Cancer Prevention Recommendations Research Articles

Prevention of gastrointestinal cancer

Throughout the past decades, considerable progress has been made in the (early) diagnosis and treatment of gastrointestinal cancers. However, the prognosis for advanced stages of gastrointestinal tumors remains limited for many patients and approximately one third of all tumor patients die as a result of gastrointestinal tumors. The prevention and early detection of gastrointestinal tumors is therefore of great importance.For this reason, we summarize the current state of knowledge and recommendations for the primary, secondary and tertiary prevention of esophageal, stomach, pancreas, liver and colorectal cancer in the following.

MULTIPLE PRIMARY SYNCHRONOUS NEOPLASMS OF THE SIGMOID COLON AND BREAST IN COMBINATION WITH SPINAL CORD MENINGIOMA. CLINICAL CASE

The incidence of multiple primary oncological diseases ranges from 2.4% to 17%. The main causes of primary multiple diseases include factors related to the patient's lifestyle, environmental and genetic factors, as well as factors related to the comprehensive treatment of previously identified malignant diseases.We demonstrate a clinical case of treatment of a patient with synchronous primary multiple cancer of the sigmoid colon and breast in combination with spinal cord meningioma. An interesting fact is the possible correlation between meningioma and breast cancer. Thus, the risk of meningioma in women who have had breast cancer and the risk of breast cancer in women with a history of meningioma is moderately increased (RR = 1.40-1.64 and 1.54, respectively). This two-way statistical association may be a consequence of common risk factors and a partial coincidence of gene-environmental interactions that determine carcinogenesis. Further research is needed to identify problems of prevention, screening, diagnosis, treatment and disease-free survival. It is important that patients diagnosed with cancer have information about possible late and long-term consequences of treatment and its symptoms, as well as possible signs of relapse and the appearance of secondary tumors. It is important that patients receiving treatment for malignant neoplasms follow the recommendations for cancer prevention and early detection, including smoking cessation, physical activity, nutrition and diet, a healthy weight and all standard cancer screening tests.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Colorectal Cancer Survival.

Patients with cancer are recommended to follow cancer prevention guidelines due to inadequate evidence for specific recommendations for cancer survivors. We examined whether diet and lifestyle scores measuring adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention guidelines were associated with colorectal cancer-specific and overall mortality among 1,491 patients with colorectal cancer in two prospective cohorts. Cox proportional hazards regression models were used to calculate the multivariable-adjusted HRs and 95% confidence intervals (CI). During a median follow-up of 7.92 years, there were 641 deaths (179 colorectal cancer-specific deaths). Patients in the highest quartile of the post-diagnostic WCRF/AICR lifestyle score including diet, body mass index (BMI), and physical activity had a 24% lower risk (HR = 0.76, 95% CI: 0.49-1.18) of colorectal cancer-specific mortality and a 37% lower risk (HR = 0.63, 95% CI: 0.50-0.78) of overall mortality compared with the lowest quartile. When BMI was not included in the lifestyle score due to potential disease-related weight loss, stronger inverse associations were observed for both colorectal cancer-specific and overall mortality for the same comparison (colorectal cancer-specific: HR = 0.50, 95% CI: 0.32-0.79; overall: HR = 0.59, 95% CI: 0.47-0.75). The post-diagnostic WCRF/AICR diet score was not statistically significantly associated with either colorectal cancer-specific or overall mortality. Greater adherence to the WCRF/AICR cancer prevention recommendations was associated with improved survival in patients with colorectal cancer. This study provides support for patients with colorectal cancer to follow cancer prevention recommendations after diagnosis. Future studies on cancer survivors will continue to contribute to evidence-based diet and lifestyle recommendations for patients with cancer.

Implementation of a Prevention Program Based on Adapted Physical Activity and Recommendations for Adolescents and Young Adults with Cancer: PREVAPAJA Study.

Purpose: In Europe, 20,000 Adolescent and Young Adults (AYAs) aged 15-25 years are diagnosed with cancer annually. Although prognosis is good, AYA cancer survivors are at greater risk of second primary cancers, cardiovascular disease, and various long-term effects. Benefits of physical activity (PA) in AYAs reported in current studies remain difficult to generalize; none has been performed in France. This single-arm intervention study tested the feasibility of combining hospital-based supervised and home-based unsupervised physical activity sessions (PAS) and providing cancer prevention recommendations for AYAs. Methods: The AYAs attended PAS concomitant to treatment and participated in one face-to-face prevention interview. PA (international physical activity questionnaire), 6-min walk distance (6MWD), sedentarity, anthropometrics, quality of life (QoL), and fatigue were assessed at baseline (T1) and end of intervention (T2). PA, satisfaction and cancer prevention behaviors were assessed 1 year after baseline (T3). Results: Fifty-nine AYAs (mean 19 years) participated in the study. Acceptability and attrition were 80% and 12%, respectively. Between T1 and T2, 6MWD and global QoL improved (p < 0.001), and fatigue decreased (p = 0.003). Total PA improved and sitting time decreased (p < 0.001) overall (T1-T3). Assessment at T3 showed interindividual differences in how participants considered risk factors (e.g., more attention to PA, UV exposures, nutrition). Conclusion: Combined supervised and unsupervised home-based PAS in AYAs undergoing cancer treatment is acceptable and feasible. The program contributes to maintaining and improving physical fitness and QoL, while reducing fatigue and other cancer and treatment symptoms. Larger randomized controlled trials are needed to confirm these results.

1058-P: The 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Score and Diabetes Risk in the Diabetes Prevention Program Outcomes Study (DPPOS)

Lifestyle changes may reduce the burdens of diabetes and cancer. We examined how changes in the 2018 WCRF/AICR Score, reflecting key cancer prevention recommendations, are associated with diabetes risk. The Diabetes Prevention Program (DPP) randomized adults with prediabetes to a lifestyle intervention (ILS), metformin (MET), or placebo (PLB) for a mean of 3.2 years, with follow-up in DPPOS for 11 years. The Score includes 7 components: weight, physical activity, plant-based diet, red/processed meat, sugar-sweetened drinks, fast foods, and alcohol (0-7 points, with 7 as the best total score). Scores were estimated at years 0, 1, 5, 6, 9, and 15 for participants with complete baseline data (N = 3,147). Covariates included sex, age, race/ethnicity, marital status, education, family history of diabetes, hormone therapy (females), and energy intake. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) stratified by treatment group estimated the association of Score changes with diabetes risk in DPP and DPPOS within and between groups. There were significant Score improvements within all groups over 15 years (p &amp;lt; 0.001); the differences between groups were only significant after 1 year (p &amp;lt; 0.001; 15 years: p = 0.137). For every 1-unit improvement in Score during DPP, there was a 29% and 16% lower diabetes risk in ILS (95% CI: 0.58 - 0.88) and PLB (95% CI: 0.72 - 0.99), respectively, and no significant association in MET. The time-dependent Score improvements in ILS and PLB were significantly associated with lower diabetes risk through year 15 (ILS HR: 0.86, 95% CI 0.77 - 0.96; PLB HR: 0.85, 95% CI 0.76 - 0.95). Changes in weight, physical activity, and plant-based diet appeared to be drivers of the Score’s effect. Findings suggest that Score improvements are associated with a long-term, lower risk for diabetes among adults with prediabetes. Future research can explore how this risk reduction impacts cancer risk. Disclosure M. M. M. Shams-white: None. B. M. Heckman-stoddard: None. D. Research group: None. A. H. Tjaden: None. S. Edelstein: None. S. Bassiouni: None. C. Kim: None. X. Pi-sunyer: None. K. A. Temple: None. E. M. Venditti: None. J. Reedy: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048489)

An Online Survey and Focus Groups for Promoting Cancer Prevention Measures.

In order to design a cancer prevention promotion program in the region, suggestions were solicited at a medical center. We hypothesized that a majority would be native to state, and would be able to articulate about the barriers that may exist. Through online survey and focus groups, suggestions were sought, and the knowledge and the compliance with cancer prevention recommendations were assessed to determine the participants' qualifications as potential educators. Sixty-five point two percent of participants (n = 1018) graduated from high school in Arkansas. The most commonly given suggestions were to provide education to increase awareness, to use social media for promotion, to improve access, and to reduce costs. Self-reported adherence rates to breast, cervical, and colorectal cancer screening were 82.6% (n = 954), 75.8% (n = 541), and 76.7% (n = 453), respectively. Having a personal history of cancer significantly increased colorectal cancer screening uptake (p = 0.04), but paradoxically decreased mammography uptake (p = 0.007). Salary of $40,000 and more and having a Bachelor's degree or higher were associated with higher compliance of Papanicolaou test only (p = 0.007 and p = 0.001, respectively). A majority (67.7%, n = 1056) of respondents expressed willingness to contribute to promoting cancer prevention measures, and 38.3% (n = 559) were willing to participate in focus groups. However, only 6.3% (n = 35) actually participated. The participants' knowledge and compliance appeared to be sufficient, but their follow through in focus group participation was poor.

Prostate-specific antigen testing in the disabled population: A cross-sectional analysis of the Health Information National Trends Survey (HINTS).

e17000 Background: Disabled patients are a unique minority population that may have lower literacy levels and difficulty communicating with physicians. Furthermore, their knowledge for cancer prevention recommendations is unknown. Herein, we aim to compare prostate-specific antigen (PSA) testing rates and associated predictors among disabled men and non-disabled men in the USA. Methods: We performed a cross-sectional study utilizing the Health Information National Trends Survey (HINTS) to analyze factors predicting PSA testing rates in men with disabilities (disabled, deaf, blind). Multivariable logistic regression models were used to determine clinically significant predictors of PSA testing in men with disabilities compared to that of the healthy cohort. Results: A total of 782 (14.6%) disabled men were compared to 4,569 (85.4%) non-disabled men. Disabled men were older with a mean age of 65.0 ± 14.2 vs. 55.0 ± 15.9 years (p &lt; 0.001). On multivariable analysis, after adjusting for all available confounders including race, age, geographical region, survey year, marital status, health insurance, healthcare provider, amongst others, men with any disability were less likely to undergo PSA screening (OR 0.772, 95% CI 0.623-0.956, p = 0.018). Variables associated with increased PSA screening rates included age, having a healthcare provider or health insurance, and living with a partner. Although prostate cancer detection rates were shown to be higher among disabled men, this did not reach statistical significance. Conclusions: Our data suggests that significant inequalities in PSA screening exist among men with disabilities in the USA, with disabled men, especially the deaf and the blind, being less likely to be offered PSA screening. There is a clear need to implement strategies to reduce existing gaps in the care of disabled men and strive to reach equality in PSA screening in this unique population.

Adherence to cancer prevention recommendations is associated with a lower breast cancer risk in black urban South African women.

Breast cancer prevention is of great importance to reduce high incidence in South Africa. This study aimed to investigate adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations and the association with breast cancer risk in black urban women from Soweto, South Africa. A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings were included. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to these recommendations, an eight-point adherence score was developed, using tertiles among controls for scoring each recommendation (0, 0·5 and 1) with zero indicating the lowest adherence to the recommendations. OR and 95 % CI were estimated using multivariate logistic regression models to analyse associations between the WCRF/AICR score and breast cancer risk. Greater adherence (>4·5 v. <3·25) to the 2018 WCRF/AICR Cancer Prevention Recommendations was associated with a significant inverse association with breast cancer risk overall (OR = 0·54, 95 % CI 0·35, 0·91) and specifically in postmenopausal women (OR = 0·55, 95 % CI 0·34, 0·95), in cases with oestrogen positive and progesterone positive breast cancer subtypes (OR = 0·54, 95 % CI 0·39, 0·89 and OR = 0·68, 95 % CI 0·43, 0·89, respectively) and in obese women (OR = 0·52, 95 % CI 0·35, 0·81). No significant association with breast cancer risk was observed in premenopausal women. Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may reduce breast cancer risk in this black urban population of Soweto. Adherence thereof should be encouraged and form a part of cost-effective breast cancer prevention guidelines.

Reasons why COVID-19 survivors should follow dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations: from hyper-inflammation to cardiac dysfunctions.

The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Recent research indicates that a proper diet could exerts beneficial metabolic and immune effects in humans through the involvement of several, not yet properly known, metabolic pathways. Here, we argue that following WCRF/AICR recommendations could be a strategy to prevent cardiovascular outcomes [fulminant myocarditis, heart failure, venous thromboembolism (VTE)] and acute respiratory distress syndrome (ARDS) in patients during follow-up post COVID-19 infection. We discuss the metabolic effects of a WCRF/AICR based diet, highlighting on the involved cardio-metabolic pathways related on NLRP3 inflammasome-cytokines axis aimed to improve prognosis of COVID-19, especially in patients with cancer.

Towards refining World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations for red and processed meat intake: insights from Alberta's Tomorrow Project cohort.

Current cancer prevention recommendations advise limiting red meat intake to <500 g/week and avoiding consumption of processed meat, but do not differentiate the source of processed meat. We examined the associations of processed meat derived from red v. non-red meats with cancer risk in a prospective cohort of 26218 adults who reported dietary intake using the Canadian Diet History Questionnaire. Incidence of cancer was obtained through data linkage with Alberta Cancer Registry with median follow-up of 13·3 (interquartile range (IQR) 5·1) years. Multivariable Cox proportional hazards regression models were adjusted for covariates and stratified by age and sex. The median consumption (g/week) of red meat, processed meat from red meat and processed meat from non-red meat was 267·9 (IQR 269·9), 53·6 (IQR 83·3) and 11·9 (IQR 31·8), respectively. High intakes (4th Quartile) of processed meat from red meat were associated with increased risk of gastrointestinal cancer adjusted hazard ratio (AHR): 1·68 (95 % CI 1·09, 2·57) and colorectal cancers AHR: 1·90 (95 % CI 1·12, 3·22), respectively, in women. No statistically significant associations were observed for intakes of red meat or processed meat from non-red meat. Results suggest that the carcinogenic effect associated with processed meat intake may be limited to processed meat derived from red meats. The findings provide preliminary evidence towards refining cancer prevention recommendations for red and processed meat intake.

US Adults Fall Short of the Dietary Guidelines for Cancer Prevention Regardless of BMI Category

BackgroundCancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk. ObjectiveThe objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status. DesignThis was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Participants/settingDietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed. Main outcome measuresDifferences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories. Statistical analyses performedLogistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate. ResultsRegarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P < .001). Adults with obesity consumed significantly less dietary fiber and more processed meat than adults with normal BMI and overweight (P < 0.001). ConclusionsFew U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.

A New Score for Quantifying Adherence to a Cancer-Preventive Mediterranean Diet

Herein a Mediterranean Cancer Preventive Diet Score (MCAP Score) is proposed to quantify adherence to both traditional Mediterranean fat intakes and the current dietary recommendations for cancer prevention. The scoring uses research-backed cutoff values, unlike other scores that are based on a population-specific median value. The MCAP score awards positive points for seven preventive food categories, including Mediterranean fats (monounsaturated fats, ω-3 fatty acids) associated with reduced adiposity, and negative points for four food categories associated with increased cancer risk, including ultra-processed foods. In a randomized trial of 120 persons at increased risk of colon cancer, the baseline MCAP Score averaged seven of 20 possible points. Counseling for a Healthy Diet or a Mediterranean Diet improved the score to either 11 or 13 points, respectively, and the highest score observed in any individual was 20 points. The MCAP Score was correlated with serum carotenoids and serum ω-3 fatty acids, and improvements in the score were associated with weight loss over six months of study. The MCAP Score is therefore proposed as a new method to assess adherence to a Mediterranean type of diet for cancer prevention using absolute criteria that will facilitate comparisons of dietary intakes across studies.

Abstract PD11-01: Adherence to the new WCRF cancer prevention recommendations associates with a decreased breast cancer risk

Abstract Background: Breast cancer remains the leading cancer in women. In 2018, following its summary report, the World Cancer Research Fund (WCRF) issued its recommendations for cancer prevention based on the nutritional risk factors with a sufficient level of evidence, several of which being related to breast cancer. Our objective was to study whether adherence to these new recommendations was actually associated with reduced risk of breast cancer. Methods: A total of 62,546 women from the NutriNet-Santé population-based cohort study (2009-2019) were included in our analyses. Adherence to the 2018 WCRF recommendations was assessed using the operationalized score on a 7-point scale, proposed by Shams-White et al (Nutrients 2019), including: weight, physical activity, fruit and vegetables, dietary fibers, ultra-processed foods, red and processed meat, sugary drinks and alcohol. Usual dietary intakes were assessed using repeated 24h-dietary records and physical activity level using the IPAQ questionnaire. Cox proportional hazard models were computed with adjustment for the following potential confounders: educational level, height, smoking status, number of 24h dietary records, family history of cancer, number of biological children, age at menarche, age at parity, menopausal status, use of oral contraception or hormonal treatment for menopause. Results: During a median follow-up of 7.3 years, 745 women were diagnosed with a first incident breast cancer. The median WCRF 2018 adherence score was 3.75 (IQR: 3.25-4.50). An increase of 1-point increment in the score was associated with a decreased risk of breast cancer (HR=0.92; 95%CI 0.85-1.00; P=0.05), and especially of breast cancer post-menopause (n=456 cases, HR=0.88; 0.79-0.98; P=0.02). No association was observed for breast cancer pre-menopause (n=289, HR=0.99; 0.87-1.12; P=0.8). Sugary drink, alcohol and weight components of the score particularly contributed to the observed association. Conclusions: Our results suggest that a higher adherence to the WCRF 2018 recommendations for cancer prevention is associated to a decreased risk of breast cancer. Considering that the WCRF cancer recommendations are consistent with overall food-based dietary guidelines, such recommendations should be promoted to the general public and transposed as public health actions to contribute to decrease the burden of cancer. Citation Format: Mélanie Deschasaux, Laurent Bourhis, Laurent Zelek, Eloi Chazelas, Charlotte Debras, Serge Hercberg, Paule Latino-Martel, Chantal Julia, Emmanuelle Kesse-Guyot, Bernard Srour, Mathilde Touvier. Adherence to the new WCRF cancer prevention recommendations associates with a decreased breast cancer risk [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD11-01.

Abstract PS8-09: Dietary supplement use in a healthy eating and exercise lifestyle intervention in breast cancer survivors: The lifestyle exercise and nutrition (LEAN) study

Abstract Background: Dietary supplements (DS), defined as herbal preparations, vitamins and minerals (DSHEA Act 1994), are used by 70% of cancer survivors. The World Cancer Research Fund/American Institute for Cancer Research 2018 Cancer Prevention Recommendations specify not to use DS to protect against cancer. There is some evidence that DS are linked to harmful outcomes, including increased mortality and breast cancer recurrence. DS have potential pharmacokinetic interactions via cytochrome P450 enzyme and pharmacodynamic interactions via estrogenic or hepatotoxic activity, which may increase or reduce clinical efficacy or potentiate adverse effects of Tamoxifen and Aromatase Inhibitors (AIs). This analysis examines baseline usage of DS and potential interactions with Tamoxifen and AIs among breast cancer survivors enrolled in the Lifestyle, Exercise, and Nutrition (LEAN) study, a randomized healthy eating and exercise lifestyle intervention. Methods: We examined the use of DS in 151 breast cancer survivors enrolled in the LEAN Study. Women with a body mass index (BMI) ≥ 25 kg/m 2 were randomly assigned to a 6-month healthy eating and exercise lifestyle intervention (n=93) or to usual care (n=58). At baseline and 6 months, we asked participants to self-report regular DS use, defined as at least 3 times a week for at least one month. The intervention group received evaluation and counseling of DS use by a Registered Dietitian (RD) with a Certified Specialty in Oncology Nutrition (CSO). Potential interactions of moderate and major ratings between DS with Tamoxifen and AIs (Letrozole, Exemestane and Anastrozole) were identified through the Natural Medicines Database by both a pharmacist specializing in oncology and a RD, CSO. Results: Out of 151 women, at baseline 120 (80%) reported using DS. Fifty-four different formulations were enumerated. The majority of women (72, 60%) were taking ≥ 3 formulations. One quarter of women (29, 24%) were taking ≥ 5 formulations (range = 1 - 20). Of the 54 formulations, 33% had potential interactions with Tamoxifen and/or AIs according to the Natural Medicines Database. Total interactions by medication were: 18 Tamoxifen, 14 Letrozole, 14 Exemestane, 9 Anastrozole. The majority of these interactions (87%) were associated with herbal preparations. Conclusions: Our findings are indicative of the high prevalence of DS use among breast cancer survivors and the potential risk of interactions with prescribed hormonal therapy. More research is needed to test if counseling from a RD, CSO can reduce DS use and ultimately lead to better outcomes due to fewer interactions with breast cancer treatments. Citation Format: ThaiHien Nguyen, Maura Harrigan, Courtney Mcgowan, Annette Hood, Fangyong Li, Brenda Cartmel, Leah Ferrucci, Melinda L Irwin, Tara Sanft. Dietary supplement use in a healthy eating and exercise lifestyle intervention in breast cancer survivors: The lifestyle exercise and nutrition (LEAN) study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-09.

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians.

As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.

Assessing the Feasibility of an Online Module for Promoting Cancer Prevention Measures.

ObjectivesThe aims of this pilot study were (1) to develop a cancer prevention module consisting of an animated video and a short questionnaire, (2) to assess new knowledge gained by the participants, and (3) to solicit feedback for improving the cancer prevention module.MethodsVolunteers who previously agreed to be contacted regarding research studies were approached via email. After completing the cancer prevention module, a list of cancer prevention recommendations was provided. Newly gained knowledge was assessed, and feedback was solicited.ResultsOverall, 290 of 3165 individuals contacted completed the online module (9.2%), and 38.6% of the participants indicated that they learned something new about cancer prevention measures. A similar proportion, 41.4%, mentioned that they learned about measures that were recommended and due. Paradoxically, response rate was the lowest in the ≥50 year old age group although this group reported the highest rate of learning about new cancer prevention measures. Feedback was favorable in that 70.7% mentioned that the recommendations were helpful to them personally, 69.3% felt motivated to take action to reduce their risk of cancers, and 67% would recommend the online module to their friends and family.ConclusionWe developed an online cancer prevention module which seems to be suitable for promoting cancer prevention measures as feedback was favorable, and new knowledge was gained. Future efforts will focus on using the module to promote cancer prevention measures to the general public particularly for the ≥50 year age group.

Use of a Clinic-Based Skin Cancer Prevention Bundle to Promote Sun-Protective Behaviors in Patients at Moderate to High Risk for Skin Cancer

ABSTRACT Background Skin cancer is the most common type of cancer in the United States, and one in five Americans will develop a skin cancer at least once during their lifetime (U.S. Cancer Statistics Working Group, 2016). Analysis of current skin cancer prevention practices in a large academic university dermatology clinic revealed a lack of skin cancer risk stratification, targeted prevention messaging, and assessment of sun-protective behavior (SPB) use. An improvement project was initiated to evaluate the impact of a skin cancer prevention bundle (SCPB) on SPB use and sunburn frequency over a 2-month period. Methods Adult clinic patients 20–65 years old, at a moderate to high risk based on Brief Skin Cancer Risk Assessment Tool scores, received an SCPB consisting of personalized Brief Skin Cancer Risk Assessment Tool risk feedback, American Academy of Dermatology skin cancer prevention recommendations, and a brief American Academy of Dermatology skin cancer prevention video. A Sun Habits Survey and an assessment of perceived skin cancer risk were performed preintervention and postintervention. Results Thirty-eight participants (92.7%) completed the project. Outcome measures showing significant difference postintervention included Sun Protection Habits Index summary scores (p &lt; .0001), sunburn frequency (p &lt; .0001), and lifetime perceived risk of skin cancer (p = .007). Individual SPB habits of limiting midday ultraviolet exposure (p = .0004) and frequency of hat use (p = .01) also showed significant increases postintervention. Conclusions and Implications Use of the clinic-based SCPB improved SPB use and reduced sunburn frequency. The SCPB is being considered for clinic-wide implementation based on the findings. Further study with a larger number of participants and ongoing postclinic implementation evaluation is recommended to confirm results and fully assess the potential of the SCPB to improve patient outcomes and reduce skin cancer risk.

Hereditary cancer syndromes: a modern paradigm

About 5-10% of malignant neoplasms (MN) are hereditary. Carriers of mutations associated with hereditary tumor syndromes (HTS) are at high risk of developing tumors in childhood and young age and synchronous and metachronous multiple tumors. At the same time, this group of diseases remains mainly an oncological problem, and clinical decisions are made only when MNs are detected in carriers of pathogenic mutations.Individual recommendations for cancer screening, treatment, and prevention should be developed for carriers of mutations associated with HTS to prevent an adverse outcome of the disease. It is essential to identify patients at risk by doctors of all specialties for further referral to medical and genetic counseling with molecular genetic testing (in case of indications). The problems of standardization of enrollment criteria for genetic tests, further tactics of prevention, screening, and treatment of many hereditary oncological diseases remain unsolved.This review was created to inform doctors of various specialties, including endocrinologists, about the HTS. This allows them to get acquainted with main clinical features of specific syndromes, helps to understand the difference between hereditary and non-hereditary cancer, recognize signs of hereditary cancer, and introduce the indications for genetic examination and genetic counseling of the patient. Also, significant differences between international and domestic recommendationson screening measures, diagnosis, and treatment of HTS underline the need to review the existing and develop new algorithms for medical support of patients with HTS.

Diet, weight status, and physical activity in cancer prevention

Background: Cancer is a multifactorial disease involving individual, behavioral and environmental factors that can contribute to its onset. More than 40% of cancers are estimated to be attributable to avoidable risk factors, particularly diet, physical activity, weight status, and alcohol consumption. Aim: To provide insight into the role of weight status, diet, and physical activity in cancer causation and prevention, and to highlight evidence-based recommendations. Material and methods: A literature review of published studies, particularly recent systematic reviews, meta-analyses, and large prospective studies was conducted using PubMed/Medline, ScienceDirect, and Google Scholar databases. Results: There is evidence that diets high in red and processed meats, fat and refined carbohydrates, and low in plant foods such as vegetables, fruits, and whole grains, high consumption of alcohol, overweight/obesity, and physical inactivity are associated with increased risk of tumor development and progression. Therefore, the current recommendations for cancer prevention are based on: (1) eating at least five portions (400g) of vegetables (3 portions) and fruits (2 portions); (2) limiting the consumption of alcohol and unhealthy foods such as red and processed meats, energy-dense foods, and trans-fatty acids; (3) maintaining a healthy weight status; and (4) being at least moderately physically active. Conclusion: While a balanced diet, as defined by the recommendations, can help reduce the risk of certain cancers, no single food can prevent the development of this pathology. The term "anticancer" associated with diet is therefore misleading. Several nutritional factors are associated with an increase or a decrease in the risk of certain cancers. Adopting a healthy and plant-based diets, avoiding overweight/obesity, and being physically active are considered as cornerstones of preventive strategies against cancer. Further studies are needed to elucidate the associations between dietary and lifestyle patterns and cancer. ​Keywords: Cancer, Diet, Weight status, Overweight, Obesity, Physical activity.

Alimentation, statut pondéral et activité physique dans la prévention du cancer

Background: Cancer is a multifactorial disease involving individual, behavioral and environmental factors that can contribute to its onset. More than 40% of cancers are estimated to be attributable to avoidable risk factors, particularly diet, physical activity, weight status, and alcohol consumption. Aim: To provide insight into the role of weight status, diet, and physical activity in cancer causation and prevention, and to highlight evidence-based recommendations. Material and methods: A literature review of published studies, particularly recent systematic reviews, meta-analyses, and large prospective studies was conducted using PubMed/Medline, ScienceDirect, and Google Scholar databases. Results: There is evidence that diets high in red and processed meats, fat and refined carbohydrates, and low in plant foods such as vegetables, fruits, and whole grains, high consumption of alcohol, overweight/obesity, and physical inactivity are associated with increased risk of tumor development and progression. Therefore, the current recommendations for cancer prevention are based on: (1) eating at least five portions (400g) of vegetables (3 portions) and fruits (2 portions); (2) limiting the consumption of alcohol and unhealthy foods such as red and processed meats, energy-dense foods, and trans-fatty acids; (3) maintaining a healthy weight status; and (4) being at least moderately physically active. Conclusion: While a balanced diet, as defined by the recommendations, can help reduce the risk of certain cancers, no single food can prevent the development of this pathology. The term "anticancer" associated with diet is therefore misleading. Several nutritional factors are associated with an increase or a decrease in the risk of certain cancers. Adopting a healthy and plant-based diets, avoiding overweight/obesity, and being physically active are considered as cornerstones of preventive strategies against cancer. Further studies are needed to elucidate the associations between dietary and lifestyle patterns and cancer. Keywords: Cancer, Diet, Weight status, Overweight, Obesity, Physical activity.