Cancer Prevention

Question: Is there anything I can do to prevent colon cancer?

Answer: Because colon cancer is the third leading cause of cancer death in the United States, there is a lot of interest in early detection and prevention.

Most colon cancers develop from small growths called "polyps." While some polyps are benign, "adenomatous" polyps can develop into cancer in about 7 years. Finding and removing adenomatous polyps early can be a life-saver.

Precancerous polyps and colon cancers both have a tendency to bleed. Checking the stool for the presence of microscopic evidence of blood can lead to early detection and improved survival. The American Gastroenterological Association guidelines recommend checking three consecutive stools once a year beginning at age 50. Patients place a small amount of stool on a card that is delivered to the physician's office and tested for the presence of blood.

Flexible sigmoidoscopy is another recommended screening test. A long tube with a fiberoptic camera in the tip is inserted into the rectum to examine the last third of the patient's colon. This is an office procedure that takes about 20 minutes, requires preparation the night before with laxatives or enemas, and may cause mild cramping. Like stool cards, flexible sigmoidoscopy every 3-5 years after age 50 can detect polyps and colon cancer early enough to cure many patients. Abnormal findings during flexible sigmoidoscopy lead to a more extensive evaluation with tests like the barium enema or colonoscopy.

If you have a close relative who has been diagnosed as having numerous polyps or colon cancer, you may be at increased risk. Screening usually begins 10 years before the youngest relative developed colon cancer. You should seek the advice of a specialist.

There is some evidence that dietary factors can prevent colon cancer. Some physicians now recommend diets rich in fresh fruit and vegetables and low in animal fat. Calcium, folic acid, aspirin, and nonsteroidal antiinflammatory drugs like ibuprofen and naproxen may protect against colon cancer. Hormone replacement therapy in postmenopausal woman may also have a beneficial effect. The mechanisms behind these protective effects are not well understood.

Question: Is there anything I can do to prevent from getting skin cancer?

Answer: It is recommended that you protect yourself from damaging ultraviolet rays on a regular basis. This includes:

Applying a good sun screen (one with a higher SPF -- sun protection factor) daily
Wearing protective clothing including hats and sunglasses
Refraining from intentionally lying in the sun or using tanning devices
Minimizing sun exposure, especially during the summer, and particularly between the hours of 10:00 a.m. and 2:00 p.m., when it is the hottest

Question: How can Ovarian Cancer be prevented?

Answer: In general, factors or behaviors that limit stimulation of the ovaries or inhibit ovulation appear to be protective.

Pregnancy.

The more times a woman has been pregnant the less likely she is to develop ovarian cancer. One study indicated that ovarian cancer was reduced by 40% with one pregnancy and by 14% with each subsequent pregnancy.

Breast Feeding.

Breast feeding, even for only one or two months, may also reduce the risk for ovarian cancer by as much as 40%. A longer duration of breastfeeding does not appear to increase its protective benefits.

Oral Contraceptives.

Studies have suggested that routine use of birth control pills that contain the female hormones estrogen and progestin, even low-dose forms, reduces a woman's risk of ovarian cancer by about 50% when compared to women who have never taken oral contraceptives. One study indicated that progestin may be the reason for their protective value. The longer a woman is on oral contraceptives the greater the protection, although one study reported that taking birth control pills for only three to six months conferred benefits for 15 years.

They even appear to protect women with the BRCA1 or BRCA2 genetic mutations and those with a family history of ovarian cancer. (The effects of oral contraceptives on breast cancer, however, are still not entirely known.)

Birth control pills should not be taken by pregnant women, or by women with breast cancer. Other conditions that may preclude taking oral contraceptives include the following:

Liver disease.
Migraines.
Coronary artery disease and any risk factors for heart disease or stroke (particularly smoking, obesity, high blood pressure, blood clotting disorders, or severe diabetes).

Tubal Ligation

One study suggested that tubal ligation, a method of sterilization that ties off the fallopian tubes, is associated with a decreased risk for ovarian cancer. However, this finding has not been supported by other studies.

Removal of Ovaries (Oophorectomy)

Surgical removal of the ovaries, called oophorectomy, significantly reduces the risk for ovarian cancer. When it is used to specifically prevent ovarian cancer in high-risk women, the procedure is called a prophylactic oophorectomy.

Some experts now consider prophylactic oophorectomy in the following situations:

Women who have two or more first-degree relatives afflicted with ovarian cancer (or who have a BRCA-1 or BRCA-2 mutation), and who are 35 years old or older and have completed their families.

Considerable controversy still exists, however for the following reasons:

One study reported that oophorectomy might improve survival rates in women carrying the BRCA1 or BRCA2 genes by about half a year to over two years. However, the impact of this procedure on survival is still uncertain.
Even after oophorectomy, women in high-risk groups for ovarian cancer still have a risk for the development of cancer in the peritoneum (the sac inside the abdomen that holds the intestines, uterus, and ovaries).
The procedure causes early menopause in younger women.

Question: I am an African-American male. My father survived colon cancer 3 years ago. What does this mean for me? In particular, how often should I be checked for colon cancer? What is the best procedure for checking?

Answer: Colon cancer is the second most common cancer in the United States. Colon cancer typically starts as a small polyp--an outgrowth in the colon that's normal, but has the potential to develop into cancer. On average, it takes approximately 10 years for a polyp to become cancerous. Because this takes so long, screening examinations allow "early detection"--identification and removal of polyps before they become cancerous. Because of this, colon cancer is considered a very preventable disease. Unfortunately, many people still fail to undergo appropriate screening to prevent colon cancer.

Guidelines have been developed by special groups to determine the most appropriate screening procedures. In general, everyone age 50 and older should have some type of screening for colon cancer. This screening can involve yearly testing of the stool for blood, flexible sigmoidoscopy, or both. Screening the stool for blood uses a special lab card that allows the patient to take a sample of stool at home and send it to the lab for analysis. Sigmoidoscopy is a procedure where a doctor uses a special camera to look at the last part of the colon. These two procedures are recommended as the mainstay of colon cancer screening. Other procedures, such as colonoscopy and barium enema, are sometimes used.

People with family members who had colon cancer are at increased risk to develop colon cancer themselves. It is generally acknowledged that if more then one family member has developed colon cancer, screening should begin at a younger age. Also, people in families with a history of many colon polyps should begin screening at a younger age. Recommendations for people who have had only one family member develop colon cancer vary depending on a number of factors, including the age of the relative and the age of the patient in question.

A high-fat, low-fiber diet is a risk factors for colon cancer. Some cultures, like certain groups in Africa, have a diet that is very high in fiber and low in fat, and they have lower rates of colon cancer. But when people from these cultures move to the United States and adopt the typical low-fiber, high-fat, American diet, their risk of colon cancer increases to that of the average American. For this reason, recommendations for colon cancer screening are the same for all races living in the United States.

All persons age 50 or older or with a family history colon cancer should see their doctors. At that visit, patients should learn about strategies to prevent colon cancer and decide on the most appropriate plan of action.

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