Evidence-based Counseling for GI Malignancy Risk Reduction - PowerPoint Presentation

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Evidence-based Counseling for GI Malignancy Risk Reduction

Mark Y. Liu, DO, FAAFPTripler Army Medical CenterHonolulu, Hawaii

The views expressed in this presentation are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

Aloha!

6 Million cans of Spam/year

Highest Life Expectancy in the U.S = 80

Case Study

Ashley, a 48 year-old woman, just learned that her 70 year-old father has inoperable gastric cancer. She wants to know if she is at risk of developing gastric cancer because she grew up eating the same smoked meats her father ate. Ashley also asks what she can do to lower her risk of developing this cancer. She has heard that calcium supplements might help prevent gastrointestinal cancers and ask whether she should begin taking a calcium supplement.

Background

140,000 + develop GI cancers each year49,000 die 9% of all cancer mortalitiesScreening and avoidance of risk factors

I. Lifestyle Risk Factors

Lifestyle factors2 Major longitudinal studiesParticipants with 4 healthful lifestyle factors, had 1/3 the risk of developing cancer

Obesity, smoking, poor diet, physical inactivity

1. Obesity

65% overweight, 30% obeseIncreases CRC, pancreatic and esophageal CAsEtiology of 20% of all cancers

Weight reduction leads to 60% less cancer mortality

2. Smoking

Implicated in 30% of all cancer-related mortalitiesOral cavity, esophagus, pancreas, liver, stomach and colonAll forms of tobaccoConversely, smoking cessation reduces risk

3. Diet

Red Meat

Charred Meat

Fried

BBQ

High Fat

Colon

Colon

Pancreas

Esophageal

Gastric

Pancreas

Colon

High-salt

content

Preserved foods

Processed foods

Fruits

& Veggies

Dairy

products

Calcium & Fiber

Hot

drinks

Coffee

Gastric

Decreases all GI cancer risks

Inconclusive

4. Physical Inactivity

Physical Activity GI CA risks3.5 hours/week of moderate exercise = 24% reduction of CRC risk

Theories: Hormones; Growth Factors

Immune function; Prostaglandin

Extra: Alcohol Consumption

1 Drink (10g) increases risk of cancers of:OropharynxEsophagusRectum

Poorly understood

Solvent properties?

II. Heredity

Heredity vs. diet/lifestyle

Cancer Type

Hereditary Syndrome

Lifetime Risk

Esophageal

None proven

NA

Gastric

Hereditary

diffuse gastric cancer

40% to 67% in men

Up

to 83% in women

Pancreatic

Hereditary pancreatitis

44% to 75%

Colorectal

FAP

HNCC

(Lynch)

20% to 40%

III. Infections

Helicobacter pylori – Gastric CAEpstein-Barr virus – Gastric CAHuman papillomavirus – Esophageal CAJC

polymavirus

– Colon CA

Chemoprevention

AspirinAnti-inflammatory properties2007 USPSTF Recommendation2011 meta-analysis of 8 trialsReduces risks for esophageal, gastric, pancreatic and colorectal cancers

50% reduction of CRC mortalities after 5 years

No dosage difference

Chemoprevention

Vitamin and Mineral SupplementationVitamin D, calcium & magnesiumStrongest evidence for calcium – lowers CRCACG recommends 3 g/day

Recommendations

Lifestyle counselingInquire family historyRule out infectionsDiscuss role of chemoprevention

Case Revisited

You inform Ashley that there is association between gastric cancer and dietYou obtain a detailed family history to exclude hereditary syndromesYou order a test for H. pylori infectionYou recommend regular use of low-dose ASA

You recommend calcium supplementation for chemoprevention and bone health

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