FINAL_Toolkit_2008 by VISAKH

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									                                                  Health Education,
                                                  Assessment and
                                                    Leadership

                                                  July 12
Cancer
Toolkit                                           2008
This toolkit has basic facts about different kinds of cancer and the tests used to
find them. It is my hope that you will use this booklet to increase your
awareness and the awareness of your community on your health needs. Read
this toolkit and think about your possible risk factors for cancer. Risk factors
are facts about you that might increase your chances of getting certain types of
cancer. For example, a close blood relative who may have or has had cancer,
personal habits and behavioral risks (i.e., cigarette smoking or other tobacco
                                                                                     Facts:
use, eating high-fat meals, having many sex partners), or extensive periods of
time in the sun.                                                                     Cancer
I hope that you will use this as a starting point to discuss these tests with your   Screenings
doctor or nurse and your community.

Thank you for making a commitment to improving your health and the health
                                                                                     and Tests
of your community.



Charles E. Moore, MD


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                   FACTS ON CANCER SCREENINGS AND TESTS



                                                                TABLE OF CONTENTS

                                                                                                                                                               PAGE

Breast Cancer .......................................................................................................................................................... 1

Colorectal Cancer.................................................................................................................................................... 6

Cervical Cancer ..................................................................................................................................................... 10

Lung Cancer .......................................................................................................................................................... 13

Ovarian Cancer ..................................................................................................................................................... 15

Prostate Cancer ..................................................................................................................................................... 18

Head and Neck Cancer.......................................................................................................................................... 21

Skin Cancer ........................................................................................................................................................... 24

My Health Screenings ........................................................................................................................................... 26

Information and Support Groups .......................................................................................................................... 29




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                  Facts on Cancer Screening and Tests
BREAST CANCER
Who is at Risk for Getting Breast Cancer?

1 out of 7 women will have breast cancer during her lifetime.

The chances of getting breast cancer may be different for different women. A
woman’s chance of getting the disease goes up:

      as she gets older

      if breast cancer is in her family (a mother or sister had breast cancer)

      in women who have not given birth, or first childbirth is after age 30

      if she started her period before age 12 or stopped after age 55

      for women who have had benign breast disease, or cancer in the milk duct

      if she has had radiation therapy used to treat Hodgkin's disease before the age of 32

Other risk factors include:

      Being overweight, especially after menopause

      Being inactive (not getting enough exercise or physical activity)

      Eating a high fat diet

      Drinking1 or more alcoholic drinks a day

Breast Cancer Screening Tests
Medical studies show that breast cancer screening can save lives! There are
different kinds of screening tests: breast self-exam (BSE), clinical breast exam
(CBE), mammography, magnetic resonance imaging (MRI), and ultrasound. A
woman’s doctor can help her decide which one is best and how often she
should be screened.

Breast Self-Exam

During a breast self-exam (BSE), a woman checks her own breasts for
changes, such as:

      lumps,

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      changes in breast size or shape,

      nipple discharge, or

      tissue thickening.

   If you notice any of the changes above, tell your doctor right away.

   BSE is easy, free, and may find some cancers but it is not enough.
   Women should also follow their doctor’s advice on getting other
   screening tests.

Clinical Breast Exam

A clinical breast exam (CBE) is a physical exam of the breast done by a
doctor or nurse. Like the self-exam, the CBE should not be the only
screening test women have.



Mammography

Mammography is a breast exam using x-rays. Yearly mammograms greatly
lower the number breast cancer deaths in women over 40.

Ultrasound

Ultrasounds are tests that use sound waves to make pictures of the breast. Breast
ultrasound is often used to look at breast changes that are found during
mammography or a clinical breast exam. Breast ultrasound has been known to
give false positives, so they are usually followed-up with other tests like a
biopsy -- which can be expensive and can cause the patient undue fear and worry.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) gives 3-D pictures of the breast. MRI is expensive and the patient must be
injected with a dye that makes it easier to see the pictures through the machine. Many doctors believe that MRI
is better at finding breast cancers than other screening tests.

Who should be screened? How often?
You and your doctor should work together to decide how often you should have your breasts checked. The
guidelines below can help:




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Women at average risk (no history of breast cancer; no close relatives with breast cancer)

      Clinical breast exam (CBE) every year, beginning at age 25

      Mammography beginning at age 40

      Women should pay attention to any changes in their breasts. Monthly breast self-exam beginning at 20
       years old is optional.

Women with a Family History of Breast Cancer -- one or more close relatives (parent or sister)

      CBE every 3 to 6 months, starting no later than 10 years before the age at which the youngest family
       member was diagnosed with breast cancer

      Mammography every year starting ten years before the age at which the youngest family member was
       diagnosed with breast cancer (but not earlier than age 25 and not later than age 40)

      Talk to your doctor about yearly MRI

      Women should pay attention to any changes in their breasts. Monthly breast self-exam beginning at 20
       years old is optional.

Women Diagnosed with Atypical Hyperplasia or Lobular Carcinoma In Situ

      CBE every 3 to 6 months

      Mammography every year

      Talk to your doctor about yearly MRI

      Women should pay attention to any changes in their breasts. Monthly breast self-exam beginning at 20
       years old is optional.

Women who were treated with Mantle Radiation for Hodgkin's Disease

      CBE every 3 to 6 months beginning no later than 5 years after treatment

      Mammography every year starting 8 years after radiation treatment

      Talk to your doctor about yearly MRI

      Women should pay attention to any changes in their breasts. Monthly breast self-exam beginning at 20
       years old is optional.




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References:

1.    Jemal A, et al. Cancer statistics, 2005. CA Cancer J Clin. 2005;55:10-30.68:208-12. [PubMed Abstract]
2.    Duffy SW, et al. The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish
      counties. Cancer. 2002;95:458-69. [PubMed Abstract]
3.    Thomas DB, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002;94:1445-57.
      [PubMed Abstract]
4.    Semiglazov VF, et al. [Results of a prospective randomized investigation [Russia (St Petersburg)/WHO] to evaluate the
      significance of self-examination for the early detection of breast cancer]. Vopr Onkol. 2003;49:434-41. [PubMed Abstract]
5.    Ellman R, et al. Breast self-examination programs in the trail of early detection of breast caner: ten year findings. Br J Cancer.
      1993. [PubMed Abstract]
6.    Smith RA, et al. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin. 2003;53:141-
      69. [PubMed Abstract]
7.    Humphrey LL, et al. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern
      Med. 2002;137:347-60. [PubMed Abstract]
8.    Berry DA, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353:1784-92.
      [PubMed Abstract]
9.    Osen O, Gotzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet 2001;358:1340-2. [PubMed
      Abstract]
10.   Dershaw DD. Mammographic screening of the high-risk woman. Am J Surg. 2000;180:288-9. [PubMed Abstract]
11.   Dershaw DD, Yahalom J, Petrek JA. Breast carcinoma in women previously treated for Hodgkin disease: mammographic
      evaluation. Radiology. 1992;184:421-3. [PubMed Abstract]
12.   Pisano ED, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med.
      2005;353:1773-83. [PubMed Abstract]
13.   Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast
      US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology. 2002;225:165-75.
      [PubMed Abstract]
14.   Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US—diagnostic yield and
      tumor characteristics. Radiology. 1998;207:191-9. [PubMed Abstract]
15.   Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology
      2001;221:641-9. [PubMed Abstract]
16.   Buchberger W, et al. Incidental findings on sonography of the breast: clinical significance and diagnostic workup. AJR Am J
      Roentgenol. 1999;173:921-7. [PubMed Abstract]
17.   Kriege M, et al. Efficacy of MRI and mammography for breast-cancer screening in women with familial or genetic
      predisposition. N Engl J Med. 2004;351:427-37. [PubMed Abstract]
18.   Leach MO, et al. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of
      breast cancer: a prospective multicenter cohort study (MARIBS). Lancet. 2005;365:1769-78. [PubMed Abstract]
19.   Kuhl CK, Kuhn W, Schild H. Management of women at high risk for breast cancer: New imaging beyond mammography. Breast.
      2005;14:480-6. [PubMed Abstract]
20.   Warner E, Causer PA. MRI surveillance for hereditary breast-cancer risk. Lancet. 2005;365:1747-9. [PubMed Abstract]
21.   CH L. Current status of MRI screening for breast cancer in Radiological Society of North America. Categorical Course in
      Diagnostic Radiology: Breast Imaging 2005.
22.   Menell JH, Dershaw DD, Abramson AF, Brogi E, Liberman L. Determination of presence and extent of pure ductal carcinoma in
      situ by mammography and MRI. Breast J, in press. [PubMed Abstract]




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                  Facts on Cancer Screening and Tests
COLORECTAL CANCER
Colorectal cancer is the second most common cause of cancer death in the US. The average American has about
a six percent chance of getting colorectal cancer in his or her lifetime.

Who is at Risk for Getting Colorectal Cancer?
The chances of getting colorectal cancer may be different for different people. Your chances of getting the
disease go up if:



      your parent, brother or sister had cancer or a colon polyp before
       the age of 60.

      Someone in your family had a rare form of hereditary colon
       cancer called familial adenomatous polyposis (FAP). FAP
       causes hundreds or thousands of polyps in the colon at a very
       early age. These people will almost always go on to develop
       colon cancer by age 40.

      Someone in your family had nonpolyposis colorectal cancer
       (HNPCC), a condition caused by changes in genes. About five
       percent of all colorectal cancers are people who had HNPCC.

      You have had Inflammatory Bowel Disease (ulcerative colitis or Crohn's colitis.) for more than 8 years.

Other risk factors include:

      Being over 50 years old, being overweight, or being inactive

      Eating s diet high in fat and low in fruits and vegetables

      Smoking tobacco

Colorectal Cancer Screening Tests
Screening can find polyps (precancerous lesions) early and prevent deaths. Removing polyps during screening,
called colonoscopy, greatly cuts the chances of getting colorectal cancer.

There are different kinds of screening tests: Your doctor can help you decide which one is best and how often
you should be screened.




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Fecal Occult Blood Test (FOBT)

The fecal occult blood test checks for blood in your feces when you have a bowel movement. Blood in the feces
may be a sign of colorectal cancer or a polyp. If blood is found, your doctor may them order a colonoscopy.

Flexible Sigmoidoscopy

In flexible sigmoidoscopy, your doctor uses a small, flexible tube with a camera to look at the inside of your
rectum and the lower part of your colon (the sigmoid colon). Your doctor may cut out a small piece of tissue
during the exam to look at under a microscope. This is called a biopsy. If the doctor sees polyps, you
should have a colonoscopy to look at the rest of the colon.

Colonoscopy

In colonoscopy, your doctor uses a flexible tube with a camera to look at your rectum and entire colon. The tube
goes into your rectum while you lie on your side. You will get a sedative to sleep during the colonoscopy to
keep you comfortable. This exam finds cancers in the early stages, before signs or symptoms may show. Polyps
or other growths your doctor finds during these exams are usually removed at the time and sent to a lab for
study.

Removing pre-cancer tumors during colonoscopy greatly reduces the chances of getting colorectal cancer.

Computed Tomographic Colonography (CTC), or "Virtual Colonoscopy"

Computed Tomographic Colonography (CTC), also called virtual colonoscopy, uses CT scans to make 3-D
pictures of your colon. Your doctor cannot do a biopsy nor remove polyps during CTC. If your doctor sees
anything abnormal, you will need to have a colonoscopy.

Double Contrast Barium Enema (DCBE)

Double Contrast Barium Enema (DCBE) is an x-ray of the inside of the colon and rectum. DCBE does not pick
up problems as well as the other tests so it is not used often for screening.

Who should be screened? How often?
You and your doctor should work together to decide how often you should have your colon checked. The
guidelines below can help:

People at average risk (People with no symptoms and no personal nor family history of colon polyps)

      colonoscopy every 10 years, starting at age 50

People whose parent, brother, or sister had colon cancer or polyps found after age 60,

      colonoscopy every 10 years, starting at age 50

People whose grandparent, grandchild, uncle, aunt, nephew, niece, or half-sibling had colon cancer

      colonoscopy every 10 years, starting at age 50.

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People whose parent, brother or sister had a cancer or polyp before the age of 60

         colonoscopy at least every five years starting either at age 40, or ten years before the youngest age of the
          family-member's diagnosis (of either colon cancer of premalignant polyps).

A person at high risk with a family history of polyps

         sigmoidoscopy every year starting between the ages of 10 and 15 or earlier if symptoms develop.

People at high risk with a family history of HNPCC

         colonoscopy every year starting between the ages of 20 and 25, or five to ten years before the earliest
          diagnosis in the family -- whichever comes first.

References:

1.    Jemal A, Murray T, Ward E, et al. Cancer Statistics, 2005. CA Cancer J Clin 2005;55:10-30. [PubMed Abstract]
2.    Winawer SJ, Zauber AG, Ho MN, et al: Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 329:1977-
      1981, 1993. [PubMed Abstract]
3.    Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F. Reducing mortality from colorectal cancer
      by screening for fecal occult blood. N Engl J Med 1993;328:1365-1371. [PubMed Abstract]
4.    Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: Effectiveness of biennial screening for fecal occult
      blood. J Natl Cancer Inst 1999;91:434-437. [PubMed Abstract]
5.    Hardcastle JD, Chamberlain JO, Robinson MHE, Moss SM, Amar SS, Balfour TW, James PD, Mangham CM. Randomized
      controlled trial of fecal-occult-blood screening for colorectal cancer. Lancet 1996;348:1472-1477. [PubMed Abstract]
6.    Kronborg O, Fenger C, Olsen J, Jorgenson OD, Sondergaard O. Randomized study of screening for colorectal cancer with fecal-
      occult-blood test. Lancet 1996;348:1467-1471. [PubMed Abstract]
7.    Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, Snover DC, Schuman LM. The effect of fecal occult-blood
      screening on the incidence of colorectal cancer. N Engl J Med 2000;343:1603-1607. [PubMed Abstract]
8.    Selby JV, Friedman GD, Quesenberry CP Jr, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from
      colorectal cancer. N Engl J Med 1992;326:653-657. [PubMed Abstract]
9.    Newcomb PA, Norfleet RG, Storer BE, Surawicz TS, Marcus PM. Screening sigmoidoscopy and colorectal cancer mortality. J
      Natl Cancer Inst 1992;84:1572-1575. [PubMed Abstract]
10.   Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults for
      colorectal cancer. N Engl J Med 2000;343:162-168. [PubMed Abstract]
11.   Imperiale TF, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransohoff DF. Risk of advanced proximal neoplasms in
      asymptomatic adults according to the distal colorectal findings. N Engl J Med 2000;343:169-174. [PubMed Abstract]
12.   Winawer SJ, Stewart E, Zauber AG, Bond JH, Ansel H, Waye JD, Hall D, Hamlin JA, Schapiro M, O'Brien MJ, Sternberg SS,
      Gottlieb LS. A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy. N Engl J Med
      2000;342:1766-1772. [PubMed Abstract]
13.   Fenlon HM, Nunes DP, Schroy III PC, Barish MA, Clarke PD, Ferrucci JT. A comparison of virtual and conventional
      colonoscopy for the detection of colorectal polyps. N Engl J Med 1999;341:1496-1503. [PubMed Abstract]
14.   Pickhardt PJ, Choi JR, Hwang I, Butler JA, Puckett ML, Hildebrandt HA, Wong RK, Nugent PA, Mysliwiec PA, Schindler WR.
      Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med
      2003;349:2191-2200. [PubMed Abstract]
15.   Cotton PB, Durkalski VL, Pineau BC, et al. Computed tomographic colonography (virtual colonoscopy): a multicenter
      comparison with standard colonoscopy for detection of colorectal neoplasia. JAMA 2004;291:1713-1719. [PubMed Abstract]
16.   Rockey D, Paulson E, Niedzwiecki D, et al. Analysis of air contrast barium enema, computed tomographic colonography, and
      colonoscopy: prospective comparison. Lancet 2005;365:305-311. [PubMed Abstract]
17.   Winawer S, Fletcher R, Rex D, Bond J, Burt R, Ferrucci J, Ganiats T, Levin T, Woolf S, Johnson D, Kirk L, Litin S, Simmang C
      for the U.S. Multisociety Task Force On Colorectal Cancer. Colorectal cancer screening and surveillance: clinical guidelines and
      rationale - update based on new evidence. Gastroenterology 2003;124:544-560. [PubMed Abstract]
18.   Smith RA, Cokkinides V, Eyre HJ. American Cancer Society guidelines for the early detection of cancer, 2005. CA Cancer J Clin
      2005;55;31-44. [PubMed Abstract]


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                  Facts on Cancer Screening and Tests
CERVICAL CANCER
Each year, about 13,000 women get cervical cancer in the US. About
4,000 women die from the disease. Cervical cancer usually grows
slowly over many years.

Who is at Risk for Getting Cervical Cancer?
The chances of getting cervical cancer may be different for different
people. The chances of getting the disease go up in women who are:

      sexually active

      infected with the human papilloma virus (HPV). HPV can be
       passed during sex.

Before true cancer cells grow, the tissues of the cervix change. If the patient is not treated, these changes can
grow into the surrounding tissue and become cancer.

Like other cancers, finding it and treating it early can save lives!

Cervical Cancer Screening Tests
A doctor can see cervical changes--called dysplasia, or precancerous changes--on a Pap
Smear or Pap test (or other tests called ThinPrep® or SurePath®). During a Pap test, a
woman lies on her back on an exam table with her knees bent. The doctor or nurse will
insert an instrument called a speculum inside the vagina. The speculum holds the vagina
open so the doctor or nurse can see the cervix. A small brush is used to scrape off cells
from the cervix. The cells are sent to the lab for study.

ThinPrep® or SurePath® cost more than regular Pap tests, but may be better at finding changes. ThinPrep® or
SurePath® can also test for the HPV. This is helpful for women whose Pap results come back positive. Many
abnormal Pap test results may mean the patient has a precancerous condition that never becomes cancer, even if
it is not treated. These results can also mean the patient has a condition that can be treated before it becomes
cancerous.

Who should be screened? How often?
First Pap Test

      About 3 years after a woman’s first sexual intercourse or by the age of 18 -- whichever comes first.

Women Up to Age 30

      Once a year

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Women 30 Years and Older

        Pap test every year

        Women who have had three negative Pap tests may spread out their screening to every 2 to 3 years.

        Pap test plus HPV-DNA test. If both tests are negative, screening should happen every 3 years.

Women of Any Age with a Weakened Immune System (from organ transplant, HIV, or cancer
chemotherapy),women treated with steroids, or women whose mothers took a drug called diethylstilbestrol
(DES) when they were pregnant

        Pap test every year

References:

1.   Jemal A. Murray T, Ward E, et al. Cancer Statistics, 2005. CA Cancer J Clin 2005;55:10-30. [PubMed Abstract]
2.   Sepulveda C, Prado R. Effective cervical cytology screening programs in middle-income countries: the Chilean experience.
     Cancer Detect Prev. 2005;29:405-11. [PubMed Abstract]
3.   Chi DS. Abu-Rustum NR, Hoskins WJ. Cancer of the Cervix. In: Rock JA, Jones HW III, eds. Te Linde's Operative Gynecology,
     9th ed. Philadelphia: Lippincott-Raven 2003.
4.   American Cancer Society (ACS) Cancer Detection Guidelines, revised 1-2004. [PubMed Abstract]
5.   American College of Obstetrics & Gynecology (ACOG) Committee Opinion, number 300 October 2004.
6.   National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology, cervical screening version 1. 2005.
7.   The National Cancer Institute (NCI) guidelines on cervical cancer screening by the US Preventive Services Task Force
     (USPSTF), 2003.




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                     Facts on Cancer Screening and Tests
LUNG CANCER
Lung cancer is the leading cause of cancer death for both men and women. It is also the most preventable.

Who is at Risk for Getting Lung Cancer?
Tobacco users are at greatest risk of getting lung cancer. But being exposed to other lung irritants also puts
people t risk such as second-hand smoke, asbestos, radon, arsenic, vinyl chloride, coal, and uranium.

Lung Cancer Screening Tests
Early detection lung cancer screening with low-dose CT scans lets doctors find lung cancers early, when they
are small and still very curable. Over 80% of patients who have lung cancer found by CT screening can be
cured. When the lung cancer is found early, and the patient receives treatment right away, the cure rate rises to
92%. Without early detection screening, over 95% of lung cancer patients die from their lung cancer, usually
within a few years of when the cancer is found.

References:

1.   Bach PB. Lung cancer screening. [Journal Article] Journal of the National Comprehensive Cancer Network. 6(3):271-5, 2008
     Mar.
2.   Owonikoko TK. Ramalingam S. Small cell lung cancer in elderly patients: a review. [Review] [89 refs] [Journal Article. Review]
     Journal of the National Comprehensive Cancer Network. 6(3):333-44, 2008 Mar.
3.   Coche E. Screening for lung cancer with low-dose CT. [Review] [32 refs] [Journal Article. Review] Jbr-Btr: Organe de la Societe
     Royale Belge de Radiologie. 91(1):1-5, 2008 Jan-Feb.
4.   Risch A. Plass C. Lung cancer epigenetics and genetics. [Review] [107 refs] [Journal Article. Research Support, Non-U.S. Gov't.
     Review] International Journal of Cancer. 123(1):1-7, 2008 Jul 1.




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                 Facts on Cancer Screening and Tests
OVARIAN CANCER
Ovarian cancer is the most common cause of female cancer deaths. About one in 70 women will get ovarian
cancer in her lifetime.

Who is at Risk for Getting Ovarian Cancer?
The chances of getting ovarian cancer may be different for different women. The chances of getting the disease
go up in women:

      as she gets older

      who are infertile (not being able to get pregnant)

      who have had endometriosis (tissue from the lining of the uterus grows outside of the uterus)

      who had took hormone replacement drugs after menopause

      who had in vitro fertilization (studies have not proven this)

      who were diagnosed with breast cancer at age 41 or older and a) no family history of breast or ovarian
       cancer or b) no Ashkenazi Jewish heritage (Eastern European Jewish).

Some women have a higher risk. These women:

      have a mother, sister, or daughter with ovarian cancer.

      had breast cancer before age 40.

      had breast cancer found before age 50, and one or more close relatives diagnosed with breast or ovarian
       cancer at any age.

      have two or more close relatives diagnosed with breast cancer before age 50 or with ovarian cancer
       diagnosed at any age.

      are Ashkenazi Jewish and a had breast cancer before age 50.

      are Ashkenazi Jewish and had a close relative diagnosed with breast cancer before age 50 or with
       ovarian cancer at any age.

Some women have a higher risk because of genetic changes. Doctors may suggest to women in this group to
consider genetic counseling and testing before getting screened for ovarian cancer. This group includes women
with any of the following:

      Presence of a BRCA1 or BRCA2 change in gene make-up.

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        Hereditary cancer syndrome.

Ovarian Cancer Screening Tests
For women at average risk of getting ovarian cancer, screening is not recommended. Women should have a
pelvic exam (an exam of the reproductive parts: vagina, cervix, uterus) each year by her OB/GYN or primary
care doctor.

If a doctor orders a screening, the following are common tests used today:

CA-125 Blood Test

CA-125 is a protein found in the blood of most women with ovarian cancers

Transvaginal Ultrasound

Ultrasound, also called ultrasonography, is a test that uses sound waves to make pictures of the vagina and
ovaries.

CA-125 Blood Test and Transvaginal Ultrasound Combo

Doctors may suggest that a woman at risk have both tests. Though this screening is better at finding cancers, it
may also cause more false positives, which adds undue worry for a patient.

Who should be screened? How often?
Women at Higher Risk

There is no proof that screening decreases the number of deaths from ovarian cancer. All women should talk to
their doctor about their risk and together decide if they should be screened or have genetic counseling.

Women at Higher Risk from their Gene Makeup and Heredity

There is no proof that screening decreases the number of deaths from ovarian cancer. Women who are found to
have gene changes should begin screenings between ages 30 and 40. Women at high inherited risk may also
consider having surgery to remove the ovaries and fallopian tubes after her childbearing years.

References:

1.   Myers E. Huh WK. Wright JD. Smith JS. The current and future role of screening in the era of HPV vaccination. Gynecologic
     Oncology. 109(2 Suppl):S31-9, 2008 May.
2.   Hogdall EV. Christensen L. Hogdall CK. Frederiksen K. Gayther S. Blaakaer J. Jacobs IJ. Kjaer SK. Distribution of p53
     expression in tissue from 774 Danish ovarian tumour patients and its prognostic significance in ovarian carcinomas. APMIS.
     116(5):400-9, 2008 May.
3.   Hogdall EV. Christensen L. Hogdall CK. Frederiksen K. Gayther S. Blaakaer J. Jacobs IJ. Kjaer SK. Distribution of p53
     expression in tissue from 774 Danish ovarian tumour patients and its prognostic significance in ovarian carcinomas. APMIS.
     116(5):400-9, 2008 May.
4.   Chobanian N. Dietrich CS 3rd. Ovarian cancer. Surgical Clinics of North America. 88(2):285-99, vi, 2008 Apr.




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                  Facts on Cancer Screening and Tests
PROSTATE CANCER
More than 230,000 US men had prostate cancer in 2005. It is the most common
cancer and the second leading cause of cancer death among American men.

Who is at Risk for Getting Prostate Cancer?
The chances of getting prostate cancer may be different for different men. Certain
factors make a man’s risk of prostate cancer go up, such as:

      Being over age 50

      Men who have a father or brothers who have had prostate cancer

      Being African American

      Diet high in animal fat

Prostate Cancer Screening Tests
Right now, no studies have shown that men who have regular prostate cancer screening live longer than men
who do not. All men should talk to their doctor about when and if they should be screened.

Below are tests that doctors may order for prostate cancer screening:

Digital Rectal Exam (DRE)

A doctor inserts a gloved finger into the rectum to feel for lumps in the prostate.

Protein Specific Blood Test (PSA)

A blood test detects the amount of a protein called prostate-specific antigen (PSA) circulating in a man's blood.

Men who have a common, noncancerous condition called benign prostatic hyperplasia (BPH) may also have
elevated PSA levels.

Doctors may use DRE and PSA as the first tests to find prostate cancer, but neither test alone or together is
enough to diagnose prostate cancer -- for this, a doctor must do a biopsy of the prostate.

Who should be screened? How often?
For most men

          PSA and a DRE should begin at age 50


                                                       - 18 -                         www.HEALingOurCommunities.org
In high-risk groups such as African-American men and men with a family history of prostate cancer

             PSA and a DRE should begin at age 40

     If a man screened with DRE receives an abnormal result, regardless of PSA level, he should be referred to a
     urologist for further testing.

References:

1.  Prostate-specific antigen (PSA) best practice policy. American Urological Association (AUA). Oncology, 14: 267, 2000.
    [PubMed Abstract]
2. Smith, RA, Cokkinides, V., Eyre, HJ and American Cancer Society: American Cancer Society guidelines for the early detection
    of cancer, 2004. CA Cancer J Clin, 54: 41, 2004. [PubMed Abstract]
3. National Comprehensive Cancer Network: Prostate Cancer. NCCN Clinical Practice Guidelines in Oncology-version 1.2004.
4. U.S. Preventive Services Task Force: Screening for Prostate Cancer: Recommendations and Rationale. Rockville, Maryland:
    Agency for Healthcare Research and Quality, 2002.
5. Screening for prostate cancer. American College of Physicians. Ann Intern Med, 126: 480, 1997. [PubMed Abstract]
6. Catalona, WJ, Smith, DS, Ratliff, TL, Dodds, KM, Coplen, DE, Yuan, JJ et al: Measurement of prostate-specific antigen in serum
    as a screening test for prostate cancer. N Engl J Med, 324: 1156, 1991. [PubMed Abstract]
7. Horninger W, Berger A, Pelzer A, Klocker H, Oberaigner W, Schonitzer D, Severi G, Robertson C, Boyle P, Bartsch G.
    Screening for prostate cancer: updated experience from the Tyrol study. Can J Urol, 12 Suppl 1: 7, 2005. [PubMed Abstract]
8. Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S, Spangberg A, Busch C, Nordling S, Garmo H,
    Palmgren J, Adami HO, Norlen BJ, Johansson JE: Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl
    J Med, 352: 1977, 2005. [PubMed Abstract]
9. Krumholtz, J. S., Carvalhal, GF, Ramos, CG, Smith, DS, Thorson, P., Yan, Y. et al: Prostate-specific antigen cutoff of 2.6 ng/mL
    for prostate cancer screening is associated with favorable pathologic tumor features. Urology, 60: 469, 2002. [PubMed Abstract]
10. D'Amico, AV, Chen, MH, Roehl, KA and Catalona, WJ: Preoperative PSA velocity and the risk of death from prostate cancer
    after radical prostatectomy. N\Engl J Med, 351: 125, 2004. [PubMed Abstract]




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                                           - 20 -                   www.HEALingOurCommunities.org
                  Facts on Cancer Screening and Tests
HEAD AND NECK CANCER
Head and neck cancer includes tumors found in the nose, sinuses, mouth, throat, larynx (voice box), tongue, and
thyroid.

About 30,000 Americans will be diagnosed with cancer of the mouth and throat this year. These cancers will
cause about 8,000 deaths. On average, only half of those with the disease will survive more than five years.

Who is at Risk for Getting Prostate Cancer?
The two biggest risk factors for head and neck cancer are tobacco (chewing and smoking) and alcohol use.
Using both increases the risk even more.

Some people are at higher risk for head and neck cancer, such as people:

          who have been treated for a head and neck cancer before

          with a pre-cancer lesion (white or red) or sore in the mouth

          lump or bump in the neck or mouth that lasts for more than 2 weeks

          with the following diseases and syndromes:

               o Fanconi's anemia - a rare, inherited disease in which the bone marrow does not work
                 properly

               o Li Fraumeni syndrome - a rare, inherited disease that greatly increases the risk of getting
                 several types of cancer

               o Plummer-Vinson syndrome - a disorder that causes long-term iron deficiency anemia, which
                 makes it difficult to swallow.

Other risk factors are:

          Excessive exposure to sunlight (risk for lip cancer)

          Increased age

          Gender (mouth cancer strikes men twice as often as it does women)

          Race (mouth cancer happens more in African Americans than in whites)

Head and Neck Cancer Screening Tests
Most dentists check the neck, throat, tongue, tonsils, and mouth as part of routine dental exams. There have
been no studies that show that these exams decrease the number of deaths from mouth cancer.
                                                      - 21 -                         www.HEALingOurCommunities.org
Right now, there are no official screening guidelines or blood or saliva tests for head and neck cancer.

Who should be screened? How often?
The average person should have a physical exam of the head, neck, and mouth by their doctor, and a regular
dental check up each year.

High Risk Patients

High risk patients who have been cured of a head and neck cancer, should follow the guidelines below:

             Physical exam:

                 o Year One: every 1 to 3 months

                 o Year Two: every 2 to 4 months

                 o Years Three to Five: every 4 to 6 months

                 o Year Five and beyond: every 6 to 12 months

             Chest x-ray

                 o Every year

A person who has had radiation treatment of the thyroid, should have a TSH thyroid function test each year.

High-risk patients with a pre-cancer lesion in the mouth that cannot be removed with surgery should follow the
same guidelines above. Their doctor may order a biopsy if they see any changes in the lesions.

References:

1.   Prout MN. Sidari JN. Witzburg RA. Grillone GA. Vaughan CW. Head and neck cancer screening among 4611 tobacco users
     older than forty years. Otolaryngology - Head & Neck Surgery. 116(2):201-8, 1997 Feb.
2.   Prout MN. Morris SJ. Witzburg RA. Hurley C. Chatterjee S. A multidisciplinary educational program to promote head and neck
     cancer screening. Journal of Cancer Education. 7(2):139-46, 1992.
3.   Specenier PM. Vermorken JB. Recurrent head and neck cancer: current treatment and future prospects. Expert Review of
     Anticancer Therapy. 8(3):375-91, 2008 Mar.
4.   Fischer DJ. Klasser GD. Epstein JB. Cancer and orofacial pain. Oral & Maxillofacial Surgery Clinics of North America.
     20(2):287-301, vii, 2008 May.
5.   Ernster JA. Sciotto CG. O'Brien MM. Finch JL. Robinson LJ. Willson T. Mathews M. Rising incidence of oropharyngeal cancer
     and the role of oncogenic human papilloma virus. Laryngoscope. 117(12):2115-28, 2007 Dec.




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                                        - 23 -                   www.HEALingOurCommunities.org
                    Facts on Cancer Screening and Tests
SKIN CANCER
Each year more than a million people in the US get skin cancer. The good news is, most skin cancers can be
found and cured early.
Melanoma, the most serious form of skin cancer, is not as common as other types, but the number of people
with this type is increasing. Melanoma can be deadly, so early detection and treatment is important.

Who is at Risk for Getting Skin Cancer?
The chances of getting skin cancer may be different for different people. The chance of getting skin cancer goes
in people who:

             have sun-sensitive or very light skin (burn easily)
             have two or more family members who have had skin cancer or melanoma
             had a severe sun burn before age 18
             use tanning beds
             have many odd-shaped or colored moles
             have many precancerous lesions (sores)-- grey to pink colored scaly patches of skin on sun-exposed
              areas of the body

Skin Cancer Screening
Most doctors do not recommend routine skin cancer screening. People with a history of melanoma or who are at
risk for skin cancer should have a dermatologist (doctor who specializes in the skin) check their skin.
References:

1.  Cancer Facts & Figures 2005. Atlanta: American Cancer Society; 2005.
2.  Christenson LJ, Borrowman TA, Vachon CM, et al. Incidence of basal cell and squamous cell carcinomas in a population younger
    than 40 years. JAMA 2005;294(6):681-90. [PubMed Abstract]
3. Lewis K. Nonmelanoma Skin Cancer Mortality. Arch Dermatol 2004;140:837-42. [PubMed Abstract]
4. Welch HG, Woloshin S, Schwartz LM. Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ-
    Epub 2005:1-4. 331:481-485. [PubMed Abstract]
5. Helfand M, Mahon SM, Eden KB, Frame PS, Orleans CT. Screening for skin cancer. Am J Prev Med 2001;20(3 Suppl):47-58.
    [PubMed Abstract]
6. Gandini, F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, Melchi CF. Meta-analysis of risk factors for cutaneous melanoma: I.
    Common and atypical naevi. Eur J Cancer. 2005 ;41:28-44. [PubMed Abstract]
7. Kefford RF, Newton Bishop JA, Bergman W, Tucker MA. Counseling and DNA testing for individuals perceived to be
    genetically predisposed to melanoma: A consensus statement of the Melanoma Genetics Consortium. J Clin Oncol.
    1999;17(10):3245-518. [PubMed Abstract]
8. Kefford R, Bishop JN, Tucker M, et al. Genetic testing for melanoma. Lancet Oncol. 2002 3:653-654. [PubMed Abstract]
9. USPSTF Skin Cancer Screening Recommendations
10. American Cancer Society's Cancer Detection Guidelines NCCN Clinical Practice Guidelines: Melanoma


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MY HEALTH SCREENINGS
If you answer YES to any question on the left, ask your doctor about getting the test on the right. Put a  by
the questions when you answer “yes.”
   Have you ever had breast cancer?
   Did you give birth to your first child after age 30?
   Do you have a mother or sister who has ever had breast cancer?
                                                                                       Mammogram
   Did you start your period before age 12?
   Are you 50 years old or older?
   Did your parent, brother, or sister have cancer or colon polyps before
    they were 50?                                                                      Colonoscopy
   Have you had inflammatory Bowel Disease (ulcerative colitis or
    Crohn’s colitis)?
   Do you have a white or red lesion or sore in your mouth?
   Do you have a lump or bump on your neck?
   Do you smoke or chew tobacco?
                                                                                 Head and Neck Exam
   Do you drink alcohol?
   Are you a woman 18 years old or older?
   Have you had sex?                                                                     Pap Test
   Have you ever had human papilloma virus (HPV)?
   Are you a man over age 50?
   Do you have a father or brother who has had prostate cancer?                       Prostate Test
   Are you African American?
   Do you have very light skin that burns easily in the sun?
   Do you have 2 or more family members who have had skin cancer?
   Do you use tanning beds?
                                                                                        Skin Check
   Do you have many odd-shaped or colored moles?




                                                      - 26 -                         www.HEALingOurCommunities.org
              My Appointments

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                   - 27 -           www.HEALingOurCommunities.org
              My Appointments

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                   - 28 -           www.HEALingOurCommunities.org
INFORMATION AND SUPPORT GROUPS


Breast Cancer                                       Head and Neck Cancer

      Breastcancer.org                                   Support for People with Oral Head and
       http://www.breastcancer.org                         Neck Cancer
      The Susan G Komen Breast Cancer                     Phone: 1-800-377-0928
       Foundation                                          www.spohnc.org
       Phone: 1-800-462-9273                              National Cancer Institute
       www.komen.org                                       www.cancer.gov
                                                          Yul Brynner Head & Neck Foundation
Lung Cancer                                                www.yulbrennerfoundation.org

      American Lung Association                    Ovarian Cancer
       Phone: 1-800-548-8252
       www.lungusa.org                                    Ovarian Cancer National Alliance
      Lung Cancer Alliance                                www.ovariancancer.org
       Phone: 1-800-298-24336                             CDC
       www.lungcanceralliance.org                          www.cdc.gov/cancer/ovarian

Colon Cancer                                        Cervical Cancer

      Colorectal Cancer Information                      National Cervical Cancer Coalition
       www.colorectalcancerinfor.com                       www.nccc-online.org
      Colon Cancer Alliance                              National Cancer Institute
       www.ccalliance.org                                  www.cancer.gov

Rectal Cancer                                       Cancer Support/Early Detection/Screening
                                                        Georgia Cancer Foundation
      Colorectal Cancer Information                      www.gacancerfoundation.org
      www.colorectalcancerinfo.com                     Health Education, Assessment and
      Colon Cancer Alliance                              Leadership
       www.ccalliance.org                                 www.HEALingOurCommunities.org
Prostate Cancer

      Prostate Cancer Foundation
       Phone: 1-800-757-CURE (2873)
       www.prostatecancerfoundation.org
      Prostate Cancer Institute
       Phone: 1-866-469-7733
       www.prostate-cancer-institute.org
      Georgia Prostate Cancer Coalition
       www.georgiapcc.org



                                           - 29 -                          www.HEALingOurCommunities.org
          Health Education,
          Assessment and
          Leadership



ROUND TABLE DISCUSSION
       Saturday,
   September 13, 2008
       10:00 AM
    Sign Up Now!
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