PREVENT OR REDUCE THE RISKS OF CANCER.
DEAR DOCTOR :
Is it possible to prevent, or at least reduce, your risk of cancer?
Absolutely, it is. It is possible both to reduce the risk that your cells will turn cancerous, and to catch cancer early and prevent it from causing suffering. But first let’s define some terms.
What does it mean to say that a “cell turns cancerous”? Cancer is uncontrolled cell growth. Most cells “grow” not by becoming larger, but from dividing. (An exception: Fat cells grow not only by dividing, but also by becoming larger.) One cell becomes two, two become four, four become eight, and so on.
Most cells should periodically divide, but in a controlled fashion. For example, as old cells die, they need to be replaced. But that process of replacing old cells is carefully controlled.
When a cell turns cancerous, growth is not controlled. In most cancers, the uncontrolled growth first causes a mass of cells — a tumor. (With cancers of blood cells, there is no tumor mass because blood cells don’t stick together.) The cells in the tumor then can spread, typically through the blood, to other parts of the body.
You can reduce the risk of cells turning cancerous with lifestyle changes.
STOP SMOKING. Exposure to tobacco smoke (including secondhand smoke) — from cigarettes, cigars and other tobacco products — increases the risk of lung cancer. Smoking also boosts your chances of developing cancer of the mouth, throat, esophagus and colon. If you smoke, ask your doctor about quit-smoking programs.
MAINTAIN A HEALTHY WEIGHT. Overweight and obesity increase the risk for many types of cancer. These include breast cancer (in postmenopausal women) and cancers of the colon, rectum, endometrium, esophagus, pancreas and kidneys. A healthy diet and regular exercise can help you maintain a healthy weight.
EAT A HEALTHY DIET. People who eat diets rich in fruits and vegetables (particularly broccoli, kale, cabbage, cauliflower and tomatoes) have lower rates of cancer. So do people who eat relatively little meat (particularly processed and cured meats, such as bacon, sausage and cold cuts).
That said, don’t focus on any single food or group of foods. It’s an overall healthy diet that counts.
EXERCISE REGULARLY. Exercise is yet another way to reduce your cancer risk. Aim for at least 30 minutes of moderate-intensity exercise, most days of the week.
PROTECT YOURSELF FROM THE SUN. Skin cancer is one of the most common cancers. To reduce your risk, stay out of the sun when it is strongest (from 10 a.m. to 4 p.m.). Apply plenty of sunscreen with an SPF of at least 15, and reapply it every two hours. Wear sunglasses and wide-brimmed hats. You can walk in the sun in the morning to get Vitamin D.
GET SCREENED. Screening tests can’t prevent cancer. But they can catch cancer early, before symptoms appear, and when chances of survival are at their best. Discuss screening tests with your doctor. He or she can help you tailor the recommendations based on your individual risks and preferences
Prevention guidelines: Guidelines and screening technology are always evolving, with new recommendations from medical organizations and societies. Which test is best, and how often to be tested, may vary depending on the technology used and your risk for particular illnesses.
Test or exam
There’s not enough evidence to prove that this is a valuable screening tool. However, monthly exams give women the opportunity to note and report lumps or other suspicious changes in a breast, and many doctors recommend monthly self-exams because they are simple to do. If you choose to do self-exams, have a clinician show you the correct technique.
Breast exam by clinician
Annually after age 40. (Women in their 20s and 30s should have one every three years, at least.)
Every two years for women ages 40 and older, though more frequent screening may be indicated for those at higher risk of breast cancer. Some professional societies recommend an annual mammogram and breast MRI (see next entry) for those at moderate or high risk. Talk with your doctor about the best age at which to stop routine screening.
If you are at moderately increased risk for breast cancer (a 15% to 20% lifetime risk), the American Cancer Society (ACS) suggests discussing risks and benefits of having breast MRI plus a mammogram annually. Women at moderate risk include those with
•a history of breast cancer, DCIS, LCIS, or atypical cell changes
•breasts that are extremely dense or unevenly dense on mammograms.
•If you are at high risk for breast cancer (a lifetime risk greater than 20%), the ACS recommends having a breast MRI and a mammogram annually. Women at high risk include those with
•a known BRCA gene mutation, or a close relative (parent, sibling, child) known to have this
•past radiation therapy to the chest between ages 10 and 30
•a condition that raises breast cancer risk or a close relative who has such a condition, such as Li-Fraumeni syndrome or Cowden syndrome.
Pelvic exam and Pap test (conventional or liquid-based)
Every year (conventional Pap test) or every two years (liquid-based Pap test) starting at age 21 or about three years after the onset of sexual intercourse (whichever is first). Starting at 30, the ACS recommends screening every two to three years for women who have had three or more consecutive normal Pap tests. (Another option for these women is having a conventional or liquid-based Pap test plus the human papilloma virus test every three years.) Women over 70 who have had three consecutive normal Pap tests and no abnormal Pap results for 10 years may elect to stop screening. You may need more frequent screening if your doctor determines your risk for cervical cancer is high.
Fecal occult blood test (gFOBT), sigmoidoscopy, or colonoscopy
The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at 50 and continuing until 75. The risks and benefits of these screening methods vary, so ask your doctor which is best for you and how often to repeat the test. The USPSTF recommends against routine screening for people ages 76 to 85, unless you and your doctor determine that there are special circumstances to support such testing. Testing is not recommended for adults over 85.
Fasting plasma glucose (FPG) test
Every three years beginning at age 45. Testing may begin earlier and be carried out more frequently if you are overweight or obese and have one or more risk factors for diabetes, such as having had gestational diabetes or having a parent, brother, or sister with diabetes.
Hemoglobin A1c (HbA1c) test
This test is sometimes used by doctors instead of the FPG and is also recommended by the American Diabetes Association.
People with diabetes need regular podiatry services. Periodic foot exams and removal or care of bunions, corns, and other causes of discomfort can encourage activity and help in stability and balance.
Every few years if you have been regularly exposed to loud noises; otherwise, every few years after age 65.
Blood pressure measurement
Check at every exam and at least every one to two years.
Fasting lipid profile (measures total cholesterol, LDL, HDL, and triglycerides)
For all men ages 35 and older, every five years. Starting at age 20, for both men and women who have risk factors for atherosclerosis, such as smoking, diabetes, a personal or family history of heart disease, high blood pressure, or obesity.
Highly sensitive C-reactive protein (hs-CRP) test
Some experts recommend this test to detect levels of C-reactive protein (CRP) in the blood for people at intermediate risk for heart disease. Your doctor can help you determine if you are a candidate for this blood test.
After age 40, every one to three years if you are at high risk for coronary artery disease or are about to start a vigorous exercise program.
Lung CT scan
While lung cancer kills more men and women annually than any other type of cancer, yearly CT screening is recommended only for high-risk adults ages 55 to 79. High-risk adults in this age group include those who have smoked a pack a day for 30 years (or some equivalent amount, such as two packs a day for 15 years) and who are still smoking or who have quit within the past 15 years. The USPSTF does not recommend screening for “casual” smokers.
Bone density test
Every two to three years for all women starting at age 65 and all men starting at age 70. Additionally, the National Osteoporosis Foundation recommends testing others at high risk for osteoporosis, including
•adults who have a fracture after age 50
•adults who have medical conditions or who take medications that can prompt low bone mass or bone loss
•men ages 50 to 69 and postmenopausal women under age 65 with specific risks for osteoporosis.
Prostate-specific antigen (PSA) test
Experts disagree. Some recommend a PSA test annually at age 50, or age 45 if you are at high risk for prostate cancer (have a father, brother, or son diagnosed with prostate cancer before 65 or are African American), or at age 40 if you are at very high risk (have several close relatives who were diagnosed before 65). Others don’t believe there is sufficient evidence to recommend PSA tests and endorse its use only for surveillance after a diagnosis of prostate cancer or to monitor treatment of the disease.
Experts disagree. Some say this is not of proven value as a screening test for prostate cancer. However, the exam sometimes detects rectal cancer or blood in the stool originating from another disease. Therefore, it may be worthwhile as a routine screening; talk to your doctor about the age to begin having this exam and how often to repeat it.
Regular self-exam to note any suspicious changes, and periodic yearly exam by your doctor at check-ups. If you’re at high risk, particularly for melanoma, a specialist should do the exam. See the doctor if you have a mole that’s 6 millimeters or larger in diameter, is asymmetrical, and has irregular borders and a mixture of colors.
Thyroid-stimulating hormone (TSH) test
Experts disagree. Some recommend that women over age 60 have this test every few years. Others, such as the American Thyroid Association, recommend that all adults have a TSH blood test every five years beginning at age 35.
Tooth decay and gum disease
Every six to 12 months.
Comprehensive eye exam
For people with healthy vision, every two years from ages 40 to 60 if your vision is good, from ages 18 to 39 if you have vision problems, and annually starting at 61. People at higher risk for eye disease—such as anyone with a family history of eye problems, a personal history of an eye injury, or African Americans over age 40—may need more frequent exams. If you have diabetes, you should have a yearly eye exam. Once you reach 65, an ophthalmologist (a medical doctor trained in diagnosis and treatment of eye diseases) should perform the exam. more