Category Archives: Cancer Prevention

Emerging New Evidence on Pancreatic Cancer Risks

By Hui Xie-Zukauskas

Risk_assessThis is a key topic on my editorial calendar this year due to the striking statistics of the increasing incidence and lethality of pancreatic cancer. For 2017, an estimated 53,670 people will be diagnosed with pancreatic cancer, and over 43,000 deaths resulting from it are expected in the U.S. alone (source: American Cancer Society).

Pancreatic cancer still has a very poor prognosis, with an overall survival of 5% over five years. The disease is remarkably aggressive, rarely diagnosed at an early stage, and difficult to treat due to its resistance to radiotherapy and chemotherapy. Therefore, the cancer’s cruelty creates a tremendous emotional burden for both patients and their loved ones. Even for survivors, the battles and treatments are brutal.

This does not mean we can do nothing.

To treat this horrible disease early and save more lives, identifying risk factors of pancreatic cancer and targeting high-risk people for effective screening are crucial. Therefore, steps to help prevent pancreatic cancer need everybody’s attention. A better understanding of the factors associated with pancreatic cancer can pinpoint preventive strategies to reduce its incidence.

Through literature review, I’ve compiled a list of risk factors for pancreatic cancer from research findings and emerging new evidence over the last 10 years. Here I share them with you in three categories.

First – Established risk factors

  1. Cigarette smoking: It is consistently associated with a two-fold increase in pancreatic cancer risk. Cancer-causing agents (i.e., carcinogens) existing in tobacco products cause DNA damage, which lead to abnormal cell growth.
  2. Obesity: Obesity produces an inflammatory state. Specifically, visceral obesity (i.e. belly fat) is linked to an increased risk for pancreatic and other cancers, independent of general obesity measured by body mass index (BMI).
  3. Chronic inflammatory conditions: such as chronic pancreatitis, liver cirrhosis.
  4. Diabetes: Particularly, type 2 diabetes is among a cluster of metabolic syndromes including hypertension, dyslipidemia, insulin resistance, and obesity.
  5. Age (55+): The risk of developing pancreatic cancer increases with age.
  6. Gender: Men are more likely to develop pancreatic cancer.
  7. Inherited genetic mutation: Genetic factors accounts for ~10% pancreatic cancer. 

Second – Emerging risk factors

  1. Environmental risk: Exposure to mutagenic nitrosamines, organ-chlorinated compounds, or heavy metals is involved in the initiating phase of pancreatic cancer.
  2. Gut microbiota: The role of the microbiota in the development of pancreatic diseases is increasingly accepted. Gut bacteria translocation and small intestine bacterial overgrowth have been found in acute pancreatitis and chronic pancreatitis, respectively.
  3. Infection: Helicobacter pylori (H. pylori) infection.
  4. Ionizing radiation: Most relevant evidence comes from studies done on workers due to occupational exposure. 

Let me add a bit more on invisible microbiota. Imbalance in gut microbiota is also related to other risk factors for pancreatic cancer (such as smoking, diabetes, and obesity). Furthermore, oral microbiota change in periodontitis is associated with an increased risk of developing pancreatic cancer.

Third – Preventable or modifiable risk factors

  1. Sedentary behavior: Physical inactivity is directly and independently linked to multiple types of cancer.
  2. Smoking: Smoking is the biggest preventable cause of cancer.
  3. Excess alcohol intake
  4. Dietary factors: A diet high in red and processed meats, fat, calories, and fructose may increase cancer risk.  In contrast, a diet rich in whole wheat or whole grains, fiber, vegetables, and fruits is associated with reduced cancer risk.
  5. Obesity: Obesity is a significant risk factor for more than 10 types of cancer, severe morbidities, and premature death; it is also considered the major modifiable risk factor for multiple cancers and chronic diseases.

Each cancer is different. Sadly, pancreatic cancer has struck individuals who were healthy, non-smokers, athletes, or as young as age 30-40.

In summary

Fighting against pancreatic cancer starts with learning about its risk factors so as to save preventable deaths in the larger population.

Meanwhile, there is hope – thanks to advanced research and technology that deliver better treatments or promising therapeutic options. So, let’s also remember HOPE.

 

Image credit: http://fatfplatform.org/risk-assessment/

The Steep Price of Overlooking Prediabetes Risk Factors

By Hui Xie-Zukauskas

Stop Prediabetes_CPDWhen you have diabetes, self-managing this condition through a list of tasks can be very challenging in your daily life.

However, whether you live with or without diabetes, your days will be happier and your life, simpler, if you cut off or minimize, improve or prevent a few of 11 risk factors for prediabetes.

Prediabetes is a condition where blood glucose (blood sugar) levels are higher than normal, but not high enough to meet the criteria as diabetes. About 86 million of Americans adults have prediabetes, and 90 percent of people with the condition don’t know they have it, based on the CDC’s data.

So, it’s urgent to know your risk. Why? Because prediabetes may develop to type 2 diabetes, the progression can lead to several health consequences. Among these is an association of prediabetes with the development of cancer. Research reveals that prediabetes is significantly linked to an increased risk for cancer of stomach, liver, pancreas, colon, breast and endometrium.

Here I’ll help you learn 11 risk factors of prediabetes, which type 2 diabetes also shares.

  1. Overweight or obesity: Obesity is an epidemic, and of our greatest concern is that it has spread to our children. The fatty tissue makes the cells become less sensitive to glucose, leaving a higher level of sugar in the blood. One more note – overweight/obesity may cause insulin resistance, which is a condition where the cells do not respond to insulin properly; and to meet the body’s demand, the pancreatic beta cells produce more insulin to help cells absorb glucose from the blood stream. Excess insulin and insulin resistance are a hallmark of type 2 diabetes, and make weight loss more difficult.
  2. Abdominal obesity: Extra fat around your abdominal region is considered a risk. A waist size over 35 inches for women or over 40 inches for men may post a higher prevalence of prediabetes. “Belly fat” is associated with high blood pressure, hyperlipidemia, heart disease, stroke, and diabetes.
  3. “SAD” diet:Standard American Diet features high in sugar, fat, and red or processed meats, and excess carbohydrates. An inadequate diet can impair insulin sensitivity over time. Additionally, portion control is also a key player. To help manage, I’d suggest you start with a smaller-size plate, rather than a regular dinner plate.
  4.  Physical inactivity: If you are not physically active or regularly exercising, you may experience weight gain over time, and you’re more likely to develop prediabetes.
  5.  Long-term stress: Under stress, the body releases the hormone cortisol into the blood stream, raising blood glucose levels, which can cause diabetes.
  6.  Metabolic syndrome: Metabolic syndrome is a group of three or more conditions that take place together and influence metabolism. When an impact of obesity, dyslipidemia (abnormal levels of “good” and “bad” cholesterol) and high blood pressure compounds, insulin resistance can occur.
  7.  Family history: Having an immediate family member or relative with type 2 diabetes considerably increases the risk of prediabetes.
  8.  Age: After the age of 45, the risk of prediabetes goes up, despite the fact that prediabetes can develop in anyone of any age. Aging alone contributes to decline in beta cell function of the pancreas. Aging could also let one easily get into inactivity, a poor diet, and a loss of muscle mass.
  9.  Ethnicity/Race: African-American, Native American, Hispanics, Asian-Americans and Pacific Islanders have a higher risk of developing prediabetes.
  10.  Gestational diabetes: Women who give birth to babies weighing over 9 pounds may be at a higher risk for prediabetes. Women previously diagnosed with gestational diabetes during pregnancy and their children have a higher risk too.
  11.  Polycystic ovary syndrome (PCOS): Women with PCOS are more susceptible to insulin resistance, thereby leading to prediabetes or type 2 diabetes.

Furthermore, activities contributing to chronic inflammation, such as tobacco smoking, excessive alcohol, and poor sleep quality, also post an increased risk of prediabetes and diabetes.

In the end, consider this price tag – The lowest cost of prediabetes or diabetes for individual health and our healthcare system is prevention, early detection, and timely treatment.

Nobody can control age, ethnicity, race or family history. But you can control those modifiable risk factors by changing lifestyle, especially having a balanced diet, exercise and healthy weight. Lifestyle modification can not only lower your risk of prediabetes or diabetes, but also that of cancer significantly.

 

Image credit: Clipart and CPD

New on How Critical Your Sleep Is and How to Optimize It

By Hui Xie-Zukauskas

5 Sleeping babies_comboDo you toss and turn at night? Do you have difficulties in getting to sleep or staying asleep or both?

If the answer is “YES”, you are a part of the statistics as to an estimated 60 million adults in the US suffering from a sleep disorder. But, taking it lightly is risky.

Previously, I discussed about how sleep disorders may increase a risk to cancer by weakening or disrupting the immune functions and promoting inflammation (see CancerPreventionDaily.com). In this post, I’d like to share some intriguing updates emerged from a new perspective.

Notably, I’m also providing a “Sleep Regimen” in ROOM that is memorable and actionable for a better sleep.

First, let’s dive into recent interesting discovery on serious sleep disorder.

As you may know, sleep apnea is a serious sleep disorder with trouble breathing during sleep; in particular, a halt/stop to breathing may last 10 to 30 seconds and numerous episodes a night. So, it’s potentially life-threatening if left undiagnosed or untreated.

Sleep-disordered breathing, e.g. sleep apnea-hypopnea syndrome (SAHS), contributed to cancer development – based on the animal studies simulating SAHS’ characters, i.e. nocturnal irregular hypoxia (deprivation of oxygen to the tissue) and sleep breakup. Repetitive hypoxia and reoxygenation influenced tumor generation by fueling new blood vessel formation and cancer cell growth. Furthermore, human studies found that higher cancer incidence and mortality are observed in patients with severe sleep-disordered breathing.

Sleep disorders (varied from chronic insomnia to obstructive sleep apnea) have also been linked to many chronic conditions, such as stroke, heart failure, lung diseases, neurological disease, kidney disease, and depression, just to cite some, in both adults and pediatric populations.

Overall, insufficient/poor sleep can impact your health, happiness, safety, career, and quality of life.

Next, how to optimize your sleep

There are multiple ways to enhance the quality of your sleep, e.g. healthy lifestyle, exercise, stress-relief, pain management, etc. However, “sleep hygiene” is one of the top fundamentals, and you can gain direct benefit.

That’s why I’d prefer a non-pharmacological management, and recommend specifically a “Sleep Regimen” in a simple, memorable ROOM to assist you optimize your sleep. Here is how it works.

R: Rest, Relax, and have a Ritual to unwind before your bedtime.

O: O=0 Zero distractions. Distractions range from electronic/mobile devices, TV/radio, bright lights, noises, air, plus Temperature (an important factor – not too hot or too cold), so eliminate or minimize them from your night environment.

O: O=0 Zero food or stimulant drinks, including alcohol, coffee, sugary drinks and/or stimulant medications. Limit water intake too. No meal intake 2 hours prior to your bedtime.

M: Mandate the time and mattress. It is critical to ensure your premier sleep time (7-8 hours per night); go to sleep at the same time and wake up at the same time every day, and stick with it even during the weekend. Remember: Invest a really good, comfortable mattress.

Let me recap itDesign or create and utilize the R.O.O.M. consistently.

In addition, find out the cause of your sleeping problem(s), and don’t rely on “sleeping pills”, unless drug intervention is absolutely necessary.

At the end, I wish you sleep like a baby, and smile like a baby too, for your well-being and vitality.

 

Image Credits: Oseias Ferreira at FreeImages.com;

Claire57100, Zinz25, Esudroff, PubicDomainPictures at Pixabay.com

Two Critical Matters in Colorectal Cancer Early Detection

By Hui Xie-Zukauskas

Time for cancer screening_Clipart library & CPDAccording to the American Cancer Society (ACS), an estimated 135,430 cases of colorectal cancer (CRC) will be diagnosed and an estimated 50,260 CRC deaths will occur in 2017 in the United States.

Zeroing in on the numbers: within the predicted colorectal cancer incidence, 71,420 will be men and 64,010 will be women, and deaths will be 27,150 among men and 23,110 among women. Consequently in cancer deaths, CRC is the second leading cause in men and the third leading cause in women among Americans. Worldwide, CRC is the third most common cancer.

These numbers make clear that CRC affects both men and women, in contrast to a myth that CRC is primarily a man’s cancer.

The good news is that most colon cancers are preventable! YES!

Yet, why are the statistics so large? Here are two areas many people often ignore or miss:

  •  Lack of adherence to the screening recommendation
  •  Delay in presenting symptoms to a physician/oncologist

Let me weigh in a bit more on each of these issues.

Adherence to screening and the value of colonoscopy

Let’s start with ACS screening guidelines: “Starting at age 50, men and women at average risk for developing colorectal cancer should use one of the screening tests…” This is because about more than 90% of this disease is diagnosed after age 50. For individuals who have a 1st degree family member or relative with colon cancer, exams should start at an earlier age (e.g. ages 40).

One recommended screening test is colonoscopy, because it can not only detect cancers at their earliest, most treatable stages; it can also detect pre-cancerous polyps that can be removed during the exam before they become cancerous.

In reality, 50-60 percent of Americans who are recommended to get screened comply with the guidance. The lower screening rate might partially explain why only about 40 percent of colon cancers are diagnosed at an early stage (i.e. localized in colon or rectum).

Why should you go for a colonoscopy screening?

  1. You gain significant value. Your anxiety, fear, or even feelings of embarrassment may be understandable. However, consider this: Individuals undergo this exam of high quality under a comfortable, sedated condition, during which the entire colon and rectum are visualized by a qualified gastroenterologist. Pre-cancerous polyps can be found and removed safely. Can you see that this is a very valuable package of diagnosis and therapeutics for your colon health care? 
  2. You acquire rigorous clarity concerning your colon health. We want rigorous clarity in science, and surely, everyone wants thorough clarity when purchasing a house or insurance policy. It makes sense to seek rigorous clarity about a matter so critical to your health. If the result is normal, the colonoscopy should be repeated every 10 years up to the age of 75. If the test detects pre-cancerous polyps, the physician will recommend repeating the exam more frequently.
  3. You benefit from one of the most effective cancer prevention methods, and it is often covered by insurance.

Help your physician to help you by presenting any indications

In some cases, especially at an early stage, colon cancer may present no symptoms. Again, that’s why screening is vital to identify cancer early when prognosis and cure are optimistic.

Nevertheless, other folks may experience symptoms such as:

-          Blood in the stool or rectal bleeding

-          Abdominal pain or discomfort

-          Feeling the bowel incompletely empty, or bloating

-          Sudden changes in bowel habits (diarrhea, constipation, or oddly narrow stools)

-          Unexplained fatigue or weakness

-          Unexplained weight loss

Remember, nobody can read what’s on your mind or what’s going on in your life. If you don’t visit or communicate with your doctor, it’s likely he or she won’t know about your cramps or unexplained changes in your bowel movements.

So, devoting yourself to meeting screening guidelines is a key preventive measure, but another critical area is to counsel with your physician about possible warning signs.

In addition, an important step to preventing colorectal cancer is to know its risk factors. These factors can be categorized as:

-          Uncontrolled: age, colon polyps, family or personal history of cancer, esp. CRC

-          Pathological: obesity, diabetes, inflammatory bowel diseases

-          Controllable or Preventable: sedentary lifestyle, tobacco smoking, heavy alcohol consumption, diet with low-fiber but high-fat (esp. animal fats)

To conclude, for colorectal cancer early detection, as for all cancer risks:

#1 Cancer screening is your first crucial preventive step.

#2 Recognizing risk factors and warning signs is your second vital protective weapon.

Image credit: Clipart library & CPD

22 Proactive Things You Can Do on World Cancer Day and Beyond

By Hui Xie-Zukauskas

Mid_Blue Globe Bkg. Red Ribbon for WCDFebruary 4th each year is designated as World Cancer Day. This day is significant because it

  • kicks off a drive to expand awareness of cancer and its prevention;
  • offers a chance to discover risk factors for cancer and take protective measures;
  • provides a time to reflect on what you can do to make a difference in the fight against cancer;
  • embraces people around the globe to fulfill whatever needs to be done to control this deadly disease; and
  • presents an opportunity to spread a message – We Can Save Millions of People from Preventable Deaths Each Year!

Lifestyle-centered cancer prevention is evidence-based and it’s science. It’s no longer a theory or hypothesis, or breaking news. Healthy lifestyle measures provide powerful ways to lower the risk for many types of cancer.

The theme of World Cancer Day for the current three years (2016-2018) is “We Can. I Can.” Surely, each of us can do something, no matter how small. So, I have compiled a list of actions you can take for World Cancer Day and every day after:

  1. Set a “Cancer Patients First” agenda: Whether from a note, gift, prayer, or—best of all—a visit, let your friend battling cancer know you are with him or her in this fight.
  2. Pack a tool kit for cancer awareness or a thoughtful kit for cancer care.
  3. Remind your loved one to get a cancer screening. Early detection saves lives.
  4. Change one unhealthy behavior, e.g., harmful sun exposure, intentional tanning, alcohol abuse, or tobacco smoking (smokeless tobacco causes cancer too). Importantly, stay on the right course.
  5. Do something about early childhood weight management, especially control obesity in childhood cancer survivors.  Unhealthy behaviors and overweight that develop early in life and persist over time can increase not only the risk for some types of cancer but also cancer-related mortality.
  6. Host a Veggies/Vegetarian party or gathering (the size doesn’t matter).  Alternatively, go on a Mediterranean diet. The point is to replace Western diet components, which are rich in refined grains, animal fats, excessive sugar, and processed meat but poor in fruits, vegetables, legumes, and whole wheat or whole grains. A substantial body of evidence has linked the Mediterranean diet to increased cardiovascular benefits and prevention of some chronic diseases.
  7. Make a “Cancer Prevention” family dinner, or make a “Cancer Prevention Salad.”  Family meals can be a cost-effective intervention for weight management. Evidence suggests that regular family meals protect against unhealthy eating and obesity in children. If time or schedule is challenging, get your teens and/or other family members involved.
  8. Start or improve your weight management plan and actions. Make sure to have a balanced diet and exercise regime.
  9. Enjoy an “Exercise Day” or “Move Day,” and at least, consider taking a 30-minute walk.
  10. Take a “NO JUNK FOOD Day,” and limit red meats. Then do it often.
  11. Drink filtered tap water at home. Drink plenty of filtered water away from home too.
  12. Drink tea to replace sugar-rich beverages.
  13. Better: Have a “Triple Combat” day, by combining three intensive but joyful actions together.
  14. Give your unexplained pain some TLC by paying attention to it, tracking its duration, frequency or pattern, and scheduling a visit to your doctor.
  15. Give cancer caregivers a token of love to honor their labor of love.
  16. Write or speak to your local/national legislator or lawmaker about a policy idea to make food systems safer or make the environment safer.
  17. Speak out or stand up against any external source that potentially promotes cancer.
  18. Volunteer for a cancer fundraising or a cancer care center.
  19. Support the great cause of fighting cancer in any form you can.
  20. Parents and teachers: Advise your girls and boys to vaccinate against HPV. Recommended vaccination starts at age 11 or 12.
  21. Go along with proven strategies to prevent cardiovascular disease (CVD). Why?  Because doing whatever is practical or plausible to lower your risk of CVD will enhance your potential to reduce the risk of cancer. For instance, research findings indicate that proven preventive measures for CVD are identical to preventive actions for prostate cancer.
  22. Take pancreatic cancer seriously. Based on the proposed “pancreatic injury−inflammation−cancer” pathway, it’s critical to avoid risk factors such as smoking, chronic pancreatitis, diabetes, and obesity.   Pancreatic cancer remains a complex, lethal malignancy with the worst prognosis, and a lack of early diagnostic symptoms. It’s also resistant to conventional chemo- and radiation therapies. The rate of its incidence is slowly increasing.

The list can go on and on…

By now, you likely see a clearly centered theme—prevention, which is the most cost-effective implement to fight cancer.

Remember: Cancer doesn’t develop overnight. It’s vitally essential to stick to a healthy lifestyle. Take protective measures such as enjoying a balanced diet, regular physical activity, and a healthy weight now and far beyond World Cancer Day.

And yes, every single small step counts! It’s a life-course approach.

 

Image credit: Designer at <a href=”http://www.freepik.com/free-photos-vectors/medical”>Medical vector designed by Ibrandify – Freepik.com</a>

Rethink Powerful Strategies for Cancer Prevention in 2017

By Hui Xie-Zukauskas

LoveHope 2017_Std.The holiday season is over and the new year started. Many of you probably have set some exciting goals or resolutions already. In reality, early or later, some folks would probably fall “off the wagon”? How would you do differently?

CancerPreventionDaily has provided plenty of practical advice, resources, and useful links on powerful strategies for cancer prevention over the years. Instead of reiterating those strategies here, I’d like to highlight a tool of “RETHINK”.

First, let’s cherish HOPE by celebrating recent scientific and medical advances in cancer treatment! Cancer Immunotherapy has been put on the spotlight – a therapy based on the principle of unleashing the body’s immune system to attack cancer. In addition, remarkable advances in other therapies (e.g. chemotherapy, targeted therapy, surgery and radiation therapy) all improved clinical outcomes, especially lives of people battling cancers.

Equally significant is advance in cancer prevention, specifically, HPV vaccine. As the human papillomavirus (HPV) is the major cause of cervical cancer – infected by passing the virus during sex, and the disease is preventable.

Now let me dive in a bit deeper on “Rethink”.

Consider Uber or Zipcar. Whether through Uber (providing you with a car and a driver) or Zipcar (providing you with a car), you can reach your desired destinies – a different approach from using traditional or old fashion rental cars. Note: These are good examples of innovation or rethinking, not paid Ads! :)

Next, how to rethink with regard to health?

Take weight loss as an example. Maintaining a healthy weight is one of the top powerful strategies for cancer prevention, as scientific evidence clearly indicate that obesity is a risk factor for several types of cancer in both men and women, needless to say risk for diabetes and heart disease.

Many folks are struggling with losing weight for various reasons. If one lesson we can learn from “Santa” to apply here, it is to lighten our load.

So, get motivated, get rid of all unhealthy baggage in all possible ways – dispose of fats, throw away junk foods, abandon extra sugar and extra salt, dispense or burn off some calories, thereby getting rid of “unwanted” pounds, consequently you will reach your goal of weight management. Certainly, you can discover creative ways that work best for you along the journey.

Rethink about cancer and prevention: Instead of fearing “Big C”, treat it as a life or health project with “small pieces”. This is because cancer is the mass (of tissues) on the surface but a collection of complex and multiple diseases in the hub, therefore, you need to tackle it with multiple approaches from genetic medicine, lifestyle to environment and early detection.

So, you got the idea.

In summary –

Rethink, Re-envision, Re-tweet, Re-evaluate and/or Re-calibrate, whatever works for you, so that you gain new perspectives and new approaches, which will help your new year’s resolutions stick, and reap your health benefits in the long run.

May more happiness and better health be all of yours throughout the year 2017!

 

Image credit: mozakdesign.com and CancerPreventionDaily

A Year End Note: Let Bundle of Love and Ray of Hope Continue

By Hui Xie-Zukauskas

A Year End NoteAs we approach the New Year, thank you for your time, reading, likes, comments and feedback in this past year!

I reach out to you because many of you are healthy but fearful of getting cancer, some folks survive cancer, while some are struggling with cancer or other chronic illnesses now.

At the beginning of 2016, one New Year’s resolution from CancerPreventionDaily.com was to bring a theme of love and hope for cancer prevention and care. Throughout the year, the site delivered this theme by serving you with knowledge and solutions for cancer prevention. Here are highlighted areas of the posts:

  • Steered self-care and preventive measures in the ways that foster your well-being from the cells to the whole body and lifestyle choices, from kids to seniors and all ages.
  • Updated serious epidemic and environmental factors.
  • Facilitated clinical care, primarily patient safety and engagement.

Many cancers are preventable; and there are so many things we can do to prevent cancer. Start within.

Let bundle of love and ray of hope carry on in 2017 and future!

Work Together to Reduce Errors in Cancer Diagnosis

By Hui Xie-Zukauskas

Patient engage comm._CPDHave you or your family member ever gotten a wrong diagnosis from your doctor? Have you heard that a doctor treated your friend for a disease or disorder that he/she actually didn’t have? “It is likely that most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences,” according to the experts on diagnostic safety.

Imagine you were diagnosed with breast cancer and went through cancer treatment, then found out the diagnosis was wrong and the treatment should never have happened. That could spell enormous damage from one diagnostic error!

Cancer diagnostic errors can be the most harmful and costly type of diagnostic errors in various ways. As many cancers are complex and multifaceted, a timely and accurate diagnosis for cancer is still often challenging. That adds weight to preventing cancer altogether and urgency to detecting cancer early.

That’s why I bring your attention to this issue: A diagnosis is something that’s done for a patient (you) and the patient (you) needs to be a part of the team in that process.

1.      Basics and facts

What is a “diagnostic error”?

The Institute of Medicine (IOM) defines a diagnostic error as the failure to:

a. Establish an accurate and timely explanation of the patient’s health problem(s); or

b. Communicate that explanation to the patient. 

What is the reality?

40,000 – 80,000 deaths each year are due to diagnostic errors, as reports vary. However, national diagnostic safety experts, Drs. Graber and Schiff, emphasize that the frequency of diagnostic error is in the range of 10%.

Does it sound like misdiagnosis happens far more frequently than you thought?

2.      When does diagnostic error occur and who may be involved?

No doubt, human factors contribute to diagnosis errors. Studies have reported that communication problems are the most frequent root cause of serious events threatening patient safety. Today’s health-care systems are transforming toward not only integrated care practice but also enhanced patient engagement, to this end, everyone is involved.

Let me bring cancer diagnosis to the forefront. A delayed cancer diagnosis may occur at various stages of the journey to fight cancer. It could be a delay in:

  • symptom recognition or interpretation,
  • decision or action to seek medical attention (e.g., putting off making an appointment due to fear or feeling embarrassed),
  • a care system’s scheduling (e.g., not being seen by a doctor in a timely fashion),
  • clinical tests or subsequent consultations, or
  • receiving cancer treatment.

In addition, putting off doing anything might simply be due to lack of insurance coverage.

Here is the key point: Delayed cancer diagnosis at an early stage may leave the cancer to progress or spread, leading to limited treatment options. Thus, a delay in cancer diagnosis can have devastating consequences, including poor clinical outcomes and a lower chance of survival.

3.      How can you help reduce or prevent diagnostic errors?

Here are 15 things you can do to enhance your communication with your doctor, medical care team, and health care system.

1)      Prepare for your visit: know or collect your medical records, medications, and family history.

2)      Remember your screenings and, importantly, follow up. Having a separate calendar can assist your memory.

3)      Always bring a list of questions or at least your top three questions when visiting your physician.

In case you don’t know where to start, Agency for Healthcare Research & Quality provides a list of questions to ask your doctor. You can also generate your own list using their Question Builder. It’s a fantastic tool!

4)      Bring your spouse or a family member to your doctor visit to facilitate communication and/or fill in missing information that might help with diagnosis or treatment.

5)      Use technology (e.g., a smartphone) to record the conversation or instructions.

6)      Feel free to ask the doctor to clarify terminology or procedure. If you don’t understand why a particular question is relevant to your situation, ask about it or let a family member do so.

7)      If you have a limited English proficiency, make sure you have a family member or a friend act as a translator.

8)      Participate in a patient experience survey to improve patient safety and care.

9)      Get involved in facilitating the chain of communication—e.g., in scheduling appointments, visits, follow-ups, and even questioning an insurance billing if you don’t understand it.

10)  Don’t self-diagnose, especially based on online information from an unreliable source.

11)  Do keep a diary or inventory of your symptoms for better recollections when needed.

12)  Seek a second opinion or multiple consultations on cancer diagnosis when in doubt or if necessary. The second opinion must be an expert’s one. Be proactive.

For example, if you have a lump in your breast but get a normal mammogram—after all, mammograms pick up only 80-90% of breast cancer. So, for your safety, you should ask for further screening, e.g., a breast ultrasound (sonogram) or even a test with a higher sensitivity like magnetic resonance image (MRI) to ensure accuracy if your physician doesn’t order such tests.

13)  If diagnosed with cancer, follow up vigorously and treat any referrals to specialists, tests, or care with urgency.

14)  Further the discussion about potentially discrepant diagnosis or different finding.

15)  When you have unintentional weight loss or unexplained pain, take it seriously and see your doctor.

One more point – Misdiagnosis may not be discovered for years if ever in some cases. That’s why I cannot emphasize enough how prevention and early diagnosis of cancer offer clear and significant benefits, especially concerning common cancers (the breast, prostate, colon, lung, and skin cancer).

Although I talked more about cancer, these principles can be applied to any other illnesses. And I’ll elaborate with more details in near the future. Stay tuned.

Finally, your take-home message: Actively engage in your health care!

Improving diagnosis for patient safety and for better health care is a responsibility of each of us. Doing that can alone save many lives.

 

Never Miss a Chance to Protect Children from Cancer

By Hui Xie-Zukauskas

Cancer Boy w-Ribbon_uthscsa.eduImagine that a tiny, precious life with a bright future was taken away by cancer, the “big C”… Nothing is more devastating than that.

That’s why I’m going to focus on what we can do about childhood cancers, so to prevent the worst loss by all means.

First, what exactly causes childhood cancers remains unclear. Risk factors of childhood cancers are different from those in adult cancers. For instance, lifestyle-related risk factors (such as tobacco smoking, alcohol intake, unhealthy diet, and sun overexposure) do not play a significant role in childhood cancers. Environmental factors have little influence, largely due to the lack of direct exposure of the fetus. Most childhood cancers result from genetic mutations, i.e. genetic errors occur randomly and unpredictably whether it’s inherited or acquired.

So, am I suggesting that there is nothing we can do to prevent childhood cancers or protect our children? No.

If you are not well-informed, you may miss a chance to prevent the unthinkable. Here is an example. Human papillomavirus (HPV) infection is linked to cancers of cervix, oropharynx, rectum, or at other body locations. Nearly 93% cancer due to HPV-infection could have been prevented with recommended HPV vaccine as routine immunization for adolescent girls and boys starting at ages 11 to 12 years, following specific guidelines.

Can you see how one could miss the chance by doing nothing? Let me expand a little more on preventative measures.

1.      Childhood cancer prevention can start before conception in young women.

The mother-to-be’s well-being has an impact on the babies. For example, a pregnant, smoking mom can affect the offspring’s health in a hazardous way. To say the least, alcohol consumption and drug abuse fall into the same category. To minimize a child’s risk of cancer, young women should stay healthy and fit, and avoid or limit the exposure to toxic chemicals and environmental pollutants in daily life. Detect cancer early by genetic testing or genetic consulting, especially when you have a history of familial cancers.

2.      Cancer prevention with a healthy lifestyle should begin early in childhood.

A lifestyle cannot be developed overnight. Lifestyle factors also take years or decades to influence a cancer risk. Fostering a lifestyle with nutrition-rich diet, regular exercises, and healthy weight from a young age forward can greatly lower the risk of several cancers in adults, as accumulating evidence shows. Childhood obesity prevention can produce considerable health benefits. Also, postpone the time for kids to use cell phone or mobile devices to prevent brain tumor, the leading cancer death in children. Growing studies reveal an association of radiation with pediatric brain tumors, especially when young kids have the thinner skulls, with still developing nervous system and brain.

3.      A long-term protection: prevent secondary cancer after childhood cancer.

Cancer treatment like radiation can harm young kids’ organs or tissues because of their vulnerability and developmental stages. Radiation or chemo therapies for childhood cancers increase a risk for secondary cancer as one ages. Particularly common are tumors of the brain, breast, skin or spine, and bones. The higher doses of radiation, the greater risk these individuals have. So, it’s important to detect cancer early in the population of childhood cancer survivors, and make sure they have regular visits or check-ups, in addition to living a healthy lifestyle.

Let me conclude with the Quote from Elizabeth Barrett Browning: Light tomorrow with today.All said and done, apply these outlined approaches today to protect every child, so that each child has a healthier, happier, and brighter life tomorrow.

 

Image credit: uthscsa.edu and CPD

Men’s Health Month Ends BUT Men’s Health Challenges Persist

By Hui Xie-Zukauskas

Happy father and son isolated on white backgroundA lot of men are “pull yourself up by your bootstraps” kind of guys and believe they can fix anything by themselves. This is true many times in life. But when it comes to health conditions, it could be a dangerous misconception.

Today, I’m going to highlight how men’s masculinity or “toughness” and emotional restraint may impede them from seeking medical or professional help, consequently having a negative or even grave effect on their health.

The Cover-Ups & Attitude

Sometimes, those “annoying” symptoms (e.g., snoring, bad breath, enlarged prostate, and unexplained weight gain or loss) show up and even persist; but a lot of guys would rather tough it out or put off a visit to the doctor with various excuses. I get that. But do you know – a quiet health crisis may be underway?

How about in the workplace? Masculinity may influence workplace health and safety particularly in male-dominated skilled trades as injured workers return to work too early and “tough” workers then reinforce dominant masculine norms. Results of a joint study from the University of Toronto showed, “A desire to be viewed as a strong, responsible, resilient worker may intersect with concerns about job loss, to influence participants’ decisions to not report safety issues and workplace accidents, to not disclose post-injury work challenges, and to not request workplace supports” (Stergiou-Kita et al., Work; 2016). Certainly, institutional identification and practices play a role too.

How about social or psychosocial beliefs? Some folks believe that cancer will inevitably lead to death (so-called cancer fatalism). A study by Mitchell et al. (Res. Aging; 2016) reported that among 1,666 African American males enrolled in Medicare, 76.5% felt helpless, 44.2% confused, and 40.7% pessimistic about the ability to prevent cancer. Despite a couple of limitations, the study reveals a challenging factor for cancer prevention and screening detection. Important to note, although African American males remain at greatest risk for dying from prostate, colorectal, and lung cancers compared to men of other races, early detection and treatment save lives.

The Facts & Evidence

Men are more vulnerable to various disorders at all ages across the lifespan. Also, men’s average life expectancy stays largely behind that of women’s. Primary physical health risks that are leading causes of death or are burdens for men include cardiovascular diseases (heart disease and stroke), cancer (especially prostate and lung cancer), diabetes, depression, and suicide. Fortunately, many of the top causes of death are preventable and can be treated, if found early.

Finally, here is a list of Strategic Actions you or your loved ones can take for men’s health:

  • Check out critical numbers such as blood pressure, blood cholesterol, and blood sugar; keep them in normal ranges.
  • Schedule recommended screenings for prostate and colon cancer, and a routine testicle exam.
  • Schedule a routine medical care or physical examination.
  • Ladies, accompany your man to his doctor visit. This can be a great help with eliminating potential communication barrier(s) to disclosing a real problem or filling in a missing note.
  • Keep mentally active; for example, take new classes, play brain games, or learn something new.
  • Forge a close relationship with a circle of friends.
  • Never ignore some seemingly common symptoms such as snoring, bad breath, and enlarged prostate. Take note of it. If the problem persists, consult your physician to rule out any medical conditions.
  • Consult professional help if you (or your man) have symptoms of depression.

In summary, to prevent a quiet health crisis in men, we all need to step in by advancing men’s mental health, strengthening men’s workplace safety, and caring about men’s overall well-being, in addition to monitoring men’s physical health.

Saving His life—men’s lives—is one of the best things to do throughout the year!

Image credit: www.communitycarechemist.com.au/category/mens-health