274. Cancer Prevention

Question 1

What are 5 key ways to prevent cancer?

Answer 1

1. Diet/Exercise
2. Prevention of Infections
3. Smoking Cessation
4. Enviro Regulations
5. Cancer Prevention Drugs or Prophylactic surgery if genetically susceptible

Question 2

What is chemoprevention?

Answer 2

Use of specific chemical, compounds to prevent, inhibit, or reverse carcinogenesis

Cornerstone of Primary Prevention

Challenge: needs minimal toxicity because will be used for long periods in healthy people

Question 3

Colorectal Cancer Screening + Prevention

• 4 ways to reduce risk (describe how)
• what is Familial Adenomatous Polyposis (tx)

Answer 3

1. Diet and lifestyle (weight control, diet, physical activity, avoid alcohol)
2. Smoking Cessation
3. Increased Screening/Early Detection
4. Drugs: NSAIDs, COX2-i, Vit D3/Ca
   - ASA, SULINDAC use shows prevention of colorectal adenomas in people with prior hx of polyps and ppl genetically susceptible, BUT other NSAIDs may have increased risk in CV events (ex: ROFECOXIB) - ONLY use if have CVD risk + CRC risk and no increased risk of bleeding for ages 50-59

FAP: <1% CRCs, hundreds of adenomas in colon, rectum
tx: colectomy
Other tx: SULINDAC - NSAID causes regression of adenomas in retained rectal segment (for people who do not get total colectomy)

Question 4

Breast Cancer Risk Reduction

- 3 meds, effects, best type of pts to tx for each, best cancers to tx for all 3 meds

Answer 4

Tamoxifen: decreases breast cancer risk in high risk women (and prevents osteoporosis) but toxicity (DVT, endometrial cancer, hot flash)
- best for women with Atypical Hyperplasia, LCIS

Raloxifene: use in post-mp women with intact uterus: decreases risk of breast and endometrial cancer

Aromatase Inhibitor (Exemestane): decreases risk breast cancer

All these therapies work to prevent hormone receptor positive breast cancer

Question 5

Prostate Cancer Risk Reduction

• Drug
• Foods?

Answer 5

Androgen Inhibitor: decrease PCa incidence, higher % high grade Ca, SE of sex dysfx, NOT FDA approved, no mortality benefit
Selenium and Vitamin E: thought to decrease cancer, but individual vitamins/supplements alone showed no effect

Question 6

Infection Related Cancer

• What is the recommendation for HPV vaccines?
• What cancers is HPV assoc with?

Answer 6

Vaccine: start at age 11-12 for girls and boys (can infect females)
- Females age 13-26
- Males age 13-21 who have not completed the THREE dose series
Protects against: cervical, vulvar, vaginal, penile, anal, oropharyngeal cancer

Vaccine for HBV protects against Liver Cancer