Despite the widespread use of the prostate-specific antigen (PSA) test for prostate cancer, it's been known for many years that it had murky benefits, especially in the face of its well-demonstrated risks - like impotence, incontinence, and unnecessary surgery.
Now, as reported in a very good article in the New York Times, the US Preventive Services Task Force appears set to recommend against widespread screening for prostate cancer in men age 50 and older, with the primary justification being that testing simply doesn't save lives - a key criteria for any cancer screening test.
For more on the PSA testing issue, see our 8 Ways video below. For more on the cancer screening issue in general, see our page: Quick Principles of Screening.
Friday, October 7, 2011
Thursday, October 6, 2011
6 Ways to Prevent Breast Cancer
Ask women what they think is the biggest threat
to their health, and most will answer “breast cancer.” And
even though lung cancer and heart disease kill more women each year, their
concern is well placed.
Breast cancer is the most common cancer among women in the US -- about
230,000 American women are diagnosed with the disease each year -- and it is the
leading killer of women in midlife (ages 30 – 55). And despite thousands
of studies on the causes of breast cancer, not many lifestyle factors have been
linked to the disease, leaving many women frustrated that there’s not more they
than can do to try to lower their risk.
Yet, looked at as a whole, there are a number of important steps women
can take to try to prevent breast cancer. Not every one applies to every
woman, but together than can have a big impact on risk:
Six Ways to Prevent Breast Cancer
1) Keep weight in check
No surprise here. Women who maintain a healthy weight have a lower risk of
breast cancer, especially when they’re post-menopausal. One reason for this is
that fat tissue produces hormones that increase the risk of breast cancer. The less fat tissue, the lower the
hormone levels, and the lower the risk of breast cancer.
2) Be physically active
Exercise is as close to a silver bullet for
health as there is. People who are
physically active for at least 30 minutes a day have a lower risk of breast
cancer, possibly because exercise has a positive effect on the levels of hormone
and other growth factors in the body. Being physically active is also one of the best ways to help keep
weight in check.
3) Avoid too much alcohol
Yes, alcohol can be good for your heart, but when
it comes to cancer there’s not too much good about it. Even moderate amounts
increase the risk of colon cancer and breast cancer. And studies show that women who have less than one drink a
day have a lower risk of breast cancer than those who drink more.
If you do drink moderately, there’s evidence that
the vitamin folate - in the amount found in most 100 % DV multivitamins and
B-complex vitamins – may help protect against the increased risk associated
with alcohol.
In general, if you drink moderately (no more than
1 drink a day for women) the overall health benefit of drinking outweigh the
risks. But if you don’t drink,
don’t feel that you need to start.
If you have any concerns, talk to a doctor about how alcohol may affect
your health.
4) Breastfeed, if possible
OK, this only applies to women who are still
having children, but there is very good evidence that breastfeeding has real
benefits for mother and child.
When it comes to breast cancer, women who breastfeed for a total of one
year or more (combined for all children) have a lower risk of the disease. Why?
Breastfeeding can cause changes both in hormone levels and in the breast tissue
itself that help protect the cells from becoming cancerous. Women who regularly
breast feed also have a lower risk of ovarian cancer.
5) Avoid birth control pills,
particularly after age 35 or if you smoke
As many women know, birth control pills have
real, practical benefits. But, they can have some downsides, too. Women
currently on birth control pills have an increased risk of breast cancer as
well as a higher risk of stroke and heart attack – particularly if they
smoke. Since their long term use,
though, can lower the risk of colon cancer, uterine cancer and ovarian cancer –
not to mention unwanted pregnancy - there’s also a lot in their favor. If you’re particularly concerned about
breast cancer risk, avoiding birth control pills can lower your risk. Even if
you take birth control pills, though, risk only seems to be increased during
the time you’re actively on them.
6) Avoid post-menopausal hormones
Even if you’ve wanted to, it’s been hard to avoid
the topic of post-menopausal hormones the past number of years, the way it’s
swept the health news, confusing thousands along the way. In a nutshell, here’s what you need to
know about how they can affect the risk of breast cancer and other important
diseases.
When all the evidence is looked at together it’s
clear that post-menopausal hormones shouldn’t be taken long term to prevent
chronic diseases, like osteoporosis and heart disease. Estrogen-only hormones
don’t lower the risk of heart disease, and actually increase the risk of breast
cancer and stroke. And estrogen plus progestin hormones—the type of hormones
taken most often by women with a uterus—raise the risk of breast cancer, heart
disease, stroke, and blood clots. While both types of hormones lower the risk
of osteoporosis, this benefit is usually offset by their risks, especially
since there are many other options for combating bone loss and fractures.
Whether women should take post-menopausal hormones
in the short term to treat menopausal symptoms like hot flashes is a personal
decision. Hormones can bring significant relief from unpleasant,
irritating, and sometimes severe symptoms, and the risks are relatively small
from 1- 2 years of hormone use, especially for estrogen-alone in women without
a uterus. If women do take hormones, it should be for the shortest time
possible. As always, the best person to talk to about the risks and benefits of
post-menopausal hormones is a doctor.
Tamoxifen and Raloxifene
Allthough not really a “healthy behavior” as most would describe it,
if you’re at high risk of breast cancer, taking the prescription drugs tamoxifen
and raloxifene can significantly lower your risk. They are powerful drugs,
though, and can also have serious side effects, so are not right for everyone
and can only be prescribed by a doctor. If you think you’re at high risk,
talk to your doctor to see if these drugs may be right for you.
What about Soy?
No doubt you’ve heard a lot about soy in
recent years as a way to boost your health, and there is growing evidence that a
high-soy diet is both safe to eat and could help lower the risk of breast
cancer. The amount of soy that
seems to bring benefits, though, is much higher than even big soy eaters in the
US typically consume. So, it’s unclear how
realistic it is for most women to eat enough to begin to see breast health
benefits.
Importance of Screening
Despite recent news storms on breast cancer screening, it remains the single
best way to protect yourself from the disease. Though it doesn’t help prevent cancer, it can help find
cancer early when it’s most treatable.
All women over the age of 20 should get screened regularly for breast
cancer. The right screening tests mainly depend on a woman's age:
If you are between ages 20 and 39:
Get a
clinical breast exam every 1 - 3 years.
If you age 40 or older:
Get a
mammogram and clinical breast exam every year.
If you’re at high risk, you may need to have mammograms more often and
begin them at an earlier age. You may also need to have some different types of
screening tests.
And don't rely on finding breast cancer yourself with self-exams. Though
it’s OK to do breast self-exams, they don't take the place of mammograms and
clinical breast exams.
Estimating Your Breast Cancer Risk
Online tools for estimating breast cancer risk abound, and many of these
sites can be useful guides for opening a dialog with doctors or other health
professionals about your cancer risk and health choices.
Not all risk assessment sites, though, are created equal, and it’s
good to do some research before using them. As with most health information on the Internet, it’s best
to start with sites from known reputable organizations, such as universities,
large health organizations, and the federal government. When
seeking out cancer risk assessment tools, it’s also very important to look for information
showing that developers of the site have experience in the field. While
it’s easy to put up a cancer risk quiz on the web, it’s much harder to get it
right.
Two of the best-established cancer risk estimation sites are the
National Cancer Institute’s “Breast
Cancer Risk Assessment Tool” and our “Your Disease Risk” site at Washington
University School of Medicine,” which offers estimates of 12 different cancers,
including breast
cancer. Unlike many tools available on the Web, these have been
scientifically validated in published studies.
Web Resources
Washington University School of Medicine
Others
Harvard School of Public Health – Nutrition Source
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