The Daily Nonpareil
Friday, June 22, 2012
Understanding Cancer Good Eats
Dieticians explain what’s best to eat during treatment and after page 3C Life After Cancer
What happens when treatments end? page 4C
Kick it in the butt, and other ways to reduce risks page 2C
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2C Friday, June 22, 2012
The Daily Nonpareil
Consider early testing Regular screenings can help catch cancer in early stages
Staff photo/Erin Duerr
Protect yourself from the sun. Skin cancer is one of the most common kinds of cancer – and one of the most preventable. When you’re outdoors, stay in the shade as much as possible. Sunglasses and a broad-rimmed hat help, too.
Reduce your risk
MIKE BROWNLEE MBROWNLEE@NONPAREILONLINE.COM
Like many men, Horst Rossbund isn’t exactly proactive when it comes to doctor’s office visits. He put off recommended cancer screenings for a while, until another ailment finally got him to a doctor. Thankfully. In spring 2009, the Council Bluffs man experienced back problems that wouldn’t subside. “I’d walk about a block and started limping. I’m one of those guys, I don’t think I saw a doctor for years,” he said. “But I went in.” The doctor recommended a physical, since Rossbund was there and hadn’t had a physical in 10 years. Included in the checkup was a prostate specific anthigens (or PSA) cancerscreening test. A “normal” PSA count for men Rossbund’s age is 4. His total was 328, “which is out of sight,” he said. A bone scan showed no cancer, but a CAT scan showed cancer cells outside his prostate. Prostate cancer. Rossbund eventually traveled to the Mayo Clinic in Minnesota for treatment. “When I saw the surgeon up there, he said, ‘We need to do a radical prostatectomy.’ Remove the prostate,” he said. Doctors performed the surgery in July 2009 and Rossbund headed home after 24 hours. “They removed twice as much tissue and lymph nodes as normal. There was concern about the lupron (a prostate cancer drug) shot masking cancer cells around the prostate. I had 13 inches of incisions,” he said, noting that doctors also removed a hernia. The surgery and other treatment helped remove the cancer, though it came back in early 2010 – there was carcinoma located in his prostate cavity – which doctors fought off with 39 treatments of radiation, administered every morning Monday through Friday. Between the surgery, administration of lupron and radiation treatment, Rossbund’s PSA count dropped to negligible, less than 1. He wishes he had gone for exams earlier, but is thankful his cancer experience turned out the way it did. Regular screenings can help catch cancer in the early stages, which often helps in the battle. According to the National Cancer Institute (can-
Important cancer risk factors that can be changed are body weight, diet and physical activity CHAD NATION CNATION@NONPAREILONLINE.COM
Horst Rossbund put off recommended cancer screenings for a while, until another ailment finally got him to a doctor. His doctor recommended a physical, which uncovered a PSA count of 328. What’s “normal” for his age is 4. He was diagnosed with prostate cancer. cer.gov), “it is important to remember that when your doctor suggests a screening test, it does not always mean he or she thinks you have cancer. Screening tests are done when you have no cancer symptoms.” Screening tests include the following: ■ Physical exam and history – An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken. ■ Laboratory tests – Medical procedures that test samples of tissue, blood, urine or other substances in the body. ■ Imaging procedures – Procedures that make pictures of areas inside the body. ■ Genetic tests – Tests that look for certain gene mutations (changes) that are linked to some types of cancer. Some screening tests are used only for people who have known risk factors for certain types of cancer. People known to have a higher risk of cancer than others include those who: ■ Have had cancer in the past; or ■ Have two or more firstdegree relatives (a parent, brother or sister) who have had cancer; or ■ Have certain gene mutations (changes) that have been linked to cancer. People who have a high risk of cancer may need to be screened more often or at an earlier age than other people.
Getting Screened When your doctor suggests a screening test, it does not always mean he or she thinks you have cancer. Screening tests are done when you have no cancer symptoms. Some screening tests are used only for people who have known risk factors for certain types of cancer. People known to have a higher risk of cancer than others include those who: ■ Have had cancer in the past; or ■ Have two or more firstdegree relatives (a parent, brother or sister) who have had cancer; or ■ Have certain gene mutations (changes) that have been linked to cancer. People who have a high risk of cancer may need to be screened more often or at an earlier age than other people. For prostate cancer, men should start discussing the pros and cons of testing at age 50, according to the American Cancer Society. Yearly mammograms (breast cancer tests) are recommended at age 40 for women. They also recomend a clinical breast exam (or CBE) about every three years for women in their 20s and 30s and every year for women 40 and older. Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider, the society said. For more informations, go online to cancer.org.
Horst Rossbund and his family. Rossbund had a radical prostatectomy in July 2009. The surgery and other treatment helped remove the cancer, though it came back in early 2010 – there was carcinoma located in his prostate cavity – which doctors fought off with 39 treatments of radiation. He wishes he had gone for exams earlier, but is thankful his cancer experience turned out the way it did.
One-third of all cancer deaths in the U.S. each year are linked to diet and physical activity, according to the American Cancer Society. That is the same percentage of cancer deaths caused by tobacco products. Common sense would dictate that enhanced activity and a healthier diet would reduce the risk of cancer. While our genes influence our risk of cancer, most of the difference in cancer risk between people is due to factors that are not inherited. For most Americans who do not use tobacco, the most important cancer risk factors that can be changed are body weight, diet and physical activity. Avoiding tobacco products, staying at a healthy weight, staying active throughout life and eating a healthy diet may greatly reduce a person’s lifetime risk of developing or dying from cancer. These same behaviors are also linked with a lower risk of developing heart disease and diabetes. To reduce the risk of cancer, the American Cancer Society recommends: Achieve and maintain a healthy weight throughout life. ■ Be as lean as possible throughout life without being underweight. ■ Avoid excess weight gain at all ages. For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to start. ■ Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weight. Be physically active. ■ Adults: Get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week. ■ Get at least one hour of moderate or vigorous intensity activity each day, with vigorous activity on at least three days each week. ■ Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainment. ■ Doing some physical activity above usual activities, no matter what one’s level of activity, can have many health benefits. Eat a healthy diet, with an emphasis on plant foods. ■ Choose foods and drinks in amounts that help you get to and maintain a healthy weight. ■ Limit how much processed meat and red meat you eat. ■ Eat at least 2½ cups of
vegetables and fruits each day. ■ Choose whole grains instead of refined grain products. If you drink alcohol, limit your intake. ■ Drink no more than one drink per day for women or two per day for men. The Mayo Clinic also advises the best practices to avoid cancer include avoiding tobacco, eating a healthy diet and maintaining a healthy weight, but the world-famous Rochester, Minn., clinic also recommends: Protect yourself from the sun. Skin cancer is one of the most common kinds of cancer – and one of the most preventable. ■ Avoid midday sun. Stay out of the sun between 10 a.m. and 4 p.m., when the sun’s rays are strongest. ■ Stay in the shade. When you’re outdoors, stay in the shade as much as possible. Sunglasses and a broadrimmed hat help, too. ■ Cover exposed areas. Wear tightly woven, loose fitting clothing that covers as much of your skin as possible. Opt for bright or dark colors, which reflect more ultraviolet radiation than pastels or bleached cotton. ■ Don’t skimp on sunscreen. Use generous amounts of sunscreen when you’re outdoors, and reapply often. ■ Avoid tanning beds and sunlamps. These are just as damaging as natural sunlight. Get immunized. Cancer prevention includes protection from certain viral infections. Talk to your doctor about immunization against: ■ Hepatitis B can increase the risk of developing liver cancer. The hepatitis B vaccine is routinely given to infants. It’s also recommended for certain high-risk adults – such as adults who
are sexually active but not in a mutually monogamous relationship, men who have sex with men, and health care or public safety workers who might be exposed to infected blood or body fluids. ■ Human papillomavirus is a sexually transmitted virus that can lead to cervical cancer. The HPV vaccine is available to both men and women age 26 or younger who didn’t have the vaccine as an adolescent. Another effective cancer prevention tactic is to avoid risky behaviors that can lead to infections that, in turn, may increase the risk of cancer. ■ Practice safe sex. Limit your number of sexual partners, and use a condom when you do have sex. The more sexual partners you have in your lifetime, the more likely you are to contract a sexually transmitted infection – such as HIV or HPV. People who have HIV or AIDS have a higher risk of cancer of the anus, cervix, lung and immune system. HPV is most often associated with cervical cancer, but it may also increase the risk of cancer of the anus, penis, throat, vulva and vagina. ■ Don’t share needles. Sharing needles with an infected drug user can lead to HIV, as well as hepatitis B and hepatitis C – which can increase the risk of liver cancer. If you’re concerned about drug abuse or addiction, seek professional help. Regular self-exams and professional screening for various types of cancers – such as cancer of the skin, colon, prostate, cervix and breast – can increase your chances of discovering cancer early, when treatment is most likely to be successful. Ask your doctor about the best cancer-screening schedule for you.
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The Daily Nonpareil
Friday, June 22, 2012 3C
Breast cancer is not Nutrition after exclusive to women cancer treatment METRO CREATIVE CONNECTION
Dieticians say what you eat, drink goes a long way in reducing chance of recoccurrence TIM ROHWER TROHWER@NONPAREILONLINE.COM
Proper nutrition is a key ingredient during the treatment of cancer and when the disease is in remission, according to local clinical dietitians. “I feel good nutrition and adequate hydration – getting enough liquids to drink – are important in cancer treatment,” said Carol Kolo, employed by Alegent Health Mercy Hospital. “I suggest eating several smaller meals and snacks per day, instead of one big meal.” “We need to eat more plant-based foods to lower the risks of getting cancer,” Reeder added Carol Reeder, employed at Jennie Edmundson Hospital. “And, for cancer survivors, these foods may lower the risk of reoccurrence. There is no guarantee it won’t reoccur, but studies have shown they may reduce the risk.” Kolo recommends to her patients, who are undergoing cancer treatment, to eat foods rich in protein at each meal. This could include one piece of fruit, one vegetable and one dairy product. “If folks are having trouble eating, I recommend nutritional drinks,” Kolo said. These could be a milkshake or a fruit smoothie. Kolo also mentioned the drink called Ensure. Reeder added that counting calories isn’t important during treatment. “During treatment, you want to keep your body strong,” she said. “If lemon meringue pie looks good, have it.” At one time, most undergoing cancer treatments occasionally suffered from nausea or vomiting, Kolo said, though many today don’t experience that because of medical advancements. For those who still have these symptoms, however, Kolo suggested keeping a journal on when nausea or vomiting occurs, and especially what they had just eaten. This journal could help their doctors “customize the medication regiment” to reduce those symptoms, she said. Reeder suggested eating lower fat foods for better digestion and colder foods, as opposed to piping hot meals. Kolo added, “Some folks do better by eating foods that are cold or at room temperatures, as opposed to hot foods, and avoid greasy, deep-fat fried foods.” Eating and drinking slowly is recommended, she said. “Avoid the smell of food,” Reeder said, suggesting that if a family member is cooking to stay away as much as possible until ready to eat. For those who are cancer survivors or if the disease is in remission, Reeder suggested a
For those who are cancer survivors or if the disease is in remission, dietician Carol Reeder, employed at Jennie Edmundson Hospital suggested a daily diet of plant-based foods like fruits, vegetables, whole grains, nuts or seeds. daily diet of plant-based foods like fruits, vegetables, whole grains, nuts or seeds. “If it is in remission, the American Cancer Society advises a low fat diet with moderate protein,” Kolo said. As far as liquids, Kolo said there is no evidence that coffee
or tea increases cancer since they are plant-based foods. “Alcohol does raise the risks of some cancers,” she said. Both dietitians recommended if alcohol is to be consumed, that women drink no more than one drink a day, and men have just two.
There are many people – male and female – who are completely unaware that men are susceptible to breast cancer. With preventative mammograms and messaging largely geared toward women, men may not even think about the breast cancer risk to themselves. Although less prevalent among men, breast cancer is not exclusive to women. The American Cancer Society estimates that about 2,000 new cases of invasive breast cancer are diagnosed in men each year, and approximately 450 men die from breast cancer annually. Male breast cancers account for approximately 1 percent of all breast cancer cases. The Canadian Cancer Society reports that less than one percent of Canadian men develop breast cancer, and men over the age of 60 are most likely to be diagnosed. To understand how men get breast cancer one must to know about the physical makeup of the male body. Like women, men have breast tissue. Before boys or girls enter puberty, they have similar breast structures, including breast tissue and a few ducts under the nipple and areola. During puberty, female hormones further develop the milk ducts and lobules, or milk-producing glands. For males, testosterone levels increase during puberty, stalling further growth of breast tissue. However, what was already there remains, and in that tissue, cancerous cells can grow and multiply. There also are lymph nodes in the breast region and under the arms. Cancer cells can travel through the lymph nodes to other areas of the body. Because men have considerably less breast tissue than women, diagnosis of cancer can be easier. A lump in the breast is more noticeable on a man than on a woman. The American Cancer Society also lists a few other symptoms that could be indicative of
Although less prevalent among men, breast cancer is not exclusive to women. The American Cancer Society estimates that about 2,000 new cases of invasive breast cancer are diagnosed in men each year, and approximately 450 men die from breast cancer annually. breast cancer: ■ lumps in the nipples or chest muscle. ■ nipples turning inward. ■ skin dimpling or puckering around the nipple. ■ redness or scaling of the nipple or breast skin. ■ discharge from the nipple. Benign growths can be mistaken for breast cancer. Also, men can have a condition called gynecomastia, which is a noncancerous breast tissue growth that may be mistaken for cancer. If any symptoms are present, they should be
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brought to the attention of a doctor for further investigation. If it is breast cancer, treatment methods are largely the same among men and women. A combination of chemotherapy, radiation and surgery may be recommended depending on the stage and positioning of the cancerous tumors. Although it is rare, breast cancer does occur in men. Therefore, guys should be aware of their bodies and the breast area and be on the lookout for any changes that could lead to problems.
4C Friday, June 22, 2012
The Daily Nonpareil
Back to beautiful RICK RUGGLES WORLD-HERALD NEWS SERVICE
OMAHA – While cancer takes aim at a woman’s health, cancer treatments exact a toll on her appearance. Five women who understand that all too well gathered recently at the Nebraska Medical Center for an American Cancer Society program called “Look Good ... Feel Better.” Two of the women, who have six bouts with cancer between them, led the program, which gives women makeup and wig tips to counter the dry, blotchy skin and hair loss that often come with chemotherapy and radiation treatments. Sharon Wiese, 56, walked into the meeting room after a long day. She had hoped to get another chemotherapy session out of the way that day, but her blood count didn’t allow it, and she had blood transfusions instead. The Omahan also had a blood clot in her leg examined. It’s been a hard fight since Wiese was diagnosed with a rare cancer early this year. She has lost her hair, her eyebrows and most of her eyelashes. She worries about how much time she might have remaining with her four grandchildren and whether she’ll have more trips to her parents’ cabin along Lake Huron in Ontario, Canada. “There are times when your mind goes places where no one wants to go,” said Wiese, who wore a reddish-brown wig. She hates the feeling of isolation and the looks her hairless face receives in public. When Peg Ricketts, one of two program leaders this evening, mentioned the “alien” appearance of a woman going through cancer treatment, Wiese said: “That’s me.” Each of the five women has been through a lot. Ricketts, 65, had cancer in 2000 and again in 2004. She remembers showering while undergoing chemotherapy treatments the first time, and her hair suddenly “just came out in these huge clumps.” She awakened one of her daughters to help her cut the
Peg Ricketts, 65, left, of Omaha has been facilitating the “Look Good...Feel Better” program in Omaha for 10 years. She was a participant in 2000 when she was diagnosed with cancer. hair, and the high school senior started to cry. “And then we looked in the mirror and we laughed and we laughed,” Ricketts said. “Because I looked like Beetlejuice.” Holly Conley, the other instructor, has had four duels with cancer. She has worn a wig for years because her hair grew back curly and stiff as a scouring pad. “As a female, your hair is – I mean, that’s like way on top as far as how you look,” Conley, 51, said. Ricketts and Conley, both volunteers from Omaha, underwent American Cancer Society training to oversee “Look Good . . . Feel Better” workshops. The participants receive guidance in skin care, tips in using foundation, blush and other makeup to cover blotches, methods to pencil in what appear to be eyelashes and eyebrows, and ways to wear wigs,
partial wigs, hats, caps and scarves. Each participant receives a batch of beauty products provided by various cosmetics companies. The first workshop took place in 1988 in New York. Four years later it was available in all 50 states. Mariela Aguilar, with long, black hair, came into the room with her husband, Domingo Silva. Aguilar, only 21, used a cane. She recently endured radiation treatments for her third bout with leukemia. “So you are strong,” Ricketts said to her. “I try to be,” Aguilar, of Omaha, said. Conley asked Aguilar if she had ever needed a wig during her leukemia treatments. “This is a wig,” Aguilar said. “It is?” Conley said. “It looks great.” Pushed along in a wheelchair, Bette Boellstorff, 71,
came in. Boellstorff, of the Brock, Neb., area, had undergone a stem-cell transplant just five days before as part of her cancer treatment. She wore a mask that covered her nose and mouth and a gray knitted cap made by her daughter, Leslie Reed, who sat with her mother. Reed is a longtime World-Herald reporter. Boellstorff removed her mask and her cap, revealing a thin crop of short gray hair. “Ready to be even more beautiful?” Ricketts asked. “Oh, you bet,” Boellstorff said. The women went through their red bags, which were stuffed with cosmetics, moisturizers, creams and brushes. With Ricketts’ and Conley’s guidance, the three practiced applying the cosmetics. They talked about chemotherapy’s harsh side effects as they worked. Ricketts
said eyelashes and eyebrows usually are the last to fall out and the first to grow back. “My skin changed,” Aguilar said of her body’s reaction to cancer treatments. “I’m way darker.” Wiese looked a bit frustrated with her effort to pencil in eyebrows and eyeliner to imitate eyelashes. It’s hard, she said, because she tends to shake, and she needs her glasses. “Just keep working at it, a little at a time,” Ricketts said. Conley asked Boellstorff if she would serve as the wig model. Boellstorff tried on wigs, partial wigs and face framers, which are partial hairpieces that are worn with hats. “I don’t look so much like Uncle Chuck now, do I?” she said to her daughter. She tried on a pink beanie, a soft blue hat and a scarf that wrapped
around her head. “You’re used to feeling hair on your head,” Boellstorff said. “You feel naked without.” The session ended after 90 minutes. Ricketts said to the women: “Putting one foot in front of the other, being patient, having hope. . . . It takes a lot of courage. We know.” Boellstorff put her mask and gray cap back on and Reed pushed the wheelchair out of the room. Leaning on her cane, Aguilar walked out with her husband. And Wiese said she had basically gotten what she wanted. She hoped to feel less alone. She wanted to be with others fighting the same fight. Wiese, an alcohol and drug counselor for parolees, said she has plenty to live for and “a lot of people to help out there.” As she walked out of the room, Conley said: “Good luck to you.”
Checkups, medication typical for follow-up after treatment TIM JOHNSON
ened by chemotherapy, she may need to take steps to prevent infection, such as staying away from sick people and following good hand-washing habits, she said. She should also get good nutrition and rest and watch for signs of an infection. Whether she should avoid crowds depends on how much her immune system is compromised. She should be able to carry out her normal activities. Someone who has been treated for colorectal cancer will be watched closely, depending on the stage of the cancer and ongoing treatment, Gittins said. “Part of any cancer followup is to make sure the regular screenings are still going on,” she said. The patient can help him or herself out by planning ahead on diet and exercise, according to the American Cancer Society. Good nutrition is important for maintaining one’s appetite and strength, a guide on the society’s website states. The American Cancer Society recommends patients stock up in advance on foods they like to eat and cook and freeze meal-size portions
Getting through cancer treatment is no easy task. But what comes after treatment? Patients who go through chemotherapy typically need to come back for a checkup in about six months, said Erin Gittins, a nurse navigator at Alegent Health Mercy Hospital. Visits gradually decrease in frequency. “After the treatment is completed, the doctor will decide how soon they need to come back,” she said. “They definitely will keep a close eye on all the patients after they complete the treatment, and especially the first year.” Those who still have cancer in their bodies may need to take medication to help retard the growth of the cancer cells, she said. If a patient lacks a support network, a nurse navigator may call them after one, three, six and 12 months to see how they are doing, Gittins said. “We keep tabs on them,” she said. A patient’s care plan depends on the type of cancer they have, their prognosis and how well their recovery goes, she said. For example, a woman with breast cancer may be put on hormone pills and given a mammogram in six months on the affected side and one year on the other side, Gittins said. A nurse navigator will call them periodically. “We make sure the women are (getting screened) and that they have the support they need,” she said. The type of breast cancer
before they begin treatment. Patients may also want to talk to friends or family members and line up someone to do some of the shopping and cooking. A person may also want to talk to a doctor, nurse or dietitian about how to prevent possible side effects of treatment, such as constipation or nausea. Patients are advised to stay active during and after treatment. The ACS website recommends a daily walk and suggests other possible activities. Some patients are able to go back to work right away or continue working during treatment on a part-time basis. Patients should consult their doctors and talk to their employers about a schedule that accommodates their treatment. Working can help patients maintain some strength, as well as a positive attitude. Ultimately, it depends on how patients feel during treatment and whether they receive orders from their doctor. For more information, visit the American Cancer Society’s website at cancer.org.
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more closely they’re going to be followed.” Because a patient’s immune system may be weak-
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The Daily Nonpareil
Friday, June 22, 2012
Recognizing the symptoms, risks for colorectal cancer METRO CREATIVE CONNECTION
As men and women know full well, cancer does not discriminate. Few and far between are the men and women whose lives have not been touched by cancer in one form or another. Be it a personal battle with the disease or a connection via a friend, family member, coworker, or other acquaintance, nearly everyone can cite someone in their life who has battled a form of cancer. According to the Centers for Disease Control and Prevention, among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the United States, claiming the lives of more than 50,000 men and women in 2007, the most recent year for which statistics are available. In Canada, a country with roughly one-tenth the population of the United States, the Canadian Cancer Society reported that colorectal cancer was expected to claim the lives of nearly 9,000 Canadians in 2011. Such figures illustrate the importance men and women must place on educating themselves about colorectal cancer and its symptoms and potential risk factors. First, however, it helps to understand just what colorectal cancer is and why it is so deadly. What is colorectal cancer? Colorectal cancer is cancer that starts in either the colon or the rectum, which make up the large intestine. Often referred to as colon cancer, colorectal cancer can begin anywhere in the large intestine and the majority of colorectal cancers begin as abnormal growths called polyps that develop inside the colon or rectum and become cancers over a long period of time. Who gets colorectal cancer? Colorectal cancer does not discriminate. In fact, of the roughly 53,000 cases of colorectal cancers reported to the U.S. Department of Health and Human Services in 2007, there was a nearly equal split of cases between men and women, with men accounting slightly less than 800 more cases than women over that time. Are there known causes of colorectal cancer? Despite its prevalence,
Photo illustration/Erin Duerr
Lifestyle choices are known to increase the risk of cancer. Some of those choices include smoking, drinking more than one drink a day if you’re a woman or two drinks a day if you’re a man, excessive exposure to the sun or frequent blistering sunburns. Changing those habits can lower the risk of cancer.
What are the known cancer risk factors? Photo illustration/Erin Duerr
Persistent stomach pain or aches is a symptom for colorectal cancer, though both colorectal polyps and colorectal cancer don’t always cause symptoms. This is especially true initially, when people could be living with polyps or cancer and not even know it. Such is the reason screenings for colorectal cancer, which should occur regularly when men and women reach age 50 are so important. colorectal cancer can rarely be traced to a specific cause. According to the CDC, roughly 75 percent of colorectal cancers occur in people with no known risk factors. However, the following may increase a person’s risk of developing colorectal cancer: ■ A personal or family history of colorectal polyps or colorectal cancer ■ Inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease In a very small percentage of colorectal cancer cases, the cause is linked to a genetic syndrome such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer, also known as Lynch syndrome. Are there symptoms of colorectal cancer?
Both colorectal polyps and colorectal cancer don’t always cause symptoms. This is especially true initially, when people could be living with polyps or cancer and not even know it. Such is the reason screenings for colorectal cancer, which should occur regularly when men and women reach age 50 are so important. But in some cases, the following symptoms may appear: ■ Blood in or on your stool ■ Persistent stomach pain or aches ■ Inexplicable weight loss Though causes of colorectal cancer aren’t always known, studies have shown exercise and maintaining a healthy weight can decrease risk. More information is available at cdc.gov/can.
THE PSA TEST CONTROVERSY METRO CREATIVE CONNECTION
Inaccurate results and less than fool-proof detection has lead many health professionals to eschew prostate specific antigen tests as an indicator of prostate cancer. A draft recommendation from the U.S. government said PSA tests should no longer be part of routine screening for men. Why? According to the U.S. Preventative Services Task Force, evidence indicates there is little, if any, reduction of prostate cancer-related deaths from the tests. Further research has indicated that PSA tests actually may turn a man’s life upside down by unnecessary stress and surgery for false-positive readings. But there are proponents of the test that say it is still vital in early detection of prostate cancer and enables men to get treatment earlier. A prostate-specific antigen test measures a protein in the blood, which has a tendency to spike when prostate cancer is present. People who support the test say that it is one of the best practices for male health screenings and that fatalities have dropped 40 percent due to prostate cancer since PSA tests were introduced 20 years ago. Opponents of PSAs say the tests often deliver flawed results. This has frequently led to overtreatment, stress and anxiety. Furthermore, the test may indicate cancer or it could be detecting something much more benign, like an infection or recent sexual intercourse. Also, a positive test reading can require a biopsy that takes place through the rectum, which can lead to a number of uncomfortable side effects. One of the biggest arguments against PSAs is that they don’t really lower a man’s risk. Prostate cancer is a slow-growing cancer for many men, which may not actually impair a man’s health in his natural lifetime, especially since prostate cancer is largely a disease of men in their 60s and older. The American Cancer Society has not taken sides on the matter. The Canadian Cancer Society has said that the PSA test cannot diagnose cancer. If your tests are high, more tests are usually needed to determine if you have prostate cancer. They also say some types of prostate cancer grow slowly, may never cause problems and don’t need to be treated. Finding this type of cancer may lead to unnecessary treatment that can have side effects. Whether to undergo a PSA test or not is largely the decision for a man and his doctor. Some believe it to be invaluable in the fight against cancer, while others are no longer so sure about a PSA test’s efficacy.
DENNIS FRIEND DFRIEND@NONPAREILONLINE.COM
Cancer is not one specific disease, but a number of diseases characterized by abnormal cells that divide uncontrollably and have the ability to infiltrate and destroy normal body tissue. Cancer also has the ability to spread throughout the human body. Known causes of cancer include genetic factors; lifestyle factors such as tobacco use, diet and physical activity; certain types of infections; and environmental exposures to different types of chemicals and radiation. Cancer is the second leading cause of death in the United States. Cancer is caused by mutations to the DNA within cells. The DNA inside a cell contains a set of instructions telling the cell how to grow and divide. Errors in the instructions may allow a cell to become cancerous. A genetic mutation can instruct a healthy cell to grow and divide too rapidly, creating new cells with the same mutation. Normal cells contain tumor suppressor genes that recognize out-of-control growth and act to stop it. But a mutation may alter the tumor suppressor. This allows more DNA mutations to occur and may lead to cancer. Someone can be born with a genetic mutation. A genetic mutation can be caused by forces within the body, such as hormones, viruses and chronic inflammation. Genetic mutations can also be caused by forces outside the body, such as ultraviolet light from the sun, cancer-causing chemicals or radiation. Some blood cancers may require just one gene mutation to drive their growth. Most cancers that form in the body’s major organs, such as the lungs and the colon, have many gene mutations. It’s not clear just how many mutations must accumulate for cancer to form. It’s likely that this varies among cancer types. The genetic mutations you’re born with and those that you acquire throughout your life work together to cause cancer. For instance, if you’ve inherited a genetic mutation that predisposes you to cancer, that doesn’t mean you’re certain to get cancer. Instead, you may need one or more other gene mutations to cause cancer. Your inherited gene mutation could make you more likely than other people to develop cancer when exposed to a certain cancer-causing substance. The genetic mutation
begins the cancer process, and the cancer-causing substance could play a role in further cancer development. While doctors have an idea of what may increase your risk of cancer, the majority of cancers occur in people who don’t have any known risk factors. Factors known to increase your risk of cancer include age, habits, family history, health conditions and environment. ■ Age: Cancer can take decades to develop. That’s why most people diagnosed with cancer are 65 or older. However, while it’s more common in older adults, cancer can be diagnosed at any age. ■ Habits: Lifestyle choices are known to increase the risk of cancer. Some of those choices include smoking, drinking more than one drink a day if you’re a woman or two drinks a day if you’re a man, excessive exposure to the sun or frequent blistering sunburns. Changing those habits can lower the risk of cancer. ■ Family history: A small
portion of cancers are due to an inherited condition. If cancer is common in your family, it’s possible that mutations are being passed from one generation to the next. Genetic testing may help determine if you have inherited mutations that might increase your risk, but having an inherited genetic mutation doesn’t necessarily mean you’ll get cancer. ■ Health: Some chronic health conditions, such as ulcerative colitis, can markedly increase the risk of developing certain cancers. Talk to your doctor about your risk. ■ Environment: The environment around you may contain harmful chemicals that can increase your risk of cancer. Even if you don’t smoke, you might inhale secondhand smoke if you go where people are smoking or you live with someone who smokes. Chemicals in your home or workplace, such as asbestos and benzene, also are associated with an increased risk of cancer.
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6C Friday, June 22, 2012
The Daily Nonpareil
Sun smarts You can’t avoid sunlight, but you can limit exposure to harmful rays AMERICAN CANCER SOCIETY
How do I protect myself from UV rays? It isn’t possible or practical to avoid sunlight completely, and it would be unwise to reduce your level of activity to avoid the outdoors because physical activity is important for good health. But too much sunlight can be harmful. There are some steps you can take to limit your exposure to UV rays. Some people think about sun protection only when they spend a day at the lake, beach, or pool. But sun exposure adds up day after day, and it happens every time you are in the sun. “Slip! Slop! Slap!… and Wrap” is a catch phrase that can help you remember the four key steps you can take to protect yourself from UV rays: Slip on a shirt. Slop on sunscreen. Slap on a hat. Wrap on sunglasses to protect the eyes and sensitive skin around them. These steps complement each other, and they provide the best protection when used together. Cover up When you are out in the sun, wear clothing to protect as much skin as possible. Clothes provide different levels of UV protection, depending on many factors. Long-sleeved shirts, long pants, or long skirts cover the most skin and are the most protective. Dark colors generally provide more protection than light colors. A tightly woven fabric protects better than loosely woven clothing. Dry fabric is generally more protective than wet fabric. If you can see light through a fabric, UV rays can get through, too. Be aware that covering up doesn’t block out all UV rays. Some companies now make clothing that is lightweight, comfortable, and protects against UV exposure even when wet. It tends to be more tightly woven, and some have special coatings to help absorb UV rays. These sun-protective clothes may have a label listing the UV protection factor (UPF) value – the level of protection the garment provides from the sun’s UV rays (on a scale from 15 to 50+). The higher the UPF, the higher the protection from UV rays. Children’s swimsuits made from sun-protective fabric and designed to cover the child from the neck to the knees are popular in Australia. They are now available in the United States. Newer products, which are used in the washing machine like laundry detergents, can increase the UPF value of clothes you already own. They add a layer of UV protection to your clothes without changing the color or texture. Use sunscreen
A sunscreen is a product that you apply to your skin for protection against the sun’s UV rays. But it’s important to know that sunscreen does not provide total protection against all UV rays. Even with proper sunscreen use, some rays get through, which is why using other forms of sun protection is also important. Sunscreens are available in many forms – lotions, creams, ointments, gels, wipes, and lip balms, to name a few. Some cosmetics, such as lipsticks and foundations, also are considered sunscreen products if they contain sunscreen. Some makeup contains sunscreen, but only the label can tell you. Makeup, including lipstick, without sunscreen does not provide sun protection. Check the labels to find out. Read the labels. When choosing a sunscreen product, be sure to read the label before you buy. Many groups, including the American Academy of Dermatology, recommend products with a sun protection factor, or SPF, of at least 30. The SPF number represents the level of protection against UVB rays provided by the sunscreen – a higher number means more protection. When using an SPF 30 sunscreen and applying it thickly, you get the equivalent of 1 minute of UVB rays for each 30 minutes you spend in the sun. So, 1 hour in the sun wearing SPF 30 sunscreen is the same as spending 2 minutes totally unprotected. People often do not apply a thick enough layer of sunscreen, so the actual protection they get is less. Sunscreens labeled with SPFs as high as 100+ are now available. Higher numbers do mean more protection, but many people mistakenly think that a sunscreen with an SPF 45 rating would give three times as much protection as one with an SPF of 15. This is not true. SPF 15 sunscreens filter out about 93 percent of UVB rays, while SPF 30 sunscreens filter out about 97 percent, SPF 50 sunscreens about 98 percent, and SPF 100 about 99 percent. The higher you go, the smaller the difference becomes. No sunscreen protects
you completely. Regardless of the SPF, sunscreen should be reapplied often for maximal protection. The SPF number indicates protection against UVB rays only. Sunscreen products labeled “broadspectrum” provide
or dermatologist tested, but the only way to know for sure if a product will irritate your skin is to try it. One common recommendation is to apply a small amount to the soft skin on the inside of your elbow every day for 3 days. If your skin does not turn red or become itchy, the product is probably OK for you. Be sure to apply the sunscreen properly. Always follow the label directions. Most recommend applying sunscreen generously. When putting it on, pay close attention to your face, ears, hands, arms, and any other areas not covered by clothing. If you’re going to wear insect repellent or makeup, put on the sunscreen first. Be generous. Ideally, about 1 ounce of sunscreen (about a palmful) should be used to cover the arms, legs, neck, and face of the average adult. For best results, most sunscreens must be reapplied at least every 2 hours and even more often if you are swimming or sweating. Products labeled “waterproof” may provide protection for at least 80 minutes even when you are swimming or sweating. Products that are “water resistant” may protect for only 40 minutes. Remember that sunscreen usually rubs off when you towel yourself dry, so you will need to put more on. Sunless tanning products, such as bronzers and extenders (described in the section called, “What about tanning pills and other tanning products?”), give skin a tan or golden color. But unlike sunscreens, these products provide very little protection from UV damage.
some protection against both UVA and UVB rays, but at this time there is no standard system for measuring protection from UVA rays. Products that contain avobenzone (Parsol 1789), ecamsule, zinc oxide, or titanium dioxide can provide some protection from UVB and most UVA rays. Check the expiration date on the sunscreen container to be sure it is still effective. Most sunscreen products are effective for at least 2 to 3 years, but after a long time in storage you may need to shake the bottle to remix the sunscreen ingredients. Some sunscreen products can irritate skin. Many products claim to be hypoallergenic
Above, the ideal sunglasses do not have to be expensive, but they should block 99 percent to 100 percent of UVA and UVB radiation. Top, when choosing a sunscreen product, be sure to read the label before you buy. Many groups, including the American Academy of Dermatology, recommend products with a sun protection factor, or SPF, of at least 30.
Wear a hat A hat with at least a 2- to 3inch brim all around is ideal because it protects areas such as the ears, eyes, forehead, nose, and scalp that are often exposed to intense sun. A shade cap (which looks like a baseball cap with about 7 inches of fabric draping down the sides and back) also is good, and will provide more protection for the neck. These are often sold in sports and outdoor supply stores. A baseball cap can protect the front and top of the head but not the neck or the ears, where skin cancers commonly develop. Straw hats are not as protective as hats made of tightly woven fabric. Wear sunglasses that block UV rays UV-blocking sunglasses are important for protecting the delicate skin around the eyes, as well as the eyes themselves. Research has shown that long hours in the sun without protecting your eyes increase your chances of developing eye disease. The ideal sunglasses do not have to be expensive, but they should block 99 percent to 100 percent of UVA and UVB radiation. Before you buy, check the label to make sure they do. Labels that say “UV absorption up to 400 nm” or “Meets ANSI UV Requirements” mean the glasses block at least 99 percent of UV rays. Those labeled “cosmetic” block about 70 percent of UV rays. If there is no label, don’t assume the sunglasses provide any UV protection. Darker glasses are not necessarily better because UV protection comes from an invisible chemical applied to the lenses, not from the color or darkness
Sunscreen may be used on small areas of exposed skin of babies younger than 6 months only if adequate clothing and shade are not available. Protect children from the sun Children need special attention, since they tend to spend more time outdoors, can burn more easily, and may not be aware of the dangers. Parents and other caregivers should protect children from excess sun exposure by using the steps described by the American Cancer Society in the story at left. Older children need to be cautioned about sun exposure as they become more independent. It is important, particularly in parts of the world where it is sunnier, to cover your children as fully as is reasonable. You should develop the habit of using sunscreen on exposed skin for yourself and your children whenever you go outdoors and may be exposed to large amounts of sunlight. If you or your child burns easily, be extra careful to cover up, limit exposure, and apply sunscreen. Babies younger than 6 months should be kept out of direct sunlight and protected from the sun using hats and protective clothing. Sunscreen may be used on small areas of exposed skin only if adequate clothing and shade are not available.
of the lenses. Look for an ANSI label. Large-framed and wraparound sunglasses are more likely to protect your eyes from light coming in from different angles. Children need smaller versions of real, protective adult sunglasses – not toy sunglasses. Ideally, all types of eyewear, including prescription glasses and contact lenses, should absorb the entire UV spectrum. Some contact lenses are now made to block most UV rays. But because they don’t cover the whole eye and surrounding areas, they are not sufficient eye protection when used alone. Limit direct sun exposure during midday Another way to limit exposure to UV light is to avoid being outdoors in sunlight too long. UV rays are strongest when the sun is high in the sky, usually between the hours of 10 am and 4 pm. If you are unsure about the sun’s intensity, use the shadow test: if your shadow is shorter than you, the sun’s rays are the strongest, and protection from the sun is most important. UV rays reach the ground throughout the year, even on hazy days, but the strength of UV rays can be different based on the time of year and other factors. The UV rays become more intense in the spring, even before temperatures get warmer. People in some areas may get sunburned when the weather is still cool because they may not think about protecting themselves if it’s not hot out. Be especially careful on the
beach or in areas with snow because sand, water, and snow can reflect sunlight, increasing the amount of UV radiation you receive. UV rays can also reach below the water’s surface, so you can still get a burn even if you’re in the water and feeling cool. Some UV rays can also pass through windows. Typical car, home, and office windows block most of the UVB rays but a smaller portion of UVA rays, so even if you don’t feel you’re getting burned your skin may still get some damage. Tinted windows help block more UVA rays, but this depends on the type of tinting. UV radiation that comes through windows probably doesn’t pose a great risk to most people unless they spend long periods of time close to a window that receives direct sunlight. If you plan to be outdoors, you may want to check the UV Index for your area first. The UV Index usually can be found in local newspaper, TV, radio, and online forecasts. It is also available on the EPA’s Web site epa.gov/sunwise/uvindex.html. Avoid tanning beds and sunlamps Many people believe the UV rays of tanning beds are harmless. This is not true. Tanning lamps give out UVA and usually UVB rays as well. Both UVA and UVB rays can cause long-term skin damage, and can contribute to skin cancer. Most skin doctors and health organizations recommend not using tanning beds and sun lamps.
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