One in Five High Schoolers Vape or Use Tobacco. Tips for Guiding Your Teen Toward Healthier Choices

Recently released numbers from a national survey show that many high school-aged youth in the United States put themselves at risk for lifelong addiction by using tobacco or electronic cigarettes.

The 2017 Youth Risk Behavior Surveillance System report found that 16 percent of girls and 24 percent of boys had vaped, used smokeless tobacco, or smoked cigarettes or cigars in the past 30 days (figure).

While experimentation is a natural part of youth, when it comes to smoking, it can have lifelong consequences.

Around 90 percent of adults who regularly smoke tried their first cigarette before age 18.  So, it’s important for parents to have open discussions with their children very early in life about the dangers of smoking, how addictive cigarettes and nicotine are, and how hard it can be to stop smoking once started.

Though in a tween and teen’s mind there can be a big draw to smoking – it can make them feel more mature and part of a group – there’s a lot going against it, too - even within the short time horizon that youth live in.  It’s expensive, and it makes clothes and breath smell.  And even some of the longer-term risks can be compelling, such as wrinkles, bad teeth, and an increased risk of many serious diseases, including cancer.

Electronic cigarettes are increasingly important to talk about in these ages as well.  Statistics show that kids are using them more and more, and though electronic cigarettes are often marketed as safe alternatives to standard cigarettes, there are a lot of possible dangers for youth who use them – from nicotine addiction to exposure to risky chemicals to a greater likelihood of taking up regular cigarettes.

As with other issues, a little media literacy can go a long way to dissuade children from falling for the allure of tobacco and electronic cigarettes.  The older children get, the more they like to feel in control and independent.  Helping them understand how tobacco companies try to manipulate them by constructing appealing images of tobacco in advertisements, TV shows, concerts, and movies can help them more easily resist smoking’s draw.  The Truth campaign by the American Legacy Foundation is a great source of information for parents and kids about Big Tobacco’s “lies and manipulation.”

One of the best thing parents can do is to lead by example and maintain a smoke-free and vape-free house and be smoke-free themselves.

A great source of information for parents and teens is smokefree.gov, a federal site, which also includes smokefreeteen.

In the tween and teen years, children begin to fully explore their independence, and this translates to many of their health choices.  While parents may slowly lose some of the direct influence they have on their childrens' choices, it's important to remember that family life remains a very strong influence on the choices they make and the lasting habits they’ll form.

Protect Your Children with the HPV Vaccine

by Dr. Lindsay Kuroki

Parents grow up wanting their kids to be healthy and happy. And taking control of your child’s health may be easier than you think with evolving research. We know that with healthy eating, encouraging exercise, staying safe in the sun, and getting scheduled vaccinations your child is on the right path to having a lower cancer risk later in life.

What’s even better news is that within the past decade, a specific vaccine has also been created to protect against at least five different types of cancers. This vaccine, the Human Papillomavirus (HPV) vaccine, is now recommended for all girls and boys during their annual check-ups. 

HPV is a common sexually transmitted infection with over 100 different types of strands in existence. In fact, HPV is so common that an estimated nine out of 10 sexually active people will at some point be infected with HPV. Often times, HPV does not present with symptoms, which makes it hard to know when someone may be infected. For this reason, it is important to protect your child against HPV, as some forms of HPV can cause multiple cancers. At least two strands of the HPV virus have been shown to cause cervical, vagina, and vulva cancers in women, penile cancer in men, and head and neck cancer in both men and women. HPV can live for a long time in a person’s body, so someone may not know they have HPV, or an associated cancer, until years after being intimate with someone who carried the HPV virus. Sadly, HPV contributes to over 31,000 new cases of cancer each year, but we can reduce that number by protecting our children with the HPV vaccine.

Unfortunately, nationwide only 65 percent of girls initiate the HPV vaccination series and 49 percent receive the two recommended doses, while only 56 percent of boys initiate and 37 percent complete the series.

The good news is now the HPV vaccine is available for boys and girls to protect thems before they become sexually active. It’s also safe and over 90 percent effective. This success rate could prevent over 90 percent of HPV cases, or eliminate 29,000 new cancer diagnoses each year.

The Centers for Disease Control and Prevention (CDC) recommends that both girls and boys be vaccinated with a two-shot vaccine around ages 11 – 12. The second vaccine will be administered within one year after the first dose. The vaccine can be given until age 26, and being vaccinated after exposure to HPV will help reduce their risk of contracting future HPV infections. Adolescents and young adults, starting at age 15, who receive the HPV vaccine will require a three-dose vaccination series.

Protect your family against cancer, as it’s never too early to reduce your child’s risk. Talk with your pediatrician to schedule your child’s HPV vaccination.

Room for Improvement: Rates of Cancer Risk Factors in Young Adults

As we've written about before on Cancer News in Context, good evidence points to the important role that behaviors in youth and young adulthood can have on cancer risk later in life.

Health habits started in youth not only have a longer time to impact risk, but they can also have unique and important interactions with the biology of certain developmental stages.  Smoking, for example, seems to have the biggest impact on breast cancer risk when it takes place in the years between a woman's first period and when she first gives birth.  Likewise, sun exposure and indoor tanning has its biggest impact on melanoma risk when it takes place early in life.

Though there is still a lot we don't know about the relationship between early life risk factors and disease risk later in adulthood - largely because the vast majority of studies to date have been done in middle-aged or older populations - it is clear from the studies we do have that the earlier in life we can cement healthy habits, the better.

Yet, a new study of national data shows that there's still great room for improvement in those critical early years. The study, conducted by researchers from the National Center for Chronic Disease Prevention and Health Promotion of the CDC, analyzed results from the 2015 National Health Interview Survey, which asked a random sampling of Americans about a range of health habits and related information.

Across nearly all behaviors reported, there were very few bright spots (see figure below).

Nearly 20 percent of all young adult men and women were obese, meaning they had a body mass index (BMI) of 30 or higher. For someone who is 5 feet, 5 inches tall, that translates to a weight of 180 pounds or more. And these numbers do not even include the percentage of young adults who were overweight (BMI 25 - 29.9) but not obese.  While obesity has the largest weight-related impact on the risk of cancer, simply being overweight also adds to risk.

While smoking rates have dropped dramatically from their high-points, 11 percent of young women and 15 percent of young men still smoke tobacco cigarettes.  And nearly 8 percent of young men use e-cigarettes, despite their short and long-term risks remaining largely unknown.

Though physical activity is one of the best ways to lower disease risk and improve health and overall quality of life, nearly 30 percent of young women and just over 20 percent of young men get little or no physical activity.

Indoor tanning - which can double the risk of deadly melanoma - remains relatively popular in young women.  While, overall, 11 percent of women ages 18 - 24 had used a tanning bed in the past year,  this number kicks up to 17 percent in non-Hispanic whites.  Two percent or less of young men had indoor tanned.

Perhaps the most striking numbers were the very high rates of sugary drink consumption, processed meat consumption, and lack of HPV vaccination.  Over half of men and women drank sugary drinks daily, which increases the risk of weight gain, among other health risk factors.  And over two-thirds of men and over half of women regularly ate processed meat, which increases the risk of colon cancer.

Approximately 58 percent of women 18 - 26 years old and 79 percent of men 18 - 21 years old had not had the HPV vaccine, despite it lowering the risk of multiple cancers - including those of the cervix, anus, penis, and throat (which is becoming increasingly common). (Data not included in figure).

We know that half of all cancers could be prevented with a healthy lifestyle, and that that number is likely higher when healthy behaviors start early in life and are maintained through adulthood.  The results of this new study show that much more work needs to be done to help instill healthy behaviors in childhood that then continue into the teens and early twenties and beyond.

Parents and other family members play a key role in helping children develop healthy habits.  As kids age, and their independence grows, they play an increasing role in their own health.  At all stages, though, neither parents nor kids nor adults exist in a vacuum.  Our health behaviors are influenced by numerous different factors.  Personal choice is just one.  And outside of that, our schools, neighborhoods, workplaces, friends and broader social circles, and local and state governments and policies have an important impact on the health behaviors we make and sustain.

Healthy school meals and daily PE can help lay the foundation for a lifetime of healthful eating and regular activity.  Nice sidewalks and bike paths can make it easier for families to get out for walks and bike rides.  Employers that provide affordable health insurance and allow time off for doctor's appointment make it easier for workers to get important preventive care and screening. Promotion of healthy choices by popular opinion leaders on Snapchat and Instagram can impact attitudes and choices of teenagers influenced by such social media. And targeted taxes on tobacco and sugary drinks can curb purchasing by youth and young adults, who are particularly sensitive to cost.

To make important headway against cancer and other preventable chronic diseases, we need to promote and support prevention on these multiple levels.  The lessons from tobacco show that such broad-based approaches work.  What is lacking in these other areas are appropriate resources and political will to tackle them as we've been able to do tobacco.

The return on the time and resources invested would, no doubt, be many times over.

The Importance of Taking an Honest Look at Your Child's Weight

It's not news that parents can sometimes have blinders on when it comes to their kids. It's only natural that we look for all the positives in our children and downplay any possible negatives.

And this is just what seems to be happening with parents and the loaded issue of their child's weight.  Parents of overweight kids can have real trouble understanding that their child is actually overweight.  One 2013 review of studies found that over 60 percent of parents of overweight kids didn't know that their child was overweight.  And for young kids (ages 2 - 6 years), this number rose to over 85 percent.

While a child's weight has no bearing on his or her character or worth, it can have important lifelong implications for health.  Overweight children are at much greater risk of becoming overweight adults, which can then put them at increased risk for a host of weight-related issues ranging from diabetes and cancer to stigmatization and lower lifetime earnings.

With 17 percent of US youth ages 2 - 19 obese and nearly 6 percent extremely obese, it's important that parents, health professionals, and health systems try to be honest about childhood weight so that children have the chance to build healthy behaviors that will benefit them throughout life.

For parents, a good place to start is the CDC’s BMI Calculator for Child and Teen.  This tool uses a special calculation of weight, height, gender, and age to estimate whether a child is underweight, normal weight, overweight, or obese.  Because children are still growing and developing, these labels are not always perfectly accurate, so it’s important to bring up any concerns about your child’s weight directly with a healthcare provider.

Additional tips:

• Keep track of your child’s weight, but don't obsess about it, and bring up any concerns with a health care provider.
• Help your children focus on healthy food choices and healthy activities rather than on weight and body image.
• Give your children the chance to be physically active every day.
• Limit sweets and processed foods, which are often high in calories as well as carbohydrates that can stimulate hunger.
• Limit TV, tablet, computer, and other screen time to under two hours a day. The less, the better.
• Help your children get enough sleep by setting a bed time and sticking to it every day. Keeping electronics out of the bedroom also helps.

It's a simple step really -- taking an honest look at our child's weight.  But it can be a key step for helping a child move toward lifelong good health.

Photo: Family Walk by Thomas Leth-Olsen  (CC License, CC BY 2.0)

Help Protect Kids from Cancer: Support a Ban on Youth Indoor Tanning

by Hank Dart

We've written a great deal in CNiC over the years on the dangers of indoor tanning, with one primary theme being the allure it has to young people, especially teenage girls.  It even seems to border on an addiction of sorts, as some research suggests. 

With UV exposure in youth and young adulthood a key contributor to later adult risk of skin cancer - including deadly melanoma - it's important to limit such exposure during the early years of life.

A new rule from the Food and Drug Administration (FDA) proposes to protect youth from UV exposure from tanning beds by banning their use by minors under age 18.  Some states already have this restriction in place.  This rule would expand it nationwide, helping to protect all kids across the country.   

See the infographic below for more details, and click to support this proposed rule by leaving a comment on the FDA website by March 21, 2016. 

 (View the PDF)

New Study Finds High Fiber Diet Early in Life Lowers Breast Cancer Risk

by Hank Dart

Though coverage of the Iowa caucuses has eclipsed most other media stories this week, there was still some important health news Monday about a large study finding that a high-fiber diet early in life may lower the risk of later adult breast cancer.

The study, part of the long-running Nurses' Health Study II, included over 44,000 adult women who were followed for 20 years and provided details on what they ate both in their early adults years and during high school.  Fiber intake in both periods of life were found to have an important impact on breast cancer risk, particularly for cancer that develops before menopause.

Women who ate the most fiber as adolescents (around 29 grams/day) had a 24 percent lower risk of premenopausal breast cancer compared to women who ate the least fiber as adolescents (around 18 grams/day).  For fiber intake in the early adults years, the findings were nearly identical, with those eating the most (around 26 grams/day) having a 23 percent lower risk of premenopausal breast cancer than those eating the least (around 12 grams/day).  And for every 10 grams per day of fiber the women ate in early adulthood or adolescence, the risk of overall breast cancer (premenopausal and postmenopausal combined) dropped by 13 or 14 percent, respectively.

Three pieces of 100 percent whole wheat bread has around 10 grams of fiber.

As we've written about previously here in CNiC, and in our new ebook TOGETHER - Every Woman's Guide to Preventing Breast Cancer, more and more evidence points to youth and the young adults years as key to lifelong breast health. And these current findings build on previous results suggesting that plant-based diets high in fiber can reduce breast cancer risk.

For parents looking to help their daughters make food choices that can help lay a foundation for lifelong breast health, there are some simple steps.  Help them focus on fruits, vegetables, nuts, and whole grains, while limiting full-fat dairy and meat -- and avoiding alcohol (more). Also key is healthy growth, helping them develop lasting eating and activity habits that help them maintain a healthy weight throughout life (more).  

We know that half of all breast caners can be prevented by steps most women can take.  This new study further confirms that lifestyle choices can have an important impact on breast cancer risk and that a cancer prevention lifestyle can almost never begin too early.

Photo: Idaho Wheat by Charles Knowles (CC License, CC BY 2.0)

Weighing Evidence: Obesity and Breast Cancer Risk Across Life

by Hank Dart

In a paper published yesterday in the journal Science Translational Medicine, Cancer News in Context's Graham Colditz and Washington University researcher, Kelle Moley, detail the important role that overweight and obesity play in the development of breast cancer.

Looking at wide-ranging evidence at all periods of life -- from gestation to the years after menopause -- Colditz and Moley show that despite some targeted times in youth, excess weight increases breast cancer risk over the course of a woman's life.

In the womb.  Though there is still a great deal to learn about the impact of mother's weight on her daughter's adult risk of breast cancer, larger weight gain during pregnancy has been linked with a higher risk of breast cancer in daughters.  The more a daughter weighs at birth has also been found to increase risk.   

Infancy and childhood.  Overweight in this period of life likely has a mixed impact on adult breast cancer risk.  It can lower breast density as well as slow the rate that girls grow to their maximum height -- each of which can reduce breast cancer risk.  At the same time, being overweight in childhood can lead to earlier first periods (menarche), which is an important breast cancer risk factor. 

Adolescence.  The lower risks linked to childhood overweight likely continue through the adolescent years.  

Premenopause.  While the protection against breast cancer from youth overweight likely persist, adult weight gain in the years before menopause can increase risk, offsetting and likely surpassing protection from youth. 

Postmenopause.  Evidence has long-shown that overweight and weight gain after menopause increases the risk of breast cancer.  

Though there are a number of possible reasons why overweight influences breast cancer risk, it's impact on hormone levels and related responses at various stages of life is a major part.

Despite some periods in life where overweight may have a beneficial effect on breast cancer risk, its overall impact is certainly negative.  And the best approach is to maintain a healthy weight throughout life - from childhood on.   Weight often tracks children and adults throughout life.  Overweight youth are more likely to become overweight adults, and overweight young adults are more likely to be overweight in later life.

For adults who are overweight, though, there is good evidence that losing weight and keeping it off can significantly lower breast cancer risk as well as the risk of other important diseases, like heart disease and diabetes.

Here in Cancer News in Context, we've previously highlighted some straightforward -- and a few off-kilter -- tips for keeping weight in check, most recently during our series, 9 Days of Practical Steps to Prevent Breast Cancer. Perhaps less familiar for many is knowing how best to approach weight and breast health issues of their children.  The focus should be on helping children be active, eat a largely plant-based diet, and avoid tobacco and alcohol.  Hardest for many parents is simply recognizing if their child has a weight issue -- so making an effort to understand where their child falls on growth charts can be really important in helping them maintain a healthy weight in their youth, and beyond. A good place to start for questions about childhood weight is the CDC’s BMI Calculator for Child and Teen. For more on breast health approaches for youth, see The Power of Youth: Beginning Breast Cancer Prevention in Childhood.

The Power of Youth: Beginning Breast Cancer Prevention in Childhood

Creative Commons photo: Flickr/CatDancing (cropped)

We've written a lot recently about the importance of breast cancer prevention starting early in life, both here on Cancer News in Context and in a guest post on the American Association for Cancer Research blog, Cancer Research Catalyst.  Though most breast cancer research focusses on women in midlife and older, more and more evidence supports the years between early adolescence and when a woman has her first child as key to laying down risk for breast cancer later in life.  Breast tissue in these years appears to be particularly vulnerable to certain risk factors that can have a durable influence on risk.

Diet and physical activity seem to be especially key in youth.  Eating foods rich in vegetable protein and low in animal products can help lower risk -- as can being physically active and keeping weight in check.  For teens and young adult women, avoiding alcohol - or at a minimum avoiding heavy drinking - is also important.

Our overarching message is that to optimize breast health a healthy diet, regular physical activity, and healthy weight are key habits that should begin in - and be fostered throughout - childhood and into adolescence and beyond.  Prevention is something that can almost never start too early.

A pie chart we use to illustrate the power of breast cancer prevention starting in childhood shows that healthy behaviors starting as early as age two years old could help avoid 68 percent of breast cancers (see figure).  The idea of beginning breast cancer prevention at two can seem extreme and has struck a chord with the media (see image).  And in many ways that is understandable, since breast cancer is a disease that seems so far off - striking most women much later in life - and breasts don't even fully develop until the teen and young adult years.

Yet, we know that healthy behaviors aren't easily turned on and off like spigots.  Healthy behaviors are learned over time, and the sooner in life they are set, the more likely they are to be carried on throughout childhood and into adulthood, and the more likely they are to have a positive impact on long term health.  This is why the Dietary Guidelines for Americans apply to everyone age two years old and over.  That breast tissue seems particularly vulnerable in youth and young adulthood adds even more reason to begin good breast health habits as early as possible.

For parents, the key is simply to help their children make healthy choices that they can follow throughout life.  This will not only help them lower their risk of breast cancer as adults, but also heart disease, stroke, diabetes, osteoporosis, and even depression.

See the excerpt below from our upcoming book on breast cancer prevention for breast health tips for the parents of young girls.

#     #     #

Young daughters (2 years – 10 years)

As challenging as the period between ages 2 years old and 10 years old can be as a parent, it does offer some sense of control and the ability to steer your children in positive directions.

Within reason, the food you put on the table is the food they will eat and likely come to enjoy – even if it can take some struggling, pouting, and tears along the way, from them, and you. Similarly, if you’re a family that plays at parks and goes for walks throughout the week, that’s something that will become ingrained in a child as well and something they’ll likely wind up doing throughout their lives and eventually with their own children.

With young daughters, there are three simple things to focus on: healthy activity, healthy food, and healthy weight. Pretty straightforward stuff, but in today’s busy world where both parents often work and have very little time to think about such things, they can be much easier said than done.

Luckily, creating a healthy environment for our children isn’t very complicated or time-consuming - with a little planning and a little effort.

Let little legs move

We can easily get caught up in all the detailed recommendations we read about physical activity. Moderate intensity. Vigorous intensity. Aerobic. Strength. X number of minutes a week. And, yes, those can be important, but when it comes to young kids, it’s really less about making our kids reach some time targets for activity than it is about simply giving kids the opportunity to be kids. Because being active is really their natural state.

• Be physically active as a family, every day if possible. Go on walks, ride bikes, shoot hoops, dance – whatever gets everyone moving.
• Encourage children to play outside (when it’s safe) and to take part in organized activities, including soccer, gymnastics and dancing. 
• Walk or ride bikes with your kids to school in the morning. 
• Find safe places for children to play when weather is really bad: indoor playgrounds, YMCA, shopping malls.

Freeze the screens

Children grow up as digital natives these days, but that doesn’t mean that all that screen time doesn’t have health repercussions. Too much screen time takes time away from physical activity and can promote unhealthy eating.

• Limit TV, tablet, computer, and other screen time to under 2 hours a day. The less the better.
• Keep TV, tablets, and smartphones out of children’s bedroom’s. 
• Choose one day each week to go TV and tablet-free as a family. Board games and family book or cooking clubs are great screen-time alternatives.

Offer a lot of plant foods

When it comes to promoting breast health later in life, getting daughters to eat a lot of plant-based foods early in life is likely important. This means focusing on fruits, vegetables, nuts, whole grains, and eating less full-fat dairy and meat.

• Make fruits and vegetables a part of every meal. Put fruit on cereal. Cut up vegetables as a snack. 
• Dice vegetables into soups, sauces, even batters. It’s an easy – and tricky - way to add more veggies to meals. 
• Keep fruit out where kids can see it: on the counter, on a desk, in a backpack. If they can see it, they’re more likely to eat it.
• Offer whole-grain cereal, brown rice and whole-wheat bread over refined choices, like white rice and white bread. 
• Keep sugary drinks, like sodas, fruit drinks, and energy drinks to a minimum.
• Try a meat-free week. The family just might like it.
• Make dishes made with olive or canola oil, which are high in healthy fats. 
• Cut back on full-fat dairy, fast food, and store-bought snacks (like cookies), which are often high in unhealthy fats.

Don’t obsess but keep track of weight

Weight is clearly a loaded issue, especially for girls. And it’s important not to create or perpetuate in your daughters – or any girls for that matter – unhealthy body image. In today’s world of Photoshopped models and selfies, females of all ages have a hard enough time comparing themselves to unreal expectations of beauty and body size.

At the same time, however, it’s important for parents to be aware of their daughter's weight and to know whether it may be too low, too high, or in the normal range. Surprisingly, studies show that many parents have trouble knowing if their child is an unhealthy weight or not. So, simply knowing can be a victory in itself.

A good place to start if you have questions about your child’s weight is the CDC’s BMI Calculator for Child and Teen. This tool uses a special calculation of weight, height, gender, and age to estimate whether a child is underweight, normal weight, overweight, or obese. Because children are still growing and developing, these labels are not always perfectly accurate, so it’s important to bring up any concerns about your child’s weight directly with a healthcare provider.

• Keep track of your child’s weight and bring up any concerns with a health care provider.
• Help your daughter focus on healthy food choices and healthy activities rather than on weight and body image.
• Give your children the chance to be physically active every day.
• Limit sweets and processed foods, which are often high in calories as well as carbohydrates that can stimulate hunger.
• Limit TV, tablet, computer, and other screen time to under 2 hours a day. The less the better.
• Help your children get enough sleep by setting a bed time and sticking to it every day. Keeping electronics out of the bedroom also helps with sleep.

HPV Vaccination Programs Shown Effective in Australia

Photo: Flickr/PAHOWHO

by Sarah Cortez

When given before the start of sexual activity, the HPV (human papillomavirus) vaccine prevents most cases of cervical cancer and genital warts. It can also lower the risk of oropharyngeal, penile and anal cancer.

HPV is a sexually transmitted infection, and we target the vaccine to 11-12 olds, as we expect children at this age to not be sexually active. This allows immunity to build up before any exposure to HPV occurs.

Though girls were the initial focus of the vaccine, it is now recommended that boys get vaccinated, too. Boys do not have cervices and, therefore, can’t get cervical cancer, but they certainly can get genital warts and the other rarer cancers linked to HPV. Importantly, males can also spread the cancer-causing virus to females.

As we have covered in previous posts, the use of the HPV vaccine has been slow to build in the US. But this is not the case in other countries.

A new study published in the open access journal PLOS ONE, details the effect of the Australian government’s national HPV vaccination program, using the Gardasil vaccine. Starting in 2007, the Australian government offered the HPV vaccine for free at school to all 11-12 year old girls on the standard schedule:

1. 1st dose at start
2. 2nd dose 1-2 months after 1st dose
3. 3rd dose 6 months after 1st dose

The Australian government also offered older schoolgirls (13-18 years old) and young adult women (18-26 year old) the vaccine for free through their general practitioners and community health clinics. This was referred to as the catch-up program due to the increased likelihood that patients were more likely to already be sexually active.

Preliminary results showed that by 2012, over 70% of all Australian girls had received the full 3 dose vaccine by age 15 and over 85% were vaccinated by the last year of high school. As a comparison, in 2012, the rates of 3-dose vaccination among adolescent girls in the US were only 35% by age 15 and 45% by age 17. 

So what resulted from this Australian vaccination program? Following its onset, the diagnosis of genital warts decreased by 93% among young women seen in the sexual health clinics. Additionally, the diagnoses of genital warts decreased by 82% among young heterosexual men. Remember, the vaccine was only free for girls, so the decrease in genital wart diagnoses for men who have sex with women was possibly due to something called “herd immunity,” where vaccination of a large percentage of a population (the “herd”) benefits even those who were not vaccinated.

The decrease in genital warts seen in the sexual health clinic is great, but the sexual health clinics see many fewer patients than general practitioners. So was the decrease in genital wart diagnoses also found in the general population?

To find out, the new study used data collected from over 11,000 Australian general practitioners who saw at least some Medicaid patients. Once a year since 1998, each general practitioner recorded 100 patient encounters. This method logged over 1 million patient encounters between 2000 and 2012.

What was the result? Did the general practitioners find the same decrease in genital warts after the start of the HPV vaccination program?

The answer is yes. Genital warts were found most often in 15-27 year old males and females. Following the vaccination program, genital wart management decreased by 61% among 15-27 year old females. As a comparison, they tracked the rate of other STDs like genital herpes. As expected, the diagnoses of other STDs did not decrease following the vaccination program.

There was no change in males or the 27+ age group, which did not receive the vaccination.

All in all, this is great news. The HPV vaccine works. It decreases genital warts among those who are vaccinated, and hopefully, in the future, we can replicate here in the United States the success Australia has seen. As for us at CNiC, we will continue to report the findings and outcomes of this important preventative health tool. 

References

Harrison C, Britt H, Garland S, Conway L, Stein A, Pirotta M, Fairly C. Decreased management of genital warts in young women in Australian general practice post introduction of national HPV vaccination program: Results from a nationally representative cross-sectional general practice study. PlosOne 2014; 9(9): e105967.

"Genital HPV Infection - Fact Sheet." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 20 Mar. 2014. Web. 12 Oct. 2014.

"National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 30 Aug. 2013. Web. 13 Oct. 2014.

Breast Cancer Prevention Now

By Graham A. Colditz, MD, DrPH

It is time to bring our focus back to lowering the risk or reducing the onset of new cases of breast cancer at all ages. Worldwide incidence of the disease is rising as societies across the globe modernize, which brings with it higher rates of breast cancer risk factors, such as overweight, lack of physical activity, and key reproductive factors like beginning families later in life and have fewer children.

While modernization has many important benefits, it is also directly driving up the risk of breast cancer. Globally, one in every four new cancers diagnosed in women is breast cancer, and over 1.7 million new cases are diagnosed each year.

We need a global breast cancer prevention strategy - now.

We currently understand how the longer interval from first menstrual period (menarche) to first baby increases lifetime risk for beast cancer. This interval has expanded over centuries in Western Europe following the Industrial Revolution, and - in dramatic fashion - over just a few decades in Asian countries. Data from China and Korea show a rapid decline in age at first menstrual period since World War II, as well as a decline in number of children, which has accelerated. The age women have their first babies is now above the Organization for Economic Cooperation and Development (OECD) average of 28 years old. This means that a typical woman has 16 or more years between her first period and her first baby (first birth at 28 minus first period at 12 years of age). In 1950 in China, this interval was just three years (first birth at 19 minus first period at 16).

Given these social movements, are there approaches early in life that can help mitigate the impact of these changes in reproductive factors? It appears so.

We, and others, have studied diet and physical activity as two key aspects of lifestyle, and then alcohol intake in later adolescence and early adult life.

• Eating a diet high in fiber and vegetable protein is related to significantly lower risk of both premalignant breast lesions and breast cancer.

• Being more physicaly active from ages 12 to 22 is powerfully protective against breast cancer.

• Avoiding alcohol before first pregnancy is strongly protective against both benign breast lesions and invasive breast cancer.

Together, we need to work to improve diet in children, adolescents, and young adults – fostering access to, and consumption of, fruits, vegetables, and whole grains – as well as reducing alcohol intake among women under age. Especially for high school- and college-aged women, we must create an environment that encourages less alcohol intake. Also important is sustaining physically active lifestyles through the adolescent and early adult years, which has both immediate and long-term benefits.

Multifaceted approaches are needed to achieve such behaviors across a broad set of the population, but doing so will have lasting benefits, not only for breast cancer but also colon cancer, heart disease, stroke, as well as mental health. Momentum in this direction can take time to gather, but is achievable and important, and can have a positive impact for generations to come.

Related posts

Preventing breast cancer: a diet with lots of fruits and vegetables
Reproductive risk factors drive risk of breast cancer in premenopausal women
Peanuts and lower risk of breast cancer
Hey, Mom & Dad, Early Life Can Be Important for Breast Cancer Risk

Reference
Colditz GA & Bohlke K. Priorities for the Primary Prevention of Breast Cancer. CA. DOI: 10.3322/caac.21225

Alcohol and Health: Three New Studies and What They Mean for Youth and Young Adults

Photo: Flickr/Tim RT

It's been a big week in the news for alcohol and health. Three separate studies were released that helped shed light on a key issue we often discuss here at Cancer News in Context: the important impact that drinking has on cancer risk - particularly when started early in life.

The first report, which appeared in the online journal Preventing Chronic Disease, details the impact that drinking has on both disease risk and lifespan.  In the overall population, excessive drinking was found to cause over 87,000 deaths each year, resulting in 2.5 million years of life lost.  Acute causes - like car crashes, suicide/homicide, and falls - accounted for a little over half of these deaths, while chronic diseases - like stroke, cancer, and liver diseases - accounted for the rest.  Among working age adults (20 - 64 years), 10 percent of all deaths each year could be attributed to alcohol.

In those under age 21, alcohol accounted for about 4,300 deaths each year and a total of 249,727 years of life lost.  Not surprisingly, the most important contributors to these deaths were more immediate causes - car crashes and suicides/homicides -  rather than chronic diseases.  

Yet, just because the full chronic disease effect of excessive drinking doesn't show itself until later in life, this doesn't mean that drinking in youth doesn't have an important impact on later risk.  This seems especially so for breast cancer, where there is now good evidence that drinking in youth and young adulthood has a pronounced influence on later-life breast cancer risk.  Unlike most other organs in the body, the breasts continue to develop until a woman has her first child, and up until then, breast tissue appears more susceptible to harmful risk factors, like alcohol.  

This makes the results of another study released this week particularly concerning.  This study, released in the Journal of the American Medical Association - Psychiatry, found that younger generations of Australian women now drink much more excessively than did their mothers when they were the same age.  One primary reason for this is, simply, that women today are more likely to delay childbirth, deciding to have children later in life than their mothers did.  Without obligations of children and family there is greater opportunity for, and fewer drawbacks to, drinking.  

This new pattern  - which is likely mimicked across multiple nations - can have important implications for breast cancer for the reasons discussed above related to breast development.  Not only are women drinking more, they're doing so during the key period in breast development between first having a period and having a first child.   

Finding effective ways to help adolescents and college-aged women understand these risks and avoid alcohol - or at a minimum avoid excessive amounts of alcohol - will be a challenge for health professionals moving forward.  

Another paper released in the journal Nature this week could eventually help with this (related NPR story).  Researchers looked at various characteristics of 700 European 14 year olds - from family history, to personality traits, to brain anatomy - to see if any patterns emerged that predicted drinking at age 16.  They found that life experiences, personality, and certain aspects of brain anatomy could predict with decent accuracy who would go on to become problem drinkers.  While using such an algorithm is a long way off from practical application, it does show that it may be possible in the future to identify in the health care setting which youth may be more likely to put their health at risk with early life drinking.  Interventions could then be better targeted and would hopefully be more effective at curbing youth drinking.

Despite the depictions in magazine, TV, and website ads, drinking is a major minefield for adolescents and young adults.  There's the very immediate dangers of car crashes, injuries, and unsafe sex, and the longer-term dangers of alcoholism, cancer, and other chronic diseases.  Forming effective channels to reach out to youth with such messages needs to be a continued priority for public health.