.1%
Texas 15.7%
Florida 16.1%
US 17.1%
Alabama 20.9%
Mississippi 22.2%
Kentucky 24.6%
West Virginia 26.0%

56. Genetics of Cancer
Cancer is a genetic disease—that is, cancer is caused by certain changes to genes that
control the way our cells function, especially how they grow and divide.
Genetic changes that promote cancer can be inherited from our parents if the changes
are present in germ cells, which are the reproductive cells of the body (eggs and sperm).
Such changes, called germline changes, are found in every cell of the offspring.
Cancer-causing genetic changes can also be acquired during one’s lifetime, as the result
of errors that occur as cells divide or from exposure to carcinogenic substances that
damage DNA, such as certain chemicals in tobacco smoke, and radiation, such as
ultraviolet rays from the sun. Genetic changes that occur after conception are called
somatic (or acquired) changes.

57. Interventions That are Known to Lower Cancer Risk
because of a precancerous condition, family history, or lifestyle factors.
Taking one of the following agents may lower the risk of cancer:
• Selective estrogen receptor modulators (SERMS) such as tamoxifen or raloxifene have been shown to reduce the
risk of breast cancer in women at high risk.
• Finasteride has been shown to lower the risk of prostate cancer.
• COX-2 inhibitors may prevent colon and breast cancer. COX-2 inhibitors may cause heart problems. Because
COX-2 inhibitors may cause heart problems there have not been many studies on their use to prevent cancer.
• Aspirin may prevent colorectal cancer. Bleeding in the gastrointestinal tract or brain is a side effect of aspirin.
Because aspirin may cause bleeding problems there have not been many studies on their use to prevent cancer.

58. Interventions That Are Not Known to Lower Cancer Risk
There is not enough proof that taking multivitamin
and mineral supplements or single vitamins or minerals can
prevent cancer The following vitamins and mineral
supplements have been studied, but have not been shown to
lower the risk of cancer:
Vitamin B6
Vitamin B12
Vitamin E
Vitamin C
Beta carotene
Folic acid
Selenium
Vitamin D

59. Physical Activity and Cancer
There is substantial evidence that higher levels of physical activity are linked to lower risks of several cancers:
Colon cancer: most physically active individuals had a 24% lower risk of colon cancer other studies reported a risk reduction
of 16%, also associated with a decreased risk of colon adenomas (polyps
Breast cancer: average breast cancer risk reduction associated with physical activity was 12%.
Endometrial cancer: the average endometrial cancer risk reduction associated with high versus low physical activity was 20%
Nearly all of the evidence linking physical activity to cancer risk comes from observational studies, but such studies cannot
definitively establish that being physically inactive causes cancer (or that being physically active protects against cancer).
That is because people who are not physically active may differ from active people in ways other than their level of
physical activity.

60. Strong evidence suggests that physical activity reduces the risk of several cancers, including breast
cancer in post-menopausal women, endometrium (corpus uterus) cancer, and colon cancer.

61. Achieve and maintain a healthy weight throughout life.
•Be as lean as possible throughout life without being underweight.
•Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has
health benefits and is a good place to start.
•Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weight.
Be physically active.
•Adults: Get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a
combination of these), preferably spread throughout the week.
•Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment.
•Doing some physical activity above usual activities, no matter what one’s level of activity, can have many health benefits.
Eat a healthy diet, with an emphasis on plant foods.
•Choose foods and drinks in amounts that help you get to and maintain a healthy weight.
•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 your intake.
•Drink no more than 1 drink per day for women or 2 per day for men.

62. • Counsel on Healthy lifestyle (may want to avoid prolonged
hormone replacement therapy, avoid alcohol, try to
exercise, consider breastfeeding
• Risk Reduction Agents (e.g. tamoxifen, raloxifene,
aromatase inhibitors)
• Risk-reduction surgery (e.g. mastectomy)
• Participation in research trial
Components of Risk/ Benefit Assessment and Counseling

63. Are you eating healthy?
“I don’t think all that natural food
is doing you any good!”
“I don’t know what you’re
eating, but you gave the dog a
can of spaghetti sauce!”

64. Every 5 years, HHS and USDA publish the Dietary Guidelines for Americans, the Nation’s go-to source for
nutrition advice.
https://health.gov/dietaryguidelines/2015/

66. Consume a healthy eating pattern that accounts for all foods and beverages within an
appropriate calorie level.
A healthy eating pattern includes:
• A variety of vegetables from all of the subgroups—dark green, red and orange, legumes
(beans and peas), starchy, and other
• Fruits, especially whole fruits
• Grains, at least half of which are whole grains
• Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes
(beans and peas), and nuts, seeds, and soy products
• Oils

67. A healthy eating pattern limits:
• Saturated fats and trans fats, added sugars, and sodium
Quantitative limits are provided for several components of the diet
• Consume less than 10 percent of calories per day from added sugars
• Consume less than 10 percent of calories per day from saturated fats
• Consume less than 2,300 milligrams (mg) per day of sodium
• If alcohol is consumed, it should be consumed in moderation—up to one drink per day
for women and up to two drinks per day for men—and only by adults of legal drinking
age

68. “You need more exercise. Run out and
get me a cheeseburger with onions!”
Getting Good Advice about Exercise

69. Strong evidence shows that regular physical activity helps people maintain a healthy
weight, prevent excessive weight gain, and lose weight when combined with a healthy
eating pattern lower in calories.
Strong evidence also demonstrates that regular physical activity lowers the risk of early
death, coronary heart disease, stroke, high blood pressure, adverse blood lipid profile,
type 2 diabetes, breast and colon cancer, and metabolic syndrome; it also reduces
depression and prevents falls

70. Less than 20% of seniors!

71. • All adults should avoid inactivity. Some physical activity is better than none, and
adults who participate in any amount of physical activity gain some health benefits.
• For substantial health benefits, adults should do at least 150 minutes (2 hours and
30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a
week of vigorous-intensity aerobic physical activity, or an equivalent combination
of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be
performed in episodes of at least 10 minutes, and preferably, it should be spread
throughout the week.
• For additional and more extensive health benefits, adults should increase their
aerobic physical activity to 300 minutes (5 hours) a week of moderate-intensity, or
150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent
combination of moderate- and vigorous-intensity activity. Additional health
benefits are gained by engaging in physical activity beyond this amount.
• Adults should also include muscle-strengthening activities that involve all major
muscle groups on 2 or more days a week.

72. 1.Overall prevention strategies (can you lower the
overall risk of getting any type of cancer?)
2.Specific cancers may have specific strategies
(breast, prostate, lung and colorectal)
3.Screening…where to find the best
advice

73. https://www.cancer.gov/types

75. Endometrial Cancer Prevention
KEY POINTS
Avoiding risk factors and increasing protective factors may help prevent cancer.
The following risk factors increase the risk of endometrial cancer:
Endometrial hyperplasia
Estrogen
Tamoxifen
Obesity, weight gain, metabolic syndrome, and diabetes
Genetic factors
The following protective factors decrease the risk of endometrial cancer:
Pregnancy and breast-feeding
Combination oral contraceptives
Physical activity
Cigarette smoking
It is not known if the following factors affect the risk of endometrial cancer:
Weight loss
Fruits, vegetables, and vitamins
Cancer prevention clinical trials are used to study ways to prevent cancer.
New ways to prevent endometrial cancer are being studied in clinical trials.

76. Cigarette Smoking and the Risk of Endometrial Cancer: A Meta-Analysis
American Journal of Medicine June 2008, 121:6:501
an increase in smoking of 20 cigarettes per day was statistically significantly associated with 16% and 27% reduced risks of
endometrial cancer
Conclusion
Cigarette smoking was found to be significantly associated with a reduced risk of endometrial cancer, especially among
postmenopausal women.
The antiestrogenic effect of cigarette smoking in women
American Journal of Obstetrics and Gynecology
Volume 162, Issue 2, February 1990, Pages 502-514
Epidemiologic results indicate that women who smoke cigarettes are relatively estrogen-deficient. Smokers have an early
natural menopause, a lowered risk of cancer of the endometrium, and an increased risk of some osteoporotic fractures.
Moreover, women who smoke may have a reduced risk of uterine fibroids, endometriosis, hyperemesis gravidarum, and
benign breast disease. Several possible mechanisms for these effects have been identified. Smoking does not appear to be
clearly related to estradiol levels, at least in postmenopausal women, although levels of adrenal androgens are increased.
Moreover, smoking appears to alter the metabolism of estradiol, leading to enhanced formation of the inactive catechol
estrogens.

77. Endometrial Cancer Screening
KEY POINTS
Tests are used to screen for different types of cancer when a
person does not have symptoms.
Endometrial cancer is usually found early.
There is no standard or routine screening test for endometrial
cancer.
Tests that may detect (find) endometrial cancer are being
studied:
Pap test
Transvaginal ultrasound
Endometrial sampling
Screening tests for endometrial cancer are being studied in
clinical trials.

78. 1.Overall prevention strategies (can you lower the
overall risk of getting any type of cancer?)
2.Specific cancers may have specific strategies
(breast, prostate, lung and colorectal)
3.Screening…where to find the best
advice

80. http://epss.ahrq.gov/PDA/index.jsp

84. Data to Justify or Explain Their Recommendation

86. General lifestyle recommendations
●Avoid tobacco
●Be physically active
●Maintain a healthy weight
●Eat a diet rich in fruits, vegetables, and whole grains and low
in saturated/trans fat, red meat, and processed meat
●Limit alcohol
●Protect against sexually transmitted infections. Vaccinate girls and boys
against HPV.
●Avoid excess sun
●Get regular screening for breast, cervical,
and colorectal cancer

87. Cancer Information
Cancer Videos
Radiation
Cancer Calculators
Other Topics
www.aboutcancer.com
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