Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.

1. Cancer Awareness
Dr. Sridevi Kolluri
Dr. Robert Carter
Kaplan University School of Health Sciences
November 6, 2013

2. Cancer Awareness
Sridevi Kolluri, Ph.D.
Adjunct Professor, Public Health
School of Health Sciences - Kaplan University

3. Webinar Agenda
• Cancer 101
• Current supporting scientific evidence
regarding risk factors and for prevention of
cancer
• Prostate Cancer Awareness
• Question and Answer Session

4. Introduction
• In 2011, cancer was the second leading cause of
death to heart disease nationally.
• The numbers worldwide are staggering with about
7.6 million deaths from cancer.
• About 30% of these cancer deaths are due to five
behavioral and dietary risk factors which can be
prevented.
• These risk factors are high Body Mass Index (BMI),
low fruit and vegetable intake, lack of physical
activity, tobacco and alcohol use (WHO, 2013).

5. What is Cancer?
• Cancer is a disease where abnormal cells divide
without control and are able to invade other
tissues. Cancerous cells then spreads throughout
the body through the blood (CDC, 2013).
• There are over 100 different types of cancer and it
is important to be educated about this disease.
• The World Health organization is projecting a rise
in deaths from cancer to 13.1 million in 2030
(WHO, 2013) but with awareness this number
may be decreased.

6. Normal cell process
• A normal cell in the human body has a life
cycle that enables a person to grow.
• There are many types of cells that make up
the body including heart, bone, and muscle
cells.
• From birth the cells normally grow, divide,
and die.

7. Abnormal Cell Process
• When this birth/death process is not followed
as it was designed then a cell mass can
develop which can be benign or not.
• Benign is another word for harmless, but
when it becomes harmful cancer occurs.
• This is because a cell mass that keeps growing
without dying can interrupt normal function
and do harm to the body.

8. Risk Factors (Who May be At Risk) for
Cancer?
•
•
•
•
•
•
•
•
Aging
Tobacco use
Sunlight Exposure
Viruses and bacteria
Hormones
Family history
Alcohol
Poor diet, lack of physical activity or obesity

9. Preventable Actions
Healthy Diet Recommendations: Make
half your plate fruits and vegetables
Exercise
Stop smoking
Protect your skin
Get preventative screenings
Reduce alcohol consumption
Images courtesy of Myplate.gov

10. Focus on Skin Cancer
• The National Cancer Institute, estimates over
82,000 people will be diagnosed and over
12,000 will die of skin cancer this year.
• For Skin cancer, the cause is known,
prevention is possible, and treatment is
available.
National Cancer Institute. (2013). SEER Fact Sheets: Skin. Retrieved from http://seer.cancer.
gov/statfacts/html/skin.html#survival.

11. Who is affected?
Anyone can get skin cancer:
– Men and Women
– Black or White
– Young and Old
Those that are more at risk are those with
excessive exposure to the sun without using
sunscreen or other protective measures.

12. Factors to consider for
greater risk:
• light skin color
• history of severe
sunburn
• family history of skin
cancer
• large dark-colored
birthmarks
• HIV
Types of Cancer
The 3 types of skin cancer
are basal cell, squamous cell
carcinoma and melanoma.
Of these, melanoma is the
most serious.
The effects of skin cancer
can be very damaging when
left untreated or unnoticed
for a long time.

13. The Good News!
Prevention:
• Sunscreen and
protective clothing
• Avoiding long periods of
sun exposure
• Screenings
• Education of prevention,
types, signs, and
treatment options.
Treatment:
❖ Early diagnosis is
best
❖ Treatment options
are widely available
❖ Follow up care
❖ Future prevention

14. Early Detection
• Routine physical exams
• Follow-up exams because of a lump or
growth.
• Lab testing of blood, urine or tissue.
• Screening tests, such as a Pap test,
mammogram, and fecal testing
• X-rays and digital imagining

15. Stages of Cancer
• Four stages: I, II, III and IV depending on:
• Size of tumor
• Whether cancer is in lymph nodes
• Has it spread to other parts of the body?

16. Get the word out!
•
•
•
•
Inform people
Understand the risks
Get screened
Healthier lifestyles

17. Prostate Cancer Awareness
Robert Carter, III, Ph.D., M.P.H., FACSM
Adjunct Professor, Public Health
School of Health Sciences - Kaplan University

18. Outline
● Introduction to Prostate Cancer
● Men’s Health
● Trends in Incidence and Death Rates
● Prostate Cancer: Risk Factors & Symptoms
● Screening and Treatment

19. Introduction
●Most common cancer in American men
●222,590 cases in 2012 with 31,360 deaths
○1 in 6 chance of diagnosis
○1 in 34 chance of dying
●5 year survival
○100% if local or regional spread
○31.9% if spread to distant organs (liver, bladder)
●African American men elevated risk
○spreading and death

20. Function and Location
o Main function
○ create part of the fluid
that makes up semen.
○ Related role in urinary
control
○ Not a vital organ
○ Men can live without it
o Location
○ near bladder, spine
& intestines
Small, E., Cecil Textbook of Medicine, Prostate Cancer, 2004, WB Saunders, an Elsevier
imprint
Theodorescu, D., Prostate Cancer: Management of Localized Disease, 20042

21. Key facts: Men’s Health
● Life expectancy for men are lower
than women
● Men tend to smoke and drink more
than women
● Men don’t seek medical help as often
as women
● Some men define themselves by their
work, which can add to stress

22. Key facts: Men’s Health
● Men are four times more likely to die of suicide and
suffer from undiagnosed mental health issues than
women
● There are also health conditions that affect only men…
● Prostate cancer also has a significant impact on those
closest to them -- most often wife or partner.
● More than half of spouses said they feel helpless,
anxious, depressed, or had a loss of intimacy (ACS,
2008).

23. 2013 Estimated US Cancer Cases
Men
854,790
Women
805,500
Prostate
29%
Lung & bronchus 14%
Colon & rectum 9%
Urinary bladder 6%
Non-Hodgkin
lymphoma
4%
29% Breast
14% Lung & bronchus
9% Colon & rectum
6% Uterine corpus
4% Non-Hodgkin
lymphoma
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
American Cancer
Society, 2013

24. 2013 Estimated US Cancer Deaths
Women
273,400
Men
306,950
Lung & bronchus
Prostate
Colon & rectum
Pancreas
Leukemia
28%
10%
9%
6%
4%
26%
14%
10%
6%
6%
Lung & bronchus
Breast
Colon & rectum
Pancreas
Ovary
American Cancer
Society, 2013

25. Disease Progression of Prostate
Cancer
●Heterogeneous (Diversity)
○Some grow slow with no symptoms
○Some grow fast and metastasize (grow and
spread)
○Some grow at moderate rate
●Patients die of something else
●No strategies for prevention of disease

26. Risk Factors: Prostate Cancer
●Risk Factors
○Strong Evidence
○ Age
○ Ethnicity and Race
○ Family history
○Weak Evidence
○ Medications
○ Dietary factors
○ Obesity
○ Smoking

27. Symptoms of Prostate Cancer
○Urinary Symptoms
○Erectile dysfunction
○Enlargement of prostate gland
○Blood in urine (older males)
○Bone pain or spinal cord compression

28. Screening
○Digital Rectal Exam (DRE)
■Inexpensive
■Useful for detecting enlarged prostate and advanced
disease
○Prostate Specific Antigen (PSA)
■Cancer screening in 90’s
■Tumor marker to identify disease progression
■Track changes in prostate health
○Tissue samples (surgical procedures)
○DRE and PSA together (very effective)!

29. Screening
“Accumulating
evidence indicates
careful observation
(active surveillance),
rather than immediate
treatment, can be an
appropriate option for
men with less
aggressive tumors and
for older men”(ACS,
2013)

30. Treatment
● Each case is different!
● Many factors, many opinions
○Age
○Medical history
○Disease status
● More Aggressive Approach
○Radical prostatectomy (complete removal)
■Erectile and urinary issues
● Less Aggressive Approach
○Watching, Hormonal therapy
○chemotherapy, local radiation

31. Questions for Research on
Prostate Cancer:
oDoes early detection extend life?
oDo benefits outweigh harms?
oIs there an optimal screening method for prostate
cancer?
oShould screening for prostate be risk based?

32. Summary: Prostate Cancer
✓Men should discuss their individual lifestyle and risk
factors with a healthcare provider.
✓PSA testing, may reduce morbidity and mortality,
yet best method of screening is undetermined.
✓Treatment may adversely affect patient without
benefit.
✓Cost-benefit remains unknown.
✓Better nutritional choices and increased physical
activity may help reduce their risk of prostate cancer
as well as lower their risk of heart disease and
diabetes.

33. ACS Recommendations
✓American Cancer Society and American Urological
Society recommend informed consent regarding the
risks and benefits of screening
✓DRE and PSA annually for men >50 yrs with life
expectancy of 10 years
✓Begin screening at age 45 yrs for high risk men
(black males and first degree relatives with prostate
cancer diagnosed at a young age)

34. ACS Recommendations
✓Achieve and maintain a healthy weight throughout
life
✓Adopt a physically active lifestyle
✓Consume a healthy diet, with an emphasis on plant
foods
✓If you drink alcoholic beverages, limit consumption

36. Resources
• CDC. (2013 August). Cancer Prevention and Control. Retrieved
2013 5-August from Center for Disease Control and
Prevention: http://www.cdc.gov/cancer/
• National Cancer Institute. (2013). Risk Factors. Retrieved
August 25, 2013, from What you need to know about: http:
//www.cancer.gov/cancertopics/wyntk/cancer/page3
• WHO. (2013 January). Cancer. Retrieved from World Health
Organization:http://www.who.
int/mediacentre/factsheets/fs297/en/index.html
• Goldenberg, L. (2011). canoe.ca. Retrieved from http:
//chealth.canoe.ca/channel_section_details.asp?text_id=1520

37. Resources
• American Cancer Society. (2013). Skin Cancer Facts. Retrieved from
http://www.cancer.
org/cancer/cancercauses/sunanduvexposure/skin-cancer-facts.
• MedicineNet. (2013). Skin Cancer Symptoms. Retrieved from http:
//www.onhealth.com/skin_cancer/article.htm
• National Cancer Institute. (2013). SEER Fact Sheets: Skin. Retrieved
from http://seer.cancer.gov/statfacts/html/skin.html#survival.
• The Skin Cancer Foundation. (2013). You Are at Risk. Retrieved from
http://www.skincancer.org/healthy-lifestyle/anti-aging/you-are-atrisk.
• American Cancer Society. (2011). Learn about cancer. Retrieved from
http://www.cancer.
org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overviewnew-research

38. Research: NCI/ACS/DoD
Prostate Cancer Clinical Trials
o Prostate Cancer Foundation and the
Department of Defense Prostate
Cancer Research Program (PCRP)
o Phase III Randomized Study of
Vitamin D, and Calcium in Preventing
or Delaying Skeletal-Related Events in
Patients With Bone Metastases
o Vitamin D and Soy Supplements in
Treating Patients With Recurrent
Prostate Cancer--Wake Forest
University
o Vitamin D in Treating Patients With
Prostate Cancer-- Roswell Park
Cancer Institute
Congressionally Directed Medical Research Program
Prostate Cancer