BE
Healthy ™
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VOL. 4 • NO. 8
© April 2010
Against the odds PH O TO C O U RT ESY O F AU G U STA W IL L IAM S
Thanks to significant medical advances over the years, Americans diagnosed with cancer are living longer with the once dreaded disease. Say this about Augusta Williams: she is fearless. Like the time she faced down a robber who invaded the beauty parlor where she stopped to have her hair done. Williams is equally combative when it comes to her health. Diagnosed with bone cancer in 1984 and breast cancer four years later, Williams plans to celebrate her 70th birthday — and almost 30 years of survival — next year in Australia. But don’t ask her about being a “survivor” of two different forms of often fatal cancers. “I’m a thriver,” she said. “I’m at a level of happiness and joy that I had not experienced before. I’m moving on with my life.” Indeed, thriving appears to be an operative word these days when it comes to living with cancer. As one of the most feared diseases, cancer is no longer an automatic death sentence. Because of significant medical advances, survival rates have improved dramatically over the years. As of January 2006, for instance, the National Cancer Institute Augusta Williams insists she is not a cancer survivor; she is a (NCI) estimated that more than 11 million people — or almost 4 percent of the population — had survived cancer. thriver. Williams battled both bone and breast cancers more than 20 years ago — and won. Furthermore, roughly 14 percent of those survivors had lived 20 years or more after their diagnosis. Cancer is still no joke. It is the second leading cause of sachusetts is 10 percent higher than that for whites, and death in this country and is now the leading cause of death roughly twice the rate for Hispanics and Asians. in Massachusetts. Blacks are the hardest hit by the disease. The numbers on disparity are similar across the counThe death rate from cancer in African Americans in Mastry. Blacks have the highest death rates in the four most
A radical solution As a registered dietitian at the Dana-Farber Cancer Institute (DFCI), Stacy Kennedy has heard it all before. She knows most people are busy. She knows processed foods are convenient and cheaper. But she also knows that a healthy diet of fruits and vegetables can help prevent cancer and ultimately, save lives. “Eating certain foods may decrease the risk of cancer or the aggressiveness of a current cancer,” Kennedy says. When it comes to fighting cancer, lifestyles matter. Just ask the Washington, D.C.-based American Institute for Cancer Research (AICR). The Institute contends that eating a plantbased diet of fruits, vegetables, whole grains and legumes, can help ward off many cancers. Add exercise and weight control to the mix and one third of all cancers each year in this country could be avoided, according to the AICR. Dr. Christopher Lathan, an oncologist at DFCI agrees. “There are certain lifestyle choices we can make to benefit us,” he said. “But you can still do those things and get cancer.” He stresses, however, that when a person follows a healthy lifestyle, “the odds are in your favor.” Though shrouded in many misperceptions, the science on cancer has become clearer over the years. First of all, it is not one disease. The cancer detected in the prostate
common cancers — lung, breast, prostate and colorectal — as well as several less common cancers. The causes of the disparity are many — lack of access to good care, lack of insurance, delayed diagnoses, fear and denial. And, unfortunately, misperceptions. A recent survey conducted by the American Cancer Society found that as many as 41 percent of the respondents clung to myths that pain medications were ineffective in treating cancer; that surgery caused the cancer to spread throughout the body; and that there is a conspiracy to withhold a cure in order to allow medical institutions to continue earning profits. Though generally considered to be more in tune with their bodies, women are also prone to misperceptions. Ask them to name the leading cause of death among women and they are likely to respond “breast cancer.” But that is incorrect. In fact, more women die of coronary heart disease — the leading cause of death — than the top ten cancers in women combined. But heart disease doesn’t have the same negative cloud that surrounds cancer. It’s so bad that many refuse to say the word “cancer,” and prefer terms like “the Big C” or “the C word.” Dr. Christopher Lathan, an oncologist at Dana-Farber Cancer Institute specializing in lung cancer, admits he gets a bit frustrated. What’s worse than the misperceptions, Lathan says, is that blacks are less inclined to seek timely treatment for cancer and are slower to recognize the symptoms or understand how to prevent it. His recent research bore that out. Lathan and his coresearchers found that blacks are less likely to link lung cancer with smoking and think that pain or other symptoms must occur before a positive diagnosis can be made. There is one problem with these perceptions — they are all wrong. “At least 85 percent of all lung cancers are caused by tobacco,” said Lathan. “And lung cancer is the number one cancer killer.” Furthermore, while many cancers are silent for years Williams, continued to page 4
is completely different from the cancer detected in the colon. As a matter of fact, there are more than 100 different cancers; breast cancer alone has more than seven. Put simply, cancer is an unnecessary proliferation of cells, the body’s basic unit of life. Normally, cells grow and divide in an orderly fashion to keep the body sound. Even a scratch or cut sets this process into motion to replace the damaged goods. Cells also grow old and die. But every now and then problems arise. New cells form when the body does not need them or old cells refuse to go when their time is up. These extra cells form tumors. Some of them are benign, which means they can grow but do not spread to other parts of the body. Once removed, they seldom come back. A malignant tumor, on the other hand, is cancerous. These cells grow out of control, and invade and destroy tissues around them. What’s worse, they can break off, travel through the bloodstream and wreak havoc on other parts of the body. While overweight, obesity and lack of exercise are highly correlated to several types of cancers, including postmenopausal breast, endometrial (uterine) and colon cancer, the importance of healthy eating cannot be overlooked. Certain foods are protective for overall good health. The reason for this protection is a bit radical — literally. There is a constant process of building, dismantling and re-building of molecules to help the body function properly. Sometimes the process goes awry and results in an unstable molecule — or free radical — that hunts around for an acceptable partner to bond. The problem is that the free radical can do its share of damage during the search, most notably to the DNA, the body’s blueprint. A damaged DNA can result in a mutation, which can in turn result in cancer. But all’s not lost. The body has a defense system to stabilize the free radicals. A cadre of organisms called antioxidants devours the free radicals. Radicals, continued to page 4
Exercise your option to reduce your risk of cancer that people who exercised the most reduced their risk for colon cancer by 21 percent (women) to 24 percent (men) compared to those who exercised the least. Likewise, an analysis of nearly 50 studies on breast cancer found that regular physical activity cut the risk by 15 to 20 percent, and even more for each additional active hour per week. Exercise may also offer protection against other cancers, such as uterine, lung and prostate cancer, although not all studies agree on this. Experts have found that exercise can be beneficial even after cancer has been diagnosed.
What kind of exercise helps? Most research focuses on aerobic activities (brisk walking, jogging, swimming, or biking, for example), which bump up your heart beat and breathing by working large muscle groups continuously. Experts at NCI estimate 30 to 60 minutes a day of moderate to vigorous activity will reduce both breast and colon cancer risks. Breaking this into smaller chunks lasting at least 10 minutes is fine.
• • •
Jogging or running Singles tennis Swimming laps
How can you get started? Walking is the simplest way to get started. It’s safe for almost everyone — even people who are not in good health. All you need is a pair of comfortable, well-padded sneakers and a pedometer if you’re counting steps. You’ll find tips for footwear, good form, setting goals and more at “Go Walking” on the Blue Cross Blue Shield of Massachusetts web site. If you aren’t usually active, or if you have chronic health problems like diabetes, heart disease, arthritis or asthma, call your doctor first to get the go-ahead and find out whether you need to adjust any medications or start out especially slowly.
What is moderate exercise?
Go ahead. Call five people in the community to ask if anyone they know has cancer. Odds are good you’ll hear “yes” probably more than once. That’s not surprising. Cancer is the second leading cause of death in America. Even more worrisome, African Americans are more likely than people of other racial backgrounds to get and die of many cancers, including colon and prostate cancer. Fortunately, the news isn’t all bad. You can take steps to cut your risks for developing certain cancers. Abundant evidence shows that being physically active substantially lowers colon cancer and breast cancer risks, according to the National Cancer Institute (NCI). Last year, a team of researchers from Washington University School of Medicine and Harvard University sifted through data from more than 50 studies on colon cancer. They learned
If you can talk, but not sing, the activity is moderate. Options include: • Basic gardening like raking or trimming shrubs • Biking on ground that is level or has few hills • Catch-and-throw sports (baseball, softball, volleyball) • Doubles tennis • Walking briskly • Golf • Water aerobics
What is vigorous exercise? If you can blurt out just a few words before stopping to catch your breath, the activity is vigorous. Options include: • Biking at speeds over 10 mph • Aerobic dance • Heavy gardening (digging or hoeing) • Hiking uphill • Jumping rope • Martial arts
Aim for a long-term goal of 30 to 60 minutes or 10,000 steps a day, but start much smaller: 1. Write down a goal or steps that you’re certain you can meet. Better to nail it than fail it. Success snowballs. 2. Exceed your goal, when possible. Let’s say you set out to walk 10 minutes, or accumulate 4,000 steps, on Monday and Saturday. If you manage more days or longer walks, that’s fabulous. Just don’t push too hard. Sore muscles or blisters may break your winning streak. 3. Once a week, add a day until you’re walking five to seven days. When you reach that goal, tack on time or steps every week. If you’re clocking minutes, add 5-minute increments: 10 minutes, 15 minutes, 20 minutes, etc. If you’re counting steps, increase your daily step goal by 10 percent. For example: 10 percent of 4,000 steps = 400 steps, so your new goal is 4,400 steps. 4. Expect setbacks. Rain, snow, ice and gloom of night make most of us think twice about walking — so plan some indoor options. An exercise DVD? March or jog in place, or crack out the jump rope? Head for a gym, mall or community center?
What if you haven’t been doing any exercise? Let’s say walking up a flight of stairs leaves you wrung out, or even rising from a chair is a struggle. That’s not unusual when people are out of shape or recovering from a serious illness, especially if they are older or overweight. So how can you possibly start a walking program — never mind take up vigorous exercise — if the least little exertion leaves you huffing as hard as if you’ve just run the Boston Marathon? First, call your doctor to make sure a gradual plan like the one described here would be helpful and safe for you. Build stamina slowly, bit by bit, day by day. Start by getting up from the chair or couch to walk in place or move around for five minutes an hour, several times a day. You can set a timer to remind you, or get up during TV commercial breaks. Add some simple movements. Try a few dance steps. Touch your shoulders, then straighten your arms overhead. Hold two soup cans at your sides, palms facing forward, then slowly lift them toward your shoulders. Pause, then slowly lower them. Once a week, add another minute to every bout of activity, so that five minutes becomes six, seven, eight, nine and ten. If you feel like you’ve reached your limit, stay at that level for an extra week. Have a setback? Try again tomorrow. When you reach 10 continuous minutes of movement, celebrate! Then lace up your shoes and try a walk outside.
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Questions & Answers 1. Can a person get cancer if he or she has no risk factors? Yes. Although some cancers occur in the setting of known risk factors, many occur sporadically without any known precipitating factor. This is why regular medical visits are essential. You should also pay close attention to changes in your body and bring those Nadine A. Jackson, M.D., M.P.H. to the immediate attention of your doc- Medical Oncologist Dana-Farber Cancer Institute tor. Always follow-up results of tests you have done — do not assume that not hearing about the results means that it was normal. 2. Does surgery for cancer cause the cancer to spread? No. For some people, surgery is a necessary part of cancer treatment and does not lead to spread of the cancer. 3. Is cancer contagious? While some cancers occur as a result of viral infections, such as human papillomavirus (HPV) and human immunodeficiency virus (HIV), cancer itself is not contagious. You cannot develop cancer by caring for or interacting with someone who is diagnosed with cancer. 4. If a person has a history of a particular cancer in the family does that mean he or she will get the disease? Not necessarily. Particular cancers, such as breast cancer, have a genetic risk and can spread in families, while others occur more frequently in families because of shared exposure to known risk factors, such as tobacco or certain chemicals. It is important to know your family history and to share that information with your doctor. It is also important to complete all screening tests for cancer appropriate for your age and gender. 5. Is cancer always painful? Although pain can be one of the first symptoms of cancer for some, it is not for others. For instance, back pain can indicate colorectal or ovarian cancer. Pain is often a symptom of cancer that is not being treated or may have spread. Fortunately, pain can usually be adequately controlled with medications.
Understanding the jargon of cancer Oncologist
a doctor who specializes in the treatment of cancer
Tumor/Neoplasm
an abnormal mass of tissue caused by an over-production of cells
Benign
non-cancerous; a tumor that does not spread and is rarely life-threatening
Malignant
cancerous; a tumor that can invade nearby organs and spread to other parts of the body; may be life-threatening
Primary cancer
the original tumor named for the part of the body in which cancer starts
In situ
the cancer is confined to its original site
Invasive
the cancer has grown into nearby tissues
Metastasis
the cancer has spread to other parts of the body; the new tumor is a metastatic tumor of the primary cancer. For example, breast cancer that has spread to the lungs is called metastatic breast cancer, not lung cancer
Staging
defines the extent or severity of cancer using Roman numerals I to IV; Stage I is the least extensive, Stage IV the most extensive
Invaluable inspection Screening is one of the most effective ways to prevent cancer or find it in its early stage when treatment is more successful. Cancer Breast Prostate Colorectal Cervical
Starting age* 40 50 50 21
Test* Mammogram PSA Colonoscopy Pap test
*Ask your doctor when to start screening and the most appropriate test.
6. Why does obesity increase the risk of cancer? Obesity has been linked to the development of several cancers (for example, cancers of the uterus, breast, colon, esophagus, breast, gallbladder and pancreas). It is associated with low levels of physical activity, high levels of the hormone estrogen and high levels of insulin-related growth factor, a hormone associated with tumor growth — all of which can increase the risk of developing cancer. Obesity can even complicate the diagnosis of cancer. Some studies link obesity to difficulty in obtaining a biopsy or CT scan because of excessive girth and weight. 7. Does a father’s family history of breast or ovarian cancer increase the risk in his daughter? Yes. Family history of breast or ovarian cancer can come from your father as well as your mother, and can increase the risk of developing those cancers in the daughter. It is important for you to know your family history and share this information with your doctor to determine if earlier breast or ovarian cancer screening is needed. 8. Why is colonoscopy the preferred screening for colon cancer? Colonoscopy is the most accurate and complete screening test available for the early detection of polyps — early indicators of colon cancer — and colon and rectal cancer itself. You should begin colon cancer screening with colonoscopy at the age of 50. If you have a family history of colon or rectal cancer, change in bowel habits or notice blood in your stool, you may need to have this test done before the age of 50. 9. Can yearly mammograms increase a woman’s chance for breast cancer? While some studies show an increased potential risk of developing breast cancer secondary to radiation exposure with mammograms, the benefit of detecting breast cancer early outweighs the potential risk identified.
SIGNS AND SYMPTOMS • Unintended weight loss • Changes in bowel or bladder habits, such as constipation or frequency of urination • Persistent cough • Hoarseness • Lump that can be felt under the skin • Fatigue
• Fever • Change in skin color – yellowing, darkening or reddening • Sores that do not heal • Changes to existing moles • Difficulty swallowing • Persistent indigestion • Unusual bleeding or discharge • Pain
The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.
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Williams, continued from page 1
certainly could face cancer.” Williams is not alone in waging a and grow undetected until a symptom apsuccessful fight. “If a person lives five pears, some cancers — colorectal, cervical, years without the disease, that is considbreast and prostate in particular — have ered a cure,” said Lathan. Even lung cangood screening tools that can detect the tucer can be cured. “Seventy to 75 percent mor long before the first symptom surfaces. of lung cancer patients survive if found The cause of cancer is not that straight early,” said Lathan. “But once it spreads, forward. What is known is that there is the overall five-year survival rate plunges a change in genes — the units that carry to 15 percent.” our hereditary information — but what While there is not yet an adequate causes that change varies. Culprits include screening test, lung cancer is largely lifestyle and environmental factors, such preventable by refraining from tobacco use as smoking, radiation from the sun or expo- although there is an increase in the percentsure to chemicals in the workplace. Even age of nonsmokers who are stricken. diet is a contributor. Some genetic mutaOther cancers are considered preventtions are hereditary, but having a mutation able as well. With the advent of the vaccine in the family is not a guarantee that a perGardasil, about 75 percent of cervical son will be afflicted. It means only that the cancers can be avoided. For those who do chance of getting not qualify for that particular canGardasil (it is cer is greater than now not recomthat of the general mended for population. women older Such was the than 26) regular case with WilPap tests can liams. She had a detect pre-canreal reason to fear cerous cells that cancer. Her mother can be treated had metastatic before the cancer breast cancer and emerges. died at the age of Colonos49 — one year copies, the older than Williams gold-standard was when she was for colon cancer first diagnosed with screening, can breast cancer. find pre-cancerWilliams ous polyps — was on alert from thereby avoiding an early age, and the problem altogether. relied on mammograms and breast The obvious and best self-examinations to provide her first solution, Lathan Christopher Lathan, M.D. says, is to see level of defense. Medical Oncologist a doctor on a Her fastidiousness Dana-Farber Cancer Institute regular basis. paid off when she “Try not to fear the information,” discovered a lump during a self-examinahe advised. “Even when it’s unfortunate. tion. Although her mammogram proved Early intervention can lead to a cure.” negative, a biopsy of the lump confirmed a When it comes to cancer, knowledge malignant tumor. really is power. It’s a good thing Williams was blessed On that point, Williams is in total with a feisty gene. She didn’t have health agreement. That’s her advice to others insurance at the time and was denied a bed at Memorial Sloan-Kettering Cancer Center facing the same predicament. “Ask ques(Sloan) in New York — the NCI-designated tions,” she advised. If a doctor says something you don’t Comprehensive Cancer Center where she understand, Williams says, get his attenreceived treatment for her bone cancer. Desperate, she turned to Nancy Reagan tion any way you can — even if that means pulling on his coat. “Tell him you don’t — yes, that Nancy Reagan — for help. understand,” she emphasized. “For every Williams said that she believed that of all medical term there is a lay term.” people who could understand her dilemma, it would be the First Lady who a year earWilliams also stresses the need for lier had been diagnosed with breast cancer. support groups. She has been a memFortunately, her aggressiveness ber of the Pink and Black campaign, a worked. Within minutes of her telephone program sponsored by the Boston Public call to the First Lady, the coveted bed at Health Commission to draw attention to Sloan appeared. the disparities in breast cancer survival To say the least, Williams is no faced by black women. Now a motivational speaker and shrinking violet. She looked at cancer as author of a book on her experience, a personal invasion. “You’re not taking Williams credits her “thriving” to just over my body,” she warned the cancer in four words. one of many conversations she had with herself. “If I could stare down a robber, I “Speak up,” she says. “Speak out.”
Celebrate National Minority Cancer Awareness Week! Health fair April 10, 1:30 pm The Power to Make a Difference – AARP Twelfth Baptist Church, 150 Warren Street, Roxbury
Health education/workshop April 14, 11:00 am to 2:00 pm Annual Alternative & Complementary Health and Wellness Fair UMass Boston, 100 Morrissey Blvd., Dorchester Events are sponsored by Dana-Farber Cancer Institute. Call 617-632-3244 for more information.
April 18 - April 30 The Choice is Yours - Boston Public Library Cancer Awareness Display • Roslindale Branch Library • Grove Hall Branch Library • South End Branch Library • Parker Hill Library April 23, 12:00 to 1:00 pm Our Time and Space Charles Street AME Church, 551 Warren Street, Roxbury May 17, 10:30 am Seniors on the Move – Nutrition – Community Servings Roxbury YMCA, 285 Martin Luther King Blvd.
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A colorful way to good health Fruits & Vegetables Legumes
Green and black tea
Research has found that the trick to healthy eating is variety — no single antioxidant can achieve optimal protection of health. The American Institute for Cancer Research suggests meals made up of at least twothirds vegetables, fruits, whole grains or beans and one third or less animal protein. Plant-based foods contain vitamins, minerals, fiber and phytochemicals — naturally occurring health protective substances. Dietitians recommend at least five servings a day of different colors of fruits and vegetables. The foods shown — including some seasonings (oregano, cinnamon, ginger) and teas — contain antioxidants that have been shown to reduce the risk of many cancers.
Whole grains Certain seasonings
There are no guarantees you won’t get cancer … but you can reduce your odds.
G
Keep a healthy weight.
Stay active. Aim for
et screened. Request screenings for breast, cervical, prostate and colorectal cancers and examinations for skin, oral and testicular cancers.
et immunized. Vaccinations are available for Hepatitis B, which is linked to liver cancer, and human papillomavirus (HPV), which can lead to cervical cancer.
30 minutes of moderate exercise, such as walking, at least five days a week.
Tobacco is associated with 16 different types of cancer. Smoking is the single most preventable cause of death in this country.
Radicals,
continued from page 1
There’s a hitch, though. The body cannot make the antioxidants — it has to rely on the food absorbed in the body. That’s where plant foods come in. These antioxidants — commonly referred to as phytochemicals or phytonutrients — are found in fruits, vegetables, beans, whole grains and even certain herbs. That’s why eating a plant-based diet has been found to reduce the risk of many types of cancer. There are thousands of phytonutrients, but only a handful has been identified. Although it’s not clear exactly which component in the phytonutrients deters cancer, it is clear that the antioxidants not only reduce the risk of cancer, they minimize its impact. In one study, researchers found that apple extract slowed the rate of reproduction of human colon cancer and liver cancer cells.
G
M
rich in fruits, vegetables, whole grains, legumes and lean proteins may help fight off cancer.
onitor your time in the sun. Although the sun is a good source of vitamin D, it is recommended to cover up during prolonged sun exposure.
T
Avoid risky behaviors.
Eat a healthy diet. A diet
Don’t use tobacco — of any kind.
Overweight and obesity can increase the risk of breast, colon, uterine and kidney cancers.
alk to your doctor about vitamin D. Low levels of vitamin D have been associated with many types of cancer.
Viruses that are transmitted sexually or by sharing contaminated needles can result in infections that increase the risk of cancer.
The good news is that there is not a particular diet of plant foods a person must eat each day. The Produce for Better Health Foundation puts it simply. If a person eats at least one cup of blue/purple, green, white, yellow/orange and red each day, you’re making your recommended quota. Health-protecting phytonutrients are “color-coded.” For instance, lycopene — that gives tomatoes and watermelon their red color — is known to combat prostate cancer, and dark green leafy vegetables, like collards and lettuce may protect against breast, stomach or oral cancers. The cruciferous family, which includes broccoli, cauliflower, cabbage and brussel sprouts, has been found to stem the growth of many tumors and help the liver rid the body of toxic substances. Kennedy sums it up. “Variety is key,” she said.
Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.