Education and Resources

Many people think cancer is inevitable, but for some types of cancer, you can take steps to reduce the risk. Healthy lifestyle habits hold the key to cancer prevention. Up to two-thirds of all cancers may be preventable by avoiding tobacco and adopting other healthy lifestyle habits. Regular screenings can help detect many cancers in the earliest stages, when they can be treated successfully.

Ocean View Oncology can help you learn to reduce your cancer risk. Thorough cancer screening examinations include cancer risk assessment, screening exams based on age and gender, as well as personalized risk-reduction strategies. Prevention strategies include genetic testing, chemoprevention, stress management and nutritional counseling.

In October 2014, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) issued its 2014 guide for cancer prevention. The updated Code Against Cancer outlines 12 specific recommendations for a healthy lifestyle, with the goal of cutting cancer cases by half. The 12 recommendations emphasize the importance of (1) avoiding tobacco, (2) avoiding alcohol, (3) avoiding excessive sun exposure, (4) avoiding exposure to radiation from radon, (5) maintaining a healthy body weight, (6) being physically active, (7-9) screening for bowel, breast, and cervical cancers, (10) vaccinating against human papillomavirus, (11) breastfeeding, and (12) limiting hormone replacement therapy.

Our Cancer Prevention Program offers a wide range of screening and early detection services recommendations. To determine which services are best for you, or to schedule an appointment, call 949-218-2800.

Screen Out Your Risk

Cancer screening examinations are medical tests performed when you’re healthy and you don’t have any symptoms. They help ensure that any existing cancers are identified at their earliest, most treatable stages.

Take time to discuss your own cancer risks with your health care provider, who can best advise you on the screening exams and risk reduction strategies that are right for you. Your health care provider can let you know about the benefits, limitations and potential harms of cancer screening so that you can make an informed decision about testing.

Breast Cancer

All women should be familiar with their breasts so that they will notice any changes and report them to their doctor without delay. An approach to breast cancer screening should incorporate an individual’s level of breast cancer risk, established by history and by use of a risk prediction model.

• All female patients should discuss breast cancer screening with their doctors starting at age 40.
• We recommend that women between the ages of 50 and 70 be screened with mammography.
• We suggest that women over the age of 70 be screened with mammography if their life expectancy is at least 10 years.
• The ideal interval for screening mammography is not known. We suggest screening every two years.
• The efficacy of breast self-examination (BSE) is unproven.
• Women at high risk for breast cancer (lifetime risk >20 to 25 percent) should be referred for genetic counseling to determine the likelihood of a BRCA mutation and to decide on management options.
• Consider additional screening if you are at risk – Women at increased risk of breast cancer (e.g., family history, genetic predisposition, past breast cancer) should talk to their doctor about the benefits and limitations of starting mammograms earlier, having additional tests (e.g., breast ultrasound or MRI) or having more frequent exams.

Colorectal Cancer

Beginning at age 50, men and women should follow ONE of the five examination schedules below. Screening tests that visualize the colon are being favored.

• Colonoscopy – Every 10 years. Polyps >6 mm should be removed.
• Fecal occult blood test (FOBT) – When visualization of the colon is not feasible, a take-home multiple sample FOBT or fecal immunochemical test (FIT, which also is a take-home test) should be taken every year.
• Flexible sigmoidoscopy(FS) – Every five years.
• Annual FOBT or FIT and flexible sigmoidoscopy – Every five years. Having both of these tests is recommended over either test alone.
• Double-contrast barium enema – Every five years.

All positive tests (FOBT, FIT, flexible sigmoidoscopy, barium enema) should be followed up with colonoscopy.

Prostate Cancer

Although screening for prostate cancer with PSA can reduce mortality from prostate cancer, the absolute risk reduction is very small, and there remain important concerns that the benefits of screening are outweighed by the potential harms to quality of life, including substantial risks for over diagnosis, and treatment-related complications.

• Screening risks and benefits should be discussed with a health care provider.
• We suggest that discussions begin at age 50 in average-risk men.
• We suggest that discussions begin at age 40 to 45 in men at high risk for prostate cancer, including black men, men with a family history of prostate cancer, and men who are known or likely to have the BRACA1 or BRACA2 mutations.
• We suggest that screening be performed with prostate specific antigen (PSA) test at intervals ranging from every two to four years.
• When a decision is made to screen, we suggest that screening stop after age 69 or earlier when comorbidities limit life expectancy to less than 10 years.
• We suggest that men with a PSA level between 4 ng/ml and 7 ng/ml undergo repeat testing several weeks later. Men with a repeat PSA level above 4 ng/ml should be referred for prostate biopsy.
• Many experts suggest not performing a digital rectal examination (DRE) for prostate cancer screening, whether alone or in combination with PSA screening.

Cervical Cancer

Observational studies have demonstrated marked reductions in cervical cancer mortality following the implementation of national or regional Pap smear screening programs.

Women at average risk of cervical cancer:

• Beginning 3 years after initiating vaginal intercourse (but no later than age 21) – Liquid-based Pap test every two years
• Beginning at age 30 – Liquid-based Pap test and human papilloma virus (HPV) test every three years
• HPV infection is common in women under age 30, and is usually transient. Therefore, HPV testing is not recommended as part of the Pap test for women under age 30 as studies have shown HPV screening at this age to be ineffective.
• Genotyping to identify HPV 16/18, the two HPV types responsible for 70% of cervical cancer in the US, can be performed either by the Cervista 16/18 test as follow-up to an abnormal HPV test, or as part of the cobas HPV test.

Women at increased risk of cervical cancer still need to be screened annually. Speak with your doctor to determine if you have cervical cancer risk factors.

Women at lower than average risk should speak with their health care provider about less frequent screening:

• Women age 70 or older with three or more normal Pap tests in a row and no abnormal Pap tests in the past 10 years
• Women who have had a hysterectomy (removal of the uterus and cervix) that was not done for cancer or pre-cancer of the cervix

Skin Cancer

Promptly show your doctor any:

• Suspicious skin area
• Non-healing sore
• Change in a mole or freckle

Lung Cancer

The best evidence now illustrates that low dose chest CT (LDCT) screening can save lives, but only if it is done well. Only a well-defined, high risk population that can potentially undergo curative treatment if a lung cancer is identified should be screen. Screening must be preceded by shared decision making based on counseling on the potential benefits as well as risks of LDCT screening. LDCT screening should be done only at centers with experience in using LDCT screening protocols.

Ovarian Cancer

Ovarian cancer is the leading cause of death from gynecologic malignancy in the United States. The strongest known risk factor for ovarian cancer is a family history. We suggest periodically screening women with a familial ovarian cancer syndrome, who have not undergone prophylactic oophorectomy, with a combination of CA 125 and transvaginal ultrasound. SOG and NCCN recommends screening these women every six months beginning between ages of 30 and 35 years.

We recommend NOT screening average-risk women for ovarian cancer.

Endometrial Cancer

Benefits of screening for individuals at average risk for endometrial, ovarian and lung cancer have not yet been proven, and screening is therefore not recommended. The following are related conditions to consider:

• Women with hereditary non-polyposis colorectal cancer – Annual endometrial biopsy is recommended beginning at age 35.

Contact Dr. Gabriel Carabulea for the most recent changes/recommendations by USCSTF.

Taking action and practicing healthy behaviors is just one way to reduce your risks for many cancers. Detecting cancer at an early stage is another way. You can do this by being aware of your body and paying attention to unusual changes, and by observing Screening Guidelines.

Here are some of the symptoms for the most common cancers. If you experience them for more than two weeks, check with your doctor. Remember, detecting cancer early can greatly increase your chances of a successful treatment.

Recommended Changes in the Typical American Diet

A simple, straightforward diet, not a strange or complicated one, is recommended for reducing your own and your children’s likelihood of cancer. Here are some good guidelines:

Increase consumption of:

• Fibrous foods such as whole-grain cereals, fruits and vegetables.
• Foods rich in vitamin C, such as oranges, grapefruit, strawberries, peppers, and cantaloupe; and of foods rich in vitamin A – carrots, sweet potatoes, peaches, apricots, and dark green leafy vegetables such as spinach. (Do not use a vitamin A supplement exclusively, because of possible toxicity.)
• Cruciferous vegetables (so called because their flowers form the pattern of a cross)-broccoli, cabbage, brussels sprouts, kohlrabi and cauliflower.

Choose foods rich in healthy omega-3 fatty acids including cold-water fish such as salmon; walnuts and walnut oils; and omega-9 fatty acids that can be found in olive oil, almonds and avocados..When using oils, choose unsaturated ones like canola, flax, walnut and olive oils.

Reduce consumption of:

• High-fat foods, including whole-milk cheese, lard, fatty cuts of beef, eggs and deep-fried foods. (Infants under one year should be kept on a higher-fat diet to meet their calorie needs.)
• Avoid salt-cured, salt-pickled and smoked foods. (These carry a danger that carcinogenic chemicals will form during cooking or digestion.)

The causes of cancer are complex; therefore, nothing can guarantee that you will never get it. However, individually we have some power of prevention over many cancers. By adhering to guidelines such as the nine listed below, your personal liability to cancer can be reduced.

1. If you smoke or chew tobacco, quit. Many smokers who conquer the habit do so on their own. Group therapy programs, nicotine replacement therapy and hypnosis are helpful to some.
   
   
2. Adjust your diet. While some foods increase the risk of cancer, other kinds apparently act as anticarcinogens, or cancer preventatives.
   
   
3. Drink alcohol in moderation, or don’t drink at all. One or two drinks a day should be the maximum.
   
   
4. Avoid overexposure to direct sunlight. Use protective clothing and sunscreen preparations of SPF 20 or higher. Avoid the sun between 10 a.m. and 3 p.m., when ultraviolet rays are strongest. Even one or two bad cases of sunburn can be dangerous in the long term, particularly for children. For those who want a “bronze” tanned look, self tanning lotions may provide a safe alternative to sunbathing. Never use a tanning bed.
   
   
5. Maintain a healthy body weight. If you are overweight, consult your physician about a plan for weight loss.
   
   
6. Be physically active, and exercise regularly.
   
   
7. Protect against sexually transmitted infections.
   
   
8. Have dental and medical X-rays only as necessary. X-ray radiation doses are usually extremely low. However, before you agree to any X-ray, be satisfied that it is medically necessary or advisable.
   
   
9. Use caution when handling any potentially harmful substance. Use protective clothing and safety equipment around industrial and home-use chemicals. Avoid breathing fumes from rubber and petroleum products, and dust from cotton and coal.
   
   
10. Be alerted to involuntary risk factors. For example, women with a family history of breast cancer should remember they are at greater risk for cancer at that site. And men over 65 should be aware of their high risk, as a group, for prostate cancer.
    
    
11. Have regular physical examinations and all recommended cancer checks and tests for your age group. Those aged 20 to 40 should have a cancer-related medical check-up every three years, and those over 40 should every year.

The Importance of Knowing Your Family Health History

According to a U.S. Department of Health and Human Services (HHS) survey, 96% of Americans believe that knowing their family health history is important. Yet only one-third of Americans have ever gathered their own family health history (also called family medical history).

Why a family health history is important

Your family tree is a visual representation of the members of your family and how they are related. Creating a family health history involves gathering health information for each person on your family tree to help your doctor assess if there are diseases that appear in multiple generations and how this may affect your risk.

Genetic research may someday make it possible to accurately predict a person’s risk for cancer; however, until then, a family’s health history may offer the best look into the future. That’s because your family health history often reflects more than your family’s shared genes, but also other shared risk factors, including environment, behavior, and culture.

For the families of people with cancer, knowing their family health history can be an important step toward cancer prevention or early detection. Ideally, it will also help lower the risk for cancer if it prompts individuals to change behaviors that have a negative impact on health, such as smoking. Similarly, it will prompt individuals to adopt healthier lifestyle habits, such as regularly exercising and eating a balanced diet. It’s important to note, although having a risk factor (anything that increases a person’s chance of developing a disease) for cancer does not guarantee that a person will develop cancer, it does mean that a person should be more aware of his or her risk.

Be open with your family

If you’ve been diagnosed with cancer, talking about your personal health history with family members is a way to help them understand the need for various screening tests, such as mammograms for breast cancer or colonoscopies for colorectal cancer, as well as other strategies for early diagnosis or prevention.

Share with your family specific information about your treatments, the medications you’re taking, the names and specialties of your doctors, and the names of the medical centers where you receive care. In the event of a medical emergency, this information may be crucial for the doctors who treat you. In the same way, learning about your relatives’ health conditions may yield some information that will help in your own medical care.

How to take a family health history

Whichever tool you use, the most useful family health histories are those that are as detailed and accurate as possible. And it’s not just parents and siblings whose health history is important to you. The health history of children, grandparents, aunts, uncles, nieces, and nephews are also important.

For families of people with cancer, a family health history typically covers:

• At least three generations, as inheritance patterns for adult-onset cancer are more identifiable over time
• Health information on maternal and paternal relatives, as hereditary cancer syndromes can be inherited from your mother or father
• Race and ethnicity information for both sides of your family, as some cancer gene mutations (changes) occur more frequently in certain ethnic groups
• Information about other medical conditions for each person, as even those conditions that seem unrelated may provide some information about cancer susceptibility or other potential health risks

For each person who has or had cancer, a personal health history should include the following information:

• Date of birth
• Date and cause of death (if applicable)
• Type and location of each cancer (medical records, especially pathology reports, can be extremely helpful in determining the possibility of a hereditary cancer risk)
• Age of diagnosis for each cancer
• The facility where the cancer was diagnosed and treated
• History of other medical problems

Incomplete or inaccessible family health histories

If you are not able to gather a complete family health history, for example, if you don’t know all of your blood relatives, or if they are unreachable or have passed away, you may be able to find additional details through state government offices or genealogy resources. For people who were adopted, the National Adoption Information Clearinghouse may be able to help access family medical information from birth parents.

Sharing your history

Once you have collected your family health history, it is important to share it with your doctors. They will use this information to assess your risk for various diseases. That, in turn, may help them make recommendations for screening tests to detect disease or lifestyle changes that might help prevent disease.

Share the health history with your children as well, as they can benefit from the information in the same way that you can. Also, share information about your own health and your children’s health with other relatives to help them maintain an accurate family health history of their own.

Genetic Testing

In addition to identifying possible lifestyle risk factors for disease, such as smoking or lack of exercise, the family health history may also be used to identify the potential need for genetic testing, which involves the analysis of human genetic make-up (DNA, RNA, chromosomes, and proteins) to predict the risk of disease, identify carriers of disease, and diagnose disease or determine the likely course of a disease.

At the most basic level, the factors suggesting inherited cancer risk include the following:

• Multiple cancers in close relatives, particularly in multiple generations. Clustering of the same type of cancer in close relatives may indicate an inherited cancer risk.
• Unusually early age of cancer onset (younger than 50 years for adult-onset cancers)
• Multiple cancers in a single individual

A family health history that includes some of these risk factors may indicate an increased cancer risk for family members. The best way to use the information gathered is to take the information to your doctors and let them guide you in making decisions about screening and other ways to reduce your risk.

A word about perceived risk

As important as a family health history may be for early detection and treatment of cancer, it also may cause people to perceive their risk of developing cancer to be greater or less than their actual statistical risk; therefore, in all cases, it is important to discuss your individual level of risk with your doctor.