Guide to Preventable Cancers for American Indians and Alaska Natives

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					Guide to

Preventable Cancers

For American Indians and Alaska Natives
Steps to wellness for you and your family

About the

Prevent Cancer Foundation
The PReveNT CANCeR fouNDATIoN (formerly the Cancer Research and Prevention foundation) empowers you to reduce the risk of cancer for you, your family and your community. we envision a future where cancer incidence and mortality will be significantly decreased through riskreducing measures. for nearly 25 years, we have carried out our mission in three main ways: • By funding research that helps us better understand how to prevent cancer • By educating the public about how they can prevent cancer or detect it early when it can be more successfully treated • By reaching out to communities across the country through our resources, projects and partnerships with other organizations The Prevent Cancer foundation has provided more than $106 million in support of our research, education and community-outreach e≠orts nationwide. To learn more about the Prevent Cancer Foundation or to make a donation, visit www.PreventCancer.org. Prevent Cancer Foundation 1600 Duke Street Alexandria, Virginia 22314 703-836-4412, fax 703-836-4413 1-800-227-2732

Cover photo by Cultural Communications, www.maisiemac.com

Leader in Cancer Prevention Research
When the Prevent Cancer Foundation began its work in 1985, prevention was not seen as an important part of working for a cancer-free world. Scientists primarily focused on discovering new cancer treatments rather than thinking about ways to prevent the disease from ever developing or to detect it in early stages. Today, however, prevention research is recognized as essential. Through its grants and fellowships program, the Foundation has played a pivotal role in initiating advances in cancer prevention in two key ways—by funding novel ideas of early-career investigators who often go on to mentor the next generation of prevention researchers, and by supporting established scientists who are changing the direction of their research to take on prevention. Now, scientists better understand how tumors develop and how people can reduce their cancer risks through a healthy lifestyle.

Commitment to the Community
The Prevent Cancer Foundation shares evidence-based ways to reduce cancer risks through diverse programs in communities across the country. Its programs “reach people where they live” with health education booths at state fairs, skills-based breast health education in urban high schools, traveling exhibits, screening programs for underserved communities and interactive conferences for health professionals.

About This Guide for American Indians and Alaska Natives
This guide invites clinic staff, health educators, community health workers and community members throughout Indian Country to learn about cancer prevention and early detection—and to use this information with their families and in their communities. Contrary to the long-standing belief of many American Indian and Alaska Native (AI/AN) people, Natives do get cancer, and AI/AN people are more likely to die from some cancers than are other Americans. The purpose of this guide is to help change that. This guide is intended to help educate AI/AN communities about cancer: what it is, how it can be detected and treated, and, in some cases, how it can be prevented. Some healthy behaviors that may decrease cancer risks may also decrease risks of type-2 diabetes and heart disease. Reliable information on cancer among AI/AN people was not available in the past. But in this decade, federal and state agencies have partnered with tribes and urban Indian organizations, and great progress has been made toward improving the quality, quantity and, most importantly, coordination of data about cancer in Native communities. While much work remains to be done, much has been learned.

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Get Smart. Get fit. Get Checked.
These three steps are more than a call to action; they’re the keys to leading a long, healthy life. Reducing our risk represents the greatest control we may ever have over certain cancers. We can all play a part in eradicating this disease by choosing a healthy lifestyle that avoids commercial tobacco and includes healthy food choices, exercise, protection against too much sun, moderate alcohol consumption and regular cancer screenings. Today, thanks to advances in cancer research, we know more about how the disease develops and what contributes to cancer risk. We now have better tools, including new technologies for early detection, more options for diagnosis and treatment and improved therapies. The Prevent Cancer Foundation created this guide to share steps you can take on a daily basis to protect you and your family against cancer. It’s never too early—or too late—to make lifestyle changes that may save your life or the life of someone you love.

Get Smart!
STAY AwAY fRom CommeRCIAL ToBACCo

Commercial tobacco use can cause great harm to you and your family. It is deadly and causes cancers of the lung, throat, mouth and esophagus, in addition to heart disease, emphysema and many other smoking-related health problems. More than 85 percent of all lung cancer is related to smoking commercial tobacco. Non-smokers who are exposed to secondhand smoke are at risk for lung cancer and other respiratory conditions. The term “tobacco” can refer to commercial tobacco as well as to traditional tobacco. Commercial tobacco is a blend of tobacco leaves and many chemical additives. This manufactured tobacco is used in cigarettes, loose tobacco, chew and other products. When these products are smoked and inhaled or held in the mouth, over time they may cause cancer. Traditional tobacco has ceremonial uses, which may or may not involve the burning of leaves. In addition, many varieties of plants may be used, either in place of or with traditional tobacco. Some uses of traditional tobacco involve exposure to smoke. The occasional ceremonial use of traditional tobacco is not known to pose a cancer risk. In contrast, the risks from regularly smoking commercial tobacco are well documented. Some Native communities and organizations seek to preserve

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the sacred use of tobacco and to educate Native people about the abuse brought by commercial tobacco. Tobacco-related cancer rates have been rising in AI/AN communities since widespread use of commercial tobacco began around the time of World War II.
PRoTeCT YouR SkIN fRom The SuN

Skin cancer is the most common—but preventable—cancer in the United States, affecting more than one million people each year. Regardless of the color of your skin, you are still at risk for skin cancer, especially if you spend a lot of time outdoors. What can you do to reduce your risk for skin cancer? Avoid exposure to the sun between 10 am and 4 pm. If you go outside, wear protective clothing. Plus, always wear sunscreen with SPF 15 or higher and UVB and UVA exposure protective chemicals, even on cloudy days, no matter your skin color. Exposure to the sun causes most skin cancer, including melanoma, the most deadly type. Be certain to protect your children’s skin as well as your own. Most damage occurs in childhood and adolescence when cells in all skin layers are still developing.
PRACTICe SAfeR Sex

Cervical cancer is linked to the human papillomavirus (HPV). Women with HPV—a sexually transmitted virus—are at increased risk of getting cervical cancer. Women who have sex should use a condom the right way every time. (However, condoms cannot give complete protection against HPV, because the virus can infect areas that are not covered by a condom.) Within three years after becoming sexually active, but no later than age 21, women should begin regular screening to detect pre-cancerous or abnormal changes in the cervix. (A Pap test is not the only reason to visit a health care professional. A yearly check-up is a good idea to ensure good health.) Public health recommendations include the HPV vaccine for girls age 11 and 12 and also for young women age 13–26 if not yet vaccinated. Girls and young women should talk with their health care professionals about the vaccine.
LImIT ALCohoL CoNSumPTIoN

Recent studies on food and cancer prevention have noted that drinking alcohol poses cancer risks, but it also provides some protection against coronary heart disease. If you are a man who drinks, have no more than two drinks a day. If you are a woman who drinks, have no more than one drink a day.

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Get fit!
eAT A vARIeTY of heALThY fooDS, eSPeCIALLY fReSh fRuIT AND veGeTABLeS

Increasing evidence links the food people eat to cancer: some foods decrease cancer risks while others increase them. Research suggests that one-third of cancers diagnosed every year may be related to what people eat. Reduce the fat, especially animal fat, that you and your family eat. Limit red meat and avoid processed meats, like bologna (baloney) and Spam. Choose buffalo, venison and fish. Make fruits such as berries, vegetables such as corn and squash, nuts, beans and whole grains a regular part of the food that you and your family eat.
STAY ACTIve AND mAINTAIN A heALThY weIGhT

Add exercise such as dancing or gathering foods and herbs to your family activities to reduce stress, increase energy, control weight and reduce the risk for cancer. Getting at least 30 minutes a day can make a big difference in the health and well-being of all. Inactivity and obesity have been linked to breast, colorectal and endometrial cancer, and there is also some limited evidence of links to lung, gallbladder, prostate and pancreatic cancer. Evidence shows that a high-fat diet along with lack of exercise seems to contribute to the development of some cancerous tumors, especially those in which hormones play a role such as some breast tumors. How can exercise help? Physical activity can help control weight. It may also help the digestive system function properly, may boost the immune system and may also have a positive effect on hormones.

Get Checked!
foLLow CANCeR-SCReeNING GuIDeLINeS

There are many tests that can help detect cancer early when it’s easier to treat and that can also detect abnormalities before they become cancer. Ask your health care professional which screening tests to have and when. Be sure to discuss your family history. Find out if you are at higher risk for some cancers because of your family history or your lifestyle. Talk with your health care professional about any need you may have for earlier or more frequent screening, and about other steps you can take to protect yourself. Be an advocate for yourself and your family. Learn more about recommended screening for each cancer in this guide.

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kNow YouR fAmILY hISToRY

Many people who get cancer do not have a family history of it. This is one reason why cancer screening is so important. But a personal or family history of cancer or certain other diseases may increase a person’s risk. To help determine your risk, complete this family medical history chart and share it with your family and your health care professional. Keep it as a permanent record, making additions as you learn more family health history. For each blood relative, note in the box any cancer or other chronic diseases the person had and the age at which each was found. Note any surgeries and the dates of the procedures. If possible, note the date of birth and date and cause of death for each family member who is deceased. This will help you and your health care professional better understand which cancer screenings you may need and when to begin screening.

Your Father’s Father

Your Father’s Mother

Your Mother’s Father

Your Mother’s Mother

Your Aunts/Uncles

Your Father

Your Mother

Your Aunts/Uncles

Your Brother/Sister YOU

Your Brother/Sister

Your Brother/Sister

Your Brother/Sister

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BReAST CANCeR
An estimated 192,370 women and 1,910 men will be diagnosed with invasive breast cancer in 2009, and 40,610 will die of the disease (an additional 62,280 will develop non-invasive ductal carcinoma in situ, which means cancer only in milk ducts). If found early and treated before it spreads, the five-year survival rate for breast cancer is 98 percent. Breast cancer is the most common cancer among AI/AN women, and breast cancer rates among AI/AN women vary greatly by region. Breast cancer in AI/AN women is often diagnosed at later stages, making a cure or long-term survival with good quality of life less likely. Regular screening for breast cancer increases the likelihood of early diagnosis and survival.
RISk fACToRS
A family history of breast cancer (Risk increases with diagnoses in several close relatives or diagnoses before age 50.) A family history of ovarian cancer Genetic mutations (BRCA-1, BRCA-2 or others) Increasing age, with most breast cancer diagnosed in women over 40 Menstrual periods before age 12 or menopause after age 55 Obesity or sedentary lifestyle Hormone replacement therapy with estrogen and progesterone Exposure of breasts to previous radiation therapy Previous breast cancer in one breast

RISk ReDuCTIoN AND eARLY DeTeCTIoN
If you have babies, breastfeed them. If you drink alcohol, limit your drinking to one drink a day if you are a woman or two drinks a day if you are a man. Be physically active and exercise regularly. Maintain a healthy body weight. In your 20s and 30s, have a clinical breast exam (CBE) by a health care professional every three years. Beginning at age 40, have an annual CBE. At age 40, begin annual screening mammography. If you are at high risk, talk to your health care professional about beginning to have screening mammograms at a younger age. If you are at very high risk, you may also have annual MRI (magnetic resonance imaging) exams. Ask your health care professional about other ways to reduce risk.

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If you have a family history of breast cancer, discuss genetic testing with a genetics counselor.

Breast self-exam is one way that you can get to know what is normal for your breasts. If you notice changes, see your health care professional right away.
SYmPTomS

Don’t wait for symptoms. Get screened according to guidelines. If you notice any of the following symptoms, talk to your health care professional.
A lump, mass or thickening in the breast A lump in the underarm area Change in the size or shape of a breast Nipple pain, tenderness or discharge, including bleeding Nipple turning inward or inverted Change in skin color and texture: dimpling, puckering or redness Breast that feels warm or swollen

TReATmeNT

Therapy depends on the type and the stage of the breast cancer.
The most common treatment is surgery to remove the cancer itself (lumpectomy) combined with radiation. In about 20% of cases, removal of the breast (mastectomy) is needed. Other therapies—chemotherapy and hormone therapy—may be used alone or in combination before or after surgery.

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CeRvICAL CANCeR
Cervical cancer used to be one of the most common causes of cancer death in women in the United States. Today, cervical cancer is one of the most preventable cancers. Lives are saved because more women are routinely screened with a Pap test (also called a Pap smear). In 2009, an estimated 11,270 women will be diagnosed with cervical cancer and an estimated 4,070 will die from the disease. Cancer of the cervix (the opening of the womb or uterus) is more common among AI/AN women than it is among white women. And among AI/AN women, it is often diagnosed at later stages.
AT RISk
Women who are infected with the human papillomavirus (HPV), a sexually transmitted virus Women who become sexually active at an early age Women who have many sex partners Women who don’t have regular Pap tests Women who smoke commercial tobacco Women who have used birth control pills for a long time Women with weakened immune systems

RISk ReDuCTIoN AND eARLY DeTeCTIoN
Avoid infection with HPV by not having sex or by using condoms the right way every time if you have sex. (However, condoms cannot give complete protection against HPV, because it can infect areas that are not covered by a condom.) Avoiding HPV is the most important way to reduce your risk of cervical cancer. Stay away from smoking commercial tobacco, and don’t breathe in second-hand smoke. Begin regular screening for cervical cancer within three years after becoming sexually active but no later than age 21. Get screened every year with the standard Pap test, or every two years with the newer liquidbased Pap test. (A Pap test is not the only reason to visit your health care professional. A yearly check-up is a good idea to ensure your health.) At age 30, consider adding an HPV test to the Pap test for your regular screening. After three normal Pap tests and a negative HPV test, a woman may get screened every three years with a Pap test and an HPV test. However, if she has been exposed to diethylstilbestrol (DES, a drug once used to prevent miscarriages) before birth, is infected with HIV or has a weakened immune system, she should continue to have yearly screening.

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Consider getting the HPV vaccine. Public health recommendations include the HPV vaccine for girls age 11 and 12 and also for young women age 13–26 if not yet vaccinated. Girls and young women should talk with their health care professionals about being vaccinated. The vaccine is most effective if given before a person has become sexually active. If you have had a total hysterectomy for reasons related to cancer, you should still continue regular screening. Screening is not necessary if you do not have a cervix as a result of a hysterectomy—surgical removal of the uterus and cervix—for a condition not related to cancer.

SYmPTomS

Precancerous conditions in the cervix usually cause no symptoms and are not detected unless a woman has a pelvic exam and Pap test. If a woman experiences any of the following symptoms, she should discuss them with her health care professional:
Increased or unusual discharge from the vagina Blood spots or light bleeding at times other than during a normal period Menstrual bleeding that lasts longer and is heavier than usual Post-menopausal bleeding Bleeding or pain during or after sex

TReATmeNT

Cervical cancer is treated through surgery, radiation therapy and chemotherapy, alone or in combination. Treatment depends on the stage of the cancer, the type of tumor cells and a woman’s medical condition.

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CoLoReCTAL CANCeR
Colorectal cancer is cancer of the colon or rectum. It is equally common in men and women. An estimated 146,970 people will be diagnosed in 2009, and an estimated 49,920 people will die from the disease. It is one of the most preventable of cancers, because it develops from polyps that can be removed before they become cancerous. The rates of colorectal cancer among AI/AN people vary greatly from one region to another, with the highest rates in Alaska and the Northern, Central and Southern Plains states. Among AI/AN people, colorectal cancer is often diagnosed at later stages. With recommended screening, this cancer can be prevented (by removing polyps before they become cancerous) or detected early, when it can be more easily and successfully treated.
AT RISk
Men and women age 50 and older People who use commercial tobacco, are obese or are sedentary People with a personal or family history of colorectal cancer or benign (not cancerous) colorectal polyps People with a personal or family history of inflammatory bowel disease, such as long-standing ulcerative colitis or Crohn’s disease People with a family history of inherited colorectal cancer

RISk ReDuCTIoN AND eARLY DeTeCTIoN
Be physically active and exercise regularly. Maintain a healthy weight. Eat a high-fiber diet rich in fruits, vegetables, nuts, beans and whole grains. Consume calcium-rich foods like low-fat or skim milk. Limit red meat and avoid processed meats. Stay away from smoking commercial tobacco. If you drink alcohol, limit your drinking to one drink a day if you are a woman or to two drinks a day if you are a man.

If you are at average risk for colorectal cancer, start having regular screening at age 50. If you are at greater risk, you may need to begin regular screening at an earlier age. The best time to get screened is before any symptoms appear.

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Use this guide to help you discuss screening options with your health care professional. Consider one of the following:
Tests that find pre-cancer and cancer: Colonoscopy Virtual colonoscopy Flexible sigmoidoscopy Double-contrast barium enema Tests that mainly find cancer: Fecal occult blood test (FOBT) Fecal immunochemical test (FIT) Stool DNA (sDNA) test Screening intervals: Every 10 years Every 5 years Every 5 years Every 5 years Screening intervals: Every year Every year Ask your health care professional

An abnormal result of virtual colonoscopy or double-contrast barium enema, or positive FOBT, FIT or sDNA test should be followed up with colonoscopy.
SYmPTomS
Rectal bleeding or blood in or on the stool Change in bowel habits or stools that are narrower than usual Stomach discomfort (bloating, fullness or cramps) Diarrhea, constipation or feeling that the bowel does not empty completely Weight loss for no apparent reason Constant fatigue Vomiting

TReATmeNT

Surgery is the most common treatment. When the cancer has spread, chemotherapy or radiation therapy is given before or after surgery.

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LuNG CANCeR
Lung cancer is the leading cause of cancer death for both men and women— an estimated 219,440 people will be diagnosed and an estimated 159,390 will die of lung cancer in 2009. Lung cancer accounts for about 15 percent of all new cancer diagnoses and about 28 percent of all cancer deaths in 2009 estimates. Men have a one in 13 average lifetime chance of developing lung cancer, and, for women, it is one in 16. More people die of lung cancer than of colon, breast and prostate cancers combined. Commercial tobacco use is the most important risk factor for lung cancer. Lung cancer is the second mostcommon cancer in AI/AN people (after prostate cancer in men and breast cancer in women). Regional differences in lung cancer rates are large: the rate of lung cancer is seven times higher in the Northern Plains than in the Southwest. These rates reflect the commercial cigarette smoking rates in these areas. In many communities there are additional factors at work which make it more likely that cigarette smoking will result in lung cancer, such as exposure to cancer-causing substances in the environment. While commercial smoking rates are falling in the general population, smoking rates among Native people are not going down. The term “tobacco” can refer to commercial tobacco as well as to traditional tobacco. Commercial tobacco is a blend of tobacco leaves and many chemical additives. This manufactured tobacco is used in cigarettes, loose tobacco, chew and other products. When these products are smoked and inhaled or held in the mouth, over time they may cause cancer. Traditional tobacco has ceremonial uses, which may or may not involve the burning of leaves. In addition, many varieties of plants may be used, either in place of or with traditional tobacco. Some uses of traditional tobacco involve exposure to smoke. The occasional ceremonial use of traditional tobacco is not known to pose a cancer risk. In contrast, the risks from regularly smoking commercial tobacco are well documented. Tobacco-related cancer rates have been rising in AI/AN communities since widespread use of commercial tobacco began around the time of World War II.

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AT RISk
People who smoke commercial tobacco People exposed to second-hand smoke People who have had exposure to substances such as arsenic, radon or asbestos People whose occupations expose them to radiation People exposed to air pollution

RISk ReDuCTIoN AND eARLY DeTeCTIoN
Stay away from commercial tobacco in any form. Avoid second-hand smoke. Create smoke-free environments in your home and community. Eat lots of fruits and vegetables. Be physically active and exercise regularly.

A spiral CT scan can detect early lung cancer in people who are smokers and former smokers. Research is under way to determine whether spiral CT screening reduces death from lung cancer. Speak with your health care professional to learn more about the risks and benefits of this approach.
SYmPTomS

In the early stages, there may be no symptoms. Later these symptoms may occur:
Persistent cough Sputum (spit) streaked with blood Chest pain Recurring pneumonia or bronchitis Weight loss and loss of appetite Hoarseness

TReATmeNT

Lung cancer treatment is determined by the type, either small cell or nonsmall cell, the size of the tumor and whether or not it has spread.
Surgery is the usual treatment for localized disease. Radiation and chemotherapy are sometimes used in combination with surgery for later stages.

New, less-invasive surgery may allow for faster recovery with results similar to older, more-aggressive surgery.

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oRAL CANCeR
Oral cancer will be diagnosed in an estimated 35,720 people in 2009, and an estimated 7,600 people will die of the disease. Men are diagnosed with oral cancer more than twice as often as women. Because some oral pre-cancers and cancers can be found early, it is important to visit your dentist regularly for screenings. Cancer of the lip, mouth and throat is less common in AI/AN people than in the general population, and it is less common in AI/AN women than in men. However, Alaska Native women are the exception: they have more than twice the risk of oral cancer compared to white women. People who drink alcohol in addition to smoking commercial tobacco or using smokeless (chewing) tobacco increase their risk of oral cancer.
AT RISk
People who chew or smoke commercial tobacco or who drink alcohol to excess or do both People who are exposed to sunlight for long periods of time People who do not eat many fruits or vegetables People with human papillomavirus (HPV) People with suppressed immune systems

RISk ReDuCTIoN AND eARLY DeTeCTIoN
Stay away from commercial tobacco in any form. If you drink alcohol, limit your drinking to one drink a day if you are a woman or to two drinks a day if you are a man. Do not combine alcohol with tobacco. Avoid being outdoors during the middle of the day when sunlight is strongest. Use lip balm containing sunscreen of SPF 30 or higher to protect against sun damage to the lips. Eat lots of fruits and vegetables. Have an annual oral cancer screening by your dentist or other health care professional. Conduct a self-examination once a month by looking in a mirror.

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SYmPTomS
A white or red lesion on the lips, gum, tongue or mouth lining A lump or mass which can be felt inside the mouth or neck Pain or difficulty chewing, swallowing or speaking Hoarseness lasting a long time In any area of the mouth, numbness or pain that doesn’t go away Swelling of the jaw or loosening of the teeth Bleeding in the mouth

TReATmeNT
Surgery and radiation therapy are standard forms of treatment. Chemotherapy may also be used for some patients with later stages of the disease.

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PRoSTATe CANCeR
An estimated 192,280 men will be diagnosed with prostate cancer in 2009, and an estimated 27,360 will die from the disease. Most prostate cancer is diagnosed in men older than 65. Prostate cancer is the most common cancer in AI/AN men, and it is the second leading cause of death for Native men (after lung cancer). The rate of prostate cancer is lower among AI/AN men taken as a group than among white men. However, in some regions, such as the Northern and Southern Plains, AI/AN men have higher than average rates of prostate cancer.
AT RISk
All men over age 50 Men with a family history of prostate cancer (a father or brother with prostate cancer more than doubles the risk)

If a man has African-American heritage, he may be at increased risk: African American men are more likely to develop prostate cancer than men of other races and ethnicities.
RISk ReDuCTIoN AND eARLY DeTeCTIoN
Eat foods containing lycopene: tomatoes, tomato products, red grapefruit, watermelon or apricots. Eat foods containing selenium: light tuna, cod, beef, oatmeal or whole wheat bread. Watch your intake of calcium: diets high in calcium may increase risk.

Talk to your health care professional about screening. Some experts encourage men at average risk to have these tests annually, beginning at age 50:
PSA (Prostate-Specific Antigen) blood test DRE (Digital Rectal Examination)

Men with a family history of prostate cancer and men with African-American heritage may need to begin testing earlier.

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SYmPTomS

In the early stages, there are usually no symptoms. Some men experience symptoms that include:
Urinary problems (not being able to urinate, having trouble starting or stopping urine flow, having a weak or interrupted urine flow, feeling pain or a burning sensation while urinating) Blood in the urine Painful or difficult erection Pain in lower back, pelvis or upper thighs

Urinary symptoms may also be caused by other health problems, including an enlarged prostate, or BPH (benign prostatic hyperplasia).
TReATmeNT

Treatment options vary, depending on the stage of the cancer and other medical conditions of the individual.
Treatments include surgery, radiation or hormone therapy. Sometimes treatments are combined. “Watchful waiting” may be an option if the possible risks of treatment seem greater than its possible benefits. This option should be open to reassessment, as a man’s condition or concerns may change.

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SkIN CANCeR
An estimated 74,610 people will be diagnosed with skin cancer in 2009. That number increases to more than 1 million when basal cell and squamous cell skin cancer estimates (not reported to cancer registries) are included. Skin cancer is the most common and most preventable of cancers. Exposure to the sun’s ultraviolet (UV) radiation causes most skin cancer. Recent research on the benefits of vitamin D (made in the skin from sunlight) indicates that just a brief exposure of your face, arms and hands to the sun is sufficient—about 15 minutes a day, three days per week. Talk to your health care professional about Vitamin D and your health. Anyone of any skin color may develop skin cancer, and everybody can take steps to prevent it. The most serious form of skin cancer, melanoma, is much less likely to occur among AI/AN people compared to white people.
AT RISk
People who have excessive exposure to ultraviolet light, usually from the sun (but also from tanning lamps and booths) People who smoke People who have blond, red or light brown hair, and blue, gray or green eyes People with fair skin or freckles, or whose skin burns easily People with a personal or family history of skin cancer People with weakened immune systems People who have had organ transplants and who take immunosuppressive drugs People who are exposed to radiation People who have several moles on their bodies, especially since birth, or who have unusual moles People who have one or more large pigmented spots People whose drinking water contains arsenic

Men are more likely than women to get non-melanoma skin cancer. People who are white are more likely to develop melanoma than are African Americans.
RISk ReDuCTIoN AND eARLY DeTeCTIoN
Avoid sun exposure between 10 am and 4 pm. Always wear sunscreen with UVB and UVA exposure protective chemicals and with SPF 15 or higher, even on cloudy days. Apply at least one ounce of sunscreen—two tablespoons—at least 20 minutes before going out in the sun, and reapply frequently, at least every two hours if in continuous sunlight.

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Wear sunglasses treated to absorb ultraviolet (UV) radiation, use a lip balm with an SPF of at least 15, and wear tight-weave clothing with long sleeves and a wide-brimmed hat. Have a routine whole-body skin check by a health care professional once a year. Check your skin once a month for: A sore that doesn’t heal A growth you haven’t noticed before Change in the border of a spot: spread of color, redness or swelling into surrounding skin Itchiness, tenderness or pain from a mole Change in sensation (painful, tender) A brown or black colored spot with uneven margins or a new mole A small, smooth, shiny, pale or waxy lump that may bleed Large areas with oozing or crust A flat red spot or a lump that is scaly or crusty

When looking at moles, remember the ABCDE rule: Asymmetry, Border irregularity, Color that is not uniform, Diameter greater than 6 mm (about the size of a pencil eraser), Evolving size, shape or color. If you discover a suspicious growth, see your health care professional. Because risk increases with age, annual clinical examinations are more important after age 50.
TReATmeNT

If found at an early stage, most skin cancer can be treated successfully. Treatment options depend on the type of skin cancer and the stage.
Common treatments for skin cancer: Surgery Various chemotherapies Radiation therapy Other possible treatments: Immunotherapy (for melanoma skin cancer) Photodynamic therapy (for non-melanoma skin cancer)

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TeSTICuLAR CANCeR
An estimated 8,400 men will be diagnosed with testicular cancer in 2009, and an estimated 380 will die of the disease. It is the most common cancer in men age 20 to 35. When found early, testicular cancer is very treatable and often curable. Testicular cancer occurs about half as often in young AI/AN men as in young white men. If you are a young man, learn the symptoms of testicular cancer and know how to check yourself. If a symptom occurs, get checked by your health care professional promptly.
AT RISk
Men with a personal history of undescended testicle (at least one testicle was not in the scrotum at time of birth) or other abnormal development of the testes Men who are infected with HIV (human immunodeficiency virus) Men who have Klinefelter syndrome (a genetic disorder in men caused by having extra X chromosomes) Men with a personal or family history of testicular cancer

Men who are white are much more likely to develop testicular cancer than men of other races and ethnicities.
ReDuCTIoN AND eARLY DeTeCTIoN
Ask your health care professional to examine your testicles as part of routine physical exams. Perform testicular self-exam once a month, especially if you are at higher risk of developing testicular cancer.

SYmPTomS

Talk to your doctor if you have any of these symptoms:
A painless lump or swelling in either testicle A change in how the testicle feels Dull aching in the lower abdomen or groin Pain or discomfort in a testicle or in the scrotum Sudden collection of fluid in the scrotum

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TReATmeNT
Surgery Radiation therapy Chemotherapy

Treatment depends on stage, type of testicular cancer, size of the tumor and extent of lymph-node involvement.

This guide uses information from the following sources: American Cancer Society, Facts & Figures, 2009 American Cancer Society Web site www.cancer.org American Institute for Cancer Research, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, 2007 Cancer in the American Indian and Alaska Native Populations in the United States: A Supplement to Cancer, Vol. 113, Issue S5, 2008 National Cancer Institute Web site www.cancer.gov For more information about cancer prevention, visit www.PreventCancer.org

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The Prevent Cancer Foundation’s mission is cancer prevention and early detection through research, education and community outreach to all populations, including children and the underserved. The Foundation is dedicated to working in collaboration with American Indian and Alaska Native communities to promote cancer prevention and early detection for the best possible outcomes. The Foundation focuses its energies and resources on those cancers—including breast, cervical, colorectal, lung, oral, prostate, skin and testicular—that can be prevented through lifestyle changes or detected early with screening, when treatment is more successful.

ThANkS To TheSe INDIvIDuALS who ShAReD TheIR IDeAS AND SuGGeSTIoNS foR ThIS GuIDe:

Roberta Cahill (Yankton Sioux) Mary Helen Deer, RN (Kiowa-Muscogee Creek), an advocate for Indian health Tinka Duran (Rosebud Sioux) Leah Frerichs, MS, Aberdeen Area Tribal Chairmen’s Health Board Ruth K. Hummingbird, BBA (Cherokee) Kerri Lopez, NPAIHB, Northwest Tribal Comprehensive Cancer Program Lana Nelson, BS, Kanza Health Clinic Noel Pingatore, BS, CPH, Inter-Tribal Council of Michigan Gwen Shunatona, MA (Prairie Band Potawatomi) Urban Indian CARES team
The wRITeRS who DeveLoPeD ThIS GuIDe ARe:

Dee Ann DeRoin, MD, MPH (Ioway) Karen J. Peterson, PhD Erica Childs Warner, MPH

ReSeARCh • eDuCATIoN • ouTReACh
1600 Duke Street, Suite 500 • Alexandria, VA 22314 1-800-227-2732 • 703-836-4412 • Fax: 703-836-4413 www.preventcancer.org
CFC #11074/United Way #0481
Printed on recycled paper. Print Date: September 2009


				
DOCUMENT INFO
Description: A new educational booklet tailored for Indian Country is available that highlights eight cancers that can be prevented or detected early, when treatment is more successful. This 23-page guide invites clinic staff, health educators, community health workers and community members throughout Indian Country to learn about cancer prevention and early detection—and to use this information with their families and in their communities.