Health Promotion and Primary Cancer Prevention

1. Health Promotion and Primary Cancer Prevention

2. Objectives • Discuss two lifestyle recommendations that may reduce cancer incidence and mortality. • Describe means to prevent human papillomavirus (HPV) infection.

3. Types of Cancer Prevention • Primary • Secondary • Tertiary

4. Impact of Primary Prevention • An estimated 75% of cancer cases in the U.S. may be caused by modifiable factors such as tobacco use, diet, infectious diseases, chemicals, and radiation exposure. • A healthy lifestyle and broader use of screening tests could prevent and delay the development of many cancers.

5. Health Promotion and Primary Prevention Recommendations • Nutrition recommendations • Alcohol consumption • Activity guidelines • Tobacco cessation • Skin protection • HPV prevention

6. ACS Guidelines on Nutrition and Physical Activity • The four basic components are: • Reaching and/or maintaining a healthy weight • Engaging in an active lifestyle • Limiting alcohol intake • Choosing a healthy diet with an emphasis on plant foods.

7. Nutrition Recommendations • Balance caloric intake with physical activity to avoid excessive weight gain throughout life cycle. • If overweight or obese, take active steps to achieve a healthy weight. • Eat five or more servings of vegetables and fruits each day—2 ½ cups. • Choose whole grains over processed (refined) grains. • Limit consumption of processed and red meats.

8. Activity Guidelines • Limit sedentary activities. • Children and adolescents: • Engage in at least one hour of moderate or vigorous intensity activity each day. • Engage in vigorous intensity activity at least three days each week. • Adults: • Engage in at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity spread throughout each week.

9. Alcohol Intake Guidelines • Women should limit alcohol intake to no more than one drink per day. • Men should limit alcohol intake to no more than two drinks per day. • A drink of alcohol is defined as • 12 ounces of beer • 5 ounces of wine • 1.5 ounces of 80-proof distilled spirits.

10. Facts About Tobacco Use • Smoking increases the risk of cancer of the mouth, nasal cavities, larynx, pharynx, esophagus, stomach, pancreas, kidney, bladder, and uterine cervix, as well as leukemia. • Risk of lung cancer: • 23 times higher in male smokers • 13 times higher in female smokers • Smoking cessation greatly reduces the risk of death from cancer and other causes. • Risk of lung cancer also is increased by exposure to secondhand smoke.

11. Benefits of Tobacco Cessation Short-Term Benefits Long-Term Benefits Decreased risk of dying from lung cancer Decreased risk of throat, bladder, kidney, or pancreatic cancer Reduced risk of stroke or heart attack • Normalization of: • Elevated blood pressure, pulse, and body temperature due to nicotine • Blood carbon monoxide and oxygen levels. • Taste and smell acuity improves. • Shortness of breath decreases. • Risk of infection decreases. • Coughing and sinus congestion decrease. • Energy level and ability to walk improve.

12. Tobacco Cessation • Cessation is most successful with a combination of behavioral counseling and pharmacotherapy. • Tobacco users should be advised to quit at each clinical encounter. • Behavioral counseling can be accomplished through group or individualized sessions.

13. START Method • S = Set a quit date. • T = Tell family, friends, and coworkers that you plan to quit. • A = Anticipate and plan for the challenges you will face while quitting. • R = Remove cigarettes and other tobacco products from your home, car, and work. • T = Talk to a healthcare provider about getting help to quit.

14. Smoking Cessation Aids • Nicotine gum and lozenges • Nicotine patch • Nicotine inhaler • Bupropion • Varenicline

15. Skin Cancer Prevention • Skin cancer prevention focuses on reducing ultraviolet radiation (UVR) exposure. • Most exposure comes from the sun but can also come from artificial sources such as sunlamps and indoor tanning parlors. • Environmental factors can influence the amount of natural UVR exposure.

16. Sunscreen Basics • Two types of sunscreens: • Physical sunscreens • Chemical sunscreens • Sunscreen should be used any time an individual is outdoors during daylight hours. • Extra steps should be taken with children to protect their skin and to prevent sunburns.

17. Selecting a Sunscreen • All sunscreen products include a sun protection factor (SPF). • SPF is a measurement of the amount of UVB protection—the higher the number, the greater the protection. • Currently, no standard rating system exists that measures UVA protection. • SPF is not an indication of how much time one can spend in the sun. • Optimally, UVR exposure should be reduced between 10 am and 4 pm.

18. Application of Sunscreen • Apply sunscreen approximately 30 minutes before being in the sun. • Reapply sunscreen at least every 90 minutes and after swimming or strenuous exercise. • Use an ounce (a handful) of sunscreen to adequately cover the entire body. • Apply thickly and thoroughly.

19. Other Skin Cancer Prevention Strategies • Seek shade and limit sun exposure between 10 am and 4 pm. • Wear hats with a wide brim. • Wear shirts with sleeves. • Wear sunglasses to protect ocular structures. • Avoid all artificial sources of UVR, including sunlamps and indoor tanning parlors.

20. HPV Infection and Cancer Prevention • Vaccination with the HPV vaccine can greatly reduce the risk of developing cervical cancer. • HPV vaccination is recommended for females aged 1112. • May be given to females as young as age 9 • Is also recommended for females aged 1318 to catch up on missed vaccine or to complete the vaccination series • HPV vaccination is recommended for males aged 926. • Decreases the risk of genital warts and anal cancer • Males can also carry and transmit HPV to their partners. • Screening for cervical cancer should continue in both vaccinated and unvaccinated women.

21. ACS 2015 Goals for Cancer Prevention Nutrition and Physical Activity • Reverse the trend of increasing rates of overweight and obesity among U.S. adults and youth so that it is no higher than it was in 2005. • Increase to 70% the proportion of adults and youth who follow ACS guidelines with respect to physical activity. • Increase to 75% the proportion of people who follow ACS guidelines for consumption of fruits and vegetables.

22. ACS 2015 Goals for Cancer Prevention Tobacco Use • Current cigarette smokers: • Reduce the proportion of adults from 21% to 12%. • Reduce the proportion of high school students from 19.5% to 10%. • Current smokeless tobacco users • Reduce the proportion of adults from 3.5% to 0.04%. • Reduce the proportion of high school students from 8.9% to 1%.

23. ACS 2015 Goals for Cancer Prevention Skin Cancer Prevention • Increase to 75% the proportion of people who use at least two of the following protective measures: • Avoid the sun between 10 am and 4 pm. • Wear sun-protective clothing. • Properly apply sunscreen with an SPF of 15 or higher. • Avoid artificial sources of ultraviolet light, including sunlamps and indoor tanning parlors.

24. References • American Cancer Society. (2014). Cancer prevention and early detection facts and figures 2014. Atlanta, GA: Author. Retrieved from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-042924pdf • Centers for Disease Control and Prevention. (2012). Cancer control and prevention. Centers for Disease Control and Prevention. Retrieved April 30, 2012, from http://www.cdc.gov/cancer/ • Smokefree.gov. (2011, August). Clearing the air: Quit smoking today. NIH Publication No. 11-1647. Retrieved from http://www.smokefree.gov/pubs/Clearing_the_Air_508.pdf