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February is Cancer Prevention Awareness Month. Here at the Abramson Cancer Center, we are committed to providing outstanding comprehensive cancer care and cancer information including ways to prevent cancer. Further, cancer researchers at Penn are at the forefront of learning new ways to prevent and detect cancer.

In this article, we discuss obesity, and how weight increases cancer risk, specifically, being obese. 

It’s no secret that more and more Americans are suffering from being overweight and obese. Perhaps it’s most evident in children, where it is estimated between 16 and 33 percent of adolescents are obese.

How Weight Increases Cancer Risk

Obesity is associated with increased risks of these types of cancers:

• Esophagus
• Breast (postmenopausal)
• Endometrium (the lining of the uterus)
• Colon and rectum
• Kidney
• Pancreas
• Thyroid
• Gallbladder

Also, obesity increases a person’s risk for heart disease, stroke high blood pressure, diabetes, and a number of other chronic diseases.

Several possible mechanisms have been suggested to explain the association of obesity with increased risk of certain cancers:

• Fat tissue produces excess amounts of estrogen, high levels of which have been associated with the risk of breast, endometrial, and some other cancers.
• Obese people often have increased levels of insulin, a condition known as hyperinsulinemia or insulin resistance, which may promote the development of certain tumors.
• Fat cells produce hormones, called adipokines that may stimulate or inhibit cell growth.
• Fat cells may also have direct and indirect effects on other tumor growth regulators.
• Obese people often have chronic low-level, or “subacute,” inflammation, which has been associated with increased cancer risk.

Other possible mechanisms include altered immune responses.

According to the National Cancer Institute:

A projection of the future health and economic burden of obesity in 2030 estimated that continuation of existing trends in obesity will lead to about 500,000 additional cases of cancer in the United States by 2030. This analysis also found that if every adult reduced their BMI by 1 percent, which would be equivalent to a weight loss of roughly 1 kg (or 2.2 lbs) for an adult of average weight, this would prevent the increase in the number of cancer cases and actually result in the avoidance of about 100,000 new cases of cancer.

Lose Weight to Lower Cancer Risk

Maintaining a healthy weight (a weight that falls within a BMI of 18.5-24.5) ranks at the top of the American Institute of Cancer Research’s recommendations for cancer prevention.

The National Weight Control Registry (NWCR) has been collecting data for more than a decade from people who have lost weight and have been able to maintain their weight loss.

They are sharing with us the top six trends that have come out of their surveillance. Nearly 90 percent of the members surveyed by NWCR reported they combined diet and exercise  to lose weight. So dig out your sneakers and get ready to move!

• Exercise. More than 50 percent of NWCR members reported expending 2000 calories a week. Check out AICR’s website for some suggestions of how you burn those calories too.
• Limit TV. Nearly two-thirds of NWCR members reported watching less than 10 hours of TV a week.
• Eat a low-calorie, low-fat diet. NWCR members maintain a similar diet 365 days a year Try filling half your plate with non-starchy fruits and vegetables that pack cancer fighting properties like spinach, broccoli, cucumbers, berries, grapes or melon.
• Eat breakfast. People surveyed said eating breakfast helped curb hunger and grouchiness as well as curb overeating later in the day
• Eat when hungry. Successful dieters from the NWCR maintained their weight loss by eating when they are hungry, not because the cake looked good or because they didn’t want to offend someone by not eating their dish. They also avoid the vending machine because when they are bored or stressed.
• Self monitor. And while you are looking for your sneakers, keep your eye out for your scale and smartphone. More than half of these successful dieters continue to weigh themselves weekly and keep a food journal. There are plenty of free websites and phone apps where you can log the calories you consumed and calories you burned each day.

Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. There are over 100 types of HPV, with more than 40 able to affect the genital area (CDC.gov). Nearly 20 million people in the United States are infected, and about 6.2 million more become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.
Most HPV infections do not cause any symptoms, and go away on their own. However, HPV can cause cervical cancer in women. The National Cancer Institute estimates that in 2011 alone, 12,710 new cases of cervical cancer will be diagnosed with 4,290 deaths from the disease.  It is the second leading cause of cancer deaths among women around the world.

HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women. HPV is also associated with several less common types of cancer in both men and women. There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

The HPV Vaccine

There are 2 FDA approved HPV vaccines on the market; Gardasil and Cervarix. The HPV vaccine Gardasil, protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11 which cause 90 percent of genital warts. Cervarix is protective against HPV 16 and 18.

Protection from the HPV vaccine is expected to be long lasting, but vaccinated women still need cervical cancer screening (such as Pap tests and HPV tests) because the vaccine does not protect against all HPV types that can cause cervical cancer.

The HPV Vaccine and Cancer Prevention

The HPV vaccine is approved for girls and boys ages 9-26.  Only Gardasil has been approved for use in males.

The CDC recommends that all girls aged 11 to 12 years old receive vaccination with either brand of HPV vaccine to protect against cervical cancer. (CDC) They also recommend that girls and young women ages 13 through 26 get the HPV vaccine if they have not received any or all doses when they were younger.

The CDC recommends Gardasil vaccine for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not receive any or all of the recommended doses when they were younger. It is recommended that all men receive the vaccine through age 26. (CDC)

The vaccine is given in a three-dose series with the second dose given two months after the first dose and the third given six months after the first dose.

Why is the HPV vaccine given at this age?

It is important for girls and boys to receive the HPV vaccine before their first sexual contact — when they have not been exposed to HPV. For these girls and boys, the vaccine can prevent almost 100 percent of diseases caused by the four types of HPV targeted by the vaccine. However, if a girl or boy is already infected with a type of HPV, the vaccine does not prevent disease from that type of the virus and will not cure a current HPV infection.

Catch–up HPV vaccinations

The vaccine is also recommended for those between the ages of 13 and 26 who did not receive it when they were younger. No booster doses are recommended at this time. The HPV vaccine may be given at the same time as other vaccines.

Who should not get the HPV vaccine?

Anyone who has ever had a life-threatening allergic reaction to yeast, latex, to any other component of the HPV vaccine, or to a previous dose of the HPV vaccine should not get the vaccine. People with severe allergies should tell their doctor before receiving the vaccine.

Pregnant women should not get the vaccine. The vaccine appears to be safe for both the mother and the unborn baby, but it is still being studied. Receiving the HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breastfeeding may safely get the vaccine.

People who are mildly ill when the shot is scheduled can still get the HPV vaccine. People with moderate or severe illnesses should wait until they recover

What are the risks of the HPV vaccine?

The HPV vaccine does not appear to cause any serious side effects. However, vaccines, like any medication, may cause problems such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small. If side effects do occur, they happen within a few minutes to a few hours after the vaccination.

Mild problems that may occur with the HPV vaccine:

• Pain at the injection site (eight of 10 people)
• Redness or swelling at the injection site (one in four people)
• Mild fever (100 degrees F) (one person in 10)
• Itching at the injection site (one person in 30)
• Moderate fever (102 degrees F) (one person in 65)
• These symptoms do not last long and go away on their own.

These are just some of the side effects that may occur. It's best to speak with your physician about side effects from the HPV vaccine.

What to do for severe reaction to the HPV vaccine

Any unusual condition, such as a high fever or behavior changes could indicate a severe reaction. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat or dizziness.

If you believe you or your child is having a severe reaction to the HPV vaccine, call a doctor or get the person to a doctor right away. Tell your doctor what happened, the date and time it happened and when the vaccination was given.

Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form or you can file this report through the VAERS website.

A cancer screening is a test that can detect cancer in its early stages or abnormalities that may lead to cancer before symptoms are present. When cancer is detected early, it may be easier to treat and its treatment may have better outcomes.
If you have a genetic predisposition to certain types of cancer, you may need to be screened more often or at an earlier age than the general population.

Some examples of screening recommendations are:

• Yearly mammograms for women beginning at age 40 and continuing or as long as a woman is in good health.
• Clinical breast exam every three years for women in their 20s and 30s and every year for women 40 and over.
• Beginning at age 50, both men and women should follow one of these testing schedules:
• Tests that find polyps and cancer
• Flexible sigmoidoscopy every 5 years*, or
• Colonoscopy every 10 years, or
• Double-contrast barium enema every 5 years*, or
• CT colonography (virtual colonoscopy) every 5 years*
• Tests that primarily find cancer
• Yearly fecal occult blood test (gFOBT)**, or
• Yearly fecal immunochemical test (FIT) every year**, or
• Stool DNA test (sDNA), interval uncertain*

• All women should begin cervical cancer screening about three years after they begin having vaginal intercourse, but no later than 21 years old. Screening should be done every year with the regular Pap test or every two years using the newer liquid-based Pap test.
• Beginning at age 30, women who have had three normal Pap test results in a row may get screened every two to three years. Women older than 30 may also get screened every three years with either the conventional or liquid-based Pap test, plus the human papilloma virus (HPV) test.
• Women 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having Pap tests.

The Centers for Disease Control and Prevention recently reported that many Americans are not getting their recommended cancer screening tests. In fact, a recent report showed that screening rates were significantly lowers for certain ethnic groups, such as Asian and Hispanic. The report also found that screening tests for cervical cancer dipped nearly 3 percent since 2000.

The cancer specialists at Penn’s Abramson Cancer Center remind everyone to get their recommended cancer screening tests. National Cancer Prevention Month serves as a reminder to you’re your screening appointments and follow this blog  for cancer prevention tips, recommendations and articles. 

Learn more about recommended screening tests for cancer.

Find out your risk for cancer with the OncoLink "What's My Risk?" tool.

Learn more about your risk for colorectal cancer at CANPrevent Colorectal Cancer on Friday, March 2, 2012 and CANPrevent Skin Cancer on Friday, May 18, 2012.

Researchers from Australia recently presented evidence from a study* that suggests sitting for long periods of time is associated with health risks – even for people who are regularly physically active.

Neville Owen, PhD, head of behavioral epidemiology at Australia's Baker IDI Heart and Diabetes Institute, says: "Sitting time is emerging as a strong candidate for being a cancer risk factor in its own right. It seems highly likely that the longer you sit, the higher your risk. This phenomenon isn't dependent on body weight or how much exercise people do.”

In the study, Dr. Owen measured waist circumference, insulin resistance and inflammation, which are indicators of cancer risk common to many physical activity-cancer studies.

His team found that when prolonged sitting is broken up with breaks as short as one minute, these biomarkers can be lowered. 

“Sedentary time is also likely an important factor for cancer survivors,” said Dr. Owen. For survivors, diabetes and cardiovascular disease are particular concerns and overweight and obesity increase the risk for both conditions. "Television viewing time, a sign of sedentary behavior, appears to increase subsequent risk of weight gain in cancer survivors."

What do you think? Based on this study’s findings, will you take more breaks away from your desk?

The Penn Transdisciplinary Research on Energetics and Cancer seeks to understand more about exercise, weight loss and quality of life of cancer patients through research. Some projects at the center include studies on exercise and weight loss as they relate to cancer recurrence, and how exercise can help manage effects of cancer treatment.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

*Dr. Owen’s study called “Adults’ Sedentary Behavior: Determinants and Inteventions” appeared in the August 2011 American Journal of Preventive Medicine.

Kale is a leafy green vegetable with many cancer-fighting qualities.

• 2-3 cloves of fresh garlic* (more if you like)
• 1 small onion, peeled and chopped
• 1-2 tbsp. olive oil
• 1 inch of peeled fresh ginger, chopped or grated.
• 2-1 inch cinnamon sticks, left whole
• 2 bay leaves, left whole
• 1/2 lb. carrots, chopped
• 4 cups, cleaned (washed) or torn kale
• 1 large partially cooked sweet potato, peeled and cubed
• *Can cook in microwave for 8-10 minutes

Serve with a tossed salad made with lots of different greens and fresh whole grain bread, using more olive oil or hummus for a spread.

Want another recipe using kale? Click here for a recipe for a delicious chopped kale salad.

Source: Suzanne Dixon, MPH, MS, RD, Cancer Nutrition Information, LLC, http://www.cancernutritioninfo.com/

Content for this post provided by Joan Karnell Cancer Center.