cancer prevention

respiratory tract Upper & lower

ANN MEREDITH U. GARCIA, MD, FPCP, DPSMO, MCMMO

Internist – Medical Oncologist Blessed Family Doctors General Hospital w Luzon Medical Center w The Medical City Pangasinan

Lung cancer is the cause of

cancer death leading

among both men & women.

HNSCC is a public health

problem. major

AmericanCancerSociety|DeVita10e

Tertiary = Treatment

Secondary = Screening

Primary = Prevention

cancer prevention Three of levels Interna5onalAgencyforResearchonCancer

How does cancer develop?

Keith&Miller.NatRevClinOncol.2013;10:334-343

Carcinogenic exposure à Diffuse epithelial injury à Chronic pattern of tissue damage & wound healing

Field cancerization field of tissue injury & the

are observed in smokers with oral & lung cancer.

Chiesaetal.Head&NeckCancer:Mul5modalityManagement.NewYork:Springer-Verlag,2011|Cohen&Khuri.CancerControl.2003;10(4):315-324|Slaughteretal.Cancer.1953;6:963-968

RISK FACTOR HEAD & NECK LUNG Tobacco smoking ✔ ✔ Environmental/occupational exposures ✔ ✔ Ionizing radiation ✔ ✔ Older age ✔ ✔ Positive family history ✔ ✔ Previous cancer ✔ ✔ Immunosuppression ✔ ✔ Male sex ✔ Alcohol abuse ✔ Betel nut/quid chewing ✔ Poor oral and dental hygiene ✔ Viral infections (e.g., HPV, EBV) ✔ UV radiation ✔ Poor nutrition ✔ Chronic obstructive pulmonary disease (COPD) ✔

High-dose nutritional supplements (e.g., beta-carotene) ✔

Risk factors

Cohen&Khuri.CancerControl.2003;10(4):315-324|DeVita10e

Smoking

85-90% tobacco smoke.

of lung cancers & HNSCC are associated with exposure to

6x

risk of oral cancer increased

10-30x

risk of lung cancer increased

AmericanCancerSociety|Garfinkel&Stellman.CancerRes.1988;48:6951-6955|Samet.ClinChestMed.1991;12:669-679|USCentersforDiseaseControl&Preven5on

increases The risk of cancer

with the

number of cigarettes smoked,

years of smoking,

earlier age of onset,

degree of inhalation, tar & nicotine content,

& use of unfiltered cigarettes.

Cohen&Khuri.CancerControl.2003;10(4):315-324

smoker a nonsmoker’s chances

of developing lung cancer by

20-30%.

increases

Living with a

USDepartmentofHealth&HumanServices

Secondhand smoke exposure of >15 years is associated with a

1.6x higher developing head & neck cancer.

likelihood of

Leeetal.CancerEpidemiolBiomarkersPrev.2008;17(8):1974-1981

hookah A typical 1-hour

100 cigarettes. equivalent is to smoking

session

USCentersforDiseaseControl&Preven5on|WorldHealthOrganiza5on

AmericanLungAssocia5on|Na5onalIns5tuteonDrugAbuse

e-cigarettes Although they do not produce tobacco smoke,

chemicals.

still contain & other nicotine potentially harmful

e-cigarettes So far, there are large, high-quality studies NO

can be used to cut down or quit smoking long-term.

looking at whether

CancerPreven5on&TreatmentFund

unknown.

The health consequences of

e-cigarette long-term

use remain

AmericanLungAssocia5on|Na5onalIns5tuteonDrugAbuse

Smoking cessation is the known

effective intervention in

the risk of lung cancer.

only

reducing Anthonisenetal.AnnInternMed.2005;142:233-239|Garfinkel&Stellman.CancerRes.1988;48:6951-6955|

Keith&Miller.NatRevClinOncol.2013;10:334-343|Lubin&Blot.JNatlCancerInst.1993;85:422-423

no There is such thing

cigarette. safe as a

Alcohol

Heavy use

2-5x. raises

the risk of head & neck cancers by

alcohol

CancerResearchUK|MemorialSloanKeeeringCancerCenter

>4 drinks/day >14 drinks/week

>3 drinks/day >7 drinks/week

Heavy use alcohol

Moderate use alcohol Up to 2 drinks/day Up to 1 drink/day

USDACenterforNutri5onPolicy&Promo5on

How a alcoholic standard drink looks like

Na5onalIns5tuteonAlcoholAbuseandAlcoholism

Alcohol produces

acetaldehyde

damage

&

reactive oxygen species that can DNA.

CancerResearchUK|Interna5onalAgencyforResearchonCancer

2% reduced by for each year that a person remains

alcohol-free.

The risk of pharyngeal & laryngeal cancers is

AhmadKiadalirietal.PLoSOne.2013;8(3):e58158

Smoking +

alcohol

Alcohol makes it for the mouth & throat

tobacco. easier

to absorb the cancer-causing

chemicals in

100x higher

risk of developing

mouth & upper throat cancer

Up to

CancerResearchUK|MemorialSloanKeeeringCancerCenter|Tura5etal.Alcohol&Alcoholism.2013;48(1):107-118

Environmental exposures

50 There are over

100

known or probable causes of occupational cancer,

substances that are

& over other substances. possible

Ins5tu5onofOccupa5onalSafetyandHealth

Asbestos

lung cancer &

laryngeal cancer.

increases the risk of developing

AmericanCancerSociety|AmericanSocietyofClinicalOncology|Na5onalCancerIns5tute

face masks. protective Wear

MemorialSloanKeeeringCancerCenter

ionizing radiation may the risk of cancer. increase

Exposure to high doses of

AmericanCancerSociety|AmericanSocietyofClinicalOncology|MemorialSloanKeeeringCancerCenter

UV radiation the risk of

skin cancers increases

in the head & neck region.

AmericanCancerSociety|AmericanSocietyofClinicalOncology|MemorialSloanKeeeringCancerCenter

sunscreen Use

regularly.

AmericanAcademyofDermatology|AmericanCancerSociety|Faurschou&Wulf.BrJDerm.2007;156:716-719

Medical conditions

104-144% Lung cancer risk is

emphysema &

higher in people with a history of

47-52% higher in smokers with a history of chronic bronchitis.

Brenneretal.AMJEpidemiol.2012;176(7):573-585|Brenneretal.PLoSONE.2011;6(3):e17479

HIV-infected individuals have ≥2x increased

risk of developing cancer.

D’Souza&Dempsey.PrevMed.2011;53(1):S5-S11|Na5onalCancerIns5tute

HPV 45-90% infection

is associated with of

oropharyngeal cancers,

CancerTreatmentCentersofAmerica|D’Souza&Dempsey.PrevMed.2011;53(1):S5-S11

24% of laryngeal cancers, &

23% of oral cavity cancers.

Oropharyngeal cancer?

HPV vaccination may potentially the risk of oral

HPV infection. reduce

AmericanSocietyofClinicalOncology|Chiesaetal.Head&NeckCancer:Mul5modalityManagement.NewYork:Springer-Verlag,2011

Safe sex

AmericanSocietyofClinicalOncology

oral hygiene People with poor or

dental care may have an risk

of oral cavity cancer. increased

AmericanSocietyofClinicalOncology|Rajeshetal.JIndianSocPeriodontol.2013;17(6):706-710

Lifestyle

ç

Betel nut/quid chewing the risk of developing

oral cancer.

increases oral precancerous lesions &

Mutagenesis.2004;19(4):251-262|Sharanetal.PLoSOne.2012;7(8):e42759

Physical activity lung cancer risk by

20-30% reduces

for women &

20-50% for men.

Emaus&Thune.RecentResultsCancerRes.2011;186:101-133

Exercise days of the week. most

MayoClinic|Na5onalCancerIns5tute

& vegetables A diet in

oropharyngeal & laryngeal cancer. may the risk of increase

low fruits

AmericanSocietyofClinicalOncology|CancerResearchUK

Chemo- prevention?

Chemoprevention aims to or

premalignancy from

progressing to invasive cancer.

reverse,suppress, prevent

Keith&Miller.NatRevClinOncol.2013;10:334-343|Spitzetal.CancerPrevRes.2008;1:250-254|Sporn.CancerRes.1976;36:2699-2702

High-risk population

agents with Efficacious tolerable adverse effects

Keith&Miller.NatRevClinOncol.2013;10:334-343|Spitzetal.CancerPrevRes.2008;1:250-254

Early phase trials chemoprevention had results. mixed

Keith&Miller.NatRevClinOncol.2013;10:334-343

Phase III trials chemoprevention harmful negative had or results.

Keith&Miller.NatRevClinOncol.2013;10:334-343

Screening

screening has been shown to by

low-dose CT scans reduce mortality

Lung cancer using

20%. Na5onalLungScreeningTrialResearchTeametal.NEnglJMed.2011;365:395-409

LDCT screening Criteria for

55-74 years old

Fairly good health

≥30 pack-year smoking history

Still smoking or quit smoking within the last 15 years

Na5onalLungScreeningTrialResearchTeametal.NEnglJMed.2011;365:395-409

physical examination An annual

of the head, neck, & oropharynx is recommended.

MayoFounda5onforMedicalEduca5onandResearch

dental evaluation An annual

is also recommended.

Hashimetal.AnnOncol.2016(acceptedmanuscript)|MemorialSloanKeeeringCancerCenter

prevention. The therapeutic goal is

secondary

leukoplakias malignant can undergo

transformation within 20 years.

of 5-36%

Chiesaetal.Head&NeckCancer:Mul5modalityManagement.NewYork:Springer-Verlag,2011

Smoking cessation

change 5 stages The of

Prochaska&DiClemente.ProgClinBiolRes.1984;156:131-140

Ask all patients about smoking

Assess readiness to quit

Advise all smokers to quit

Assist Arrange follow-up

5As The approach

WorldHealthOrganiza5on

#SayNoToCancer

q  Stopsmoking.

q Don’tsmoke.

q Avoidsecondhandsmoke.

q Avoiddrinkingalcohol.q Avoidbetelnut/quidchewing.

q Avoidcarcinogensatwork.q Avoidunnecessaryexposuretoradia@on.

q Usesunscreenregularly.

q  Exercisemostdaysoftheweek.

q  Eatadietfulloffruits&vegetables.

q Avoidtakinglargedosesofvitaminsinpillform.q Prac@cesafesex.q Maintaingoodoralhygiene.q Getscreenedasappropriate.

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