Monday, December 14, 2015

We Are Family: Understanding Your Family History of Cancer


by Katy Henke

Family members share many things that can impact cancer risk: lifestyle choices, habits, physical environments and their genetic makeup. Of all of these, genetics can be particularly key.

Because of this, it’s important to understand your family history of cancer and how it may impact your risk for the disease. Some types of family history and related genetic mutations can greatly increase the risk of certain cancers, while other types can have an impact similar to common lifestyle risk factors - like being overweight.

So, take the opportunity over the holidays to talk with your family members about their health history. Jennifer Ivanovich, MS, MBA, CGC, a board certified clinical cancer genetic counselor at Siteman Cancer Center and Assistant Professor of Surgery in the Division of Public Health Sciences at Washington University School of Medicine, recommends asking some of the following questions:
  • Has anyone in the family had cancer?
  • If so, where did the cancer start or what was the specific cancer type?
  • About what age was the person diagnosed? 
  • Has the family member had genetic testing and, if so, what were the specific results? (Having a copy of the genetic testing results is always helpful).
There are many tools available to help chart your family health history. A doctor or genetic counselor is the the best source for understanding your family history of the disease and how it may affect your risk.

If your family history or genetics puts you at increased risk, your doctor may recommend special steps that can help you reduce or manage that risk.

A healthy lifestyle also remains important for people with a family history of cancer. While you cannot change your genes, shifting to healthier behaviors, such as quitting smoking and keeping weight in check, can improve your overall health and lower the risk of cancer and other important diseases.

Knowing that cancer runs in your family offers a great opportunity to focus on prevention. For tips on lowering cancer risk, check out  8IGHT WAYS to Stay Healthy and Prevent Cancer. Start with one or two changes, and build from there.

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To learn your risk for common diseases, visit Your Disease Risk calculator.

For more resources on family history, visit the CDC’s Family Health History website or the Surgeon General’s My Family Health Portrait website.


Thursday, December 10, 2015

Unwrapping Holiday Weight Gain - and Ways to Prevent It


by Hank Dart

We’re in the middle of it now. The holiday season – that wonderful and stressful five-week stretch from Thanksgiving to New Year’s where at every turn, there seems to be food. And not just everyday food, but food of such amounts and enticing types that it can feel nearly impossible at times to refuse them.

Add the long nights, cold weather, and busy schedules that throw us off our normal exercise routines, and the stage can be set for entering 2016 with our clothes fitting just a bit tighter than they did earlier in the fall.

If this scenario feels all too familiar from holidays past, you can find some comfort in knowing you’re not alone. Studies have found that holiday weight gain is a very real thing that many people struggle with.

How much weight gain are we talking about?
Though it can vary greatly from person to person, typical weight gain over the holidays is around 1 to 1.5 pounds. But, many people gain considerably more, on the order of 5 pounds or more, says Dr. Samuel Klein, William H. Danforth Professor of Medicine and Nutritional Science at Washington University School of Medicine.

And the weight put on over the holidays makes up a large proportion of the weight that most people gain every year. A study in the New England Journal of Medicine found that of the weight that participants on average gained over the course of a year, just over half was put on during the holidays (1).

It’s like the party guest that never leaves. And that’s what makes holiday gains problematic, according to Klein: “People usually do not lose the weight they gain during the holidays and it is a major cause of yearly weight gain and increasing body weight in the United States.”

Of course, the amounts don’t sound like anything that’s really worth worrying about. A pound here. A pound there. But weight gain has a way of silently creeping up on people. And over the years, it can turn into noticeable amounts that can have a negative impact on both health and quality of life.

Assuming a gain of just one pound per year, for example, someone who is 5’9”, weighs 165 pounds, and has a “healthy” BMI of 24 would be well into the middle of the “overweight” category after 20 years (BMI of 27) and then crest into “obesity” after 40 years (BMI of 30). With the large majority of people in the United States already overweight or obese, these movements can happen even faster, not only because the starting BMI is higher but also because holiday weight gain is often larger in those who are already overweight.

“In general, [holiday] weight gain is proportional to BMI. People with higher BMI tend to gain more weight,” says Klein.

And findings from the New England Journal of Medicine study provide a good example of this. Of those participants who were overweight, 11 percent experienced “major holiday weight gain” of 5 pounds or more. In obese, participants, the proportion rose to 17 percent. In healthy weight participants, only 5 percent experienced a major gain.

How many extra calories does it take?
So, how much overeating does it take from Thanksgiving through New Year’s to cause the typical holiday weight gain? Surprisingly little it turns out.

In a paper in Physiology & Behavior, Dale Schoeller of the University of Wisconsin ran some numbers and concluded that it took just 55 extra calories a day to build up to the average holiday gain of about a pound (2). That’s around the amount in that cookie you grabbed on the way out the door at your work party or that dollop of whip cream you put on your pie.

What can we do about it?
Keeping weight in check is hard any time of year, let alone over the holidays when we’re thrown off our regular routines. But it’s far from impossible. A lot of people come through the holidays without gaining any weight, and some even harness the change in schedule to their advantage and are able to lose a few needed pounds.

Looking at all the meals, parties, and other holiday-themed gatherings that are part of the Thanksgiving to New Year’s season, there are some practical approaches that can help us keep excess calories, and weight gain, at bay.

Klein offers these practical tips for holiday events:
“Portion control”
One of the best ways to keep calories in check is to cut back on portion size. We’ve gotten really used to huge meals, huge snacks, and huge drinks. Put smaller amounts of food on your plate, or try simply choosing a smaller plate. Most of the time you’ll find that smaller amount is all you really wanted.

“Eat before going to parties so that you are less hungry”
Coming to a party when you’re feeling ravenous can lead to overeating. The better approach is to have a healthy meal or snack at home and then head to the festivities. This way, all those alluring high-calorie choices won’t hold quite as much sway.

“Stay as far away as possible from the food tables at parties”
This falls into the “out-of-sight., out-of-mind (and stomach)” category. Just giving yourself some distance from the food at an event can make it less likely that you’ll grab food mindlessly, even when you’re not hungry.

“Minimize alcohol intake”
Alcohol is a big part of many holiday gatherings, which is fine in moderation, of course. It’s a time of celebration. But, if you’re watching calories, it’s probably best to keep drinking to a minimum. Alcohol is an appetite stimulant and can quickly disrupt your best-laid plans to avoid eating too much.

“Keep a low-calorie or zero-calorie drink in your hand”
From eggnog to wine to sugary soda, the holidays are filled with high-calorie (and often alcoholic) beverages that can contribute to extra calories. When you get to an event, pick up a low-calorie drink – like fizzy water, coffee, or diet soda – so your host, or best friend, isn’t tempted to give you a high-calorie option.

“Bring a low-calorie dessert or food”
It’s good form to bring a small gift when you’re invited to a dinner party. And most of us default to a bottle of wine or six-pack of beer or sugary soda. If you’re watching calories, try bringing a low-calorie appetizer or dessert option instead – like a platter of vegetables or fresh fruit with a low-calorie yogurt dip. It may feel a little self-serving, but you can bet that others will appreciate it, too.

On top of these special tips for holiday events, it’s also important to keep up with the tried-and-true weight control strategies that apply year-round: exercise every day; keep screen time to a minimum; choose a diet rich in fruits, vegetables, and whole grains; and try to be aware of how much you’re eating. In the end, it’s the calories we burn and the calories we eat that really matter.

Crazy as they can be, the holidays always hold a special place on our calendars. With a little planning, and a few simple steps, we can keep them from making a lasting mark on our waistlines as well.


For more healthy tips - for the holidays and year-round, visit
8IGHT WAYS to Stay Healthy and Prevent Cancer 
Your Disease Risk
Siteman Cancer Center - Healthy Holiday Cookbook 


References

1. Yanovski JA, Yanovski SZ, Sovik KN, Nguyen TT, O'Neil PM, Sebring NG. A prospective study of holiday weight gain. N Engl J Med. 2000;342(12):861-867.

2. Schoeller DA. The effect of holiday weight gain on body weight. Physiol Behav. 2014;134:66-69.



Thursday, December 3, 2015

8 Ways to Lower Colon Cancer Risk in One Simple Graphic

by Katy Henke

Colon cancer is the third most common cancer in the United States. The good news is that 75 percent of cases could be prevented with healthy lifestyle choices. These eight simple tips can help you lower your colon cancer risk and improve your overall health (PDF). For more information and prevention tips, visit 8ways.wustl.edu.


(PDF)

Monday, November 23, 2015

A Meaty Topic: Red Meat, Cancer Risk, and the Benefits of a Plant-Based Diet


By Yikyung Park, ScD

A recent report on red and processed meat and cancer risk, written by the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO), sent shockwaves worldwide. After reviewing existing evidence, the report concluded that processed meat consumption is a cause of cancer and red meat consumption is probably a cause of cancer, too. Although the adverse effect of meat on health has been known for quite a while, many people seemed to be surprised by the IARC report.

As a part of IARC’s Monographs Programme, 22 experts from 10 countries reviewed more than 800 different studies on cancer in humans and concluded that high consumption of red and processed meat is carcinogenic to human. Most convincing evidence came from studies on colorectal cancer. For every 100 grams per day of red meat consumption , colorectal cancer risk incased by 17 percent.  One hundred grams is equal to about 3.5 ounces of steak, or a piece of meat about the size of a deck of cards.  Every 50 grams per day of processed meat consumption (about 6 slices of bacon) also increased colorectal cancer risk by 18%.

Although these risks aren't large, they are still important.

Cutting back on red and processed meat offers those at increased risk of cancer (such as those with a family history of the disease or who have previously had cancer) a relatively simple option for helping to lower their risk.

More broadly, the meat/cancer link has huge public health implications simply because so many people eat meat, with consumption increasing worldwide. On average in the United States, people eat about 50–100 grams per day of red meat and some people eat more than 200 grams daily. According to the U.S. Department of Agriculture Commodity Consumption by Population data, in 2012, Americans consumed on average 163 grams of total meat daily, of which 92 grams was red meat and 54 grams was poultry. Red meat consumption was higher in men, younger people, and obese people.

Red meat refers to unprocessed animal meat such as beef, veal, pork, lamb, and goat. Processed meat refers to any meat (such as, beef, pork, chicken, turkey) that has been salted, cured, fermented, smoked, or processed to enhance flavor or improve preservation. Examples of processed meat are hot dogs, luncheon meat, ham, sausages, corned beef, beef jerky, and canned meat. When meat is cooked at high temperatures (e.g., grilling, barbecuing, and pan-frying), it produces heterocyclic amines (HAA) and polycyclic aromatic hydrocarbons (PHA), which are known to cause cancer in animals. Also, meat contains heme iron that increases formation of N-nitroso compounds (NOC), another cancer causing agents. Nitrate and nitrite that are added to processed meats during the processing also forms NOC.

Meat is a good source of protein and B vitamins, which are needed to maintain health, but also high in saturated fat and may contain potentially cancer-causing chemicals mentioned above. Numerous studies have showed that high consumption of red and processed meat was related to an increased risk of colorectal cancer, but also an increased risk of coronary heart disease, diabetes, and premature death.

Furthermore, people who eat high amounts of red and processed meat also tend to eat more high-fat foods, sweet desserts, and refined grains, but fewer fruits and vegetables. This kind of overall dietary pattern has also been linked to an increased risk of cancer as well as other chronic diseases. 

On the other hand, a Mediterranean type-diet that is high in fruit, vegetables, beans, and whole grains and low in consumption of red meat has many health benefits. 

This recent wave of media coverage on the risks of red and processed meat - while a bit overblown - did highlight the important role that a largely plant-based diet has in lowering cancer risk and improving overall health.  Cutting back on red and processed meat by choosing more poultry, fish, and legumes is one step you can take.  Choosing more fruits, vegetables and whole grains while cutting back on refined grains and unhealthy fats (like saturated and trans fats) are others.  

Making such changes isn't always easy but everyone can do it.  The key is to start small and build from there. Change just one thing at a time.  Try out "meatless Mondays."  Or add an extra vegetable to your dinners a few times a week.   When such changes become a habit, add on other healthy options.  

For additional healthy eating and lifestyle tips, see our series - 8IGHT WAYS to Prevent Cancer (website).



References

Bouvarda V et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncology, 2015. Available online 29 October 2015

Micha R et al. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010;121(21):2271-83.

Sinha R et al. Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med. 2009;169(6):562-71.

Sofi F et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.

USDA Economic Research Service. http://www.ers.usda.gov/data-products/commodity-consumption-by-population-characteristics.aspx

Thursday, October 29, 2015

Practical Steps to Prevent Breast Cancer: Day 9 - If High Risk: Consider Risk-Reducing Medications


It's the final day in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
_ _ _ _
If High Risk: Consider Risk-Reducing Medications
Although not commonly thought of as a “healthy behavior,” taking prescription risk-reducing medications – such as, tamoxifen, raloxifene, and possibly exemestane – can significantly lower the risk of breast cancer in women at high risk of the disease. They can also have important side effects, so they aren’t right for everyone.

“High risk” is specifically defined as a woman with a five-year risk of breast cancer of 1.67 percent or higher, typically calculated by the National Cancer Institute’s Breast Cancer Risk Assessment Tool. If you think you’re at high risk, either after estimating your risk or for some other reason, it’s important to talk to a doctor. Together, you can decide if risk-reducing medication or other steps to lower or manage your risk may be right for you.

Tips and Tricks – Tamoxifen and Raloxifine

Talk to a doctor about your risk and your options. Many women who feel they’re at high risk are likely not. And some who feel they aren’t, likely are. So it’s important to talk to a doctor or other qualified health professional about your risk of breast cancer. If you are at high risk, together you can talk about your options for managing that risk and decide which option is likely best for you.

Review the possible benefits and risks of risk-reducing medication. For many high-risk women, tamoxifen, raloxifene, and possibly exemestane are good choices for managing their risk. Though each does have potential side effects, these can be dramatically offset by their ability to cut the risk of breast cancer in half. Talk to a doctor about how these might balance out for you. A huge percentage of women in the United States who stand to benefit greatly from risk-reducing medications choose not to take them – and not always for accurate reasons (more).


Next Steps – Tamoxifen and Raloxifene

American Cancer Society
http://goo.gl/dyHRbS

National Cancer Institute
http://www.cancer.gov/bcrisktool

Your Disease Risk
http://yourdiseaserisk.wustl.edu

Wednesday, October 28, 2015

Practical Steps to Prevent Breast Cancer: Day 8 - Find Out Your Family History

It's day eight in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
_ _ _ _

Day 8 - Find Out Your Family History



Women with a strong family history of breast cancer can take special steps to protect themselves, so it’s important for women to know their family history of breast and other cancers. You may be at high risk of breast cancer if you have a mother or sister who developed breast or ovarian cancer (especially at an early age) or if you have multiple family members (including males) who developed breast, ovarian and/or prostate cancer. A doctor or genetic counselor can help you understand your family history of the disease.  A doctor is also the best source of information on ways to lower or manage your breast cancer risk.


Tips and Tricks – Family History

Learn your family history. Most women will have a general idea of their family history of breast cancer, but it’s a good idea to spend a little time to get a more detailed idea of your cancer history, especially if it’s pretty clear that breast or other cancers run in your family.  A doctor or genetic counselor can help.

Keep things in perspective. Most women with a family history of breast cancer are not at high risk of the disease. In most instances, family history behaves on par with many other breast cancer risk factors. Of course, women with a very strong family history (multiple family members with cancer or inherited BRCA1 or BRCA2 mutations) have a very strong risk of breast cancer. But even these situations don’t guarantee a woman will develop the disease.


Next Steps – Family History

Looking for more in-depth information on family history? Here are some good sources:

US Surgeon General
http://goo.gl/VTT2yU

Centers for Disease Control and Prevention
http://goo.gl/c2iNuO


Tuesday, October 27, 2015

Practical Steps to Prevent Breast Cancer: Day 7 - Avoid Postmenopausal Hormones

It's day seven in our nine day series highlighting key steps and practical tips that can help women lower their risk of breast cancer. Previous days.
_ _ _ _

Day 7 - Avoid Postmenopausal Hormones


The issue still comes up in the news, and study results still get parsed and discussed, but in the end, the basic conclusion about postmenopausal hormones and breast cancer remains the same: While postmenopausal hormones can effectively treat moderate to severe symptoms of menopause, when it comes to breast cancer, it’s best to avoid them long term.

If women choose to take postmenopausal hormones to relieve menopausal symptoms (like night sweats, hot flashes, and vaginal dryness), it should be for the shortest period of time possible – not more than 1 – 3 years. And they shouldn’t be taken long term with the intent of lowering the risk of chronic diseases like heart disease or osteoporosis.

The best person to talk to about the risks and benefits of postmenopausal hormones is your doctor.


Tips and Tricks – Postmenopausal hormones

Try to deal with menopausal symptoms without postmenopausal hormones. Menopausal symptoms are no fun – to put it mildly. And finding relief from them is key. It’s best, though, to look past postmenopausal hormones and try to find relief in other ways. Physical activity, for example, can help with mood swings, troubled sleep, and forgetfulness. Identifying triggers (and then avoiding them) can help deal with hot flashes, as can some non-hormonal medications. Over-the-counter lubricants can help with vaginal dryness. At a certain point, symptoms may be so bad that it makes sense to consider postmenopausal hormones. Talk to your doctor about the best approach.

Next Steps – Postmenopausal hormones

Looking for more in-depth information on postmenopausal hormones? Here is a good source:

WomensHealth.gov
http://goo.gl/2YL5KE