Prevention in Plain Language

Often, an article in the paper or a story on the national news will present a lot of great information about cancer prevention. Sometimes, the information can be confusing, and viewers might have a difficult time pulling out the details in the story that apply to their daily lives in real time. New diets and fitness routines can seem too complicated to begin or maintain, and medical research stories don't make it clear how the new findings apply to individuals' daily lives, so it becomes easy to dismiss the information entirely.

To help you navigate the sometimes confusing messages we hear in the media, we've asked our Director of Cancer Prevention and Outreach, Casey Shelor,to answer a few questions for us. Casey is one of our Certified Health Education Specialists who work in the community of Northwest Arkansas providing education and information in group settings and to individuals.

Q: Recently, reports have shown that more young people are being diagnosed with skin cancer than in previous years. What is causing that trend, and how can it be reversed?

A: Most young people don't equate tanned skin with damaged skin, but that's what is actually is. Dr. Bob Burns, PhD in the Department of Neurobiology and Developmental Sciences at the UAMS College of Medicine explains:

"All skin cancers are caused by unprotected exposure to ultraviolet radiation. Research has proven that the cause of skin cancers is not necessarily related to a lifetime of unprotected exposure to UV radiation, but to unprotected exposure such as sunburns or tanning booth exposures in early childhood/adolescent years. Unprotected exposure in the younger years not only causes the development of skin cancers... these skin cancers develop [faster]."

Avoiding unprotected exposure to UV radiation, both natural and mad-made, would reverse the upward trend of skin malignancies in younger people.

Q: Does ending a smoking habit really make a difference for people who have been smoking for decades? 

A: Absolutely. The benefits of quitting smoking (even if you have smoked the majority of your life) can be seen almost immediately - within 20 minutes! According to the American Cancer Society, after you quit smoking the following are benefits you will see over time:

• 20 minutes after quitting: Your heart rate and blood pressure drop.
• 12 hours after quitting: Your carbon monoxide level in your blood returns to normal.
• 2 weeks - 3 months after quitting: Your circulation improves and lung function increases. 
• 1-9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) start to regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs and reduce risk of infection.
• 1 year after quitting: The excess risk of coronary heart disease is cut to half that of a continuing smoker. 
• 5 years after quitting: Risk of cancer of the mouth, throat, esophagus, and bladder are cut in half. Cervical cancer risk falls to that of a non-smoker. Stroke risk can fall to that of a non-smoker after 2-5 years. 
• 10 years after quitting: The risk of dying from lung cancer is about half that of a person who is still smoking. The risk of cancer of the larynx (voice box) and pancreas decreases. 
• 15 years after quitting: The risk of coronary heart disease is the same as that of a non-smoker.

No matter how long you have smoked - 1 year or 50 years - it is never too late to quit. You will see benefits for years to come!

Q: The HPV vaccine is supposed to prevent cervical and other cancers caused by the sexually-transmitted Human Papillomavirus (HPV). But if my children are not sexually active, do they still need to have the vaccine?

A: I would definitely recommend the vaccination to any young female or male. It is actually recommended that to receive the maxiumum benefit from the HPV vaccination, an individual should complete all three doses before sexual activity begins.

The vaccination protects against the types of HPV that cause most cervical cancers. It can be administered between the ages of 9 and 26 years, but the recommended age for receiving the vaccination is 11 or 12 years of age.

Q: If you were recommending just one thing people could do to reduce their risk of being diagnosed with cancer, what would it be? 

A: I would urge people to quit, or never start, using tobacco products. According to the American Cancer Society, tobacco use is responsible for most cases of lung cancer and it increases the risk for cancers of the mouth, lips, nasal cavity (nose) and sinuses, larynx (voice box), throat, esophagus, stomach, pancreas, kidneys, bladder, uterus, cervix, colon/rectum, ovaries, and acute myeloid leukemia.

Cancer can not only increase the risk of being diagnosed with cancer, but is also responsible for at least 30% of all cancer deaths and 87% of lung cancer deaths.


Thanks to Casey for all this great information! Share your cancer prevention-related questions with us and we will post another Q & A in the future based on your questions.

5 Minutes with a Dermatologist

May is Skin Cancer Awareness Month, and we've been sharing information all month about skin cancer and sun safety. Many local dermatologists participated in our free skin cancer screening in April, including Dr. Chris Schach and Dr. Eric Stewart of Ozark Dermatology Clinic. We thought you might want to know the answers to a few questions we recently asked their staff - which also includes Dr. Kevin St. Clair, Dr. Robert Brown, and Physician's Assistants Robert Stevens and Joshua Matthews. Feel free to post your own questions in the comments section at the end of the post.

Question: How have your cases changed over the last 10 years with respect to the skin cancer you are seeing?

Answer: Overall, the rate of nonmelanoma skin cancer (primary basal cell and squamous cell carcinomas) has remained about the same. As the baby boomer generation continues to age, however, we are seeing an increased number of nonmelanoma skin cancer in that population. The main concerning change that we have seen is the increased rate of melanoma in younger and younger women. It is not unusual to see malignant melanoma now in women in their late 20s or early 30s. Hopefully, increased awareness of measures to take to prevent sunburn and minimize sun exposure will pay off over time with decreasing rates of all types of skin cancer.


Question: There has been a lot in the news about the danger of tanning beds. Is any indoor tanning safe? What about outdoor tanning - is any level of sun exposure okay?

Answer: There are many efforts underway at the state level to regulate tanning bed use and to prevent minors from using or abusing tanning beds. If the skin darkens in response to exposure to ultraviolet radiation, whether the source is sunlight or a tanning bed, this does result in damage to the skin. This not only increases skin cancer risk, but also the risk of premature aging of the skin. Despite advertising to the contrary by the tanning bed industry, there is no such thing as a "safe tan." There are only degrees of injury. The only tanning that would be considered safe is the spray-on variety where no ultraviolet radiation is used at all. Of course, it is not necessary to avoid sunlight - only avoid sunburn and minimize your overall exposure.

Question: What should we look for in a sunscreen?

Answer: As of June 2012*, the FDA is changing labeling requirements for sunscreen. The new guidelines will include a comment addressing whether or not the sunscreen is "broad spectrum". If the sunscreen product is broad spectrum, this will imply that it provides UVA protection in addition to UVB protection. The Sun Protection Factor, or SPF, which has been used to label sunscreens for many years, implies only the degree of protection against UVB radiation. If a product is considered broad spectrum, a 4-star labeling system will be employed to give consumers some idea of the degree of UVA protection the product provides, with 1 being relatively less protection, and 4 being the maximum.

Another new requirement will be labeling to indicate whether the product is water resistant for 40 minutes or water resistant for up to 80 minutes. Claims of being "waterproof" will no longer be allowed. In my opinion, the best overall sunscreens are titanium dioxide and zinc oxide, which are now available in small enough particles that the sunscreen can be rubbed in without leaving a white film.

*the new label requirements have been delayed by six months.

Question: If the sun is not out, do I need to wear sunscreen?

Answer: Yes, because even though it does not feel as warm and it is not as bright if it is a cloudy day, a significant proportion of ultraviolet radiation will penetrate through clouds and can still cause sunburn. In addition, quite a bit of ultraviolet radiation, especially UVA, can be reflected and scattered, and this is why many people have noticed that one can sunburn even standing under a tree or in a shaded area.

In the News: Sunscreens and Vaccines

May is Skin Cancer Awareness Month. Since we shared information recently on skin cancer awareness and prevention, we're sharing some related but unique information this week that has recently made the news.

New Sunscreen Labels

In 2009 the U.S. Food and Drug Administration approved new labeling for sunscreen products that will finally go into effect next month. There have always been guidelines in place, but they were adopted on a voluntary basis - which meant many companies didn't adopt them at all. Using terms such as "All Day Protection" and "Waterproof" were not only misleading, they were downright inaccurate. The new guidelines are mandatory.

Here are the major changes in labeling that will help consumers buy exactly what they need, and know exactly what they're getting:

Sunblocks: No product on the market today can completely shield your skin from the sun. For this reason, sunscreens will no longer be labeled as "sunblock".

SPF level: A sun protection factor (SPF) of 15 or more means the product lowers the risk of skin cancer and aging. For SPFs from 2-14, this is not the case. Those products prevent sunburn at best. Sunscreen labels will have to be clear about how much SPF they provide - and whether they actually reduce your risk of developing skin cancer and curb visible aging or just prevent sunburns. The highest level of SPF allowed with the new guidelines will be 50.

One common misunderstandings that lingers today is that the higher the SPF number on a bottle of sunscreen, the better. In truth, a product with a number above 30 really doesn't add enough additional protection to make it worthwhile. That said - you should always choose a sunscreen with an SPF of at least 15.

Broad Spectrum: To be labeled "broad spectrum," sunscreens must provide equal protection against the sun's two types of radiation: UVB and UVA. Both types can lead to cancer - but UVA gives you more wrinkles and UVB causes sunburns.

"Waterproof" and "sweatproof" claims will disappear . Sunscreens can only say how long they offer water resistant protection. And, the company marketing the products must be able to back up their claims with text results.

Instant protection: Sunscreens can't say they provide "instant protection" or protect skin for more than two hours unless the FDA approves the claims for the specific sunscreen in question.

There is a 2-2-2 rule that goes hand in hand with these new requirements, even though it's been around a while:

2 tablespoons. Use at least this much sunscreen on each part of your body.This is about the size of a golf ball. Rub it in until it disappears.
2 hours. That’s how often you should reapply it. Evaluate and apply more often if you're involved in active water activities such as skiing.
2 years. That’s how long you should keep it. The ingredients lose their effectiveness after 2 years. Be sure to check expiration dates if you find overstock sunscreens for sale at thrift stores.

Melanoma Vaccine

Recently, The Mayo Clinic announced that their researchers are working on a melanoma vaccine to combat skin cancer. Melanoma is the most deadly form of skin cancer, with the major risk factor being exposure to UV light. Incidence rates continue to rise, with the largest increase being seen in young women.

The research has been done on mice, using a genetic combination of human DNA from melanoma cells and a cousin of the rabies virus. In early studies, 60 percent of the mice with tumors were cured in fewer than three months with minimal side effects. Human clinical trials related to this research aren't anticipated for a few more years, but the results look very promising. More information on this research can be found in the story originally shared by Mayo Clinic here.

Slip, Slop, Slap, Wrap!

It's easy to get complacent about being outside in the sunshine - especially during the cooler seasons and in the early part of summer when the sun's rays aren't especially hot. But you can get a sunburn any time of the year, and therefore set yourself up for a potential skin cancer diagnosis in the future.

Sometimes it's assumed that a lot of exposure all at once is the most dangerous thing for you. While it's true that spending several unprotected hours in the sun can result in a red, stinging burn, lots of short periods of exposure can cause just as much damage even if your skin doesn't burn. The American Cancer Society has come up with a catch phrase we use in schools when we're providing sun-safety education: "Slip, Slop, Slap and Wrap!"

• Slip on a shirt.
• Slop on sunscreen.
• Slap on a hat.
• Wrap on sunglasses to protect the eyes and sensitive skin around them.

SLIP:
When it comes to clothes, longer is better. Longer sleeves and longer pants or skirts protect more of your skin from the sun. That may seem like common sense, but you might be surprised to learn that darker colors offer more protection than light ones. It's often thought that lighter colors are better because they will reflect the sunlight - but light reflection doesn't keep you from getting hit with those burning UV rays. This goes for other shade-providing items such as sun canopies and umbrellas as well. Don't assume that shade = sunburn protection! Pay attention to the weave of fabrics - the tighter the weave, the better protected you are. And while a t-shirt over your swimsuit may cover a few things you'd like to hide, it won't hide you from the sun! Wet fabric offers less protection than dry.

SLOP: 
There are a lot of things to consider when choosing sunscreen. In fact, it can be confusing at times and you can end up being less protected than you thought. Many groups, including the American Academy of Dermatology, recommend products with a sun protection factor (SPF) of at least 30. The SPF number represents the level of protection against UVB rays provided by the sunscreen – a higher number means more protection. That said, the percentage of increased protection changes only 2% between SPF 30 and SPF 100. (97% vs. 99%) so if you're looking at a big price difference, it's fine to stay with the 30.

When using an SPF 30 sunscreen and applying it thickly, you can count one minute of UVB rays for each 30 minutes you spend in the sun. So, one hour in the sun wearing SPF 30 sunscreen is the same as spending two  minutes totally unprotected. However, many people do not apply a thick enough layer of sunscreen, so the actual protection they get is less. Lay it on thick, and try to do so at least 30 minutes before actually going out in the sun to let the product soak in well before you start to sweat or get it wet. To be sure you use the right amount, fill your palm to cover the arms, legs, neck, and face of the average adult.

Pay special attention to areas on your body that are not protected by clothing: the backs of hands, ears, face and legs. Don't forget the tops of your feet if you're wearing sandals! For best results, most sunscreens must be reapplied at least every two hours and even more often if you are swimming or sweating. Products labeled "waterproof" may provide protection for at least 80 minutes even when you are swimming or sweating. Products that are "water resistant" may protect for only 40 minutes. And drying off with a towel will probably rub it off, so be sure to reapply after you take a dip.

SLAP:
All hats are not created equal when it comes to sun protection. A hat with at least a 2- to 3-inch brim all around is ideal because it protects areas such as the ears, eyes, forehead, nose, and scalp that are often exposed to intense sun. A shade cap (which looks like a baseball cap but has fabric draping down the sides and back) is also a good choice, and will provide more protection for the neck.A traditional baseball cap can protect the front and top of the head but not the neck or the ears, where skin cancers commonly develop. Straw hats are not as protective as hats made of tightly woven fabric.

WRAP:
UV-blocking sunglasses are important for protecting the delicate skin around the eyes, as well as the eyes themselves. Research has shown that long hours in the sun without protecting your eyes increase your chances of developing eye disease.

The ideal sunglasses do not have to be expensive, but they should block 99% to 100% of UVA and UVB radiation. Be sure to check the label before you purchase. Labels that say "UV absorption up to 400 nm" or "Meets ANSI UV Requirements" mean the glasses block at least 99% of UV rays. Those labeled "cosmetic" block about 70% of UV rays. If there is no label, don't assume the sunglasses provide any UV protection.
Just as with the light vs. dark fabric surprise, you may be surprised to know that darker glasses are not necessarily better. UV protection comes from an invisible chemical applied to the lenses, not from the color or darkness of the lenses. Look for an ANSI label.

Large-framed and wraparound sunglasses are more likely to protect your eyes from light coming in from different angles and therefore protect the skin and your eye itself better. Don't forget the kids! Children need smaller versions of real, protective adult sunglasses – not toy sunglasses.They are more expensive, but they're worth it.

All this information and more can be found at the American Cancer Society's website. Including a Sun Safety Quiz to let you test what you've learned. Skin cancer is definitely preventable. Stay safe this summer and have fun for many years to come!

Cancer Screenings for Everyone!

We know you'd probably rather have ice cream for everyone. Or, a half-day off on Fridays. But today we're going to tell you how important it is to do the work on your end to prevent cancer, or at least detect it in early stages. The earlier it's diagnosed, the better the chance for survival.

For people having periodic health examinations, a cancer related checkup, beginning at age 20, should include health counseling and, depending on a person's age, might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, and ovaries or testes as well as for some non-malignant diseases. Cancer Screening Guidelines are recommended by the American Cancer Society as outlined:

Colorectal Cancer Screening

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below. The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you. Talk to your doctor about which test is best for you.

• Flexible sigmoidoscopy every 5 years*
• Colonoscopy every 10 years
• Double contrast barium enema every 5 years*
• CT colonography (virtual colonoscopy) every 5 years*
• Fecal occult blood test (FOBT) every year*,**
• Fecal immunochemical test (FIT) every year*,**
• Stool DNA test (sDNA) interval uncertain*

*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.

Breast Cancer Screening

Age 20-39:
Clinical Breast Examination (CBE) by a healthcare professional every three years.
Breast Self-Exam (BSE) monthly. 

Age 40 and Over:
Yearly Mammogram and Clinical Breast Examination (CBE) by a healthcare professional, near the time of the mammogram.
Report any breast changes to your doctor or nurse.

Women at High Risk:
Talk with your doctor about starting earlier, and about the possible benefit of breast MRI or ultrasound in addition to mammograms and CBE.

Cervical Cancer Screening:

Yearly PAP test to begin about 3 years after you first have sex, or by age 21, whichever is earlier.
PAP test should be done annually.

Skin Cancer Screening:
Become familiar with any moles, freckles or other spots on your skin. Use mirrors or have a family member or close friend look at areas you can't see (ears, scalp, lower back).
Check on skin changes once a month.
Show any suspicious or changing areas to your doctor.
Have a healthcare professional perform a skin cancer screening every three years for ages 20-39 and every year for ages 40 and over.

Prostate Cancer Screening:
Men with an average risk of prostate cancer should be offered prostate screening tests - the prostate specific antigen (PSA) blood test and the digital rectal exam (DRE) - beginning at age 50.
    For men with a higher than average risk of prostate cancer, screening is recommended starting at age 45. This includes African-American men and men with at least one first-degree relative with prostate cancer that was diganosed before age 65. (First-degree relatives include fathers, brothers, and sons.)
    For men with markedly higher risk of prostate cancer, screening is recommended starting at age 40. "Markedly higher risk" means that several first-degree relatives were diagnosed with prostate cancer early in life.

These cancer screening guildelines are recommended by the American Cancer Society for those people at average risk for cancer (unless otherwise specified) and without any specific symptoms.

For more information, call Sandy Prince, Certified Health Education Specialist, at 479-361-5847.

Here Comes the Sun!!

It's not too early to talk about sun safety, especially since we've seen a few pink arms and faces around the office today after a sunny weekend. Additionally, there was this news today about a higher rate of melanoma being diagnosed in "wealthy white women". Obviously, the people who need to hear our message of sunscreen, hats and shade most are not hearing it - or they're ignoring it. We still have work to do in that area.

But this week we're more interested in being aware of signs of past sun transgressions. Most of us already know that too much sun can damage our skin. In fact, any amount of sun causes damage, with the level and severity increasing over time. Tanning (whether by the pool or in a bed) is, technically, an intentional cooking of one's outer layers of skin. Now that you know that, we are confident you will remember to use more sunscreen in the future. But what about all those unprotected days you've already spent acquiring a "healthy glow"?

Many skin cancers start out as a weird-looking mole or patch of skin that itches or bleeds and doesn't heal properly. But there are a myriad of other skin anomalies that a dermatologist checks for during a screening for skin damage. Most people don't go see a dermatologist on their own unless they have a diagnosis that requires it - eczema for example, or rosacea. Several reasons might be offered for not getting regular check ups: lack of time, the high cost of a specialist that's not covered under your health insurance plan, or just no clue how to choose one out of the long list of clinics in Northwest Arkansas.

Have we got a deal for you!!!  Mark your calendar for our upcoming skin cancer screening clinic that will be held April 2nd at our office. All that is required of you is that you call to set an appointment. Easy! We will bring seven local dermatologists to you to check moles, freckles, and that funny little patch on your forehead that flakes and itches. And all that special attention is absolutely free of charge!!

Take a minute and schedule an appointment - call 479-361-5847 and we'll get you set up. After you've made your own appointment, call or email all your friends and family in NWA and challenge them to do the same. It's a quick visit, doesn't cost a thing, and could be the key to preventing a loved one from having to deal with Melanoma, the most lethal type of skin cancer that killed almost 9,000 people in the U.S. last year. Help us help reduce that number this year by scheduling your screening today.