Cancer prevention aspec

Cancer Prevention and Screening
ASPEC 2019

Cancer
Prevention
and Screening
www.aboutcancer.com

Discovering New Information
We recently learned
the important role the
air force played in
Washington’s success
in the Revolutionary
War

Can you reverse engineer mother nature and avoid cancer?
Much of the ‘science’ about cancer
is based on case-control studies
which proves association.
Correlation is not Causation!
Hypothesis generating.
Why are so many of the
‘intervention trials’ failures?
Caveat emptor!

Key Web Sites for Cancer Prevention and Screening
www.aboutcancer.com Dr. Miller Site
cancer.gov/about-cancer/causes-prevention NCI prevention Site
www.cancer.gov/types NCI specific cancers
seer.cancer.gov/ Cancer Statistics
epss.ahrq.gov/PDA/index.jsp Screening Guidelines
www.nccn.org National Comprehensive
Cancer Network (NCCN)
Uptodate.com Current review article about all
medicine
gis.cdc.gov/Cancer/USCS/DataViz.html CDC Cancer Risk Graphs
https://health.gov/dietaryguidelines/2015 Diet Guidelines

1.Overall prevention strategies (can you lower the
overall risk of getting any type of cancer?)
2.Specific cancers may have specific strategies
(breast, prostate, lung and colorectal)
3.Screening…where to find the best
advice

In 2019 in the US there would be over 1.7 million new
cancer cases and over 600,000 deaths from cancer.
The probability of getting cancer during your life time
based on data from 2013 to 2015 is 39.3% for men and
37.1% for women (not counting skin cancers).

Site Men Woman
All 39.3% 37.7%
Breast 12.4%
Prostate 11.2%
Lung 6.7% 5.9%
Colorectal 4.4% 4.1%
Uterus 2.9%
Melanoma 3.7% 2.5%
Lymphoma 2.4% 1.9%
Kidney 2.1% 1.2%
Leukemia 1.8% 1.3%
Thyroid 0.6% 1.8%
Probability of Developing Invasive Cancer
(US 2013-2015)

The best approach would be to prevent cancer in the first
place. Some approaches are obvious and effective (e.g.
avoiding known carcinogens like smoking and asbestos or
excessive sun exposure to prevent skin cancer.)
Next best approach would be screening
(only if it’s been shown to be beneficial
and ? cost effective)

Prevention is defined as the reduction of cancer mortality via reduction in
the incidence of cancer. This can be accomplished by
• avoiding a carcinogen or altering its metabolism
• pursuing lifestyle or dietary practices that modify cancer-causing factors or
genetic predispositions
• medical interventions (e.g., chemoprevention) or risk-reducing surgical
procedures
• early detection strategies that can result in removal of precancerous
lesions, such as colonoscopy for colorectal polyps
cancer.gov/about-cancer/causes-prevention

Lifestyle factors have been linked to a variety of malignancies, including the most common
in the developed world: lung, colorectal, prostate, and breast cancer.
In a longitudinal study, participants who had all four lifestyle factors:
1. never smoking,
2. body mass index [BMI] <30,
3. physical activity >3.5 hours weekly,
4. prudent diet (high intake of fruits, vegetables, and whole-grain bread and low
meat consumption)
had approximately one-third lower risk of cancer compared with those who had none of
these factors
Ford ES. Arch Intern Med.
2009;169(15):1355.

Healthy living is the best revenge: findings from the European Prospective
Investigation Into Cancer and Nutrition-Potsdam study.
Ford ES. Arch Intern Med. 2009;169(15):1355.
23,153 German participants aged 35 to 65 years end points included confirmed incident type 2 diabetes mellitus, myocardial
infarction, stroke, and cancer.
Risk of developing a chronic disease decreased progressively as the number of healthy factors increased.
Participants with all 4 factors at baseline had a 78% lower risk of developing a chronic disease:
- diabetes: 93%
- myocardial infarction: 81%
- stroke: 50%
- cancer: 36%
than participants without a healthy factor.

Healthy Life Style Can Overcome Bad
Genetics for Dementia
Lourida. JAMA July 14, 2019
• Study of 196,383
• 4 Healthy Life Styles (healthy diet,
proper exercise, no smoking,
moderate alcohol
• Included were polygenic factors
associated with Alzheimer disease
Lifestyle: Favorable (3, or 4)
Intermediate (2) Unfavorable (0, 1)
Risk of Getting Dementia

Risk Factors for Cancer
Age
Alcohol
Cancer-Causing Substances
Chronic Inflammation
Diet
Hormones
Immunosuppression
Infectious Agents
Obesity
Radiation
Sunlight
Tobacco

Probability of Developing Cancer During this
Age Interval (2013-2015)
Birth to 49 50 – 59 60 – 69 70 or older Lifetime
Male 3.4% 6.1% 13.2% 31.9% 39.3%
Female 5.6% 6.2% 10.0% 26.0% 37.7%
So 82% in men (31.9/39.3) and 69% in women (26/37.7) occur at 70+ (when screening may be stopped!)

Probability of Developing Cancer During this
Age Interval (2013-2015)
Birth to 49 50 – 59 60 – 69 70 or older Lifetime
Male 3.4% 6.1% 13.2% 31.9% 39.3%
Female 5.6% 6.2% 10.0% 26.0% 37.7%
So 82% in men (31.9/39.3) and 69% in women (26/37.7) occur at 70+ (when
screening may be stopped!)

Avoiding Old Age and Cancer…only solution die young!
Anne Frank 15
Ritchie Valens 17
Joan of Arc 19
Buddy Holly 22
River Phoenix 23
James Dean 24
Tupac Shakur 25
Kurt Cobain 27
Jim Morrison 27
Amy Winehouse 27
Janis Joplin 27
Jimi Hendrix 27
John Belushi 33
Mozart 35
Marilyn Monroe 36
George Gershwin 38
Chopin 39

There is a strong scientific consensus that alcohol drinking can
cause several types of cancer, an estimated 3.5% of cancer
deaths in the US are related to alcohol
Type of Cancer Increased Risk
Oral Cavity, Pharynx 1.8 X – 5 X
Larynx 2.6 X
Esophagus (squamous) 1.3 – 5X
Liver 2 X
Breast 1.04 (light) 1.23 (moderate) 1.6 X (heavy)
Colon, Rectal 1.2 – 1.5 X

There is a strong scientific consensus that alcohol drinking can
cause several types of cancer, an estimated 3.5% of cancer
deaths in the US are related to alcohol
According to the federal government’s Dietary Guidelines for Americans
2015-2020, individuals who do not drink alcohol should not start
drinking for any reason.
It recommends that if alcohol is consumed, it should be done in
moderation and defines moderate alcohol drinking as up to one drink
per day for women and up to two drinks per day for men.
Heavy alcohol drinking is defined as having 4 or more drinks on any
day or 8 or more drinks per week for women and 5 or more drinks on
any day or 15 or more drinks per week for men

Drinking alcohol raises your risk of getting six kinds of cancer—mouth and throat, voice
box (larynx), esophagus, colon and rectum, liver, and breast (in women).

Cancer-Causing Substances in the Environment
Aflatoxins
Aristolochic Acids
Arsenic
Asbestos
Benzene
Benzidine
Beryllium
1,3-Butadiene
Cadmium
Coal Tar and Coal-Tar Pitch
Coke-Oven Emissions
Crystalline Silica (respirable size)
Erionite
Ethylene Oxide
Formaldehyde
Hexavalent Chromium Compounds
Indoor Emissions from the Household
Combustion of Coal
Mineral Oils: Untreated and Mildly Treated
Nickel Compounds
Radon
Secondhand Tobacco Smoke
(Environmental Tobacco Smoke)
Soot
Strong Inorganic Acid Mists Containing
Sulfuric Acid
Thorium
Trichloroethylene
Vinyl Chloride
Wood Dust

EPA: Glyphosate, the Herbicide
in Roundup, Does Not Cause
Cancer
EPA reaffirmed that glyphosate
does not cause cancer in its
review process of the U.S.’s most
widely used herbicide.
US News April 30, 2019
President Trump's first EPA Administrator,
Scott Pruitt, resigned effective July 6,
2018, amid a series of scandals. Deputy
Administrator Andrew Wheeler, a former
coal industry lobbyist was confirmed
as EPA Administrator on February 28,
2019.

Chronic Inflammation
Chronic inflammation may be caused by infections that don’t go away, abnormal immune
reactions to normal tissues, or conditions such as obesity. Over time, chronic inflammation
can cause DNA damage and lead to cancer.
For example, people with chronic inflammatory bowel diseases, such as ulcerative
colitis and Crohn disease, have an increased risk of colon cancer.
Many studies have investigated whether anti-inflammatory medications, such as aspirin or
non-steroidal anti-inflammatory drugs, reduce the risk of cancer. However, a clear answer
is not yet available

Diet
With few exceptions, studies of human populations have not yet shown definitively that any dietary component
causes or protects against cancer.

Balanced, Low-Fat Diet Reduces Risk of Death From Breast Cancer in
Postmenopausal Women May 15, 2019
The federally funded Women’s Health Initiative (WHI) clinical trial of dietary modification This is the first large,
randomized clinical trial to show that diet can reduce the risk of dying from breast cancer.

Balanced, Low-Fat Diet Reduces Risk of Death From Breast Cancer in
Postmenopausal Women May 15, 2019
The federally funded Women’s Health Initiative (WHI) clinical trial of dietary modification This is the first large, randomized
clinical trial to show that diet can reduce the risk of dying from breast cancer.

The Importance of Dietary Fiber
Denis Parsons Burkitt , British surgeon
noted how rare colon cancer was in Africa
which he related to dietary fiber

Fiber — A number of laboratory, nutritional, and epidemiologic
studies have identified a role for dietary fiber in the pathogenesis of
colorectal cancer.

●A decreased risk of colonic adenomas and CRC with higher intake of fiber was
reported in five large epidemiologic studies.
●On the other hand, in the Nurses' Health study, no relationship was noted
between fiber intake and the risk of CRC or adenomas. Similarly, the Women's
Health Initiative Trial found no protective effect of a modest low-fat, increased
fiber, and increased fruit and vegetable dietary intervention on CRC incidence.

●A pooled analysis of 13 prospective cohort studies (involving 725,628 men and women
followed for 6 to 20 years) found that dietary fiber intake was inversely associated with the
risk of CRC, but the association was no longer apparent after accounting for other dietary risk
factors.
●A meta-analysis funded by the World Cancer Research Fund found that for every
10 g/day increase in dietary fiber consumption, there was a significant reduction in the risk of
CRC by 10 percent.

●In two randomized controlled studies from the United States as well as one from Australia,
fiber supplementation had no significant protective effect for the development of total
colorectal adenomas.
●A systematic review of five studies involving a total of 4349 patients concluded that there
was no definitive evidence that increased dietary fiber reduces the incidence or recurrence of
adenomatous polyps within a two- to four-year period.

A systematic review of 38 studies found that neither vitamin C nor vitamin
E supplementation was beneficial for prevention of the cancers evaluated .
A 2006 National Institutes of Health (NIH) consensus conference panel concluded
that "present evidence is insufficient to recommend either for or against the use
of multivitamin supplements by the American public to prevent chronic disease“
VITAMINS AND MICRONUTRIENTs

A subsequent long-term randomized trial (mean 9.4 years treatment) in 8000
women found no evidence that supplementation with vitamin C, E, or beta-
carotene (singly or in combination) decreased cancer incidence or cancer
mortality.

Additionally, two long-term observational studies, one including over 160,000
women with follow-up of approximately eight years and another including over
180,000 multiethnic participants with 11-year follow-up, found no association
between multivitamin use and risk of cancer.
It has not been established that multivitamin and mineral supplements provide
added benefit to a balanced, healthful diet for most individuals

The Selenium and Vitamin E Cancer Prevention Trial (SELECT)
SELECT is a phase III randomized, placebo-controlled trial of
selenium and/or vitamin E supplementation for prostate cancer
prevention.
A total of 35,533 men were randomized from 427 sites in the
U.S., Canada, and Puerto Rico achieving minority representation
of 21% (15% African Americans).

The Selenium and Vitamin E Cancer Prevention Trial (SELECT)
Primary results were reported early (planned futility analysis)
indicating neither vitamin E nor selenium supplements were
associated with prevention of prostate cancer.
An updated analysis in 2011 showed a statistically significant
increased risk of prostate cancer in the vitamin E compared to
placebo arms (hazard ratio 1.17)

Beta-carotene and lung cancer: a case study.
Am J Clin Nutr. 1999 Jun;69(6):1345S-1350S.
More than 30 case-control and cohort studies were conducted over many
years in various populations and indicated that people who eat more
vegetables and fruit, foods rich in carotenoids, and carotenoids (beta-carotene
in particular), as well as those with higher blood beta-carotene concentrations,
have a lower risk of lung cancer

In contrast, the intervention results from large, controlled trials of
beta-carotene supplementation do not support the observed
beneficial associations or a role for supplemental beta-carotene in
lung cancer prevention; instead, they provide striking evidence for
adverse effects (ie, excess lung cancer incidence and overall
mortality) in smokers

One study of 29,000 male smokers (ATBC Trial) found an 18% increase in lung
cancer in the group receiving 20 mg of beta-carotene a day for 5 to 8 years.
Another study of 18,000 (CARET Trial) people found 28% more lung cancers in
people with a history of smoking and/or asbestos exposure. These people took
30 mg of beta-carotene

Beta Carotene
No Beta Carotene
18% More Lung
Cancer
ATBC Trial
New Lung Cancer

CARET Trial…Beta Carotene and Vitamin A Prevention Trial
New Lung Cancer 28% Higher in those
taking Beta Carotene
and Vitamin A
N Engl J Med 1996; 334:1150-1155

Hormones
Taking estrogen alone will increase the risk of breast and uterus
cancer
Taking estrogen plus progesterone will lower the risk of uterus
cancer but further increase the risk of breast cancer
Premarin is a mixture of the sodium salts of
estrogen conjugates found in the urine of
pregnant mares used since 1942

Immunosuppression
Many people who receive organ transplants take medications to suppress the immune
system so the body won’t reject the organ. These "immunosuppressive" drugs make the
immune system less able to detect and destroy cancer cells or fight off infections that cause
cancer.
Infection with HIV also weakens the immune system and increases the risk of certain
cancers.
transplant recipients are at increased risk of a large number of different cancers. Some of
these cancers can be caused by infectious agents, whereas others are not. The four most
common cancers among transplant recipients and that occur more commonly in these
individuals than in the general population are non-Hodgkin lymphoma (NHL) and cancers of
the lung, kidney, and liver.

Infectious Agents
Certain infectious agents, including viruses, bacteria, and parasites, can cause cancer or increase the risk that cancer will
form. Most of the viruses that are linked to an increased risk of cancer can be passed from one person to another through
blood and/or other body fluids. As described below, you can lower your risk of infection by getting vaccinated, not having
unprotected sex, and not sharing needles.
Epstein-Barr Virus (EBV)
Hepatitis B Virus and Hepatitis C Virus (HBV and HCV)
Human Immunodeficiency Virus (HIV)
Human Papillomaviruses (HPVs)
Human T-Cell Leukemia/Lymphoma Virus Type 1 (HTLV-1)
Kaposi Sarcoma-Associated Herpesvirus (KSHV)
Merkel Cell Polyomavirus (MCPyV)
Helicobacter pylori (H. pylori)
Opisthorchis viverrini
Schistosoma hematobium

Human papillomavirus (HPV) causes most cervical cancers, as well as some
cancers of the vagina, vulva, penis, anus, and oropharynx (cancers of the back
of the throat, including the base of the tongue and tonsils).

Non-HPV = Yellow, HPV = blue
HPV Infections and Oropharynx Cancer

HPV Most Common
Smoking Less Common
Dramatic Rise in HPV + Tonsil Cancer

There is sufficient evidence for an association between excess body fatness, including overweight, obesity, and
weight gain, and at least 13 cancers—adenocarcinoma of the esophagus; cancers of the adenocarcinoma of the
esophagus; cancers of the breast (in postmenopausal women); colon and rectum; endometrium (corpus
uterus); gallbladder; gastric cardia; kidney (renal cell); liver; ovary; pancreas; thyroid; meningioma; and multiple
myeloma.

Radiation
Radiation of certain wavelengths,
called ionizing radiation, has enough energy to
damage DNA and cause cancer.
Ionizing radiation includes radon, x-rays,
gamma rays, and other forms of high-energy
radiation.
Lower-energy, non-ionizing forms of radiation,
such as visible light and the energy from cell
phones and electromagnetic fields, do not
damage DNA and have not been found to
cause cancer.

Older man and one hip X-ray
will increase cancer risk by 1 in
37,189

Multiple PET scans in a child
increase the cancer risk by at least
1 in 42

Sunlight
The sun, sunlamps, and tanning booths all give off ultraviolet
(UV) radiation. Exposure to UV radiation causes early aging of
the skin and skin damage that can lead to skin cancer.
People of all ages and skin tones should limit the amount of
time they spend in the sun, especially between mid-morning
and late afternoon, and avoid other sources of UV radiation,
such as tanning beds.
It is important to keep in mind that UV radiation is reflected by
sand, water, snow, and ice and can go through windshields and
windows.
Even though skin cancer is more common among people with a
light skin tone, people of all skin tones can develop skin cancer,
including those with dark skin

Cigarette Smoking
Smoking is the leading cause of premature, preventable
death in this country.
Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature
deaths each year in the United States. Of those premature deaths, about 36% are from
cancer, 39% are from heart disease and stroke, and 24% are from lung
disease. Mortality rates among smokers are about three times higher than among people
who have never smoked.
Smoking harms nearly every bodily organ and organ system in the body and diminishes a
person’s overall health.
Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder,
liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia
Lauren Bacall

Cigarette Smoking
Cigarette smoking and exposure to tobacco smoke cause
about 480,000 premature deaths each year in the United
States.
Of those premature deaths, about 36% are from cancer,
39% are from heart disease and stroke, and 24% are from
lung disease.
Mortality rates among smokers are about three times
higher than among people who have never smoked.
Lauren Bacall

Cigarette Smoking
Smoking harms nearly every bodily organ and
organ system in the body and diminishes a
person’s overall health.
Smoking causes cancers of the lung, esophagus,
larynx, mouth, throat, kidney, bladder, liver,
pancreas, stomach, cervix, colon, and rectum, as
well as acute myeloid leukemia Lauren Bacall

Tobacco smoke has at least 70 chemicals that cause cancer, also
known as carcinogens.

Smoking cigarettes can cause cancer almost anywhere in your body, including in
the bladder; blood (acute myeloid leukemia); cervix; colon and rectum; esophagus; kidney
and renal pelvis; liver; lungs, bronchi and trachea; mouth and
throat; pancreas; stomach; voice box (larynx)

Additionally, the use of smokeless tobacco (snuff and chewing tobacco) causes
cancers of the oral cavity, pancreas and esophagus; cigar use causes cancers of
the oral cavity, pharynx, esophagus, larynx, and lung; and secondhand smoke
exposure causes lung cancer.

Cigarette Consumption in the US and Health Events

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Smoking in the US
Humphrey Bogart
Dead at 57 from esophagus cancer in
1957

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Smoking in the US
Humphrey Bogart
1957
Men

0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020
Men
Women
Smoking in the US
Humphrey Bogart
1957
Women

Smoking
Steep decline since 1950 - 60’s
Less dramatic decline in women
Time 1975-82 1982-91 91-2008 2008-15
Men + 1.5% -.5% -1.7% -2.9%
Women +5.6% +3.4% +.5% -1.5%
Lung Cancer Incidence

Lung cancer
mortality in men
starts declining
in the 1980-90’s
Doesn’t start
down in women
until the 2000’s

Lung cancer
mortality in men
starts declining
in the 1980’s
Doesn’t start
down in women
until the 2000’s

Percentage of adults aged ≥18 years who reported cigarette use “every day” or “some days,” by selected characteristics —
National Health Interview Survey, United States, 2017

Smoking by Level of
Education in 2017

Smoking by Income or
Health Insurance in 2017

Lung Cancer Mortality by County in the US in 2014

Smoking By State in 2018
Utah 8.9%
California 11.3%
New York 14.1%
Texas 15.7%
Florida 16.1%
US 17.1%
Alabama 20.9%
Mississippi 22.2%
Kentucky 24.6%
West Virginia 26.0%

Genetics of Cancer
Genetic changes that promote cancer can be inherited from our parents if the
changes are present in germ cells
Cancer-causing genetic changes can also be acquired during one’s lifetime, as
the result of errors that occur as cells divide or from exposure
to carcinogenic substances that damage DNA such as certain chemicals in
tobacco smoke, and radiation, such as ultraviolet rays from the sun.
Genetic changes that occur after conception are called somatic (or acquired)
changes.

Interventions That are Known to Lower Cancer Risk
• Selective estrogen receptor modulators (SERMS) such
as tamoxifen or raloxifene have been shown to reduce the risk of breast cancer in
women at high risk.
• Finasteride has been shown to lower the risk of prostate cancer.
• COX-2 inhibitors may prevent colon and breast cancer. COX-2 inhibitors may cause
heart problems. Because COX-2 inhibitors may cause heart problems there have not
been many studies on their use to prevent cancer.
• Aspirin may prevent colorectal cancer. Bleeding in the gastrointestinal tract or brain
is a side effect of aspirin. Because aspirin may cause bleeding problems there have
not been many studies on their use to prevent cancer.

The Influence of Finasteride on the Development of Prostate Cancer. N Engl J Med 2003; 349:215-224
Prostate Cancer Prevention Trial, randomly assigned 18,882 men 55 years of age or older to treatment with finasteride
(5 mg per day) or placebo for seven years.
Outcome Placebo Finasteride
Cancer 1147 803
Gleason 7+ 237 280
Incidence of New Prostate Cancer
Placebo
Finasteride

Interventions That Are Not Known to Lower Cancer Risk
There is not enough proof that taking multivitamin
and mineral supplements or single vitamins or minerals can
prevent cancer The following vitamins and mineral supplements have
been studied, but have not been shown to lower the risk of cancer:
Vitamin B6
Vitamin B12
Vitamin E
Vitamin C
Beta carotene
Folic acid
Selenium
Vitamin D

Physical Activity and Cancer
There is substantial evidence that higher levels of physical
activity are linked to lower risks of several cancers:
Colon cancer: most physically active individuals had a 24%
lower risk of colon cancer other studies reported a risk
reduction of 16%, also associated with a decreased risk of
colon adenomas (polyps
Breast cancer: average breast cancer risk reduction
associated with physical activity was 12%.
Endometrial cancer: the average endometrial cancer risk
reduction associated with high versus low physical activity
was 20%

Physical Activity and Cancer
Nearly all of the evidence linking physical activity to
cancer risk comes from observational studies, but
such studies cannot definitively establish that being
physically inactive causes cancer (or that being
physically active protects against cancer).
That is because people who are not physically active
may differ from active people in ways other than
their level of physical activity.

Strong evidence suggests that physical activity reduces the risk of several
cancers, including breast cancer in post-menopausal women, endometrium
(corpus uterus) cancer, and colon cancer.

Are you eating healthy?
“I don’t think all that natural food
is doing you any good!”
“I don’t know what you’re
eating, but you gave the dog a
can of spaghetti sauce!”

Every 5 years, HHS and USDA publish the Dietary Guidelines for Americans, the
Nation’s go-to source for nutrition advice.
https://health.gov/dietaryguidelines/2015/

Consume a healthy eating pattern that accounts for all foods and beverages within an
appropriate calorie level.
A healthy eating pattern includes:
• A variety of vegetables from all of the subgroups—dark green, red and orange, legumes
(beans and peas), starchy, and other
• Fruits, especially whole fruits
• Grains, at least half of which are whole grains
• Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
• A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes
(beans and peas), and nuts, seeds, and soy products
• Oils

A healthy eating pattern limits:
• Saturated fats and trans fats, added sugars, and sodium
Quantitative limits are provided for several components of the diet
• Consume less than 10 percent of calories per day from added sugars
• Consume less than 10 percent of calories per day from saturated fats
• Consume less than 2,300 milligrams (mg) per day of sodium
• If alcohol is consumed, it should be consumed in moderation—up to one drink per day
for women and up to two drinks per day for men—and only by adults of legal drinking
age

“You need more exercise. Run out and
get me a cheeseburger with onions!”
Getting Good Advice about Exercise

Strong evidence shows that regular physical activity helps people maintain a healthy
weight, prevent excessive weight gain, and lose weight when combined with a healthy
eating pattern lower in calories.
Strong evidence also demonstrates that regular physical activity lowers the risk of early
death, coronary heart disease, stroke, high blood pressure, adverse blood lipid profile,
type 2 diabetes, breast and colon cancer, and metabolic syndrome; it also reduces
depression and prevents falls

All adults should avoid inactivity. Some
physical activity is better than none,
and adults who participate in any
amount of physical activity gain some
health benefits.

For substantial health benefits, adults
should do at least 150 minutes (2 hours
and 30 minutes) a week of moderate-
intensity,

Aerobic activity should be performed in
episodes of at least 10 minutes, and
preferably, it should be spread
throughout the week.
Adults should also include muscle-
strengthening activities that involve all
major muscle groups on 2 or more days
a week.

Endometrial Cancer Prevention
KEY POINTS
Avoiding risk factors and increasing protective factors may help prevent cancer.
The following risk factors increase the risk of endometrial cancer:
Endometrial hyperplasia
Estrogen
Tamoxifen
Obesity, weight gain, metabolic syndrome, and diabetes
Genetic factors
The following protective factors decrease the risk of endometrial cancer:
Pregnancy and breast-feeding
Combination oral contraceptives
Physical activity
Cigarette smoking
It is not known if the following factors affect the risk of endometrial cancer:
Weight loss
Fruits, vegetables, and vitamins
Cancer prevention clinical trials are used to study ways to prevent cancer.
New ways to prevent endometrial cancer are being studied in clinical trials.

Cigarette Smoking and the Risk of Endometrial Cancer: A Meta-Analysis
American Journal of Medicine June 2008, 121:6:501
an increase in smoking of 20 cigarettes per day was statistically significantly associated with 16% and 27% reduced risks of
endometrial cancer
Conclusion
Cigarette smoking was found to be significantly associated with a reduced risk of endometrial cancer, especially among
postmenopausal women.
The antiestrogenic effect of cigarette smoking in women
American Journal of Obstetrics and Gynecology
Volume 162, Issue 2, February 1990, Pages 502-514
Epidemiologic results indicate that women who smoke cigarettes are relatively estrogen-deficient. Smokers have an early
natural menopause, a lowered risk of cancer of the endometrium, and an increased risk of some osteoporotic fractures.
Moreover, women who smoke may have a reduced risk of uterine fibroids, endometriosis, hyperemesis gravidarum, and
benign breast disease. Several possible mechanisms for these effects have been identified. Smoking does not appear to be
clearly related to estradiol levels, at least in postmenopausal women, although levels of adrenal androgens are increased.
Moreover, smoking appears to alter the metabolism of estradiol, leading to enhanced formation of the inactive catechol
estrogens.

Endometrial Cancer Screening
KEY POINTS
Tests are used to screen for different types of cancer when a
person does not have symptoms.
Endometrial cancer is usually found early.
There is no standard or routine screening test for endometrial
cancer.
Tests that may detect (find) endometrial cancer are being
studied:
Pap test
Transvaginal ultrasound
Endometrial sampling
Screening tests for endometrial cancer are being studied in
clinical trials.

http://epss.ahrq.gov/PDA/index.jsp

Data to Justify or Explain Their Recommendation

General lifestyle recommendations
●Avoid tobacco
●Be physically active
●Maintain a healthy weight
●Eat a diet rich in fruits, vegetables, and whole grains and low
in saturated/trans fat, red meat, and processed meat
●Limit alcohol
●Protect against sexually transmitted infections. Vaccinate girls and boys
against HPV.
●Avoid excess sun
●Get regular screening for breast, cervical,
and colorectal cancer

Cancer Information
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