Cancer Prevention

About Cancer Prevention

In 2006, an estimated 1,399,790 new cancer cases and 564,830 deaths from cancer are expected in the United States.

Cancers that can be prevented or detected earlier by following the American Cancer Society's testing guidelines account for approximately half of all new cancer cases in the United States. Scientific evidence suggests that about half of the cancer deaths expected in the United States will be related to tobacco use, unhealthy diet, physical inactivity, and being overweight or obese.

Talking to your doctor about your cancer risks, screenings recommended and preventive steps, is important to do at each annual visit. There also are cancer risk assessment tools available online. Both of the following assessments take less than 10 minutes to complete.

The Harvard Center for Cancer Prevention risk assessment tool can be found at www.yourdiseaserisk.harvard.edu. This site provides risk levels specific to certain cancers as well as great prevention tips.

The Great American Health CheckSM is an easy, confidential, online health assessment tool available at www.cancer.org/healthcheck. The tool was developed by the American Cancer Society and is made possible by Metropolitan Life Insurance Company ("MetLife"), with additional support from official sponsors Quest Diagnostics and Bayer AspirinR.

 

What Is Cancer?

Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer cells develop because of damage to DNA. This substance is in every cell and directs all activities.

Most of the time when DNA becomes damaged the body is able to repair it. In cancer cells, the damaged DNA is not repaired. People can inherit damaged DNA, which accounts for inherited cancers. More often, though, a person's DNA becomes damaged by exposure to something in the environment, like smoking. Cancer usually forms as a tumor. Some cancers, like leukemia, do not form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. Often, cancer cells travel to other parts of the body where they begin to grow and replace normal tissue. This process is called metastasis. Regardless of where a cancer may spread, however, it is always named for the place it began. For instance, breast cancer that spreads to the liver is still called breast cancer, not liver cancer. Not all tumors are cancerous. Benign (noncancerous) tumors do not spread (metastasize) to other parts of the body and, with very rare exceptions, are not life threatening.

Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer. Cancer is the second leading cause of death in the United States. Half of all men and one third of all women in the United States will develop cancer during their lifetimes. Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking and eating a better diet. The sooner a cancer is found and treatment begins, the better are the chances for living for many years.

Who Gets Cancer?

Over one million people get cancer each year. Approximately one out of every two American men and one out of every three American women will have some type of cancer at some point during their lifetime. Anyone can get cancer at any age; however, about 77% of all cancers are diagnosed in people age of 55 and older. Although cancer occurs in Americans of all racial and ethnic groups, the rate of cancer occurrence (called the incidence rate) varies from group to group. Today, millions of people are living with cancer or have been cured of the disease. The sooner a cancer is found and the sooner treatment begins, the better a patient's chances are of a cure. That's why early detection of cancer is such an important weapon in the fight against cancer.

What Are the Risk Factors for Cancer?

A risk factor is anything that increases a person's chance of getting a disease. Some risk factors can be changed, and others cannot. Risk factors for cancer can include a person's age, sex, and family medical history. Others are linked to cancer-causing factors in the environment. Still others are related to lifestyle choices such as tobacco and alcohol use, diet, and sun exposure. Having a risk factor for cancer means that a person is more likely to develop the disease at some point in their lives. However, having one or more risk factors does not necessarily mean that a person will get cancer. Some people with one or more risk factors never develop the disease, while other people who do develop cancer have no apparent risk factors. Even when a person who has a risk factor is diagnosed with cancer, there is no way to prove that the risk factor actually caused the cancer. Different kinds of cancer have different risk factors. Some of the major risk factors include the following: § Cancers of the lung, mouth, larynx, bladder, kidney, cervix esophagus, and pancreas are related to tobacco use, including cigarettes, cigars, chewing tobacco, and snuff. Smoking alone causes one-third of all cancer deaths. § Skin cancer is related to unprotected exposure to strong sunlight. § Breast cancer risk factors include several factors: age; changes in hormone levels throughout life, such as age at first menstruation, number of pregnancies, and age at menopause; obesity; and physical activity. Some studies have also shown a connection between alcohol consumption and an increased risk of breast cancer. Also, women with a mother or sister who have had breast cancer are more likely to develop the disease themselves. § While all men are at risk for prostate cancer, several factors can increase the chances of developing the disease, such as age, race, and diet. The chance of getting prostate cancer goes up with age. Prostate cancer is more common among African-American men than among white men. (We do not yet know why this is so.) A high-fat diet may play a part in causing prostate cancer. Also, men with a father or brother who have had prostate cancer are more likely to get prostate cancer themselves. Overall, environmental factors, defined broadly to include tobacco use, diet, and infectious diseases, as well as chemicals and radiation cause an estimated 75% of all cancer cases in the United States. Among these factors, tobacco use, unhealthy diet, and physical activity are more likely to affect personal cancer risk. Research shows that about one-third of all cancer deaths are related to dietary factors and lack of physical activity in adulthood. Certain cancers are related to viral infections and could be prevented by behavior changes or vaccines. More than 1 million skin cancers expected to be diagnosed in 2003 could have been prevented by protection from the sun's rays

Can Cancer Be Prevented?

Smoking and drinking alcohol cause some people to get certain types of cancer. These cancers might be prevented by avoiding tobacco and alcohol. The best idea is to never use tobacco at all. Cigarettes, cigars, pipes and smokeless tobacco cause cancer and should not be used. People who already smoke should try to quit. Former smokers have less risk of cancer than do people who continue to smoke. The chances of getting skin cancer can be lowered by staying in the shade as much as you can, wearing a hat and shirt when you are in the sun, and using sunscreen. We know that our diet, (what we eat) is linked to some types of cancer, although the exact reasons are not yet clear. The best advice is to eat a lot of fresh fruits and vegetables and whole grains like pasta and bread, and to cut down on high fat foods. There are tests, called screening examinations, that adults should have in order to find cancer early. If cancer is found early it can often be cured.

What Causes Cancer?

Some kinds of cancer are caused by things people do. Smoking can cause cancers of the lungs, mouth, throat, bladder, kidneys and several other organs, as well as heart disease and stroke. While not everyone who smokes will get cancer, smoking increases a person's chance of getting the disease. Drinking a lot of alcohol has also been shown to increase a person's chance of getting cancer of the mouth, throat, and some other organs. This is especially true if the person drinks and smokes. Radiation (x-rays) can cause cancer. But the x-rays used by the doctor or dentist are safe. Too much exposure to sunlight without any protection can cause skin cancer. In many cases, the exact cause of cancer remains a mystery. We know that certain changes in our cells can cause cancer to start, but we don't yet know exactly how this happens. Many scientists are studying this problem.

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Cancer Incidence and Mortality
In 2006, an estimated 1,399,790 people in the United States will be diagnosed with cancer, and 564,830 will die of cancer.[1] Estimates of the premature deaths that could have been avoided through screening vary from 3% to 35%, depending on a variety of assumptions. Beyond the potential for avoiding death, screening may reduce cancer morbidity since treatment for earlier-stage cancers is often less aggressive than that for more advanced-stage cancers.
Several potential harms must be considered against any potential benefit of screening for cancer.[2] Although most cancer screening tests are noninvasive or minimally invasive, some involve small risks of serious complications that may be immediate (e.g., perforation with colonoscopy) or delayed (e.g., potential carcinogenesis from radiation). Another harm is the false-positive test result, which may lead to anxiety and unnecessary invasive diagnostic procedures. A less familiar harm is overdiagnosis, i.e., the diagnosis of a condition that would not have become clinically significant had it not been detected by screening. This harm is becoming more common as screening tests become more sensitive at detecting tiny tumors. Finally, a false-negative screening test may falsely reassure an individual with subsequent clinical signs or symptoms of cancer and thereby actually delay diagnosis and effective treatment.
In developing the cancer screening summaries, the PDQ Screening and Prevention Editorial Board uses the following definitions:

• Screening is a means of detecting disease early in asymptomatic people.
• Positive results of examinations, tests, or procedures used in screening are usually not diagnostic but identify persons at increased risk for the presence of cancer who warrant further evaluation.
• Diagnosis is confirmation of disease by biopsy or tissue examination in the work-up following positive screening tests. (Following a positive screening result, cancer can often be ruled out by procedures other than biopsy or tissue examination.)

The purpose of this summary is to present an explicit evidence-based approach used in the development of the screening summaries. In reaching conclusions, evidence on the balance of risks and benefits is weighed. Cost and cost-effectiveness, however, is not taken into account. Assignment of levels of evidence associated with such screening tests is also discussed.
Summary Development
The cancer screening summaries are based on various levels of published scientific evidence and collective clinical experience. The highest level of evidence is taken as mortality reduction in controlled, randomized clinical trials. The results of clinical studies, case-control studies, cohort studies, and other information are also considered in formulating the summaries. In addition, the incidence of cancer, stage distribution, treatment, and mortality rates are considered. The summaries are subject to modification as new evidence becomes available.
The Scientific Basis
At least 2 requirements must be met for screening to be efficacious:

• A test or procedure must be available to detect cancers earlier than if the cancer were detected as a result of the development of symptoms.
• Evidence must be available that treatment initiated earlier as a consequence of screening results in an improved outcome.

These requirements are necessary but not sufficient to prove the efficacy of screening, which requires a decrease in cause-specific mortality. For example, these 2 criteria are met in the case of screening for childhood neuroblastoma by assessment of urinary catecholamine metabolites. On the basis of these criteria, a mass screening program was conducted in Saitama Prefecture, Japan, from 1981 to 1992 for 6-month-old infants.[3] Over that 12-year period, the annual incidence of neuroblastoma in children younger than 1 year increased from about 28 per million to 260 per million but without a significant reduction in incidence in children older than 1 year. Because there also was no reduction in mortality for the disease, this experience provided strong evidence of overdiagnosis—diagnosis of some neuroblastomas detectable by screening, which would not have been clinically diagnosed later. Similar experiences have been reported elsewhere in Japan [4] and in the Quebec Neuroblastoma Screening Project (QNSP) in Canada.[5] The history of screening for neuroblastoma also provides a useful illustration of the benefit of undertaking well-designed evaluations of emerging screening technologies before implementing screening programs. Although such studies are very costly, it has been shown that the QNSP itself averted unnecessary morbidity for thousands of children and did so while returning a yield plausibly estimated at a cost savings 64.5 times the investment in the study.[6]
Detection
Direct or assisted visual observation is the most widely available examination for the detection of cancer. It is useful in identifying suspicious lesions in the skin, retina, lip, mouth, larynx, external genitalia, and cervix.
The second most available detection procedure is palpation to detect lumps, nodules, or tumors in the breast, mouth, salivary glands, thyroid, subcutaneous tissues, anus, rectum, prostate, testes, ovaries, and uterus and enlarged lymph nodes in the neck, axilla, or groin.
Internal cancers require procedures and tests such as endoscopy, x-rays, magnetic resonance imaging, or ultrasound. Laboratory tests, such as the Pap smear or the fecal occult blood test have been employed for detection of specific cancers.
The performance of screening tests is usually measured in terms of sensitivity, specificity, and positive-predictive values (PPV) and negative-predictive values (NPV). Sensitivity is the chance that a person with cancer has a positive test. Specificity is the chance a person without cancer has a negative test. PPV is the chance that a person with a positive test has cancer. NPV is the chance that a person with a negative test does not have cancer. PPV and, to a lesser degree, NPV are affected by the prevalence of disease in the screened population. For a given sensitivity and specificity, the higher the prevalence, the higher the PPV.
High-Risk Populations
The type, periodicity, and commencement of screening in high-risk populations for most cancers reflect the judgment of practitioners rather than evidence from scientifically conducted studies. Some individuals are known to be at high risk for cancer, such as those with a personal history of cancer or a strong family history of cancer (in 2 or more first-degree relatives); increasingly, as genetic mutations and polymorphisms are found to be associated with specific cancers, high-risk individuals will be identified through genetic testing. Physician judgment is needed in such circumstances to determine the most appropriate application of available screening methods. Prudence suggests increased vigilance in the higher-risk populations. At a minimum, this means that the high-risk person is identified, is counseled appropriately, and regularly undergoes those screening procedures that have been shown to be of benefit to the general population.
Cancer Recurrence
Please see the PDQ treatment summaries for information on cancer recurrence.
Improved Outcomes
For nearly all cancers, treatment options and survival are related to stage, which is generally characterized by the anatomic extent of disease. On this basis, it is assumed that early detection of cancer, at an earlier stage, may yield better outcomes. In the 1940s, a generalized staging classification of localized, regional, and distant disease was developed to show long-term trends, and it is still useful. In the more detailed TNM system, which has been periodically modified, the (T)umor size, the status of the lymph (N)odes, and the status of distant (M)etastases are also categorized. These elements are grouped into stages 0-IV according to their association with survival. In general, larger primary malignant tumors have a higher incidence of metastasis to regional lymph nodes and to distant sites. Stage has such a profound effect on outcome that all randomized treatment trials require the comparison of similar stages in evaluating differences in outcome. Shifts in stage may also herald improved survival and decreased mortality, though stage shift alone does not establish benefit.
Biologic cellular characteristics of cancer, such as grade, hormone sensitivity, and gene overexpression are recognized as important predictors of cancer behaviors. For example, high-grade cancer may be fast growing and quick to metastasize regardless of stage at the time of diagnosis. Therefore, detection of these cancers when small may not affect outcome. Randomized controlled trials with survival outcomes are necessary to prove screening benefits.
The Natural Experiment
The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute gathers cancer incidence data from 11 geographic areas, covering approximately 14% of the US population. These population-based data of long duration (1973-present) are a unique and important resource in monitoring stage-related survival.
Interpreting Changes in Relative Survival Over Time
Increases in survival over time, however, even when based on data from tumor registries, such as SEER that include all cases in a given population, are difficult to interpret. They may reflect the benefits of early detection or improved treatment or both, but they may also result from lead-time bias and overdiagnosis, both of which occur commonly with screening.
Lead-time bias, which may result in longer survival of screen-identified cancers because the time before the cancer would have been diagnosed clinically, is included in the calculation of survival.
Overdiagnosis may result from finding cancers that would never have become manifest clinically and which might have a good prognosis. For example, autopsy series have shown a high percentage of occult early prostate carcinomas in elderly men who died of causes unrelated to prostate cancer.[7] The discovery of these cancers through screening could increase the number of cases and give the appearance of stage shift, and of increases in survival or cure rates, without necessarily reducing mortality. An analysis of data reported by the SEER program for 1950 to 1996 found that changes over time in 5-year relative survival rates for 20 major cancers were essentially unrelated to trends in mortality rates for those cancers over the same period.[8] The authors suggest that changes in 5-year survival rates are largely due to earlier diagnosis and to detection of subclinical cases that might never have surfaced clinically. They conclude that inferences about the effectiveness of early diagnosis or treatment should not be drawn from temporal changes in 5-year survival rates, but rather should be based on changes in mortality rates. Thus, changes in 5-year survival rates or stage shifts are not appropriate measures of the effectiveness of screening for early disease. Reductions in incidence rates for late-stage tumors represent a better measure of progress due to screening than 5-year survival trends, although such evidence is less compelling than reductions in mortality.
Study Designs
Varying study designs may be available to support a given summary. The strongest design would be obtained from a randomized controlled trial. It is, however, not always practical to conduct such a trial to address every question surrounding the field of screening. For each summary of evidence statement, the associated strength of study designs are listed. There are 5 study designs that are generally used in judging the evidence. In order of strength of design, the 5 levels are as follows:

• Evidence obtained from randomized controlled trials.
• Evidence obtained from nonrandomized controlled trials.
• Evidence obtained from cohort or case-control studies.
• Evidence obtained from ecologic and descriptive studies (e.g., international patterns studies, time series).
• Opinions of respected authorities based on clinical experience, descriptive studies, or reports of expert committees.

Experimental trials are designed to correct for or eliminate selection, lead-time, length, healthy volunteer, and other biases when prospectively testing a detection procedure to determine its effect on health outcome. The highest level of evidence and greatest benefit from screening is mortality reduction in a randomized controlled trial. For most sites, such evidence is not available. Theoretically it is possible to conduct randomized trials for most interventions, but the sample size that is needed, the expense, and the duration of such trials for most cancers, frequently make this approach impractical. Therefore, evidence obtained by other methods is often used.
Case-control and cohort studies provide indirect evidence for the effectiveness of screening. Such evidence is particularly compelling for the effectiveness of screening for cervical cancer.[9] Ecological correlation of mortality and intensity of screening has also been used in this context. Such studies do not prove a mortality-reduction effect, and the potential for bias to invalidate inferences from nonexperimental studies or to give misleading results, however, can be substantial.[10-15]
Descriptive uncontrolled studies based on the experience of individual physicians, hospitals, and nonpopulation-based registries may yield some information about screening. The performance characteristics of various detection tests, such as sensitivity, specificity, and PPVs, are generally first reported in such descriptive studies. The first evidence that screening may be successful is an increase in the incidence of early cancers as well as a decreased incidence of late-stage metastatic cancers (stage shift); later, a reduction in deaths may occur. These descriptive studies do not establish efficacy because of the absence of an appropriate control group.
A more detailed description of how the overall evidence regarding benefits and harms of screening tests is graded by the PDQ Screening and Prevention Editorial Board can be found in the PDQ summary on Levels of Evidence for Cancer Screening and Prevention Studies.
Disease-Specific and All-Cause Mortality Endpoints
Disease-specific mortality has been the most widely accepted endpoint in randomized clinical trials of cancer screening; however, the validity of this endpoint rests on the fundamental assumptions that the cause of death can be accurately determined and that the screening and subsequent treatment have negligible effects on other causes of death. Recent reviews of randomized clinical trials of cancer screening suggest that misclassification in cause of death has been a major problem and that misclassification has led to an overestimation of the effectiveness (or an underestimation of the harms) of screening.[16-18] In contrast to disease-specific mortality, all-cause mortality depends only on an accurate ascertainment of deaths and when they occur and therefore is not affected by misclassification in cause of death. One major limitation of the all-cause mortality endpoint however is that it is unlikely to reveal a statistically significant effect of cancer screening because this intervention is usually targeted to a disease that causes only a small proportion of all deaths. Nevertheless, all-cause mortality should be considered in conjunction with disease-specific mortality to reduce the possibility that a major harm (or benefit) from screening is hidden by misclassification in cause of death.
Measures of Risk
Several measures of risk are used in cancer research. Absolute risk or absolute rate measures the actual cancer risk or rate in a population or subgroup (e.g., U.S. population, or whites or African Americans). For example, the SEER Program reports risk and rate of cancer in specific geographic areas of the United States.
Rates are often adjusted (e.g., age-adjusted rates) to allow a more accurate comparison of rates over time or among groups. The purpose of the adjustment is to make the groups more alike with respect to important characteristics that may affect the conclusions. For example, when the SEER Program compares cancer rates over time in the United States, the rates are adjusted to one age distribution. If this were not done, cancer rates would seem to increase over time simply because the U.S. population is getting older and the risk of cancer is higher in older age groups.
Relative risk (RR) compares the risk of developing cancer among those who have a particular characteristic or exposure with those who do not. RR is expressed as a ratio of risks or rates; it ranges from infinity to the inverse of infinity (i.e., zero). If the RR is greater than 1, the exposure or characteristic is associated with a higher cancer risk; if the RR is 1, the exposure and cancer are not associated with one another; if the RR is less than 1, the exposure is associated with a lower cancer risk (i.e., the exposure is protective). RR is often used in clinical trials of cancer prevention and screening to estimate the reduction in cancer risk or risk of death, respectively.
An odds ratio (OR) is often used as an estimate of the RR. It, too, indicates whether there is an association between an exposure or characteristic and cancer. It compares the odds of an exposure or characteristic among cancer cases with the odds among a comparison group without cancer. For relatively uncommon events/diseases such as a cancer diagnosis, it can be interpreted like a RR is interpreted; however, it becomes a progressively inaccurate estimate of the RR as the underlying absolute risk of an event/disease in the population under study rises above 10%. ORs are typically used in case-control studies to identify potential risk factors or protective factors for cancer.
Risk or rate difference (or excess risk) compares the actual cancer risk or rate among at least 2 groups of people, based on an important characteristic or exposure, by subtracting the risks or rates from one another (e.g., subtracting lung cancer rates among nonsmokers from that of cigarette smokers estimates the excess risk of lung cancer due to smoking). This can be used in public health to estimate the number of cancer cases that could be avoided if an exposure were reduced or eliminated in the population.
Population-attributable risk measures the proportion of cancers that can be attributed to a particular exposure or characteristic. It combines information about the RR of cancer associated with a particular exposure and the prevalence of that exposure in the population, and estimates the proportion of cancer cases in a population that could be avoided if an exposure were reduced or eliminated.
Number needed to screen estimates the number of people that must participate in a screening program for 1 death to be prevented over a defined time interval.
Average life-years saved estimates the number of years that an intervention saves, on average, for an individual who receives the intervention. This reflects mortality reduction as well as life extension (or avoidance of premature deaths).

What Should I Ask My Doctor About Cancer?

Your relationship with your doctor is a critical part of your care. Ideally, you will have one doctor who coordinates all of your care. This doctor should be someone with whom you feel comfortable, someone you feel listens to your concerns and answers all of your questions thoughtfully and thoroughly. Your doctor will explain your diagnosis, health status, treatment options, and progress throughout treatment. There will also be nurses working with your doctor who have specialized knowledge and skills. These nurses are there to assist you with your treatment or any side effects you may have. In many cases, the nurse can answer your questions directly. Nurses can also help you get the answers you need from other members of your health care team.

Like all successful relationships, your relationship with your doctor is a two-way street. It is your responsibility to ask questions and become educated about your treatment and health - to become an active part of your cancer care team. Doctors differ in how much information they give to people with cancer and their families. Likewise, people who are newly diagnosed also differ in the amount of information they need or want. If your doctor is giving you too much or too little information, let them know. Ask them whatever questions you have, and keep them informed of your needs. As in any relationship, clear and honest communication is the key to success. Your doctor will discuss your treatment plan with you. The following are examples of questions to ask during the discussion:

• What type of cancer do I have? What is the stage or extent of my cancer?
• What is my prognosis, as you view it?
• What treatment do you recommend and why?
• What is the goal of treatment; cure or control of my symptoms?
• What are the possible risks or side effects of treatment?
• What are the pros and cons of my treatment?
• Are there other treatments for me to consider?
• How often will I need to come in for treatment or tests?
• How long will my treatments last?
• What if I miss a treatment?
• Will my life change? Will I need to make changes in my work, family life, and leisure time?
• What are the names of the drugs I will take? What are they for?
• What other drugs or treatments may I have to take?
• How will you know that my treatment is working?
• Why do I need a blood test and how often?
• If other specialists take part in my care, who will coordinate my entire treatment program?
• What symptoms or problems should I report right away?
• If I do not feel sick, does that mean the treatment is not working?
• What are the chances that my cancer may recur (come back), with the treatment programs we have discussed?
• What can I do to be ready for treatment?
• Will I still be able to have children after treatment?
• Are there any special foods I should or should not eat?
• Can I drink alcoholic beverages?
• What costs will I have?
• What is the best time to call you if I have a question?

Make sure that all your concerns and questions, no matter how small, have been answered. It may take more than one visit to discuss all of your concerns, as new questions may come to mind. It may be hard to remember all your doctor says to you. Some people find it helpful to take notes, bring a family member or friend, tape record the conversations, and/or bring a prepared list of questions and write down the doctor's answers.

Remember that you have the right to a second opinion about your diagnosis and the recommended treatment. Asking for a second opinion does not mean that you don't like or trust your doctor. Doctors understand you need to feel that every possibility for the best treatment is being explored. You can also ask your doctor if they have consulted with other specialists at their treatment center.

Information provided by the American Cancer Society.

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References

• American Cancer Society.: Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society, 2006. Also available online. Last accessed October 10, 2006. 
• Kramer BS: The science of early detection. Urol Oncol 22 (4): 344-7, 2004 Jul-Aug.  [PUBMED Abstract]
• Yamamoto K, Hayashi Y, Hanada R, et al.: Mass screening and age-specific incidence of neuroblastoma in Saitama Prefecture, Japan. J Clin Oncol 13 (8): 2033-8, 1995.  [PUBMED Abstract]
• Bessho F: Effects of mass screening on age-specific incidence of neuroblastoma. Int J Cancer 67 (4): 520-2, 1996.  [PUBMED Abstract]
• Woods WG, Tuchman M, Robison LL, et al.: A population-based study of the usefulness of screening for neuroblastoma. Lancet 348 (9043): 1682-7, 1996 Dec 21-28.  [PUBMED Abstract]
• Soderstrom L, Woods WG, Bernstein M, et al.: Health and economic benefits of well-designed evaluations: some lessons from evaluating neuroblastoma screening. J Natl Cancer Inst 97 (15): 1118-24, 2005.  [PUBMED Abstract]
• Woolf SH: Screening for prostate cancer with prostate-specific antigen. An examination of the evidence. N Engl J Med 333 (21): 1401-5, 1995.  [PUBMED Abstract]
• Welch HG, Schwartz LM, Woloshin S: Are increasing 5-year survival rates evidence of success against cancer? JAMA 283 (22): 2975-8, 2000.  [PUBMED Abstract]
• Hakama M, Miller AB, Day NE, eds.: Screening for cancer of the uterine cervix. Lyon, France: International Agency for Research on Cancer, 1986. 
• Connor RJ, Prorok PC, Weed DL: The case-control design and the assessment of the efficacy of cancer screening. J Clin Epidemiol 44 (11): 1215-21, 1991.  [PUBMED Abstract]
• Friedman DR, Dubin N: Case-control evaluation of breast cancer screening efficacy. Am J Epidemiol 133 (10): 974-84, 1991.  [PUBMED Abstract]
• Janzon L, Andersson I: The Malmo mammographic screening trial. In: Miller AB, Chamberlain J, Day NE, et al., eds.: Cancer Screening. Cambridge: Cambridge University Press, 1991, pp 37-44. 
• Moss SM: Case-control studies of screening. Int J Epidemiol 20 (1): 1-6, 1991.  [PUBMED Abstract]
• Weiss NS, Lazovich D: Case-control studies of screening efficacy: the use of persons newly diagnosed with cancer who later sustain an unfavorable outcome. Am J Epidemiol 143 (4): 319-22, 1996.  [PUBMED Abstract]
• Suzuki KJ, Nakaji S, Tokunaga S, et al.: Confounding by dietary factors in case-control studies on the efficacy of cancer screening in Japan. Eur J Epidemiol 20 (1): 73-8, 2005.  [PUBMED Abstract]
• Black WC: Overdiagnosis: An underrecognized cause of confusion and harm in cancer screening. J Natl Cancer Inst 92 (16): 1280-2, 2000.  [PUBMED Abstract]
• Olsen O, Gøtzsche PC: Screening for breast cancer with mammography. Cochrane Database Syst Rev (4): CD001877, 2001.  [PUBMED Abstract]
• Black WC, Haggstrom DA, Welch HG: All-cause mortality in randomized trials of cancer screening. J Natl Cancer Inst 94 (3): 167-73, 2002.  [PUBMED Abstract]

Breast
http://www.cancer.gov/cancertopics/screening/breast

Prostate Cancer
http://www.cancer.gov/cancertopics/pdq/screening/prostate/Patient/page3

Lung Cancer
http://www.cancer.gov/cancertopics/pdq/screening/lung/Patient/page3

Colorectal
http://www.cancer.gov/cancertopics/pdq/screening/colorectal/Patient/page3

GYN Cancers
Cervical Cancer
http://www.cancer.gov/cancertopics/pdq/screening/cervical/Patient/page3

Ovarian Cancer
http://www.cancer.gov/cancertopics/pdq/screening/ovarian/Patient/page3

Endometrial Cancer
http://www.cancer.gov/cancertopics/pdq/screening/endometrial/Patient/page3

Testicular Cancer
http://www.cancer.gov/cancertopics/pdq/screening/testicular/Patient/page2

Hepatocellular Carcinoma (Liver Cancer)
http://www.cancer.gov/cancertopics/pdq/screening/hepatocellular/Patient/page
2

Exams and Tests Descriptions
http://www.cancer.org/docroot/PED/ped_2_1_methods.asp?sitearea=PED

How/Where to get screened?
If you do not have a primary care physician to complete your yearly physical
please use this link to find a Piedmont physician
http://piedmont.photobooks.com/

Benefits of Early Detection
http://www.cancer.org/docroot/PED/ped_2.asp?sitearea=PED&level=1

 

If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.

 

Cancer Research

Piedmont Hospital participates in clinical trials for a variety of cancers. We are a member of the Atlanta Regional Community Clinical Oncology Program (ARCCOP), a National Cancer Institute (NCI) project, which allows community hospitals access to clinical trials. We also participate in pharmaceutical sponsored clinical trials. This enables patients to participate in cutting edge research studies without having to travel far distances to a research institution or the NCI.

For more information, please contact the Oncology Research department at:

Bonita Feinstein
Piedmont Hospital
Oncology Research
1968 Peachtree Rd. NW
Atlanta, GA 30309
404.605.2887

For a listing of current Atlanta Regional CCOP clinical trials open at Piedmont, you may access www.atlantaccop.org.
For other information related to cancer clinical trials, you may access the following web-sites:
Georgia’s Cancer Clinical Trials - www.georgiacancertrials.org
National Institutes of Health (NIH) Clinical Trials – www.clinicaltrials.gov
National Cancer Society (NCI) – www.cancer.gov

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Clinical Trials

Studies of promising new treatments are known as clinical trials. A clinical trial is done only when there is some reason to believe that the new treatment may be of value to the patient. Clinical trials are needed in order to find new and better ways to treat cancer. Treatments used in clinical trials are often found to have real benefits. The main questions the researchers want to answer are:

• Is this treatment helpful?
• Does it work better than the one we're now using?
• What side effects does it cause?
• Do the benefits outweigh the side effects?
• Which patients are most likely to find this treatment helpful?

Clinical trials are carried out in steps called phases. Each phase is designed to answer certain questions.

Phase I clinical trials look at the best way to give a new treatment and how much of it can be given safely. The main purpose of a phase I study is to test the safety of the new drug.

Phase II clinical trials are designed to see if the drug works. Patients are given the highest dose that doesn't cause serious side effects and then watched closely to see if there is an effect on the cancer.

Phase III clinical trials compare the new treatment with standard treatment. Large numbers of patients are divided into 2 groups. The control group receives standard treatment and the other group receives the new treatment. Everyone is closely watched to see which treatment is more effective. The study is stopped if the side effects are too severe or if one group has much better results than the other.

If you are in a clinical trial, you will have a team of experts watching your progress very carefully. However, there are some risks. No one knows in advance if the treatment will work or exactly what side effects will occur. That is what the study is designed to discover. Keep in mind, though, that even standard treatments have side effects.

 

To Learn More

CALL

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

WEB SITES AND ORGANIZATIONS

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

PUBLICATIONS

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

LIVEHELP

The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

WRITE

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

About PDQ

PDQ IS A COMPREHENSIVE CANCER DATABASE AVAILABLE ON NCI'S WEB SITE.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ CONTAINS CANCER INFORMATION SUMMARIES.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

THE PDQ CANCER INFORMATION SUMMARIES ARE DEVELOPED BY CANCER EXPERTS AND REVIEWED REGULARLY.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ ALSO CONTAINS INFORMATION ON CLINICAL TRIALS.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Date Last Modified: 2006-01-04

If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.