Reducing Risk for Cancer

Finding ways to reduce your risk for cancer in the future is important, especially if you have already had cancer. Healthy living habits, avoiding risky behaviors, getting recommended screening tests and understanding the risks of certain health conditions can reduce risk for cancer and contribute to quality of life.

Reducing Risk for Cancer: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

Current statistics from the Centers for Disease Control and Prevention (CDC) show that there are nearly 12 million cancer survivors living in the United States. That compares to 9.8 million survivors in 2001 and just 3 million in 1971 including anyone who had a cancer diagnosis.

Based upon recent cancer survival statistics, about 65 percent of all patients newly diagnosed with cancer are now likely to be alive and clinically cancer-free five years later and 40 percent for 10 years or more. Unfortunately, many cancer survivors are at increased risk of developing new or recurrent cancers. Finding ways to reduce the risk for cancer in the future is important, especially if you have already had cancer.

The CDC reports that healthy behaviors like quitting smoking, eating well and exercising regularly can help reduce the risk of developing cancer. Healthy habits, avoiding risky behaviors, and getting recommended early detection (screening) tests, can also improve the chances of surviving cancer and having a better quality of life. There are also ways to reduce the risks of health conditions that can also be a contributor to the development of cancer.

This topic explores factors that may affect the chances of developing new and recurring cancers including:

• Screening tests
• Dietary choices
• Alcohol use
• Body weight
• Tobacco use
• Sun and ultraviolet rays
• Radon exposure
• Chronic health challenges
• Genetic factors

What is cancer screening and can it be helpful?

Screening is checking for cancer and for conditions that may lead to cancer in people who do not have symptoms. Screening and diagnostic testing for many cancers has been proven to save lives, by detecting precancerous tumors that may lead to cancers and cancers before they spread to other parts of the body. According to the National Cancer Institute (NCI), some types of cancer can be found even before symptoms appear.

Types of screening and diagnostic tests generally include the following:

• Physical exam and history: During an exam of the body, the health care provider checks for general signs of disease or anything else that seems unusual. A history of the patient’s health habits, past illnesses and treatments are taken and discussed, and may be used to guide the use of screening tests.

Laboratory tests: Lab tests may be ordered such as samples of blood, or urine.

• Imaging procedures: Imaging procedures, such as x-rays and a of types of scans that create pictures of areas inside the body to check for unusual changes. Mammograms are the only type of imaging tests that are routinely used for screening.
• Genetic tests: Tests that look for gene mutations (changes) that are linked to some types of cancer.

Cancer screening can help health care providers find and treat some types of cancer early when cancer treatment may be more effective. Unfortunately, not all types of cancer have screening tests, and some tests are only for people with specific genetic risks. Talk with your provider about the types of screening that may be recommended and beneficial to you. Be sure to ask your health care provider about the potential benefits and risks of any screening or testing procedure.

How can dietary choices help reduce the risk of cancer?

The overall link between diet and cancer risk is complex, and is not entirely clear at this time. Much of the research data within this field of study is not consistent. However, there is a lot of useful research data to consider when developing a strategy around diet to reduce your lifetime risk of cancer.

Research has shown that what individuals eat affects cancer risk for specific types of cancers. For example, multiple cancer prevention studies have shown that increased consumption of red meat, highly processed meats including sausages and luncheon meats, and other sources of animal fats are associated with increased risk of death from several types of cancer–as well as from cardiovascular disease.

On the other hand, studies of research volunteers who adhere to the “Mediterranean Diet” have shown a significantly reduced risk of cancers of the lung, esophagus, breast, stomach, colon, and rectum. The Mediterranean Diet includes an abundance of fresh fruits and vegetables, and moderate amounts of nuts, fish, and healthy cooking oils such as canola oil and olive oil. This diet substitutes herbs and spices for salt and may include a modest amount of red wine. None or very little red meat and processed meats are consumed in the Mediterranean Diet.

At least one public health study, found that strict adherence to the Mediterranean Diet was associated with a 50 percent decrease in the risk of gastrointestinal (GI) tract cancers. The role of diet in the prevention of cancers of the GI tract appears to be particularly strong. GI cancers include cancer of the esophagus, stomach, small intestine, colon, rectum, and anus, as well as cancers of the liver, pancreas, gallbladder, and bile ducts inside and outside the liver.

Other recent and large public health studies further confirm that there are lifestyle and dietary habits that are linked with a decreased risk of developing cancer. Many of these same healthy lifestyle habits also reduce the risk of cardiovascular disease.

For example, the results of a very large study, involving more than 23,000 clinically healthy German volunteers between the ages of 35 and 65 years, identified four basic lifestyle and diet-based factors were linked to reducing the risk of cancer by almost 40 percent:

• Having never smoked
• Maintaining a healthy weight with body mass index (BMI) less than 30
• Engaging in robust physical activity for at least 3.5 hours per week, and
• Maintaining a healthy diet rich in fresh fruits, vegetables and whole grains

How can alcohol use affect cancer risk?

There is a great deal of research data linking regular alcohol intake to the risk of multiple forms of cancer. Based on research, both men and women are affected and are advised to drink only moderate amounts of alcohol, or no alcohol at all. Regular drinking of alcohol has been clearly shown to increase the risk of cancers of the breast, esophagus, stomach, colon, rectum, liver, pancreas, lung, bladder, and kidney. It is important to point out that increased cancer risks have been observed for all types of alcoholic beverages, including wine.

The Million Women Study, one of the largest studies ever undertaken, followed nearly 1.3 million middle-aged women for an average of more than seven years. The women participants in this research study were generally found to drink low to moderate amounts of alcohol on average. This enabled researchers to study the effects of relatively low alcohol intake on the risk of a wide range of cancers. The relationship of alcohol intake by these women was then correlated with the incidence (frequency) of new cancers diagnosed during the study.

Researchers from the Million Women Study found that the overall cancer risk was greater with increasing levels of drinking. Specifically, overall risk increased 6% for every 10-gram drink (less than .4 ounces or 2.4 teaspoons) of alcohol per day. Risk increased most (30-40%) for cancers of the mouth and throat in women who also smoked. However, the risk of breast cancer (by far the most common cancer in middle-aged women) increased about 12% for each daily drink, whether the women smoked or did not.

In summary, the research data showed that for every increase in the average number of daily alcohol drinks, the following percentages of relative risk existed by specific types of cancer:

• 44 percent increase in risk of laryngeal cancer in smokers
• 29 percent increase in risk of oral cavity cancer in smokers
• 24 percent increase in risk of liver cancer
• 22 percent increase in risk of esophageal cancer
• 12 percent increase in risk of breast cancer
• 10 percent increase in risk of rectal cancer

Women need to be especially aware that multiple clinical research studies have shown a significant link between regular alcohol intake and risk of breast cancer. A recent analysis of data collected and combined from 53 different clinical research studies also concluded that alcohol significantly increases the relative risk of developing breast cancer. Even a single alcoholic beverage per day was found to be associated with a statistically significant increase in the risk of developing breast cancer. The results of this very large study analysis suggested that about 4 percent of all breast cancers in developed countries may be directly caused by alcohol consumption.

How does being overweight affect the risk of getting cancer?

Being overweight, or obese, is estimated to be a factor that directly accounts for 14 percent of all cancers in men and 20 percent of all cancers in women. Based upon data compiled by the American Institute for Cancer Research and the American Cancer Society, excess body fat is estimated to cause at least 100,500 (7 percent) of the new cancer cases every year in the United States. Even without changing our lifestyle in other ways, we can bring down our risk of cancer by almost 10 percent by maintaining a normal body weight.

The cancer types that have currently been linked to excessive body weight include the following types of cancers:

• Breast
• Cervix
• Colon
• Esophagus
• Gallbladder
• Kidney
• Liver
• Ovary
• Pancreas
• Prostate
• Rectum
• Stomach (at least in men)
• Uterus

Based on research, it has been estimated that the adoption of healthy dietary and related lifestyle measures would dramatically decrease the incidence of obesity-associated cancers. This includes an estimated 60 to 70 percent reduction in the risk of cancers of the breast, prostate, colon, and rectum.

Those considered obese have an abnormally high and unhealthy proportion of body fat. BMI provides a more accurate measure of obesity (BMI or 30 or more) or being overweight than does weight alone. Normal body weight is considered to be a BMI of less than 25.The following National Cancer Institute chart can be used to determine your BMI category. Find your height, and move across the chart to your weight.

 

The above BMI chart is from the National Cancer Institute (NCI) website related to Obesity and Cancer: http://www.cancer.gov/cancertopics/factsheet/Risk/obesity

In addition to contributing to the development of certain types of cancers, being overweight can increase the risk of other health problems such as diabetes, heart disease, and stroke. If you need help with healthy weight management, ask your health care team about the best ways to do this for your situation. General recommendations include avoiding a high-calorie diet that includes fats. As you age, it may be necessary to further increase physical activity and reduce calories.

Can exercise help reduce the risk of developing cancer?

There are many known health benefits related to physical activity. Exercise can reduce stress, increase energy and help maintain a healthy weight. Researchers are also learning that physical activity appears to contribute to reduced risk of cancers of the colon and breast. A number of studies have also reported links between physical activity and a reduced risk of cancers of the prostate, lung, and uterine lining (endometrial cancer). There is some evidence that other types of cancer may also be less common among people who regularly exercise including stomach (gastric) cancer and other GI tract cancers.

Experts report that exercising even three times a week may improve health. Physical activity can range from gentle stretching to activities such as walking, running or bicycling. There are likely to be physical activities you can do, even if you are dealing with a chronic health challenge. Talk with your health care team about the best type of exercise program for your situation.

How do tobacco products increase the risk of cancer?

Research has clearly shown that tobacco products increase the risk of cancer and contribute to the development of many types of cancer. These include cancer of the lungs, throat, mouth, esophagus and kidneys. Tobacco use also contributes to other serious health problems such as heart disease and emphysema.

Cigarette smoking causes 34 percent of all cancer deaths in this country. Tobacco smoke contains a variety of substances that have been proven carcinogenic (cancer causing). Exposure to secondhand smoke has also been linked to cancers. There are at least 62 known carcinogenic substances present in tobacco smoke, and at least 15 of these chemical substances have been shown to cause cancer in humans. More than 90 percent of all lung cancers are directly caused by smoking. While lung cancer is the #1 cause of cancer death in the United States, it is also the easiest cancer to prevent.

Many people believe that the use of snuff and other forms of smokeless tobacco is safer than smoking. However, potent human carcinogens (N-nitrosamines) are also present in high concentrations in smokeless tobacco. These carcinogens have been clearly linked to cancers of the lung, esophagus, liver, pancreas, bladder, cervix, nasal and oral cavities. There simply is no safe way to use tobacco products.

How can exposure to ultraviolet rays affect the risk for cancer?

Exposure to ultraviolet (UV) rays from the sun is a known risk factor for the three most common types of skin cancer: basal cell cancer, squamous cell cancer and melanoma. The use of tanning beds and sunlamps also sharply increases ultraviolet radiation exposure and can increase risk for skin cancer. In addition, UV exposure can damage your skin, eyes, and can cause early aging and other problems. Fair-skinned people are particularly at increased risk of developing skin cancer from long-term or repeated exposure to ultraviolet rays.

Basal cell and squamous cell skin cancers rarely spread (metastasize) to other areas of the body. However, melanoma can rapidly spread to almost any organ in the body if not detected and treated early enough. In addition to a family history of melanoma, frequent blistering sunburns during childhood and adolescence have been clearly linked with an increased lifetime risk of melanoma. Having a large number of pigmented moles (nevi) is also a known risk factor for melanoma.

To reduce the risk of cancer from ultraviolet rays, use sunscreen that blocks both UV-A and UV-B radiations with a sun protective factor (SPF) of at least 15. Wear protective clothing and a hat when you are outdoors. UV damage occurs most during the mid-morning to late afternoon hours. Protect your eyes by wearing sunglasses that block 99-100 percent of UV-A and UV-B radiation.

Can medical x-rays and CT scans affect the risk for cancer?

The risk of harm from radiation exposure from having diagnostic testing, such as x-rays and computed tomography (CT) scans, is generally considered low. In most cases, the benefits of these tests usually outweigh the risks. However, repeated exposure can have the potential to cause cancer.

Recent estimates are that up to 2 percent of all cancer cases are directly caused by exposure to medical x-ray tests. It is well known that exposure to increasing doses of x-rays, and undergoing repeated x-ray examinations, increases the overall risk of cancer formation. Most radiation experts believe that there is no completely safe level of exposure to x-rays.

A CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the internal body. It is estimated that CT scans of the body may cause at least 2 percent of all new cases of cancer. Most CT scans are performed for very important clinical information. However, some CT scans are still being ordered and performed when they may not be necessary. Talk with your health care provider to be certain that CT scans are done only when they are medically needed.

Magnetic resonance imaging (MRI) is a screening procedure that uses a high-powered magnet and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). MRI does not use any x-rays. However, MRI screening results sometimes appear abnormal, even when no cancer is present.

Talk with your health care providers about the need for each test that will include x-rays. Women should always let the health care provider and the technician know if there is any possibility that they are pregnant.

How can radon affect the risk of cancer?

We all breathe a certain level of radon gas every day, usually at very low levels. It is an invisible, odorless, tasteless gas that seeps up through the ground and diffuses into the air. Radon is a radioactive gas released from the normal decay of uranium in rocks and soil. In a few locations, depending on the geology of the area, radon dissolves into ground water and can be released into the air when the water is used. Radon gas usually exists at very low levels outdoors.

Those who inhale high levels of radon are at an increased risk for developing lung cancer. Ongoing exposure to radon gas is the second most common risk factor for lung cancer. Researchers generally agree that 5 to 10 percent of all lung cancer cases are directly caused by radon gas. Smokers who are exposed to radon gas long term, have an even greater risk of developing lung cancer than non-smokers with similar exposure.

Radon can enter homes through cracks in floors, walls, or foundations, and collect indoors. Radon gas can also be released from building materials or from water obtained from wells that contain radon. Radon levels may be higher in homes that are well insulated, tightly sealed or built on uranium-rich soil. Because of closeness to the ground, basement and first floors in a house typically have the highest radon levels. In most cases, radon gas can be eliminated from closed spaces by installing special ventilation equipment.

Testing is the only way to know if a home has elevated radon levels. Indoor radon levels are affected by the soil composition under and around the area and the ease with which radon enters the house. Homes located very near one another other can have different indoor radon levels. A number of factors can cause radon levels to vary from month to month or day to day. Both short- and long-term radon tests are available to help you find out whether your home is being exposed to high levels of radon.

Does diabetes affect the risk for cancer?

Diabetic patients who maintain excellent control of their diabetes can significantly reduce their risk of developing cancer. However, diabetes that is not well controlled has been found to be a risk factor for cancer. Uncontrolled diabetes is known to increase the risk of pancreatic cancer by as much as 50 percent. Diabetes has also been linked to a 43 percent increase in the relative risk of colon cancer and an 11 percent increase in the relative risk of rectal cancer. Studies have also suggested that uncontrolled diabetes may also be associated with an increased risk of cancers of the breast, liver, kidney, and uterus.

If you have diabetes, reduce your risk of developing cancer by effectively managing your diabetes. Talk with your health care team about the best ways to do this for your situation.

Can chronic infections affect the risk of cancer?

Your immune system is a network of cells, tissues, and organs throughout your body that defends you against invasions by viruses and bacteria. Chronic (long-term) infections with oncogenic (cancer-causing) viruses and bacteria can lead to a variety of cancers. However, protection from many oncogenic organisms can be provided by vaccines, antibiotics, or by reducing risk through safe behaviors such as protected sex.

• Helicobacter pylori (H. pylori) is a type of bacteria that is estimated to chronically infect two-thirds of the world’s population. This bacterium resides in the human stomach and is a common cause of inflammatory illnesses of the stomach and small intestine including gastritis, gastric (stomach) ulcers, and duodenal ulcers. Chronic infection with H. pylori is now also known to be a direct cause of stomach (gastric) cancer as well as an unusual form of lymphoma of the stomach.
  
  There is still some debate about the best way to manage chronic H. pylori infection. Recent research suggests that H. pylori infection may actually reduce the risk of cancer of the esophagus. However, most medical experts currently recommend that all confirmed H. pylori infections be treated with one of several approved antibiotic regimens.

• Human Papilloma Virus (HPV) is most commonly passed by sexual contact. Many people have HPV and do not even know it. Because this virus is known to cause more than 95 percent of cases of cervical cancer, a great deal of research effort and money have been invested to create HPV vaccines. HPV vaccines work by stimulating the immune system to become resistant to HPV infection. The vaccines are effective only if given before any exposure to HPV virus has occurred―this means before becoming sexually active. HPV also causes genital warts in both men and women.
  
  There is evidence that chronic HPV infection may also be associated with cancers other than cervical cancer. A great deal of clinical and laboratory research data points to chronic HPV infection as the primary cause of cancers of the anus, vulva, vagina, penis, and the oropharynx (the structures within the mouth and throat).
  
  HPV vaccines were originally intended for adolescent girls to prevent cervical cancer. However, there is an increasing awareness of other HPV-associated cancers in both men and women. Many public health experts now recommend that these vaccines also be administered to adolescent boys. Two HPV vaccines have now been approved by the Food and Drug Administration in the United States.

• Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) cause inflammation of the liver. Hepatitis can be passed from person to person through body fluids and blood, such as through sexual contact or shared needles. An infant may catch these viruses from an infected mother. According to the National Cancer Institute, approximately 2 percent of the US population is chronically infected with either HBV or HCV.
  
  If a hepatitis virus is diagnosed, the health care provider will suggest treatment and discuss ways to avoid infecting other people. Liver cancer can develop after many years of infection with either of these viruses. People infected with HCV are also at approximately a 20-30 percent increased risk of developing certain lymphomas (cancers of the lymphatic system).
  
  HBV and HCV infections may not cause symptoms, but blood tests can show whether either virus is present. In people who are not already infected with HBV, the hepatitis B vaccine can prevent HBV infection. Researchers are working to develop a vaccine to prevent HCV infection. You may want to talk with your health care team about the benefits and risks of vaccines for you.

• Chronic suppression of the immune system is known to increase the risk of certain cancers. This means that the immune system is not working as effectively as it should. Long-term suppression of the immune system has been observed in patients who have experienced organ transplantation and are taking immunosuppressive medications.
   
  HIV infection results in varying degrees of immune system suppression and brings an increased risk of cancer. HIV can be transmitted by unprotected sexual activity or intravenous (IV) drug abuse. The Centers for Disease Control and Prevention (CDC) reports that some health care workers have become infected after being stuck with needles containing HIV-infected blood, when infected blood comes in contact with a worker's open cut or is splashed into a worker's eyes or inside their nose.
  
  Cancers most commonly associated with HIV infection are known to be caused by other associated cancer-causing viruses, including Kaposi sarcoma and the human papilloma virus (HPV). The risk of other types of cancer is less common but may be increased in patients who are infected with the HIV virus, especially when an individual smokes or drinks alcohol heavily. These risks include cancers of the anus, liver, mouth and throat, lung, testicles, colon, rectum, and skin.

Can family genetic factors affect the risk of developing cancer?

Research has shown that certain types of cancer may be more common to some families than other types. These cancer types include melanoma, breast, ovarian, prostate and colon. If a certain pattern of cancer appears to exist in your family, genetic testing might be suggested by your health care provider. These tests check for gene changes, but finding a change does not mean that have, or will develop, cancer. However, it may mean that there is a higher than average possibility of developing these or other types of cancer. Your provider may then recommend steps to reduce your risk such as increasing frequency of screening tests for disease.

Talk with your health care provider if there is a history of cancer in your family. There may be things you can do to try to reduce your risk, including regular screening tests and medical exams.

In addition, there are other things you can do to make the most of your health such as:

• Taking prescription and preventive medicines as recommended by your health care team
• Having needed immunizations
• Getting regular dental check-ups and care
• Getting vision and hearing checked regularly
• Asking your health care provider about flu shots and other vaccinations

While not every case of cancer can be prevented at this time, approximately half of all new cancer cases are thought to be preventable through relatively moderate changes in lifestyle and diet.

This doument was produced in collaboration with:
Robert A. Wascher, MD, FACS
Surgical Oncologist, Cancer Treatment Centers of America, Western Regional Medical Center in Goodyear, Arizona.

Cited works:

Allen NE, Beral V, Casabonne D, Kan SW, Reeves GK, Brown A, Green J. Moderate Alcohol Intake and Cancer Incidence in Women. J Natl Cancer Inst 2009;101:296-305.

American Cancer Society. Cancer Facts & Figures 2010. Atlanta, Ga: American Cancer Society; 2010. http://www.cancer.org/Research/CancerFactsFigures/index

CDC (Centers for Disease Control and Prevention). Cancer survivorship---United States, 1971--2001. MMWR 2004;53:526--9.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5324a3.htm

Giordano TP, Henderson L, Landgren O, Chiao EY, Kramer JR, El-Serag, H, Engels EA. Risk of Non-Hodkin Lymphoma and Lymphoproliferative Precursor Diseases among 146,394 Hepatitis C Virus Infected U.S. Veterans, Journal of the American Medical Association, May 8, 2007, 297 (18).

LIVESTRONG. LIVESTRONG Guidebook. ©2004-2011 Lance Armstrong Foundation.

National Cancer Institute. Cancer prevalence statistics: approaches to estimation using cancer registry data. Bethesda, MD: National Cancer Institute; 2010. Available at http://srab.cancer.gov/prevalence/approaches.html . Accessed March 4, 2011.

Perrett, Linda. NCI Benchmarks, Diabetes is the Most Common Risk Factor for Liver Cancer in the U.S,.April 19, 2010. http://benchmarks.cancer.gov/2010/04/diabetes-is-the-most-common-risk-factor-for-liver-cancer-in-the-u-s/

Wascher RA. A Cancer Prevention Guide for the Human Race. Indianapolis, IN: Dog Ear Publishing, 2010. http://acancerpreventionguide.com/author.php

World Cancer Research Fund published Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective, November 2007.
http://www.aicr.org/site/PageServer?pagename=research_science_expert_report

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Reducing Your Risk for Cancer: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

• Try to find balance and live a healthy lifestyle. Take steps to maintain a healthy balance in your lifestyle:
  
  • Know your medical history. This includes an understanding about your family history, including any diseases found in family members.
  • Work with your health care provider to develop a health care plan with recommendations for diet and exercise.
  • Develop a schedule for screening exams and regular screening and check-ups with your health care team


• Talk with your health care team and ask them to help you make choices to contribute to your health.
  Good nutrition, exercise, and other healthy behaviors may help you stay healthy and reduce your risk for cancer. Work with your health care team to develop a plan for a healthy lifestyle. Consider your entire medical history and include new goals you have set such as:
  
  • Avoiding tobacco products
  • Developing an exercise plan
  • Maintaining a healthy body weight
  • Eating five to seven servings of fruits, vegetables, and whole grains a day
  • Performing regular breast or testicular self-exams and skin exams each month
  • Using sunscreen and avoiding exposure to the sun, especially during the late morning and early evening
  • Getting enough rest and sleep
  
  Healthy behaviors can become part of your life. Start by doing things you enjoy, and expand on your efforts as you can over time. There can be comfort in knowing you are doing what you can to reduce your risk for cancer and other health problems.


• Keep track of the history of cancer in your family.

  If there is a history of cancer in your family, it is especially important to understand risk factors and have regular screenings. Your health care team can help you decide if genetic counseling or testing is recommended.

  If you do not know about your genetic background, start talking with relatives or friends who know your family’s medical history. In many cases, no one has written down the information and only an oral history is known. You can begin to develop these records for yourself. It may also be helpful to other members of your family.

  “My Family Health Portrait” is a useful online tool for recording your family health history. This free tool helps organize information. You can then print it out to share with the health care provider and other family members. Go online to https://familyhistory.hhs.gov.

• Use a health journal to write down important information.
  A health journal can help you prepare for your next visit with a member of your health care team. It can also help you to keep all of your team members informed about medications, treatments, and other important information. The LIVESTRONG Guidebook and Planner and Journal is a free resource that can help your loved ones organize and keep track of your treatments and other experiences during your cancer journey. To request a free copy, visit www.LIVESTRONG.org/guidebook.
  
  Take the following steps as you keep track of your health care:
  
  • Write down everything you want to ask your health care team. You can make notes and keep track of questions between visits.
  • Make a list of your medications. Bring this information to the visit along with all of your medication bottles. This will help the health care team keep track of all the medications you are taking, including vitamins and over-the-counter medications.
  • Take notes during health care appointments.
  • Keep all of your health records together and bring this information with you to health care appointments.
  • Bring extra copies of important documents to give to appropriate health care team members. You can also fax or mail these before your appointment. Having the health care team read your documents may be an easier way for you to communicate.
  • Store pamphlets, information about medication side effects and important phone numbers in your notebook so that everything is in one place.


• Some types of cancer can be found before they cause symptoms. Screening is checking for cancer and for conditions that may lead to cancer. Screening can help health care providers find and treat some types of cancer early. Cancer treatment may be more effective when the disease is found early. However, not all types of cancer have screening tests, and some tests are only for people with specific genetic risks.
  
  Look into the following screening resources:
  
  • An excellent summary of cancer screening recommendations has been published online by the American Cancer Society (ACS) and can be found at the following page on the ACS website: http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer
  • A detailed review of the benefits of cancer screening examinations can also be found in Dr. Robert Wascher’s book, “A Cancer Prevention Guide for the Human Race.”
  • The National Cancer Institute (NCI) offers recommendations for cancer screening and testing on their website: http://www.cancer.gov/cancertopics/screening
    
    • Cancer Screening Overview (PDQ®)
      http://www.cancer.gov/cancertopics/pdq/screening/overview/patient Information about measuring the effectiveness of cancer screening tests and weighing the evidence from screening research studies.
    • What You Need To Know About™ Cancer: Screening
      http://www.cancer.gov/cancertopics/wyntk/cancer Describes possible risks, screening, symptoms, diagnosis, and treatment for cancer.

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Reducing Risk for Cancer: Additional Resources

The previous sections of this document provide detailed information, suggestions, and questions to ask related to this topic. This section offers a listing of additional resources that are known to provide support and quality services that may be helpful to survivors during the cancer journey.

LIVESTRONGCare Plan
www.LIVESTRONGcareplan.org

This free online tool was created to help you develop a personalized plan for post-treatment care. It can help you work with your oncologist and primary health care provider to address medical, emotional and social challenges that may arise after cancer treatment is completed. By answering some questions related to your cancer treatment, you will receive information about your follow-up care. This information includes symptoms to watch for in the future and steps you can take to stay healthy.

LIVESTRONG Cancer Navigation Center
www.LIVESTRONG.org/GetHelp

Email:	Cancer.Navigation@LIVESTRONG.org
Phone:	1.855.220.7777 (English and Spanish)
	Navigators are available for calls Monday through Friday, 9 a.m. to 5 p.m. (Central Time). Voicemail is available after hours.

The Navigation Center provides free, confidential one-on-one support to anyone affected by cancer. This is not a medical facility, but rather a center that provides the following support services:

• Emotional Support—assistance coping with a cancer diagnosis, help accessing support groups, as well as peer-to-peer connections
• Fertility Risks and Preservation Options—information on fertility risks and help accessing discounted rates for fertility preservation options
• Insurance, Employment and Financial Concerns—information on employment rights and benefits, financial assistance and debt management, including insurance and billing issues as well as medication co-pay assistance

In addition to professional cancer navigators on staff, LIVESTRONG partners with specialty organizations such as Patient Advocate Foundation, Imerman Angels, Navigate Cancer Foundation and EmergingMed to provide support services.

American Cancer Society (ACS)
www.cancer.org

Email:	Submit questions in English or Spanish from the “Contact Us” page.
Phone:	1-800-227-2345
	TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. ACS can connect you to support and services in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

National Cancer Institute (NCI) — National Institutes of Health
www.cancer.gov

Online:	The LiveHelp online chat service is available Monday through Friday from 8:00 a.m. to 11:00 p.m. Eastern Time.
Email:	Send an email through the website.
Phone:	1-800-422-6237
	Information specialists answer calls Monday–Friday, 8:00 a.m. to 8:00 p.m. Eastern Time.

The National Cancer Institute's website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment and financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. Cancer information specialists can answer your questions about cancer and help you with quitting smoking. They can also help you with using the website and can tell you about NCI’s printed and electronic materials. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

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