Men’s Health and Its Relationship to Cancer

Adam Liss, MDRadiation Oncologist

Agnesian Cancer Center

Brief Introduction…

The New Guy

Born and raised in Franklin

Tami is from AntigoMet Tami in Madison

The New GuyBorn and raised in FranklinTami is from AntigoMet Tami in MadisonChased Tami around the globe

Madison National Cancer Institute

Still Chasing…to SingaporeBorn and raised in FranklinTami is from AntigoMet Tami in MadisonChased Tami around the globe

Madison National Cancer Institute Singapore

Back to the Midwest, Home to Wisconsin

Completed family in Ann ArborSidney (7)Violet (5)Hazel (2)

Moved home to Wisconsin

Men’s Health and Screening Principles of screening

Primary prevention Prevent a new disease or cancer by reducing risk

factors. Secondary prevention Detect a disease or cancer in early stages,

allowing for early treatment and better prognosis.

Disclaimer Many medical groups have different

recommendations about screening. My bias tends to be for a more conservative

approach. (Because I see patients who have been diagnosed

with cancer, often with a screening test.) It’s best to discuss any screening test or

preventive measure with your primary care provider.

Men’s Health and Screening Created in 1984, the United States Preventive Services Task

Force (USPSTF) is an independent, volunteer panel of national experts in prevention and evidence-based medicine.

Works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services and preventive medications.

USPSTF has published recommendations on screening for 53 different conditions or disease for adult males. Too much to cover today.

Men’s Health and Screening

Men’s Health, Screening and Cancer

Skin cancerLung cancerColon and rectal cancerProstate cancer

Skin Cancer Many types Hard to distinguish at times. Prevention is important and it’s

easy to do.

Skin Cancer Risk FactorsLifetime UV Light Exposure

H&N & dorsal hand/forearm predilection

Skin Cancer Risk Factors Lifetime UV Light Exposure

H&N and dorsal hand/forearm predilection Chronic Immunosuppression

Organ transplant, HIV, chronic glucocorticoid use Chronic Inflammation (SCC – Marjolin’s ulcer)

Scars, burns, non-healing ulcers, fistula tracts, inflammatory dermatoses (i.e. lichen sclerosis)

Smoking - Mostly SCC HPV - SCC Arsenic exposure

Prevention Controversy

Reducing Risk of Skin Cancer Use sunscreen

Tips on following slide Seek shade

The sun’s rays are strongest between 10 a.m. and 2 p.m. If your shadow is shorter than you are, seek shade.

Wear protective clothing Including a long-sleeved shirt, pants, wide-brimmed hat and sunglasses, when

possible. Use extra caution near water, sand or snow

They reflect and intensify the damaging rays of the sun, which can increase chances of sunburn.

Check your skin for signs of skin cancer. Your birthday is a great time to check your birthday suit. Checking your skin and

knowing your moles are key to detecting skin cancer in its earliest, most treatable stages.

See your primary care provider if you find something worrisome.

Reducing Risk of Skin Cancer

What Dr. Liss Does… Apply SPF 50 to high risk

skin of face and ears every morning.

Why…. “H zone” skin cancers

What Dr. Liss Does… Apply SPF 50+ to my children

whenever they are outside. Why….

Even one blistering sunburn during childhood or adolescence can nearly double a person's chance of developing melanoma.

Five or more blistering sunburns in late adolescence increases melanoma risk by 80 percent and non-melanoma risk by 68 percent.

What Dr. Liss Avoids…

Lung CancerNew cases in the United States - 221,200New cases in Wisconsin - 4,370Deaths in Wisconsin - 3,050

Lung CancerCancer death in men

Lung Cancer Risk Factors Smoking

Tripling the number of cigarettes smoked per day was estimated to triple the risk, whereas a tripling of the duration of smoking was estimated to increase the lung cancer risk 100-fold.

3 ppd x 10 yrs safer than 1 ppd x 30 yrs Passive smoking

Accounts for 20 to 50 percent of lung cancers in never-smokers in the United States.

Other Radon, asbestos, indoor and outdoor pollution, male

gender, family history of lung cancer.

Chest. 2003 Jan;123(1 Suppl):21S-49S.

Percent of smokers that get any cancer = 25 percent.

Increased risk of lung cancer in smokers = Up to a tenfold increase risk of lung cancer.

Percent of lung cancer patients that are smokers = 90 percent.

Time to normalize increased risk after quitting = Never.

Better outcomes for smokers or non-smokers in lung cancer? Non-smokers.

Smoking Data

W.H.O. Tobacco Free Initiative

What Dr. Liss Avoids…

Quit smoking.Screen for lung cancer.

Reducing Risk of Lung Cancer

53,000 people who smoked 30 pack years One pack per day for 30 years -or- two packs per day

for 15 years Half had a chest X-ray every three years Half had a CAT scan every three years

20 percent relative reduction in lung cancer deaths CAT scans of the chest picked up more lung cancers

than chest X-rays

Diagnosing a lung cancer early, before a patient notices symptoms, significantly increases chances of cure. Stage I – Three-year survival rate:

60 to 95 percent1,4

One surgery -or- Three to five radiation treatments

Stage III – Three-year survival rate: 25 to 35 percent2,3

30 to 33 radiation treatments combined with chemotherapy

How Can Screening Help In Lung Cancer?

1STARS-ROSEL pooled analysis2RTOG 94103INT 01394RTOG 0236

Lung Cancer Screening:Less controversy

Lung Cancer Screening:Less controversy

Early Stage Lung Cancer Treatment: Surgery

Eric Lilly, MD

Early Stage Lung Cancer Treatment: SBRT

4-dimensional CAT scan radiation planning

Early Stage Lung Cancer Treatment: SBRT

https://www.youtube.com/watch?v=nZ044EicYO4

Early Stage Lung Cancer Treatment: SBRT

Early Stage Lung Cancer Treatment: SBRT

https://www.youtube.com/watch?v=flPWAZk2wkI

Lung Cancer Screening at Agnesian HealthCare

If someone is interested and meets the criteria, please mention this to your provider.

Provider will send you to Rebecca Lentscher, APNP, to review the pros and cons of the CT and make sure the patient meets the criteria.

An order will be placed for the CT. If patient meets the criteria, the insurance companies will pay for it.

Rebecca Lentscher, NP

Medicare Criteria: Age 55 to 77 years old No signs or symptoms of lung cancer 30-pack years or greater history of tobacco smoking Current smokers or have quit smoking within the last 15 years Need written order for LDCT from a qualified healthcare

professional following a lung cancer screening counseling that attests to shared decision-making having taken place before their first screening CT.

Annual screening thereafter.

Lung Cancer Screening at Agnesian HealthCare

Colon/Rectal CancerNew cases in the United States - 132,700New cases in Wisconsin - 2,460Deaths in Wisconsin - 850

Colon/Rectal CancerCancer death in men

Increased risk: Lack of physical activity Alcohol use Obesity Red meat consumption Cigarette smoking Male Family history

Harvard Report on Cancer Prevention, Cancer Causes and Control 1999;10:167.

Colon/Rectal Cancer Risk Factors

Colon/Rectal Cancer Screening

”The USPSTF has chosen to highlight that there is convincing evidence that colorectal cancer screening substantially reduces deaths from the disease among adults aged 50 to 75 years and that not enough adults in the United States are using this effective preventive intervention.”

What Dr. Liss Does (Will Do)…

Many Options for Screening

Why a Colonoscopy?Screening and treatment in

one test.Direct visualization.

Many adenomas are flat or depressedDifficult to detect Subtle distortion of mucosal

patternMore likely to contain dysplasia

or cancer than comparable polypoid adenomas

Why a Colonoscopy? Screening and treatment in one test Direct visualization

Many adenomas are flat or depressed Difficult to detect Subtle distortion of mucosal pattern More likely to contain dysplasia or

cancer than comparable polypoid adenomas

Visualize entire colon

Why a Colonoscopy?Screening and treatment in one testDirect visualization

Many adenomas are flat or depressed Difficult to detect Subtle distortion of mucosal pattern More likely to contain dysplasia or cancer than comparable

polypoid adenomasVisualize entire colon

Why a Colonoscopy? Early diagnosis

Precancerous or early-stage cancer Adenoma-carcinoma sequence

Most CRCs arise from adenomas ~10 year progression

Early Diagnosis Regardless of the screening test you and your

provider choose, early diagnosis is key.

Prostate CancerNew cases in the United States - 220,800New cases in Wisconsin - 4,310Deaths in Wisconsin - 590

Prostate CancerCancer death in men

Prostate Cancer Risk Factors Age

Rare if < 40 years old, chances increase rapidly after 50.

Race African-Americans have increased risk

Family history Especially if diagnosed at a young age

Genetic syndromes Lynch syndrome, BRCA 1/2

Prostate Cancer Screening (very controversial)

Prostate cancer screening (very controversial)

Prostate Cancer Screening (very controversial)

What Does Dr. Liss Think? I favor PSA screening in healthy men.

I am biased. I see men with metastatic prostate cancer.

Significant flaws in the evidence the USPSTF used.

Increased understanding of “Active Surveillance”… figuring out who needs treatment.

Improvements in treatment technology decreases the toxicity of treatment which improves the risk, benefit ratio of treatment. 3 Tesla MRI Sparing of normal tissue with RT techniques

76,000 men - ages 55 to 74 Enrolled 1993 to 2001 Randomized to “usual care” or invitation to annual PSA

(4 ng/ml cut-off) and DRE Usual care could include PSA/DRE

Concerns with the trial: 44 percent of patients had PSA in three years prior to enrollment 52 percent of controls screened by sixth year on trial 85 percent screening patients complied

22%

More cancers diagnosed Same survival rates

Prostate cancer is still the number two cause of cancer death in men.

What does Dr. Liss Think?

Improvements in TechnologyProstate CAT scan

Improvements in TechnologyProstate 3 Tesla MRI

Agnesian Cancer Screening

Agnesian Cancer Screening

We have been doing the event for 20 years.

Over the past 15 years we have had 1,591 participants.

Event is scheduled annually in April.

Web Site Resources http://www.uspreventiveservicestaskforce.org/

https://www.nccn.org/

AAD: https://www.aad.org/

http://www.cancer.org/

Now Part of the Team

Thank You