Category Archives: Cancer Risk Factors

Precision Medicine: From Buzzword to Promise or Reality (Part II)

By Hui Xie-Zukauskas

Target_Precision Prevention_CPDHappy New Year to All! This article is the continuation (Part Two) of Precision Medicine mini-series, with a focus on Precision Prevention intended to help foster and improve your health in the new year.

So, let’s dive right in.

From Precision Medicine to Precision Prevention

Prevention and medicine work side-by-side, as ancient wisdom signifies “Prevention is better than cure.”

Similarly, precision medicine and precision prevention play a joint role in cancer outcome. While precision medicine is targeting the genetic characteristics and genetic changes of each patient’s cancer, precision prevention is aimed at changing an individual’s behavior.

Precision prevention requires a better understanding of the molecular pathways of a particular disease at a level of each individual, which involves mapping out genomic profile, identifying individual’s risk, behavioral, social and environmental interactions. Then tailored interventions can be strategized to modify individual’s physical and biological characteristics.

Impact on Cancer Prevention

Precision medicine, together with precision prevention, has certainly facilitated/improved cancer prevention whether you realize it or not, particularly in early detection.

Colonoscopy screening is a good example. Let me highlight the steps:

First, there is a guideline to identify people at a risk for colon cancer and/or who need to be screened – e.g. starting 40 years old if having a family history, or 50 years old without a family history.

Second, this test can detect a growth in the entire colon through imaging.

Finally, doctors can implement treatments immediately to prevent or slow down cancer progression, e.g. to surgically remove a benign growth (polyp) or premalignant lesion during the screening, or to start an aggressive therapy for a cancerous tumor.

As a result of such a cancer prevention strategy, colon cancer is highly preventable if caught in a precancerous stage.

Meanwhile, additional findings should be taken into consideration. Recent clinical studies found that 80% of people with colorectal cancer have no known family history of this disease, which suggests that other risk factors (environmental, diet or lifestyle) play a role in colon cancer development, and that current colon cancer screening recommendation (mainly based on age and family history) could miss many individuals at risk.

So, next prospective is how to improve precision prevention. Advances in precision risk stratification has done so. To identify who may benefit from preventive measures or early aggressive treatment or alternative therapies, precision risk stratification can separate individuals at a high risk from those at a low risk through innovative technologies, genetic profiling and multiple risk factors reporting. In colon cancer prevention, while those at higher risk benefit from colonoscopy, people at a lower risk can get screened through sigmoidoscopy, a non-colonoscopy screening with clinical value in detecting advanced growth. Subsequently, precision risk stratification-based screening for colorectal cancer will also reduce healthcare cost stemming from unnecessary colonoscopy screening.

Immunoprevention presents other successful examples. It can be demonstrated by hepatitis B virus (HBV) vaccination and human papilloma virus (HPV) vaccination in preventing related cancers. Immunoprevention can also draw in patients carrying cancer predisposition genes.

In addition, precision prevention may imply identifying novel genomic biomarkers for cancer detection and prevention, applying predictive biomarkers, and analyzing gene-environmental interactions especially associated with modifiable risk factors to develop target preventive strategies.

Precision Prevention beyond Cancer 

Undoubtedly, precision medicine, along with precision prevention, is transforming cancer diagnostics and treatment to reduce cancer incidence, morbidity and mortality in the near future. And one day, the promise of precision prevention for Alzheimer’s disease, metabolic syndromes, or other chronic illnesses can lead us to a remarkable horizon.

Imagine – the beauty alongside benefit of precision nutrition blossoms in your plate of food. As the prevalence of obesity, prediabetes and diabetes increases, tailored nutritional approaches are needed to manage and prevent these conditions. Precision nutritional interventions can be achieved via analyzing and monitoring your dietary habits, food eating behaviors, physical activity, microbiota profile, along with deep phenotyping (i.e. precise and comprehensive analysis of abnormalities in physical and biochemical characteristics).

End Note with Key Numbers

Lifestyle factors (smoking, diet, sedentary, etc.) contribute to over 40% of cancers, and infections, to about 18% of cancers. Thus, many cancers are preventable by lifestyle modification, preventing infections, having balanced diet and regular exercise, and maintaining a healthy weight.

Remember: Prevention is not a sprint, nor a marathon; is a sustained life-long journey. Prevention is not done through virtual world, but achieved in a real world and requires actions. If precision prevention is aimed at changing individual behaviors, the power of control is within each of us.

Going into 2018, imagine a year with your best well-being!

 

Image credit: CanStockPhoto & CPD

 

 

Precision Medicine: From Buzzword to Promise or Reality (Part I)

By Hui Xie-Zukauskas

Target for Precision Med_CPDIn a cheering spirit of the season, an amazing gift for each of us, in a perspective of health and future healthcare, is Precision Medicine. Precision medicine is no longer just a buzzword, its remarkable ability to impact detection, treatment and prevention has extended beyond cancer, and advanced clinical care for cardiovascular diseases, neurological disorders, and other acute or chronic illnesses.

This is an exciting era that treating a disease is transformed from following standard guidelines or the conventional “one-size-fits-all” approach to tailoring of medical treatment to individual characteristics of each patient.

So, what does it mean to cancer treatment and cancer prevention? I’ll provide some remarkable findings for you.

First, Let’s Clarify Precision Medicine vs Personalized Medicine

According to NIH, precision medicine refers to the tailoring of medical treatment to the individual characteristics of each patient, i.e. to identify what approaches will be effective for which patients based on their genetic, environmental, and lifestyle factors.

Precision medicine and “personalized medicine” are interchangeable sometimes. However, the term “personalized medicine” tends to be misinterpreted or misunderstood as the practice that treatments are uniquely designed for each individual. This is not always the case with precision medicine, and I’ll elaborate upon it more in cancer treatment later to help you understand better, so read on.

How Can Precision Medicine Steer Cancer Treatment Precisely?

Cancer is essentially a genetic disease. Errors, defects and malfunctions in the sequence of DNA or changes in the ways how genes are regulated can overthrow a cell’s apparatus, triggering uncontrolled cell growth, and eventually, tumor development.

The cause of these changes can be lifestyle – such as smoking, environmental – such as exposure to toxins, and/or spontaneous – such as a result of mutations in genes or inherited genetic alterations. Furthermore, research findings show that the changes that occur in one person’s cancer may not occur in others who have the same type, and the same cancer-causing changes may be displayed in different types of cancer.

These genetic changes in cancer can be examined using extraordinary technologies such as DNA sequencing, genomic testing and tumor molecular profiling. Samples can be collected by biopsies from tumors or in some cases, circulating DNA from patients with premalignant lesions. Cancer molecular profiling can uncover patients’ genetic variations, transcriptomic or proteomic profiling, tumor metabolism and microenvironment, and tumor immunity.

Considerable evidence indicates that a specific sequence of acquired genomic events over many years characterizes the transition from a normal cell to invasive carcinoma, and that specific “driver” events, developed in a particular order, enable cells to progress from benign growth to a malignant cancer.

Traditionally, tumors from the same organ or anatomical site are treated as one tumor entity. With breakthrough advances in genomics and technology, molecular tumor profiling may identify cancer “drivers” that are shared among different cancer types, prompting an approach to target driver’s pathways across anatomical sites, and clinical trials (so-called umbrella trials) to test whether molecular alterations in one tumor entity can be extrapolated to all other cancers.

For example, an inflammatory signature proved to be shared by seven cancer types including breast, prostate, colon, gastric, pancreatic, oral and lung.  Karyopherin alpha 2, a protein that plays a vital role in causing cancer, is uniformly up-regulated across these cancer types. Hence, a cancer-related molecular inflammatory pattern may position this protein as a uniform marker for poor prognostic cancers. Alternatively, oncologists can use specific drugs that target this protein to stop cancer growth.

Take a look at traditional chemotherapy, it works by killing cells that multiply quickly whether they are normal or cancerous. Precision medicine works differently. Because cancer cells need specific proteins or cancer-causing genes to survive, grow and spread, targeted therapies are designed to go after specific cancer-causing genes or proteins, leading to stopping or slowing down cancer progression.

Collectively, precision medicine can improve diagnostics, treatment, early detection and prevention. The goal of precision cancer medicine is to identify which mutation that drives a tumor, and to target therapies on what and how cancer-causing genetic changes occur in a tumor, no matter where the tumor develops in the body.

 

Image credit: CanStockPhoto & CPD

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

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>

How Can Climate Change Impact Cancer Risk

By Hui Xie-Zukauskas

Climate change & Cancer_CPD comboMuch of the talk lately is about a heat wave. “Are you cooked?” “Are you baked?”

Yes, massive, harsh and dangerous heat waves that hit most regions of the country are certainly unwelcomed, and unexpected in its increasing intensity, frequency and duration. Sure, mother nature is something to blame, but climate change and consequential global warming cannot be ignored. Particularly, I’m going to weigh in an issue seemingly less visible yet closely related.

Global warming is no longer a theory or myth, rather a reality. Just look around – those extreme weather cases, more wildfires, more rainfalls and floods, especially the worst, deadly flooding in West Virginia in 1,000 years. A warming planet undoubtedly plays a role.

As an alarming and disturbing note, climate change posts the biggest threat to public health in the 21st century (Castello et al., Lancet 2009). Solid science has told us so. Now, a more specific question should be addressed – Is there a connection between climate change and cancer development? If so, how? My focus here is to explain how climate change affects a risk for cancer, directly and indirectly, in FIVE ways.

  1. Increased our exposure to toxic chemicals by heavy and long-lasting rainfalls or floods: Global warming followed by excessive rainfalls wash toxic chemicals into water and surrounding communities. Then what? Think about smoking. A cigarette releases plentiful chemicals (>7000); out of them about 70 are carcinogens (i.e. cancer-causing substances). These harmful agents damage almost every organ in the body by causing genetic or DNA mutation, leading to the development of cancer.
  2. More intensified exposure to toxins by higher temperature: Heat itself can make toxic chemicals either more poisonous or unstable with unpredictable fallouts.
  3. More bacterial growth driven by a warmer or higher temperature: Bacteria have been attributing to cancer through inducing chronic inflammation and generating bacterial metabolites as carcinogenic end-products.
  4. Increased diffusion of UV radiation by depleting stratospheric ozone (i.e. “good ozone”): As you know, the overexposure to UV radiation causes skin cancer. Noticeably, UV radiation also suppresses some aspects of immunity, as a result, weakening your defense against cancer.
  5. Reduced air quality we breathe by producing ground-level ozone (i.e. “bad ozone”): Increasing evidence suggests considerable or long-term exposure to air pollutants may lead to lung diseases, such as lung cancer and chronic obstructive pulmonary disease (COPD), though it’s not conclusive.

In addition, chronic exposure to air pollutants associated with global warming causes an increase in oxidative stress and inflammation that contribute to cancer. Research findings also reveal that sensitive individuals and vulnerable populations such as children and the elderly are more susceptible to air pollution related illness because of potential genetic predisposition.

So, collectively, climate change can impact cancer risk, cancer development, and for sure, cancer care. Any misconception of global warming is relatively naïve and potentially dangerous.

Climate change is largely man-made, which is beyond the scope of this article. However, it is clear that we must take responsibility to safeguard a healthy environment, because a healthy environment supports healthy living for each and every one of us.

 

Image credits: www.freeimages.com/; www.medicinenet.com/

Skin Cancer and Aging: Causes and Solutions

By Hui Xie-Zukauskas

UV radition n Ozone layerHere comes the sun! And we all enjoy it. You may be heading for sunny beaches soon. I’d like to remind you of damage from the sun overexposure. By providing some key insights into harmful effects of the sun, and reflecting on skin aging, I am diving a little deeper into this subject, and will equip you with a sun protection tool kit – 5 Essentials or “SHADE”.

Numbers and Notions

First, do you know that more people suffered from skin cancer than all other cancers combined over the past three decades? Breaking down the statistics, it reveals approximately 40-50% of Americans who live to age 60+ will have one type of common skin cancers, and more than 90% of skin cancer is caused by excessive or unnecessary exposure to the sun?

Types of skin aging

If the above numbers cannot transmit the roles of aging and sun hazard in skin cancer, let me briefly elaborate what happened to our skin over our lifetime. As we age, our skin – the largest organ in the human body – goes through the same escalating loss of structure and function as other organs. But unlike other organs, the skin is openly exposed to environmental pollutants and lifestyle-related hazards (e.g. excessive sun, tanning, smoking, etc.). ALL is cumulative! Mostly concerning, ultraviolet (UV) radiation from sunlight causes so called “photoaging”.

I summarize here how photoaging differs from natural skin aging, to help you understand how biological evolution of the skin and adverse effects of the sun are interplayed.

Natural / Intrinsic Aging Photo- / Extrinsic Aging
Cumulative process Yes Yes
Common locations face, neck, forearm, and lower leg Yes
Cause Aging-related Sun damage overlaying natural aging
Visible characteristics Looseness, sagginess, fine wrinkles, dryness Increased pigmentation, deep wrinkles, harsh or rough skin
Structural alterations Epidermal − dermal area thinning and weakening, reduced elasticity, delay in wound healing Severe damage of dermal and connective tissues, promoting age-related skin diseases and skin cancer

Fundamental nature of Sun Damage

UV radiation is a known human carcinogen (i.e. cancer-causing agent). Let me expand further on UV radiation as a major causal factor of skin cancer and premature skin aging at cellular and molecular levels.

  1. UV radiation can modify DNA, intensify oxidative stress, and alter cellular antioxidant and immune defense, as well as other cellular structural or signal transduction pathways.
  2. UV-induced immune suppression contributes considerably to skin malignancies.
  3. UVB can directly cause specific DNA damage, when left unrepaired, it leads to mutations, consequently predisposing individuals to any cancer.

Importantly, bear in mind that UV exposure in children under age 10 has been linked to an increased risk of developing melanoma (malignant) and non-melanoma skin cancer later in life. Thus, childhood is a susceptible window for long-term dangerous effects of sun damage.

Sun safety with 5 Essentials – SHADE

Fortunately, skin cancer is one of the most preventable types of cancer. So, how can you protect yourself and your family? Employ this tool kit, i.e. the acronym “SHADE”.

S stands for “Sunscreen application”

A wide variety of sunscreens are available on the market but not all products are created equal. Make sure to use sunscreens that block both UVA and UVB. In addition, use a moisturizer with SPF 15 or higher on a daily basis.

H stands for “Hide away from the sun”.

Whether you stroll under the sun or enjoy outdoor adventures, wear sunglasses, a hat, and cover up with loose clothing. Also, make sure your sunglasses have both UVA and UVB blocking properties. 

A stands for “Avoid the sun during its most intensive time”

Staying away from the sun is especially paramount between the hours of 11 a.m. and 3 p.m., because during this window of time, the sun is at its strongest, thereby making this time the riskiest for sun damage.

D stands for “Detect early and Defense daily”.

Skin cancer can occur just about anywhere on the skin, but most often on the areas exposed to the sun, of course, also in odd places. With that in mind, look out vigilantly for moles, bumps or spots, by following the “ABCDE” guidance from WebMD, and noticing pain or fluid as a red flag too, for early detection. Schedule an annual skin cancer screening if you are among those “high risk” individuals.

In addition, antioxidants are powerful weapons to fight or “catch” free radicals generated from UV. Hence, build up your antioxidant defense by eating plenty of fresh, colorful fruits and vegetables, and more salmon.

E stands for “Educate everyone”.

To emphasize, E is for educating, not entertaining under the sun! Start with children and young adults. Regardless of gender and age, we are all exposed to the same sun. Today, the sun is getting less merciful compared to three or more decades ago due to thinning of ozone protection.

Take home message: 

Keep a balance between sun pleasure and sun damage, and hold the value of proper skin care. At the end, healthy skin in the course of life may promote better mental and emotional health. And remember “SHADE”.

 

Reference (on the table): Quan & Fisher. Gerontology. 2015; 61:427-34.

Image credit: thezonehole.com

Links between Obesity, Diabetes, and Colon Cancer

By Hui Xie-Zukauskas

Links 3 conditions_CPDColorectal cancer remains the 3rd most common cancer and is the 2nd leading cause of cancer-related deaths in the United States.

The causes of colon cancer are multi-factorial. They include cellular, molecular, and genetic factors, as well as dietary and lifestyle factors. Today, I’m going to focus on one significant yet modifiable risk factor, obesity.

We start with a glimpse at the numbers.

The incidence rate of obesity is alarmingly high among U.S. adults based on CDC data. Rates for different age groups include middle-aged (40.2%), older (37.0%), and younger (32.3%). Also, about 17% of children and adolescents (age 2-19) are obese.

More than 29 million adults and children in the U.S. have diabetes. 86 million Americans have pre-diabetes, a condition that can lead to type-2 diabetes. Note that an estimated one in two seniors has pre-diabetes.

Obesity may be a factor in approximately 300,000 deaths each year. Diabetes will cause an estimated 75,578 deaths and colorectal cancer, an expected 49,190 deaths in 2016.

A look beyond the numbers

Obesity is a leading cause of diabetes, a disease for which the body fails to control blood sugar levels. High blood sugar levels are characteristic of both obesity and diabetes. What is less well known is that diabetes and obesity are also linked to an increase in cancer risk.

In fact, obesity is linked to many types of cancer (colon, esophageal, thyroid, breast, prostate, uterine, kidney, pancreas, gallbladder and non-Hodgkins lymphoma) and, needless to say, heart disease, stroke, and other chronic illnesses.

Research shows that obesity and diabetes are associated with an increased risk of developing colon cancer.

Intrinsic links between obesity, diabetes, and colon cancer are vastly complicated. One clear tie is sugar. High levels of blood sugar are a characteristic in both obesity and diabetes. High blood sugar also makes us predisposed to cancer by increasing the activity of a gene involved in cancer progression. Apparently, dietary sugar is a link tying together obesity, diabetes, and colon cancer, and thus excess sugar has an impact on our risk for cancer.

Certainly, other links play a causal role. For instance, chronic inflammation is a central process that likely leads obese individuals to an elevated risk of diabetes and colon cancer, which all three conditions share a common inflammatory loop participated by multiple cell signaling molecules, growth and nuclear factors.

Highlighted Call for Actions

1. Colon Cancer screening

If you or your loved ones turn 50, you all should begin screening for colorectal cancer and then continue getting screened at regular intervals. This is because colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum. Colorectal polyps can be found by screening and then removed before they develop into cancers. Plus, any developing cancer can be found earlier by screening when treatment works best.

2. Diabetes Control

Early intervention is critical to preventing or delaying the onset of type-2 diabetes. Good news for our nation’s seniors is that Medicare will extend coverage for pre-diabetes care. Check out the National Diabetes Prevention Program, a preventive health initiative via the Center for Medicare & Medicaid Innovation.

3. Healthy Weight Management

Nutrition and balance diet, weight loss, daily physical activity and healthy lifestyle are all beneficial for keeping weight down. Look for further details in CancerPreventionDaily earlier posts.

In brief, obese people are at a higher risk for developing cancer. Also, an obese condition is often resistant to chemotherapy regimens. The bottom line is that obesity prevention is a key life-saving approach.

 

Image source: CancerPreventionDaily

Inspired by World Cancer Day

By Hui Xie-Zukauskas

WCD_WeCan n ICanWorld Cancer Day (February 4th, each year) is a global observance and initiative to fight cancer. The theme of 2016 World Cancer Day is “We can” and “I can”, being selected by the Union for International Cancer Control (UICC).

We can and I can – clarity, simplicity and forcefulness.

Much focus of World Cancer Day goes towards raising awareness of cancer, reducing risks of cancer, and learning how to prevent, detect and treat cancer early. To help achieve this goal, I’d like to bring one thing to the spotlight: Lifestyle modification.

Why? Only 5–10% of all cancer cases are attributed to genetic or inherited mutation. 35- 40% of cancer can be prevented by a major lifestyle change.

Next, how can you modify lifestyle to a healthier, livelier one? I’ve given a lot of information and strategies through CancerPreventionDaily.com. Here are 7 quick and effective tips:

1.      Quit smoking, period. This is not only for the individual but also for your loved ones and many, many others.

2.      Avoid or limit alcohol. Have we seen enough how alcohol takes a toll at physical, mental, emotional and social levels?

3.      Get physically active! Walk, run, jump, play or gardening … do whatever you can at where you are to move each day.

4.      Eat smart. Diet is intimately linked to diseases, as English Proverb cautions, “Don’t dig your grave with your own knife and fork”. In developing cancer, processed meats and foods speed it up, while a plenty of fresh vegetables and fruits slow it down.

5.      Maintain a healthy weight. It is well-accepted that obesity is a significant risk factor of several types of cancer. Taking the above actions will benefit weight loss.

6.      Avoid over-exposure to sun.

7.      Remember early detection.

Cancer is preventable disease. With hope and love, we all can do our own part and contribute to prevention or cure of cancer, ultimately making a difference in saving lives.

 

Image credit: worldcancerday.org

10 Things Important to Know about Lead Poisoning

By Hui Xie-Zukauskas

Lead Q & Tap Water_CPDWhat are your thoughts on the Flint lead-poisoning water crisis? Are you concerned about the quality of your drinking water? Do you know how lead may impact your body in the long-term? Read on, you’ll get an instant and clear idea.

Exposure to lead is a serious public health problem because of its association with numerous damages to nearly every system in the human body and various cancers. Here are 10 key concerns and strategies you need to know:

1. A hidden fact: Lead contamination is colorless, odorless, tasteless, and likely symptomless. So, it often goes unknown.

2. Routes of lead toxicity: Lead can get into your body through the water you drink, the food you eat and the air you breathe. How can lead get into your water? Your municipal water system or your house may have pipes containing lead or joined with lead solder.

3. The critical numbers: For lead awareness, I suggest to focus on these two: First, tap water lead should be below the EPA’s action level of 15 parts per billion (ppb) or 15 mg/L.Second, in children (esp. under age 5), a blood lead level of 5 micrograms per deciliter (5 mg/dl) or higher should raise a red flag, as the reference level of CDC recommended public health initiatives. If their blood lead levels exceed 10 mg/dl, the children can be in serious trouble!

4. The irreversible health consequences: Lead is a common occupational and environmental toxin with well-known adverse effects on intelligence, school achievement and behavior. Lead exposure also increases a risk for a variety of chronic illnesses such as hypertension, heart disease and kidney disease.

5. The Link to cancer: Lead is one of the heavy metals that are classified as a probable human carcinogen, according to the International Agency for Research on Cancer (IARC). Lead has been linked to cancers of lung, stomach, breast, and renal cells, although further studies await.

6. The influence on generations: Lead compounds cause genetic impairment through various mechanisms including interfering with DNA synthesis and repair, interaction with DNA-binding proteins and tumor-fighting proteins, so genotoxicity can potentially pass on to generations.

7. Drinking and cooking water safety – 3 Rules:

  • Rule 1: Never use warm or hot tap water for drinking, cooking or mixing baby formula.
  • Rule 2: Flush the cold water system for 1-2 minutes especially when the faucet has not been used for several hours. (Otherwise, use the water that’s flushed out for other purposes.)
  • Rule 3: Most desirable is to filter tap water for drinking and cooking. It also costs less than buying bottled water.

8. Children and lead beyond water: Infants and children are susceptible to lead toxicity. So, test your children’s blood lead level.

In fact, the biggest source of lead poisoning in children today is dust and chips from deteriorating lead paint on interior surface or toys. Also be aware that Pica behavior (esp. the ingestion of lead-containing foreign bodies) is a well-established risk factor of lead intoxication in children that may cause grave consequences. Lead is such a ubiquitous environmental toxin widely distributed around the world (e.g. the soil in your kids’ playground) that as a surprise, some traditional herbs (e.g. Ayurveda) may contain toxic amounts of lead.

9. Enough calcium intake: Lead mainly interrupts calcium-dependent processes and calcium signaling in the cells. So ensure enough consumption of calcium and antioxidants from fresh veggies or fruits helps combat negative effects of lead.

10. Everybody has responsibility to prevent water polluting. Learning from the Flint water disaster, we all need to keep vigilant at protecting clean water sources. If you suspect any change in the water, immediately contact your local public health or water system authority.

Bonus ending: Bottled water can serve as an alternative, as the FDA sets specific regulations for it. Take a cautious measure, because not all bottled water is created equal, and bottled water may contain 40% or more of tap water.

 

Image credit: oxfordcounty.ca & CPD