“Women participating in the last two breast cancer screening examinations prior to breast cancer diagnosis had the largest reduction in breast cancer death. Missing either one of the last two examinations conferred a significantly higher risk.

The incidence of breast cancers proving fatal within 10 years of diagnosis was 50% lower for serial participants than for serial nonparticipants. Compared to women who attended only one of the two previous screens, women who attended both had 29% fewer breast cancer deaths” (Radiology in ASCO).

Cancers that ARE MISSED DUE TO MISSED ROUTINE SCREENING are going to be discovered later, when they are a more advanced stage with a lower survival rate.

There is a whole continuum of cancer diagnoses, from precancerous lesions to stage 4 metastatic cancer and over 100 types of cancer. There are many variables that contribute to how fast a cancer grows. Typically the faster the cancer grows, the more dangerous it is. The goal of cancer screenings it to catch early cancers, when cure is most likely and treatment is typically less-invasive.

An at-home Colon cancer FIT test (or a fecal DNA test) is one of the newer ways we are performing completely non-invasive screenings. In some cases, the screening can also be the complete cancer treatment, such as removing cancerous polyps during a screening colonoscopy. The patient had their cancer removed before they ever knew they had it!

HOW TO REDUCE YOUR RISK OF DEVELOPING CANCER

Detoxes?

Clean Beauty?

Supplements?

Goji Berries?

BPA free water bottled?

Avoiding Disneyland?

What makes the biggest impact on your health?

There are a lot of businesses standing to make a lot of money from scaring consumers into avoiding cancer.

Your time and attention are precious and it’s wisest to focus on risk reduction that we have evidence for, starting with:

• Know your family history.

•  Make sure you are up to date on cancer screenings (ask your primary care doctor or find one!).  In general, cancer screenings start 10 years prior to the youngest family member diagnosed OR the recommended screening age, whichever is younger.

• Determine your risk of developing breast cancer in the next 5 years and lifetime risk by completing a Breast Cancer Risk Assessment. This is what qualified Olivia Munn for a breast MRI, which diagnosed her bilateral breast cancer and saved her life!

• Get Moving. At least 150 minutes per week of moderate-intensity physical activity; increase to 300 minutes to support weight loss. (World Cancer Research estimates 20% of all cancers in US are related to excess body fat and physical inactivity)

• Don’t Smoke. Once you start smoking your risk for lung cancer never goes back to the level of someone who has never smoked. Quit Smoking- it’s not too late!

• Limit Alcohol. If you do drink, no more than 1 drink per day for women or 2 for men (3 drinks per week if there is a higher risk of breast cancer).

• Limit exposure to known carcinogens: Asbestos, the HPV virus (can get Gardasil vaccines, use condoms).

• Practice Safe Sun. Use Broad Spectrum SPF 50 or higher every 2 hours and after swimming and broad-rimmed hats. Avoid the sun between 10-4.

• Get (your kids) vaccinated. “The HPV vaccine is given as a series of shots and protects against the HPV types that are the most common cause of cancer, precancer, and genital warts. Vaccination works best when it is done before a person is sexually active and exposed to HPV. But vaccination can still reduce the risk of getting HPV for people who have already been sexually active. The ideal age for HPV vaccination of girls and boys is 11 or 12, but it can be given starting at age 9 and through age 26. See Human Papillomavirus (HPV) Vaccination for details” (ACOG).

• Risk Reducing medications and surgery can be used for certain high risk populations (such as BRCA 1+ 2 carriers).

DIET

• Eat a mainly plant-based diet packed with phytochemical-rich minimally processed vegetables, fruit, whole grains, beans, legumes, whole soy foods, nuts, seeds, herbs, and spices. Fill 2/3 of your plate and especially dark leafy greens and other richly colored options.

• Limit highly processed forms of carbohydrates (i.e: foods made out of flour) and added sugar (limit to no more than 24 grams added sugar/day for women and 36 grams for men).

• Avoid red meat and processed meats. If you consume animal foods: choose lean, high quality animal proteins and low fat dairy.

• Do not use large doses of vitamin and mineral supplements to prevent cancer; use them instead to help meet basic nutrition needs, or to correct a known nutrient deficiency. There is risk for Nutritional Deficit if there is any dietary restrictions (dairy, carb, animal products) or having symptoms like fatigue or depression (can check iron and vitamin levels). Can use any multivitamin, just check the label for 100% RDV or DV. Don’t use any megadoses of vitamins.

  Phytochemicals are more easily absorbed and bioavailable from food than supplements.

• Instead of taking probiotics, eat probiotic rich cultured foods and prebiotic fibers that may help promote the growth of good bacteria:

  Activia, Yakult, Good Belly, kefir, buttermilk

  Kombucha Tea. Raw miso paste

  sauerkraut, natto, kimchi, tempeh

  Jerusalem artichoke (aka sunchoke)

  Asparagus, Banana, Garlic, Leeks, Onions

Thank you to Dr May Chen (Oncologist) , Dr Liza Zaba (Dermatologist- Immunologist) Astrid Shapiro RD and Julie Simco RD (Registered Dieticians), Courtney Rowe-Teeter (Genetic Counselor) and Dr Karam (Gynecologic-Oncologist) for contributing.

Talk to your doctor with worrisome symptoms: unintentional weight loss, feeling full earlier than you normally would, blood in urine or stool, night sweats, or any new lumps or bumps.

Usually 6 mutations/division errors need to occur before a single cancer cell is formed. That cell has to divide to become 1 billion cancer cells to become around 1 cm, or the size of a pea, which is the smallest lump that can be felt (still can be early stage/local)

CANCER SCREENINGS: ARE YOU UP TO DATE?

For Someone at Average Risk (you need to know your family history to determine this!)

Cervical:

• Women who are 21 to 29 should have a Pap test alone every 3 years (preferred), regardless of when you first start having sex (ACOG).

• Ages 25-65 should get an HPV test every 5 years (ACS, ACOG is 30 to 65).

Breast:

• Ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms

• Ages 45 to 54 should get mammograms every year

Colorectal:

• Start regular screening at age 45

Prostate:

• Talk to doctor at 50

 Lung:

• 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

U.S. Preventative Task Force and American Cancer Society are helpful to see screening recommendations, which can vary slightly.

When to talk to your primary care doctor about a referral to have Genetic Testing:

If you have a Personal or Family History of:

• Breast, Colon or Endometrial cancer prior to age 50

• Ovarian cancer at any age

• Male breast cancer at any age

• Pancreatic cancer at any age

• High Risk, Very High Risk or Metastatic Prostate Cancer at any age

• >10-20 cumulative colon polyps (especially adenomas)

• Multiple primary cancers in an individual

• Multiple affected relatives & generations

  • Particularly with the same or associated cancer types

• Known pathogenic (cancer causing) gene mutation in family

Genetic testing typically starts with the person diagnosed with cancer and if they test positive, then their relatives are tested.

HEALTH EQUITY:

• Breast and Gynecologic Screenings for ‘PEOPLE’ versus ‘WOMEN‘

• There are cancer cells from a Black patient named Henrietta Lacks, who had a biopsy of her cervical cancer in 1950 and those cells are still being studied in labs around the world. The cells were named HeLa immortalized cell  line. She died in 1951 and did not give consent to be studied.

• Blacks have higher death rates than all other racial/ethnic groups for many, although not all, cancer types.

• Despite having similar rates of breast cancer, Black/African-American women are more likely than White women to die of the disease.

• Cancer disparities may also be exacerbated by the lack of diversity in clinical research participation. Because of this lack of diversity, research results may not be applicable to all populations (Cancer Disparities, NCI).

REFERENCES

1.       https://jamanetwork.com/journals/jamaoncology/fullarticle/2778916 (JAMA)

2.       https://pubs.rsna.org/doi/10.1148/radiol.2021203935 (Radiology)

3.       https://science.sciencemag.org/content/368/6497/1290 (Sharpless)

4.       https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html (ACS Cancer Prevention)

5. https://www.cancer.gov/about-cancer/understanding/disparities (Cancer Disparities, NCI).