Upper & Lower Respiratory Tract Cancer Prevention
-
Upload
ann-meredith-garcia -
Category
Healthcare
-
view
227 -
download
2
Transcript of Upper & Lower Respiratory Tract Cancer Prevention
cancer prevention
respiratory tract Upper & lower
ANN MEREDITH U. GARCIA, MD, FPCP, DPSMO, MCMMO
Internist – Medical Oncologist Blessed Family Doctors General Hospital w Luzon Medical Center w The Medical City Pangasinan
Lung cancer is the cause of
cancer death leading
among both men & women.
HNSCC is a public health
problem. major
AmericanCancerSociety|DeVita10e
Tertiary = Treatment
Secondary = Screening
Primary = Prevention
cancer prevention Three of levels Interna5onalAgencyforResearchonCancer
Carcinogenic exposure à Diffuse epithelial injury à Chronic pattern of tissue damage & wound healing
Field cancerization field of tissue injury & the
are observed in smokers with oral & lung cancer.
Chiesaetal.Head&NeckCancer:Mul5modalityManagement.NewYork:Springer-Verlag,2011|Cohen&Khuri.CancerControl.2003;10(4):315-324|Slaughteretal.Cancer.1953;6:963-968
RISK FACTOR HEAD & NECK LUNG Tobacco smoking ✔ ✔ Environmental/occupational exposures ✔ ✔ Ionizing radiation ✔ ✔ Older age ✔ ✔ Positive family history ✔ ✔ Previous cancer ✔ ✔ Immunosuppression ✔ ✔ Male sex ✔ Alcohol abuse ✔ Betel nut/quid chewing ✔ Poor oral and dental hygiene ✔ Viral infections (e.g., HPV, EBV) ✔ UV radiation ✔ Poor nutrition ✔ Chronic obstructive pulmonary disease (COPD) ✔
High-dose nutritional supplements (e.g., beta-carotene) ✔
Risk factors
Cohen&Khuri.CancerControl.2003;10(4):315-324|DeVita10e
85-90% tobacco smoke.
of lung cancers & HNSCC are associated with exposure to
6x
risk of oral cancer increased
10-30x
risk of lung cancer increased
AmericanCancerSociety|Garfinkel&Stellman.CancerRes.1988;48:6951-6955|Samet.ClinChestMed.1991;12:669-679|USCentersforDiseaseControl&Preven5on
increases The risk of cancer
with the
number of cigarettes smoked,
years of smoking,
earlier age of onset,
degree of inhalation, tar & nicotine content,
& use of unfiltered cigarettes.
Cohen&Khuri.CancerControl.2003;10(4):315-324
smoker a nonsmoker’s chances
of developing lung cancer by
20-30%.
increases
Living with a
USDepartmentofHealth&HumanServices
Secondhand smoke exposure of >15 years is associated with a
1.6x higher developing head & neck cancer.
likelihood of
Leeetal.CancerEpidemiolBiomarkersPrev.2008;17(8):1974-1981
hookah A typical 1-hour
100 cigarettes. equivalent is to smoking
session
USCentersforDiseaseControl&Preven5on|WorldHealthOrganiza5on
AmericanLungAssocia5on|Na5onalIns5tuteonDrugAbuse
e-cigarettes Although they do not produce tobacco smoke,
chemicals.
still contain & other nicotine potentially harmful
e-cigarettes So far, there are large, high-quality studies NO
can be used to cut down or quit smoking long-term.
looking at whether
CancerPreven5on&TreatmentFund
unknown.
The health consequences of
e-cigarette long-term
use remain
AmericanLungAssocia5on|Na5onalIns5tuteonDrugAbuse
Smoking cessation is the known
effective intervention in
the risk of lung cancer.
only
reducing Anthonisenetal.AnnInternMed.2005;142:233-239|Garfinkel&Stellman.CancerRes.1988;48:6951-6955|
Keith&Miller.NatRevClinOncol.2013;10:334-343|Lubin&Blot.JNatlCancerInst.1993;85:422-423
Heavy use
2-5x. raises
the risk of head & neck cancers by
alcohol
CancerResearchUK|MemorialSloanKeeeringCancerCenter
>4 drinks/day >14 drinks/week
>3 drinks/day >7 drinks/week
Heavy use alcohol
Moderate use alcohol Up to 2 drinks/day Up to 1 drink/day
USDACenterforNutri5onPolicy&Promo5on
Alcohol produces
acetaldehyde
damage
&
reactive oxygen species that can DNA.
CancerResearchUK|Interna5onalAgencyforResearchonCancer
2% reduced by for each year that a person remains
alcohol-free.
The risk of pharyngeal & laryngeal cancers is
AhmadKiadalirietal.PLoSOne.2013;8(3):e58158
Alcohol makes it for the mouth & throat
tobacco. easier
to absorb the cancer-causing
chemicals in
100x higher
risk of developing
mouth & upper throat cancer
Up to
CancerResearchUK|MemorialSloanKeeeringCancerCenter|Tura5etal.Alcohol&Alcoholism.2013;48(1):107-118
50 There are over
100
known or probable causes of occupational cancer,
substances that are
& over other substances. possible
Ins5tu5onofOccupa5onalSafetyandHealth
Asbestos
lung cancer &
laryngeal cancer.
increases the risk of developing
AmericanCancerSociety|AmericanSocietyofClinicalOncology|Na5onalCancerIns5tute
ionizing radiation may the risk of cancer. increase
Exposure to high doses of
AmericanCancerSociety|AmericanSocietyofClinicalOncology|MemorialSloanKeeeringCancerCenter
UV radiation the risk of
skin cancers increases
in the head & neck region.
AmericanCancerSociety|AmericanSocietyofClinicalOncology|MemorialSloanKeeeringCancerCenter
sunscreen Use
regularly.
AmericanAcademyofDermatology|AmericanCancerSociety|Faurschou&Wulf.BrJDerm.2007;156:716-719
104-144% Lung cancer risk is
emphysema &
higher in people with a history of
47-52% higher in smokers with a history of chronic bronchitis.
Brenneretal.AMJEpidemiol.2012;176(7):573-585|Brenneretal.PLoSONE.2011;6(3):e17479
HIV-infected individuals have ≥2x increased
risk of developing cancer.
D’Souza&Dempsey.PrevMed.2011;53(1):S5-S11|Na5onalCancerIns5tute
HPV 45-90% infection
is associated with of
oropharyngeal cancers,
CancerTreatmentCentersofAmerica|D’Souza&Dempsey.PrevMed.2011;53(1):S5-S11
24% of laryngeal cancers, &
23% of oral cavity cancers.
Oropharyngeal cancer?
HPV vaccination may potentially the risk of oral
HPV infection. reduce
AmericanSocietyofClinicalOncology|Chiesaetal.Head&NeckCancer:Mul5modalityManagement.NewYork:Springer-Verlag,2011
oral hygiene People with poor or
dental care may have an risk
of oral cavity cancer. increased
AmericanSocietyofClinicalOncology|Rajeshetal.JIndianSocPeriodontol.2013;17(6):706-710
ç
Betel nut/quid chewing the risk of developing
oral cancer.
increases oral precancerous lesions &
Mutagenesis.2004;19(4):251-262|Sharanetal.PLoSOne.2012;7(8):e42759
Physical activity lung cancer risk by
20-30% reduces
for women &
20-50% for men.
Emaus&Thune.RecentResultsCancerRes.2011;186:101-133
& vegetables A diet in
oropharyngeal & laryngeal cancer. may the risk of increase
low fruits
AmericanSocietyofClinicalOncology|CancerResearchUK
Chemoprevention aims to or
premalignancy from
progressing to invasive cancer.
reverse,suppress, prevent
Keith&Miller.NatRevClinOncol.2013;10:334-343|Spitzetal.CancerPrevRes.2008;1:250-254|Sporn.CancerRes.1976;36:2699-2702
High-risk population
agents with Efficacious tolerable adverse effects
Keith&Miller.NatRevClinOncol.2013;10:334-343|Spitzetal.CancerPrevRes.2008;1:250-254
Phase III trials chemoprevention harmful negative had or results.
Keith&Miller.NatRevClinOncol.2013;10:334-343
screening has been shown to by
low-dose CT scans reduce mortality
Lung cancer using
20%. Na5onalLungScreeningTrialResearchTeametal.NEnglJMed.2011;365:395-409
LDCT screening Criteria for
55-74 years old
Fairly good health
≥30 pack-year smoking history
Still smoking or quit smoking within the last 15 years
Na5onalLungScreeningTrialResearchTeametal.NEnglJMed.2011;365:395-409
physical examination An annual
of the head, neck, & oropharynx is recommended.
MayoFounda5onforMedicalEduca5onandResearch
dental evaluation An annual
is also recommended.
Hashimetal.AnnOncol.2016(acceptedmanuscript)|MemorialSloanKeeeringCancerCenter
prevention. The therapeutic goal is
secondary
leukoplakias malignant can undergo
transformation within 20 years.
of 5-36%
Chiesaetal.Head&NeckCancer:Mul5modalityManagement.NewYork:Springer-Verlag,2011
Ask all patients about smoking
Assess readiness to quit
Advise all smokers to quit
Assist Arrange follow-up
5As The approach
WorldHealthOrganiza5on
#SayNoToCancer
q Stopsmoking.
q Don’tsmoke.
q Avoidsecondhandsmoke.
q Avoiddrinkingalcohol.q Avoidbetelnut/quidchewing.
q Avoidcarcinogensatwork.q Avoidunnecessaryexposuretoradia@on.
q Usesunscreenregularly.
q Exercisemostdaysoftheweek.
q Eatadietfulloffruits&vegetables.
q Avoidtakinglargedosesofvitaminsinpillform.q [email protected] Maintaingoodoralhygiene.q Getscreenedasappropriate.