 Hi, I'm Dr. Joan Herbert, the Director for Oncology Service Line at MidMichigan Health, and I'm here today to talk to you about cancer screening and prevention. So should you really worry about getting cancer? The answer is that although you should not spend your life worrying about whether you will get cancer, but rather have the knowledge to address how you can perhaps prevent it or at a minimum catch it early when it is most curable. Now we will turn our attention to the number of new cancers projected for the US this year. It is estimated that more than 1.6 million new cases of cancer will be diagnosed in 2014. The most common cancers are estimated to be prostate in men and breast in women. Lung and colorectal cancers are the second and third most common cancers in both men and in women. Lung cancer is by far the leading cause of cancer death among men, 28 percent, followed by prostate, 10 percent, and colorectal, 8 percent. Among women, lung, 26 percent, breast, 15 percent, and colorectal, 9 percent are the leading causes of cancer death. The risk of an American woman developing cancer over her lifetime is a little more than one in three. Looking at the trends with screening techniques for colon cancer that can catch and remove a polyp prior to it evolving into cancer, we are seeing colorectal cancer incidences begin to decline. Smoking still is the leading cause of many cancers and in particular lung cancer. So with the declining smoking rates in the US, we are also seeing a leveling off or decline of other related cancers. The women's health study that linked post-menopausal hormone replacement with breast cancer has led to a decline and now leveling off of the incidence of breast cancers. Here's the good news, slowly but surely we are winning the war on cancer. The lung cancer death rate in women began declining in the early 2000s after increasing for the previous 70 years. The lag in the decline in lung cancer in women compared to men reflects differences in smoking patterns. Smoking rates peaked about two decades later in women than in men and women lagged behind men in quitting smoking in large numbers. In comparison, breast cancer death rates changed little between 1930 and 1990 but decreased 34% between the peak year of 1989 and 2010. Since 1930, the death rate for stomach cancer has decreased by more than 90%. The death rate for uterine cancer, cervix and utercorpus combined, which was the leading cause of cancer death in the early 20th century, has declined 80% from 1930 to 1997 but has since been fairly stable. Colorectal cancer deaths have been decreasing for more than 60 years. Similar to men, pancreatic cancer death rates have been increasing slightly from 8.8 per 100,000 women in 1980 to 9.6 in 2010. The number one risk factor for cancer is age. Of course we cannot stop the clock from ticking but there are a number of other risk factors that we can mitigate or eliminate such as tobacco use, vaccination for human papillomavirus and maintaining a healthy weight. There are hereditary factors or genes that we inherit that are known to place families at higher risk for developing cancer. An example are the BRCA1 and 2 genes that are associated with developing breast cancer. Hereditary factors or genes at this time are associated with only about 5 to 10% of all known cancers. Something to look for is cancer being diagnosed in a first degree relative such as a mother, sister, daughter at a younger than normal age, which would be less than 60. Seeking guidance from a master prepared genetic counselor can help you map out your family history and determine if you are at higher risk for a hereditary type of cancer or whether or not you should be tested for specific genes known to be associated with high risk. We all know that smoking is a big risk factor for developing lung cancer. It is actually right on the Surgeon General's warning on each pack of cigarettes. Smoking tobacco is also associated with head and neck, esophageal, and many other types of cancer. Never starting to use tobacco is the best way to avoid this risk. However, if you are a tobacco user, even if you have already been diagnosed with cancer, there are benefits to quitting. Reduction of your cancer risk begins almost immediately and if you have already been diagnosed, quitting decreases your risk for cancer recurrence as well as it helps you to tolerate your cancer treatments better and heal more quickly. This graph shows the benefits of reducing your risk for cancer by quitting smoking. Now pick a date and start. If you slip back, pick a new date and start stopping again. Keep doing this until you are no longer using a tobacco product. Start by listing all the benefits from quitting smoking, not just the reduction in cancer risk but the dollars saved. Then pick up the phone and ask for help. Counseling is not easy and you will need all the support you can get. Free tobacco replacement products and counseling are available through the quit line and personal counseling is offered through the Freedom from Smoking classes held at Mid-Michigan Health. Being morbidly overweight is a risk factor for many diseases such as heart attack, stroke, and diabetes. It is also now well known that it can be a risk factor for cancer too. Specifically, colon, breast, and endometrial cancers have been shown to be more prevalent in those that are above a healthy weight. We are often told that fruits and vegetables are cancer preventative. That is a myth. Maintaining a healthy weight is supported by having more fruits and vegetables as part of your daily diet. Is organic better? To date, organic fruits and vegetables have not been shown scientifically to be any better than non-organic. Several strains of the human papillomavirus are now linked with a number of cancers. This virus is sexually transmitted and is very common. Many strains are benign or the cause of benign genital warts. But four strains in particular are now directly responsible for much of the cervical and head and neck cancers that are being diagnosed. A vaccination is available and recommended as a three-part injection, beginning in adolescence as part of the childhood vaccination schedule. However, young women who have not been vaccinated should consider vaccination up to age 30 if they have not already done so. Regular checkups with your primary care physician where pap smear is checked can catch precancerous conditions, which can then be treated to avoid the precancer from evolving into a cancer. There are new guidelines available for when to get pap smears, so make sure you have this discussion with your physician and stay on schedule. Screening is a way to find precancerous situations such as a polyp in the colon or dysplasia in a cervix, which can then be treated so that the cancer doesn't get a chance to take hold. Other cancer screenings such as a mammogram serve the purpose to catch a cancer at an early stage when it is most curable. There is a new screening available for lung cancer that can also detect cancer at an early, more curable stage. This is called a low-dose CT and is appropriate for those that are 55 years or older who have smoked at a minimum one pack of cigarettes on average per day for more than 30 years. This select population is at the highest risk of having developed lung cancer and a low-dose CT of the chest can determine over time if there is a nodule that is growing and potentially developing into a cancer. Head and neck cancers can be checked for when you go to the dentist for your regular cleaning. They should be doing an oral cavity exam as well as feeling for lymph nodes. Ask your dentist about this and finally, skin cancer screenings. Your skin is the largest organ in your body. Make sure you do a regular check of your skin with help to see areas that you yourself cannot visualize and bring any changes in your skin to your physician's attention. You are your best screening device. Know your body and report changes to your doctor. Some key takeaways to cancer prevention. First, quit smoking. Second, make sure you talk with your primary care provider to get your age-appropriate cancer screenings. And third, live a healthy lifestyle to maintain a healthy weight. I hope you found this information on cancer screening and prevention helpful. At MidMichigan Health, we celebrate the power of health throughout life with you.