CANCER RISK FACTORS

Scientists study risk factors and protective factors to find ways to prevent
new cancers from starting. Some risk factors for cancer can be avoided, but
many cannot.
Cancer risk factor - anything that increases your chance of developing
cancer
Cancer protective factor- anything that decreases your chance of
developing cancer
Modifiable risk factor- risk factors that a person can control
Cancer is a group of more than 100 different diseases, each with their own
set of risk factors. The risk of developing cancer increases as we age, so age
along with gender, race and personal and family medical history, are risk
factors for cancer. Other risk factors are largely related to lifestyle choices,
while certain infections, occupational exposures and some environmental
factors can also be related to developing cancer.
Oral Cavity & Pharynx
Mouth
Tobacco and alcohol usage accounts for most mouth cancers. Another
risk factor is a diet low in fruits and vegetables and possible risk factors
are poor tooth development and oral hygiene, trauma due to ill-fitting
dentures or jagged teeth, use of mouthwashes with high alcohol
content, and iron-deficiency anemia.
Digestive System
Colorectal
Risk factors are personal or family history of colorectal polyps or
inflammatory bowel disease, certain rare hereditary conditions, and a
diet high in fat and/or low in fiber, fruits and vegetables. Possible risk
factors are physical inactivity, alcohol consumption, obesity, and
smoking. Risk may be reduced by estrogen replacement therapy, nonsteriodal anti-inflammatory drugs (e.g. aspirin, ibuprofen), dietary
calcium and vitamin D.
Pancreas
Risk factors are cigarette smoking and possibly alcohol, coffee, or tea
consumption, diabetes, chronic pancreatitis, cirrhosis, allergies, diet
high in meat or butter fat.
Stomach
Risk factors are dietary nitrites (in pickled, salted, and smoked foods),
pernicious anemia, and diet low in fruits and vegetables. Possible risk
factors are infection with Helicobacter pylori, high doses of ionizing
radiation, cigarette smoking, and genetic factors.
Liver
Risk factors are chronic infection with hepatitis B or C virus, cirrhosis of
the liver (chronic liver injury, usually due to alcohol abuse ), aflatoxin
ingestion (produced by a common mold that invades poorly stored

peanuts and other foods), and occupational exposure to thorium

dioxide or vinyl chloride. Possible risk factors are use of steroids,
smoking,
and
some
inherited
metabolic
diseases
(e.g.
hemochromatosis).
Esophagus
The most important risk factors are tobacco use (cigarettes, cigars,
pipes), and excessive alcohol use along with the syndrome, Barrett's
esophagus. Possible risk factors are obesity, inadequate diet, poor
nutrition, decreased levels of certain nutrients (carotene, ascorbic acid,
riboflavin, niacin, thiamin, zinc, magnesium, and selenium), and
insufficient consumption of fruits and vegetables.
Gallbladder
The most important risk factor is gallstones; factors related to stone
formation are increasing age, being female, being pregnant, certain
ethnicity, obesity, use of estrogen-containing drugs and high fat and
caloric intake.
Respiratory System
Lung
Tobacco smoking is responsible for nearly 90% of all lung cancers.
Other contributing risk factors are smoking cigars or pipes and
environmental tobacco smoke (second-hand smoke). High doses of
ionizing radiation, residential radon exposure and occupational
exposure to mustard gas, chloromethyl ethers, inorganic arsenic,
chromium, nickel, vinyl chloride, radon, asbestos or byproducts of fossil
fuel are also thought to increase risk. Possible risk factors are air
pollution and insufficient consumption of fruits and vegetables.
Larynx
Most cases are caused by cigarette smoking. Other risk factors are
alcohol and occupational exposure to asbestos or mustard gas.
Skin
Melanoma
Risk factors are excessive exposure to ultraviolet radiation (sunlight),
fair skin, history of severe sunburns, personal or family history of
melanoma, multiple moles or atypical moles (colored skin spots), giant
congenital moles, xeroderma pigmentosum (a rare hereditary disease),
personal history of melanoma, and reduced immune function due to
organ transplants or HIV infection. Melanoma occurs almost exclusively
among whites.
Non-melanoma
Risk factors are ultraviolet radiation (sunlight), fair skin, high doses of
ionizing radiation, occupational exposure to arsenic, polycyclic
hydrocarbons (coal tars, pitches, asphalt, creosote, soot, lubricating
and cutting oils) and rare hereditary diseases such as multiple basal
cell carcinoma syndrome, xeroderma pigmentosum, and albinism.
Possible risk factors are burn scars, chronic infections, and
photosensitizers in tanning aids, cosmetics, and medicines.

Breast
Breast
For women, risk factors are family history (especially mother or sister)
of breast cancer, personal history of breast, ovarian, or endometrial
cancer, susceptibility genes (BRCA-1, BRCA-2), some forms of benign
breast disease (atypical hyperplasia), higher education and
socioeconomic status, menstruation at an early age, late menopause,
never bearing children, first child born after age 30, high doses of
ionizing radiation, long term use of post-menopause estrogens and
progestins, obesity after menopause, and excessive alcohol
consumption. Possible risk factors are dietary fat and physical
inactivity. For men, risk factors include increasing age, family history,
radiation exposure, and having high levels of estrogen due to inherited
gene mutations or treatments. Possible risk factors include
gynecomastia and obesity.
Reproductive Organs
Prostate
Risk factors are some types of prostatic hyperplasia and a family
history, especially a father or brother. Possible risk factors are a diet
high in animal fat, obesity, hormonal factors, a sexually transmitted
agent, smoking, alcohol, and physical inactivity. Black males have
much higher prostate cancer rates than white males.
Endometrium
High cumulative exposure to estrogens including never bearing
children or bearing few children, menstruation beginning at an early
age, failure to menstruate, late menopause, estrogen replacement
therapy are major risk factors. Also, use of tamoxifen, infertility,
obesity, diabetes, hypertension, gallbladder disease, and SteinLeventhal syndrome are known risk factors. Possible risk factors are
dietary fat and hereditary non-polyposis colon cancer.
Ovary
Risk factors are personal history of breast cancer, family history of
breast or ovarian cancer, susceptibility genes (BRCA-1, BRCA-2), never
bearing children, and hereditary non-polyposis colon cancer. A possible
risk factor is dietary fat. Risk may be reduced by tubal ligation and
hysterectomy
Cervix
Risk factors are infection with human papilloma viruses (HPV), early
age at first sexual intercourse, many sexual partners or partners who
have had many sexual partners, multiple births, long-term oral
contraceptive use, and cigarette smoking. Possible risk factors are
certain vitamin deficiencies and hormonal factors.
Urinary System
Bladder
The most important risk factor is cigarette smoking; other risk factors
are occupational exposure to benzidine and 2-naphthylamine and

occupations in the dye, leather or rubber industry. Possible risk factors

are heavy coffee consumption, bladder infection with schistosoma
haematobium (a parasitic flatworm), treatment with chlornaphazine or
cyclophosphamide (anti-cancer drugs), long-term use of pain killers
containing phenacetin, urinary tract infections or low urine flow,
dietary factors, tobacco use other than cigarettes, and genetic factors.
Kidney
Cigarette smoking is the most important risk factor; others are obesity,
abuse of analgesics (especially phenacetin-containing pain relievers),
and occupational exposure to arsenic. Possible risk factors are regular
use of prescription diuretics and increased meat consumption.

Lymphoma/Leukemia/Multiple Myeloma
Non-Hodgkin Lymphoma
Risk factors are reduced immune function due to organ transplants or
nfection with HIV, Epstein-Barr or human T-cell leukemia/lymphoma
virus. Possible risk factors are occupational exposure to pesticides,
herbicides, or organic solvents.
Hodgkin Lymphoma
Risk factors are infectious mononucleosis and Epstein-Barr virus
infection. Possible risk factors are family history of Hodgkin lymphoma
especially among siblings and genetic factors.
Leukemia
Risk factors are family history, high doses of ionizing radiation,
alkylating drugs used to treat cancer and other diseases, human T-cell
leukemia/ lymphoma virus I infection, Down syndrome or other genetic
abnormalities, and occupational exposure to benzene. Possible risk
factors are exposure to electromagnetic fields, pesticides, smoking,
and several immune-related diseases.
Multiple myeloma
High doses of ionizing radiation is a risk factor. Possible risk factors are
repeated infections, allergic conditions, autoimmune disease, genetic
factors, cigarette smoking, farming, and occupational exposure to
benzene.
Other
Brain
Risk factors are genetic factors, certain rare inherited syndromes such
as neurofibromatosis, being a parent or sibling of a child with brain
cancer, high doses of ionizing radiation, and occupational exposure to
certain aromatic hydrocarbon compounds, bis-chloromethyl ether, vinyl
chloride, and acrylonitrile. Possible risk factors are exposure to
electromagnetic fields, exposure to farm animals and pets, severe
head trauma, loud noise, and N-nitroso compounds in the diet,
cigarettes, and alcohol.
Thyroid
Risk factors are high doses of ionizing radiation and goiter.

BREAST CANCER
Facts:
Philippines has the highest incidence of breast cancer in the continent
and an estimated 3 out of 100 Filipino women will contract the disease
before age 75; 1 out of 100 will die before age 75, according to the
Philippine Society of Medical Oncology in 2012
breast cancer is the most common cancer in the country, comprising
16 percent of the 80,000 new cancer cases in 2010
Breast cancer is the most common invasive cancer in females
worldwide. It accounts for 16% of all female cancers and 22.9% of
invasive cancers in women. 18.2% of all cancer deaths worldwide,
including both males and females, are from breast cancer.
Breast cancer rates are much higher in developed nations compared to
developing ones. There are several reasons for this, with possibly lifeexpectancy being one of the key factors - breast cancer is more
common in elderly women; women in the richest countries live much
longer than those in the poorest nations. The different lifestyles and
eating habits of females in rich and poor countries are also
contributory factors, experts believe.
Classification:
Invasive breast cancer
the cancer cells break out from inside the lobules or ducts and invade
nearby tissue. With this type of cancer, the abnormal cells can reach
the lymph nodes, and eventually make their way to other organs
(metastasis), such as the bones, liver or lungs. The abnormal (cancer)
cells can travel through the bloodstream or the lymphatic system to
other parts of the body; either early on in the disease, or later.
Non-invasive breast cancer
this is when the cancer is still inside its place of origin and has not
broken out. Lobular carcinoma in situ is when the cancer is still inside
the lobules, while ductal carcinoma in situ is when they are still inside
the milk ducts. "In situ" means "in its original place". Sometimes, this
type of breast cancer is called "pre-cancerous"; this means that
although the abnormal cells have not spread outside their place of
origin, they can eventually develop into invasive breast cancer.
Signs and symptoms:

Women who detect any of the following signs or symptoms should tell their
doctor:
A lump in a breast
A pain in the armpits or breast that does not seem to be related to
the woman's menstrual period
Pitting or redness of the skin of the breast; like the skin of an orange
A rash around (or on) one of the nipples
A swelling (lump) in one of the armpits
An area of thickened tissue in a breast
One of the nipples has a discharge; sometimes it may contain blood
The nipple changes in appearance; it may become sunken or
inverted
The size or the shape of the breast changes
The nipple-skin or breast-skin may have started to peel, scale or
flake
Causes:
Getting older - the older a woman gets, the higher is her risk of
developing breast cancer; age is a risk factor. Over 80% of all female
breast cancers occur among women aged 50+ years (after
the menopause).
Genetics - women who have a close relative who has/had breast
or ovarian cancer are more likely to develop breast cancer. If two close
family members develop the disease, it does not necessarily mean
they shared the genes that make them more vulnerable, because
breast cancer is a relatively common cancer. The majority of breast
cancers are not hereditary. Women who carry the BRCA1 and BRCA2
genes have a considerably higher risk of developing breast and/or
ovarian cancer. These genes can be inherited. TP53, another gene, is
also linked to greater breast cancer risk.
A history of breast cancer - women who have had breast cancer,
even non-invasive cancer, are more likely to develop the disease again,
compared to women who have no history of the disease.
Having had certain types of breast lumps - women who have had
some types of benign (non-cancerous) breast lumps are more likely to
develop cancer later on. Examples include atypical ductal hyperplasia
or lobular carcinoma in situ.
Dense breast tissue - women with more dense breast tissue have a
greater chance of developing breast cancer.
Estrogen exposure - women who started having periods earlier or
entered menopause later than usual have a higher risk of developing
breast cancer. This is because their bodies have been exposed to
estrogen for longer. Estrogen exposure begins when periods start, and
drops dramatically during the menopause.
Obesity - post-menopausal obese and overweight women may have a
higher risk of developing breast cancer. Experts say that there are
higher levels of estrogen in obese menopausal women, which may be
the cause of the higher risk.
Height - taller-than-average women have a slightly greater likelihood
of developing breast cancer than shorter-than-average women. Experts
are not sure why.
Alcohol consumption - the more alcohol a woman regularly drinks,
the higher her risk of developing breast cancer is.
Radiation exposure - undergoing X-rays and CT scans may raise a
woman's risk of developing breast cancer slightly. Scientists at the
Memorial Sloan-Kettering Cancer Center found that women who had
been treated with radiation to the chest for a childhood cancer have a
higher risk of developing breast cancer.

 HRT (hormone replacement therapy) - both forms, combined and

estrogen-only HRT therapies may increase a woman's risk of
developing breast cancer slightly. Combined HRT causes a higher risk.
Certain jobs - French researchers found that women who worked at
night prior to a first pregnancy had a higher risk of eventually
developing breast cancer. Canadian researchers found that certain
jobs, especially those that bring the human body into contact with
possible carcinogens and endocrine disruptors are linked to a higher
risk of developing breast cancer. Examples include bar/gambling,
automotive plastics manufacturing, metal-working, food canning and
agriculture. They reported their findings in the November 2012 issue
of Environmental Health.
Cosmetic implants may undermine breast cancer survival women who have cosmetic breast implants and develop breast cancer
may have a higher risk of dying prematurely form the disease
compared to other females, researchers from Canada reported in
the BMJ (British Medical Journal) (May 2013 issue).
Diagnosis:
Breast exam - the physician will check both the patient's breasts,
looking out for lumps and other possible abnormalities, such as
inverted nipples, nipple discharge, or change in breast shape. The
patient will be asked to sit/stand with her arms in different positions,
such as above her head and by her sides.
X-ray (mammogram) - commonly used for breast cancer screening. If
anything unusual is found, the doctor may order a diagnostic
mammogram. Routine screening should start when the woman is 40
years old, others insist on 50 as the best age, and a few believe that
only high-risk groups should have routine screening.
2D combined with 3D mammograms - 3D mammograms, when
used in collaboration with regular 2D mammograms were found to
reduce the incidence of false positives, researchers from the University
of Sydney's School of Public Health, Australia, reported in The Lancet
Oncology.
Breast ultrasound - this type of scan may help doctors decide
whether a lump or abnormality is a solid mass or a fluid-filled cyst.
Biopsy - a sample of tissue from an apparent abnormality, such as a
lump, is surgically removed and sent to the lab for analysis. It the cells
are found to be cancerous, the lab will also determine what type of
breast cancer it is, and the grade of cancer (aggressiveness).
Breast MRI (magnetic resonance imaging) scan - a dye is injected
into the patient. This type of scan helps the doctor determine the
extent of the cancer.
Treatment:

A multidisciplinary team will be involved in a breast cancer patient's

treatment. The team may consists of an oncologist, radiologist,
specialist cancer surgeon, specialist nurse, pathologist, radiologist,
radiographer, and reconstructive surgeon. Sometimes the team
may also include an occupational therapist, psychologist, dietitian,
and physical therapist. The team will take into account several
factors when deciding on the best treatment for the patient,
including:
The type of breast cancer
The stage and grade of the breast cancer - how large the tumor is,
whether or not it has spread, and if so how far
Whether or not the cancer cells are sensitive to hormones
The patient's overall health
The age of the patient (has she been through the menopause?)

 The patient's own preferences

The main breast cancer treatment options may include:

Radiation therapy (radiotherapy)

Surgery
Biological therapy (targeted drug therapy)
Hormone therapy
Chemotherapy

Surgical Treatment:
Lumpectomy - surgically removing the tumor and a small margin of
healthy tissue around it. In breast cancer, this is often called breastsparing surgery. This type of surgery may be recommended if the
tumor is small and the surgeon believes it will be easy to separate from
the tissue around it. British researchers reported that about one fifth of
breast cancer patients who choose breast-conserving surgery instead
of mastectomy eventually need a reoperation.
Mastectomy surgically
removing
the
breast. Simple
mastectomy involves removing the lobules, ducts, fatty tissue, nipple,
areola, and some skin. Radical mastectomy means also removing
muscle of the chest wall and the lymph nodes in the armpit.
More than 90% of Filipino women diagnosed with breast
cancer prefer complete removal rather than breast
conservation as surgical treatment. The Philippines has the
highest mastectomy rate in Asia and one of the lowest breast
conservation rates.
Sentinel node biopsy - one lymph node is surgically removed. If the
breast cancer has reached a lymph node it can spread further through
the lymphatic system into other parts of the body.
Axillary lymph node dissection - if the sentinel node was found to
have cancer cells, the surgeon may recommend removing several
nymph nodes in the armpit.
Breast reconstruction surgery - a series of surgical procedures
aimed at recreating a breast so that it looks as much as possible like
the other breast. This procedure may be carried out at the same time
as a mastectomy. The surgeon may use a breast implant, or tissue
from another part of the patient's body.

Radiation therapy (radiotherapy)

Breast radiation therapy - after a lumpectomy, radiation is
administered to the remaining breast tissue
Chest wall radiation therapy - this is applied after a mastectomy
Breast boost - a high-dose of radiation therapy is applied to where
the tumor was surgically removed. The appearance of the breast may
be altered, especially if the patient's breasts are large.
Lymph nodes radiation therapy - the radiation is aimed at the axilla
(armpit) and surrounding area to destroy cancer cells that have
reached the lymph nodes
Breast brachytherapy - scientists at UC San Diego Moores Cancer
Center revealed that patients with early-stage breast cancer in the milk
ducts which has not spread, seem to benefit from undergoing breast
brachytherapy with a strut-based applicator. This 5-day treatment is
given to patients after they have undergone lumpectomy surgery.
***Side effects of radiation therapy: may include fatigue, lymphedema,

darkening of the breast skin, and irritation of the breast skin.

Hormone therapy (hormone blocking therapy)
Used for breast cancers that are sensitive to hormones. These types
of cancer are often referred to as ER positive (estrogen receptor
positive) and PR positive (progesterone receptor positive) cancers.
The aim is to prevent cancer recurrence.
Hormone blocking therapy is usually used after surgery, but may
sometimes be used beforehand to shrink the tumor. If for health
reasons, the patient cannot undergo surgery, chemotherapy or
radiotherapy, hormone therapy may be the only treatment she
receives.
Hormone therapy will have no effect on cancers that are not sensitive
to hormones. Hormone therapy usually lasts up to five years after
surgery.
The following hormone therapy medications may be used:
Tamoxifen - prevents estrogen from binding to ER-positive cancer
cells. Side effects may include changes in periods, hot flashes, weight
gain, headaches, nausea, vomiting, fatigue, and aching joints.
A gel containing the drug tamoxifen and applied to the skin was
as effective in reducing the growth of breast cancer cells in
women with noninvasive cancer as the pill form of the
medication and it caused fewer side effects, according to a
new study. The paper was published in Clinical Cancer Research,
a journal of the American Association for Cancer Research.
Aromatase inhibitors - this type of medication may be offered to
women who have been through the menopause. It blocks aromatase.
Aromatase helps estrogen production after the menopause. Before the
menopause, a woman's ovaries produce estrogen. Examples of
aromatase inhibitors include letrozole, exemestane, and anastrozole.
Side effects may include nausea, vomiting, fatigue, skin rashes,
headaches, bone pain, aching joints, loss of libido, sweats, and hot
flashes.
Ovarian ablation or suppression - pre-menopausal women produce
estrogen in their ovaries. Ovarian ablation or suppression stop the
ovaries from producing estrogen.
Preventing breast cancer:
Some lifestyle changes can help significantly reduce a woman's risk of
developing breast cancer.
Alcohol consumption - women who drink in moderation, or do not
drink alcohol at all, are less likely to develop breast cancer
compared to those who drink large amounts regularly. Moderation
means no more than one alcoholic drink per day.
Physical exercise - exercising five days a week has been shown to
reduce a woman's risk of developing breast cancer. Researchers
from the University of North Carolina Gillings School of Global Public
Health in Chapel Hill reported that physical activity can lower breast
cancer risk, whether it be either mild or intense, or before/after
menopause. However, considerable weight gain may negate these
benefits.
Diet - some experts say that women who follow a healthy, wellbalanced diet may reduce their risk of developing breast cancer.
Fish oils help reduce breast cancer risk - a study published
in BMJ (June 2013 issue) found that women who regularly consumed
fish and marine n-3 polyunsaturated fatty acids had a 14% lower risk

of developing breast cancer, compared to other women. The

authors, from Zhejiang University, China, explained that a "regular
consumer" should be eating at least 1 or 2 portions of oily fish per
week (tuna, salmon, sardines, etc).
Postmenopausal hormone therapy - limiting hormone therapy
may help reduce the risk of developing breast cancer. It is important
for the patient to discuss the pros and cons thoroughly with her
doctor.
Bodyweight - women who have a healthy bodyweight have a
considerably lower chance of developing breast cancer compared to
obese and overweight females.
Women at high risk of breast cancer - the doctor may
recommend estrogen-blocking drugs, including tamoxifen and
raloxifene. Tamoxifen may raise the risk of uterine cancer. Preventive
surgery is a possible option for women at very high risk.
Breast cancer screening - patients should discuss with their
doctor when to start breast cancer screening exams and tests.
Breastfeeding - women who breastfeed run a lower risk of
developing breast cancer compared to other women. A team of
researchers from the University of Granada in Spain reported in
the Journal of Clinical Nursing that breastfeeding for at least six
months reduces the risk of early breast cancer. This only applies to
non-smoking women, the team added. They found that mothers who
breastfed for six months or more, if they developed breast cancer,
did so on average ten years later than other women.

Prepared by: Erika May B. Molano, RN

MAN-II

Reference:
Pathophysiology Concepts of Altered Health States 7th Edition by Carol
Mattson Porth (pp.1090-1092)
http://www.gmanetwork.com/news/story/329126/cbb/phl-has-highest-breastcancer-rate-in-asia
http://www.medicalnewstoday.com/articles/37136.php
http://www.state.nj.us/health/cancer/cariskfactorsfsfinal02.htm
http://www.cancer.gov/cancertopics/pdq/prevention/overview/patient/page2
http://www.washingtonpost.com/national/health-science/skin-gel-newammunition-in-fight-against-breast-cancer/2014/07/14/f764fb4c-0b6f-11e48341-b8072b1e7348_story.html