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The Surprising Link Between Alcohol and Cancer

Categories: Other

By Dafna Kanny, PhD
Senior Scientist, Excessive Alcohol Use Prevention Team, Epidemiology and Surveillance Branch, CDC’s Division of Population Health

Working at CDC often means wearing your “expert hat” wherever you go. One weekend, while pushing my shopping cart in a grocery store, I ran into a CDC colleague I haven’t seen in a while. After catching up on the latest news about our kids, we started chatting about healthy foods; after all, we were at the grocery store.

The conversation quickly turned to our dinner plans for that evening. As a scientist in CDC’s Alcohol Program, I soon found myself wearing my “expert hat” and answering questions on how much alcohol can be consumed. I based my answer on the recommendations in the 2010 U.S. Dietary Guidelines, [PDF-967KB] which define moderate drinking as up to one drink per day for women and up to two drinks per day for men. My colleague was surprised to hear this, as is often the case when people learn about these Guidelines.

There is often a lot of confusion about alcohol consumption in the United States. What is clear, though, is that excessive drinking or drinking too much,* is a serious public health problem. It kills about 88,000 Americans each year and cost the United States about $224 billion ($1.90 per drink) in 2006.

Often when people think about the effects of drinking too much, images of car crashes or other fatal injuries come to mind. However, alcohol is also an important—though often overlooked—risk factor for cancer. In fact, studies have shown that alcohol was responsible for about 20,000 cancer deaths in the United States in 2009. Alcohol is known to be a risk factor for cancers of the head and neck (mouth, throat, and voice box), liver, colon, rectum, and breast. According to the National Cancer Institute and the American Cancer Society, this risk increases with the amount of alcohol consumed. Yet about 1 in 6 U.S. adults binge drinks** an average of 4 times per month, and consumes an average of 8 drinks per binge episode, far exceeding the definition of moderate drinking specified in the Dietary Guidelines.

April is Alcohol Awareness Month. So what should we be aware of? First, drinking too much is never a good idea. Second, if you choose to drink, do so in moderation. Lastly, there are effective ways to reduce excessive drinking that can help reduce the risk of cancer and of many other health problems too.

*Drinking too much includes binge drinking** (for women, 4 or more drinks on an occasion, within about 2 hours; for men, 5 or more drinks), heavy drinking (for women, 8 or more drinks per week; for men, 15 or more drinks per week), and any drinking by pregnant women or those younger than 21 years.

How Health Care Providers Can Use Genomics to Prevent Cancer

Categories: Breast Cancer, Cervical Cancer

by Katrina Trivers, Deb Duquette, and Kate Reed

Today, a state public health department received the following phone calls:

  • A third-year family medicine resident at a clinic in an underserved community asks if a 25-year-old female patient with several family members who died of breast cancer at a young age should have BRCA testing.
  • A mother of three young children who just moved to the state asks where to go for counseling because there is a known BRCA mutation in her family.
  • An OB/GYN wonders if there is a tool to identify a low- versus high-risk family history of cancer.

If you are a public health practitioner, health care professional, or individual with a family or personal history of cancer, what information or resources would you turn to?

Genomic medicine is a reality for many families.

Certain cancers can be prevented by knowing a patient’s family history of cancer or which genetic mutations they carry. About 5%–10% of breast cancers and 10%–15% of ovarian cancers are due to inherited changes in genes. For example, everyone has BRCA1 and BRCA2 genes. Normally, these genes help fix damaged DNA. But mutations in these genes cause them to function incorrectly and prevent damaged DNA from being fixed correctly, leading to cancer. A woman’s risk of developing breast cancer, ovarian cancer, or both is greatly increased if she has one of these harmful mutations; she’s at more than a 65% lifetime risk of breast cancer and a 40% risk of ovarian cancer. For comparison, people without such genetic mutations have a 12% lifetime risk of breast cancer and a 1%–2% risk of ovarian cancer.

Family history can help identify people who are more likely to carry these mutations and may benefit from genetic counseling and testing. Finding a harmful BRCA1 or BRCA2 change can empower patients to potentially prevent a cancer or manage their cancer risk through enhanced screening, risk-reducing surgery, and certain medications (chemoprevention).

Family history information can save patients’ lives! Encourage your patients to learn their family history of cancer for all relatives through their grandparents’ generation if possible, including the type of cancer and age when it was diagnosed.

Hereditary Breast and Ovarian Cancer: Is Your Patient at High Risk?

Learn more about identifying patients at increased risk to develop breast cancer, ovarian cancer, or both. Hereditary Breast and Ovarian Cancer: Is Your Patient at High Risk? is a free CME course for primary care providers developed by collaborators from the Michigan Department of Community Health, Georgia Department of Public Health, Oregon Health Authority, Moffitt Cancer Center, National Coalition of Health Professional Education in Genetics (now The Jackson Laboratory), and CDC’s Division of Cancer Prevention and Control. The program includes interactive cases and resources designed to improve your ability to identify, evaluate, and manage patients at risk for hereditary breast and ovarian cancer. It also includes links to risk assessment tools and resources.

We’re Increasing Colorectal Cancer Screening; You Can, Too!

Categories: Colorectal (Colon) Cancer

By guest blogger Frank Colangelo, MD, FACP
Internist and Director of Quality Improvement for Premier Medical Associates, an affiliate of the Allegheny Health Network in Pittsburgh, Pennsylvania

Photo of Dr. Frank Colangelo

I am a physician at Premier Medical Associates in the eastern suburbs of Pittsburgh. We are a multi-specialty group with 100 providers. Each of our seven adult primary care offices has embraced the patient-centered medical home concept. This means we practice a team-based approach to medicine that is comprehensive, continuous, and centered on patient needs.

One of the most difficult tasks I face is convincing reluctant patients to be screened for colorectal cancer. Many patients do not fully understand the prevalence of this disease or the benefits of timely screenings.

I became a very strong champion for colorectal cancer screening several years ago after one of my patients died from this terrible disease in his early 50s. Despite my advice at every annual visit to complete some form of colorectal cancer screening, he did not comply.

Of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the United States. Both men and women are affected by this disease. About 50,000 people die from colorectal cancer each year.

Most people who need to be screened are between the ages of 50 and 75. The United States Preventive Services Task Force recommends either a colonoscopy every 10 years, a flexible sigmoidoscopy every five years in combination with a high-sensitivity stool test (fecal occult blood test or fecal immunochemical test) every three years, or a high-sensitivity stool test every year. For patients who are not at high risk for colorectal cancer, stool tests are easy to use and can be done discreetly at home.

Many studies have shown it is more likely that patients will get screened for colorectal cancer if their doctors recommend it. A few years ago, I attended a lecture where I heard Richard Wender, MD, chair of the National Colorectal Cancer Roundtable and Chief Cancer Control Officer of the American Cancer Society, talk about CDC’s Colorectal Cancer Control Program. One of its goals is to increase colorectal cancer screening rates for adults aged 50–75 years to 80% by the end of 2014 among funded states.

As a participating provider with the Pennsylvania Colorectal Cancer Control Program, I worked with the state health department to invite Dr. Wender to our practice, where he gave an impassioned talk about each practice’s responsibility to work as a team to improve screening rates. Our practice kicked off this effort in December 2012. At the time, our screening rates were very close to the national screening rates (in the low 60% range).

We began to make changes. I realized that the patient registry function of our electronic health record system could help us. Our organization worked to make sure that every patient’s colon cancer screening information was captured so it could be tracked. For every patient visit (not just at preventive physical exam visits), I encouraged each provider and staff member to use the registry function to look for patients who had not been screened so they could recommend screening to these patients. To help answer questions, every exam room was stocked with copies of the Colorectal Cancer Screening Saves Lives [PDF-2.6MB] brochures provided by CDC’s Screen for Life: National Colorectal Cancer Action Campaign.

We also used the registry function to identify patients who required or will require specific outreach efforts. Patients who were screened but fell behind on follow-up testing were contacted. Patients whose FIT results were positive were monitored closely to ensure that they had a follow-up colonoscopy. Every doctor gets a monthly report card with each panel’s percentage-to-be-screened rate.

Finally, we compiled a list of patients who had never been screened. In conjunction with March’s National Colorectal Cancer Awareness Month observance, we are sending a letter to each person, educating them about the importance of screening.

My practice cares for about 17,000 patients who need to be screened for colorectal cancer. We are closing in on the 75% screened mark, and are using many resources to reach the 80% goal by the end of 2014. I am confident that these efforts will prevent deaths from this disease. My practice is proof that we can increase screening. I challenge other medical practices to commit to increasing colorectal cancer screening rates, and saving more lives from this largely preventable disease.

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