Dr. Jerry Goodwin, chief medical officer of Sylvester Comprehensive Cancer Center/UMHC, presented "Can Cancer Be Prevented?" at the 2011 WellBeingWell Conference in Miami.

1. W. Jarrard Goodwin, M.D., F.A.C.S.Chief Medical Officer, Sylvester Comprehensive Cancer Center Can We Prevent Cancer?

2. Cancer in America 1.44 million Americans will be diagnosed in 2008 570,000 deaths annually (1 in 4) 1,500 deaths daily Lifetime risk 1 in 2 men 1 in 3 women These figures exclude non-melanoma skin cancer Age-adjusted death rate is decreasing Lots of good news

3. Impact of Total Eradication Impact of Total Eradication Life expectancy of general population ↑ 2.5 years For the approx 25% who would have died - ↑ 10 – 15 years ↓ Suffering for patients, friends and family Economic costs 1990 Direct $27 billion Indirect $69 billion Total $96 billion

4. Carcinogenesis Multiple genetic mutations Germline – 20% Spontaneous Abnormal proteins Cell cycle Cell surface Malignant phenotype Cell proliferation > apoptosis Loss of contact inhibition, invasion Escape immune surveillance Angiogenesis

5. Nature vs. Nurture Environment more important Inhibitors Diet Micronutrients Exercise Anti-inflammatory agents Hormone inhibitors Carcinogens Tobacco/Alcohol Obesity Radiation Stress Chemicals Viruses Gene Pool less

6. 50% of Deaths are Preventable Tobacco/Alcohol Screening Prevention Early Detection Lifestyle Diet Exercise Stress/frustration Depression Social support Viruses Sun exposure +/- Drugs/Micronutrients Hormone agonists Vitamins, antioxidants Anti-inflammatory drugs –aspirin, NSAs

7. Socialand Behavioral Issues Socialand Behavioral Issues Personal freedoms vs. good of society Medical economics – focus on treatment, sick care vs. well care Knowledge/education Individual fears / cultural factors Ignore symptoms and signs Disregard screening guidelines Disparities – minority and medically underserved bare an unequal burden

8. Tobacco Cancer of the lung Mouth and throat cancer Kidney cancer Bladder cancer Pancreatic cancer Esophageal cancer Breast cancer?

9. Tobacco Prevalence Problems- low income, low education, minorities, stable since 2004

10. Second Hand Smoke 3,400 deaths from lung cancer 35,000 deaths from heart disease Occupational exposure Family exposure Legislation and litigation helping

11. Industry Marketing 1998 2005 $6.7 B $13.1 B Discounting strategies

12. Quitting Quitting Behavioral interventions Pharmaceutical treatment Social initiatives Legislative – taxes/pricing, clean air Judicial ACS quitline in Florida Success rate 16% 200 calls/month to 400/day

13. Excess Alcohol Excess Alcohol Mouth and throat Esophagus Liver Breast

14. Screening Screening Breast Prostate Colon Lung - controversial Uterine cervix Skin Mouth Esophagus Prevention Early detection

15. Diet Diet Calories Fruits and Vegetables Animal Fat Fiber Bioactive Micronutrients Preservatives vs. Organic

16. Exercise Exercise 25-50% reduction in breast and colon cancer Effects on fat distribution and metabolism Reduced stress Immune enhancement Hormones Reduced estrogen levels Reduced insulin growth factors Anti-angiogenesis

18. Improves survival after diagnosis

20. Frustration

21. Depression 

23. Effect on the Tumor

24. Infections Viruses HPV, Hepatitis B & C, EBV, HIV&HHV-8 Bacteria Helicobacter pylori Immunization, antivirals, antibiotics Gardasil – HPV types 16, 18 - FDA approved in 9-26 year old females

25. Environmental Carcinogens Environmental Carcinogens 5-10% of deaths? Ionizing Radiation Radon: 15 – 20,000 lung cancer deaths annually Sun Occupational exposures – now regulated Pesticides – skin contact Pollutants – second hand smoke

26. Gastro-esophageal Reflux Gastro-esophageal Reflux Millions of Americans Barrett’s esophagus – approximately 10%, annual screening Esophageal cancer – 3-4/100,000 overall, 3-8% of Barrett’s patients, .5%/year Treatment Lifestyle changes Medications Surgery

27. Inhibitors of Carcinogenesis Inhibitors of Carcinogenesis Antioxidants BHT, BHA, selenium Red wine, chocolate, garlic, herbals Vitamins A, B12, C, D and E Retinoids, beta carotene, lycopene Anti-inflammatory drugs Aspirin Cox 2 inhibitors Estrogen and androgen inhibitors

28. American Cancer Society American Cancer Society Don’t smoke – or be around anyone who does! Choose most foods from plant sources Five servings of fruits and vegetables a day Cereal and grains Limit high fat foods – especially from animal sources Be physically active – at least 30 minutes daily Maintain a healthy body weight Limit alcohol intake Follow screening guidelines Know the danger signals

29. CDC/HHS/NCI CDC/HHS/NCI www.fruitsandveggiesmatter.gov

30. ACS Screening Guidelines ACS Screening Guidelines Breast Cancer Yearly mammogram starting at age 40 Annual MRI if lifetime risk > 20% Colon Cancer – beginning at age 50 Annual stool test (occult blood, DNA) Every 5 years – sigmoidoscopy/colonoscopy

31. ACS Screening Guidelines ACS Screening Guidelines Cervical cancer Annual Pap test beginning at 21 years Less frequent if 3 normal tests in a row and may stop at age 70 years Prostate cancer Annual PSA and digital exam beginning at age 40 - 50 years depending on risk

32. Individual Issues & Choices Individual Issues & Choices Know your own risk, but don’t obsess about it. Manage stress and especially frustration Invest time in family and friends Should you take: Aspirin? Vitamin D? Selenium? Estrogen replacement therapy? Red wine, chocolate, garlic, herbals? Avoid gastroesophogeal acid reflux Include laughter in every day

33. Future Future Better public education Personalized messaging Behavioral research Choices Coping Early detection Imaging Genetic and protein screening Inhibitors Vaccination Public Policy / legislation Research Cures Cancer