Diabetes Treatments

6. Having diabetes doubles the risk of CVD for men and triples the risk for women. Most people with diabetes die of CVD and usually die at younger ages than people …

Chapter 12: Cardiovascular Disease and Cancer

Learning Objectives
After completing this chapter, the student will be able to:
List the major components of the cardiovascular system and describe how
blood is pumped and circulated throughout the body
Describe the controllable and uncontrollable risk factors associated with
cardiovascular disease
Discuss the major forms of cardiovascular disease and how they develop
Explain what cancer is and how it spreads
List and describe common cancers-their risk factors, signs and symptoms,
treatments, and approaches to prevention
Discuss some of the causes of cancer and how they can be avoided or
minimized, and describe how cancer can be detected, diagnosed, and
treated
List specific actions you can take to lower your risk of cardiovascular
disease and cancer

Online Learning Center Resources wwwmhhecom/inselbrief9e
Student Center resources include the following:
Learning objectives
Chapter outline
Multiple choice questions
True-or-false questions
Glossary
Flashcards
Internet Exercises
Vital Statistics Links
In the News Links
Wellness Worksheets
Behavior Change Workbook
For More
Information
Crossword puzzles
Journal Entry
Health Links

Additional Instructor Center resources include:
Instructors Manual
Digital transparencies
PowerPoint Image Set
PageOut/TestBank
Links to professional resources
Wellness Worksheets
Learning To Go: Health

The Online Learning Center that accompanies Core Concepts in Health Brief
Update can be found at wwwmhhecom/inselbrief9e At the login box, type
username Insel314 and password instructor

Resources at a Glance

General Health Information
For the latest health information, check the current issues of:
Annual Editions: Health at wwwmhhecom/catalogs/007250692xmhtml
The U C Berkeley Wellness Letter wwwberkeleywellnesscom
The McGraw-Hill Online Learning Center wwwmhhecom/inselbrief9e
The Mayo Clinic health site wwwmayoedu
MedLinePlus wwwmedlineplusgov
The InteliHealth site wwwintelihealthcom

Also check the following media sites:

Print Media
Reuters headlines: http://dailynewsyahoocom/h/hl/nm/?u
AP Health headlines: wwwcnncom/health
Time magazine: wwwTIMEcom
Newsweek: wwwNewsweekcom
US News and World Report: wwwusnewscom

Broadcast
Media
ABC: http://abcnewsgocom
CBS: wwwcbscom
NBC: wwwmsnbccom/news

PowerPoint Presentation and Supplemental Illustrations
A PowerPoint presentation of this chapter and supplemental illustrations
are available on the McGraw-Hill Interactive Instructor CD-ROM IICD and
online at wwwmhhecom/inselbrief9e

Lecture Outline

This chapter contains information about cardiovascular disease, cancer, and
measures people can take to reduce their risk of illness or death from the
two leading causes of death in the United States

I The cardiovascular system

A The cardiovascular system comprises the heart and blood vessels, which
pump and circulate blood containing oxygen, carbon dioxide, nutrients,
hormones, enzymes, wastes, and so forth There are two circulatory
systems: pulmonary and systemic

B The heart is a four-chambered muscle about the size of a fist

1 Each side of the heart has an upper chamber called the atrium,
and a lower chamber called the ventricle

2 Blood returns to the heart through the vena cava and into the
right atrium, then into the right ventricle-ventricular
contraction
forces the blood out of the heart, through the pulmonary artery,
and into the lungs for reoxygenation This process is called
pulmonary circulation

3 The blood then returns through the pulmonary veins to the left
atrium and the left ventricle, then into system circulation through
the aorta, the bodys largest artery

C The contraction of the heart is called systole, and the relaxation is
called diastole

1 The action of the heart is controlled by an electrical signal
that originates in a group of specialized cells, the pacemaker, in
the right atrium

2 The rate remains steady unless the brain signals it to change in
response to danger, exhaustion, or other stimuli

D Veins carry blood to the heart; arteries carry it away from the heart

1 Arterial walls are thick and elastic; veins have thinner walls

2 The aorta branches into capillary arteries, which supply blood
to the heart itself, and ultimately into tiny capillaries

II Risk factors for cardiovascular disease

A Risk factors for cardiovascular disease CVD can be classified
as
major and contributing Many risk factors for CVD are linked to
controllable lifestyle choices

B There are six major risk factors for CVD that can be changed: tobacco
use, high blood pressure, unhealthy levels of blood cholesterol,
physical inactivity, obesity, and diabetes

1 Cigarette smokers have two to three times the risk of heart
attack that nonsmokers have

a As a stimulant, nicotine causes increased blood pressure and
heart rate

b Carbon monoxide in cigarette smoke displaces oxygen in the
blood

c Smoking damages the linings of arteries and reduces beneficial
levels of high-density lipoproteins

d Smoking causes platelets to become sticky and cluster, promoting
clotting
e Smoking permanently accelerates the rate at which fatty
deposits are laid down in the arteries

f The risk of death from coronary heart disease increases up to
30 among those exposed to environmental tobacco smoke

2 High blood pressure is both a risk factor for many forms of CVD
and a disease in itself

a
High blood pressure occurs when too much pressure is exerted
against the walls of the arteries

b The heart must work harder and eventually weakens and enlarges;
arteries scar and harden

3 Cholesterol is essential to the bodys functioning, but in
excessive levels it can clog arteries and increase risk of CVD

a Desirable cholesterol levels vary depending on diet, age, sex,
heredity, and other factors

b The body obtains cholesterol from the liver, which manufactures
it, and from food

c Cholesterol is carried in the blood in lipoproteins

1 Low-density lipoproteins LDLs carry cholesterol from the
liver to organs and tissues that require it Excess amounts
are deposited in the blood vessels, where they may be
oxidized by free radicals, speeding inflammation and damage
to artery walls and increasing the likelihood of a blockage
For this reason, LDLs are considered bad cholesterol

2 High-density lipoproteins HDLs carry unused cholesterol
back to the liver for recycling By
removing cholesterol from
blood vessels, HDLs help protect against atherosclerosis and
are known as good cholesterol

d The risk of CVD increases with increasing blood cholesterol
levels, especially LDL

e High LDL levels and low HDL levels are associated with a high
risk of CVD; low LDL levels and high HDL levels are associated
with lower risk

f Reducing blood cholesterol levels reduces heart attack risk and
helps to clean out diseased arteries

4 Physical inactivity is a major risk factor for CVD Exercise
reduces risk by helping reduce blood pressure, increase HDL levels,
maintain desirable weight, prevent or control diabetes, and improve
the functioning of endothelial cells that line coronary arteries A
minimum of 30 to 60 minutes per day of moderate physical activity
is recommended

5 Body weight of more than 30 over recommended weight is a risk
factor in and of itself

a Excess weight contributes to high cholesterol levels and high
blood pressure, increasing the strain on the heart

b The distribution of fat is also an indicator of CVD Fat
collected in the torso area is more dangerous than fat collected
around the hips

6 Having diabetes doubles the risk of CVD for men and triples the
risk for women Most people with diabetes die of CVD and usually
die at younger ages than people without diabetes
C Contributing risk factors for CVD that can be changed include
elevated triglyceride levels and psychological and social factors

1 Elevated triglyceride levels, especially in combination with low
HDL levels, obesity, and/or diabetes, are a reliable predictor of
CVD

2 Psychological and social factors can increase risk for CVD

a Excessive stress is a risk factor because the stress response
can put a strain on the heart and blood vessels

b Hostility, cynicism, and anger increase the risk for heart
disease

c Suppressing psychological distress, instead of sharing it with
others, may have negative physical as well as psychological
effects

d Depression, anxiety, and social isolation are also
risk factors

e Low socioeconomic status and low educational attainment also
increase CVD risk

D Certain risk factors, such as heredity and age, cannot be changed, and
some segments of the population have special risks

1 CVD has a genetic component A person is at greater risk if a
parent had heart or blood vessel disease High cholesterol levels,
hypertension, blood-clotting problems, diabetes, and obesity also
have genetic links

2 The risk of heart attack increases after age 65

3 Men have a higher risk for CVD than do women, especially earlier
in life By age 75, the gender gap nearly disappears

4 African American men and women have a greater risk of
hypertension; many Hispanic Americans have greater risks of high
blood pressure and angina Asian Americans have had lower rates of
CVD than white Americans, but their cholesterol levels appear to be
rising

E Several other possible risk factors include homocysteine,
lipoproteina, LDL particle size, and certain infectious agents

1 Inflammation occurs when smoking, cholesterol,
infectious
agents, and other factors injure an artery C-reactive protein
CRP is released into the bloodstream during the inflammatory
response Studies suggest that high levels of CRP indicate an
elevated level of risk for heart attack and stroke Testing for CRP
is recommended for people at intermediate risk for CVD

2 Certain risk factors-high blood pressure, high triglycerides,
low HDL, abdominal obesity, and insulin resistance-are often found
in cluster; they are called syndrome X or metabolic syndrome
Weight control and physical activity are recommended for people
with metabolic syndrome

3 Elevated levels of homocysteine, an amino acid, may be a direct
cause of CVD or a marker for some other risk factor

4 Infectious agents that may contribute to heart disease include
Chlamydia pneumoniae, cytomegalovirus CMV, and helicobacter
pylori
5 High levels of lipoproteina, a specific type of LDL, have a
strong genetic component and are difficult to treat Preliminary
research suggests that hormone replacement therapy in

postmenopausal women, a diet rich in omega-3 fatty acids, and
treatment for reducing elevated LDL levels may help reduce the
associated risk

6 Research shows that LDL particles differ in size and density and
that concentrations vary among individuals People with small,
dense LDL particles are at greater risk for cardiovascular disease
Exercise, a low-fat diet, and certain lipid-lowering drugs may help
reduce CVD risk in people with small, dense LDL particles

7 High levels of fibrinogen, a protein essential for the formation
of blood clots, are linked to coronary heart disease and stroke

8 High blood viscosity and excess iron stores increase the risk of
cardiovascular disease

9 There may be a link between high blood levels of uric acid and
CVD mortality, particularly among postmenopausal women and African
Americans

10 Eating a diet high in high-glycemic-index carbohydrates may
contribute to CVD and other diseases

III Major forms of cardiovascular disease

A Many forms of CVD are interrelated and have elements in common

B
Hypertension, which is usually asymptomatic, can cause major damage
before it is ever detected

1 Blood pressure is the force exerted by the blood on the walls of
the blood vessels, especially the arteries, and it fluctuates
considerably When blood pressure exceeds normal limits most of the
time, it becomes a problem

2 Blood pressure is measured with a stethoscope and an inflatable
cuff attached to a sphygmomanometer

3 Average blood pressure readings for a young adult are 110 to 120
mm Hg systolic over 70 to 80 diastolic High blood pressure is
defined as greater than 140 mm Hg systolic over 90 mm Hg diastolic

4 High blood pressure can result from either increased output of
blood by the heart or increased resistance to blood flow in the
arteries The result is that the heart must work harder than
normal

5 High blood pressure can damage vital organs and blood vessels

6 Hypertension occurs in about one in four adults

7 Mild hypertension can be reduced with lifestyle changes
Medication is prescribed when lifestyle changes do
not adequately
control high blood pressure

C Atherosclerosis is a slow, progressive process that may begin in
childhood Arteries become narrowed by deposits of fat, cholesterol,
and other substances

1 When the cells that line the arteries become damaged, the bodys
response to this damage results in inflammation and changes in the
artery lining

2 In response to these changes, LDL, platelets, and other cells
build up and cause a bulge in the artery wall
3 As these deposits, called plaques, accumulate, the arteries lose
elasticity, restricting blood flow and making the artery vulnerable
to blockage by blood clots

4 Blockage of a coronary artery causes a heart attack; blockage of
a cerebral artery causes a stroke

D Heart attack, or myocardial infarction MI, is usually the result of
a long-term disease process, occurring in about 11 million Americans
annually

1 A heart attack caused by a clot is called a coronary thrombosis,
in which part of the heart muscle may die from lack of oxygen If
the attack is not fatal, the heart muscle
may partially repair
itself

2 Angina pectoris is chest pain that occurs when the heart does
not get the oxygen it requires Angina may also occur as shoulder,
neck, arm, hand, or back pain; it is a warning that load on the
heart should be reduced

3 Abnormal heartbeats, resulting from a disruption of the
electrical system that regulates the heartbeat, are called
arrhythmias and can be fatal

4 Ventricular fibrillation is a type of arrhythmia that can cause
cardiac death

5 A person having a heart attack should be transported to an
emergency room as quickly as possible Most people who die from a
heart attack die within 2 hours of the first symptoms Many experts
recommend chewing an aspirin for its immediate anti-clotting
effect

a CPR can be administered by a qualified person

b If a person receives emergency care quickly enough, a clot-
dissolving agent can be injected to break up the clot

6 Detection involves several diagnostic tests

a Stress tests use electrocardiograms taken while the person is

exercising to record the electrical activity of the heart and
show abnormalities

b Several noninvasive tools for evaluating CVD are electron-beam
computed tomography EBCT, echocardiography, and magnetic
resonance imaging

c If noninvasive tests suggest coronary artery disease is present,
a coronary angiogram is used A catheter is threaded into an
artery and a special dye is injected into the bloodstream X-
rays are then used to trace the flow of blood through the
coronary arteries and heart

7 Treatments for heart problems range from changes in diet to
major surgery

a A low-fat diet, regular exercise, and smoking cessation are
recommended lifestyle changes

b Taking half an aspirin daily may reduce the risk of heart attack
because of its anticoagulant effect, but too much aspirin may
also cause gastrointestinal irritation or ulcers

c Balloon angioplasty uses a catheter with a balloon tip, which is
inflated at the area of blockage to flatten the fatty plaque and
widen the opening It is
currently the most common surgical
procedure for treating heart disease; however, repeat clogging
is common
d Coronary artery bypass surgery uses a healthy vein from
one of the patients legs to reconnect the coronary artery
around the occlusion

E Stroke, or cardiovascular accident, is a blockage in blood supply to
the brain Prompt treatment can greatly reduce the risk of permanent
disability

1 There are two major types of stroke: ischemic stroke, caused by
blockages in blood vessels, and hemorrhagic strokes caused by
rupture of blood vessels

a One type of ischemic stroke, thrombotic stroke, is caused by a
blood clot that forms in a cerebral artery Ischemic strokes
account for 80 of all strokes and are treatable with clot-
dissolving drugs

b The second type of ischemic stroke, embolic stroke, is caused by
a wandering blood clot that is carried in the blood stream and
may become wedged in one of the cerebral arteries

c Less common, but more severe, is the hemorrhagic stroke, which
occurs
when a blood vessel in the brain bursts, spilling blood
into surrounding tissue

1 A subarachnoid hemorrhage occurs when a blood vessel on
the brains surface ruptures and bleeds into the space
between the brain and skull

2 A ruptured vessel within the brain causes an intercerebral
hemorrhage

3 Hemorrhages can be caused by head injuries or the bursting
of a malformed blood vessel, an aneurysm

4 An aneurysm is a blood-filled pocket that bulges out from
a weak spot in an artery wall It may be caused, or worsened,
by high blood pressure

5 Some aneurysms in the brain may never break

2 About 700,000 Americans have strokes yearly, and about one-third
of those die Most survivors suffer lasting disabilities that vary,
depending on the part of the brain that has been damaged

3 Transient ischemic attacks TIAs may occur before a full
stroke They may produce similar symptoms that last only briefly

4 A person who has had or is having a stroke should be rushed to a

hospital because early treatment can significantly reduce the
severity of disability

a A computed tomography CT scan can be used to assess brain
damage and determine the type of stroke

b If a clot is detected, the patient can be given the same clot-
dissolving drugs used to treat coronary artery blockages

c People who have had TIAs or are at high risk for stroke may
obtain a carotid endarterectomy

5 Damaged or destroyed brain tissue cannot regenerate, but the
brain can form new neural pathways, and other parts of the brain
can take over some of the functions of the damaged parts

F Congestive heart failure occurs when, for any number of reasons, the
heart cannot maintain its regular pumping rate and force; fluids back
up and collect in the lungs and other areas
1 When fluid accumulates in the lungs, it can interfere with
breathing This condition is called pulmonary edema

2 Congestive heart failure can be controlled by reducing cardiac
load, eliminating excess fluid, restricting salt, and giving
digitalis or other drugs to
increase the strength of pumping action
and diuretics to eliminate excess salt and water

G Other forms of heart disease include congenital heart disease,
rheumatic heart disease, and heart valve disorders

1 The most common congenital defects are holes between the
ventricles, although they can also occur between the atria
Diagnosis is made by listening to the distinctive sounds produced

2 Coarctation of the aorta, a congenital narrowing, may lead to
heart failure unless surgically corrected

3 Hypertrophic cardiomyopathy is the most common cause of sudden
death among athletes under the age of 35

4 Rheumatic heart disease can follow certain types of untreated
streptococcal infections and damage heart muscle and valves and
cause inflammation of the lining of the heart

5 Congenital defects and certain types of infections can cause
heart valve disorders When valves fail to open fully or close
completely, blood flow through the heart is impaired

IV Protecting yourself against cardiovascular disease

A A heart-healthy diet reduces CVD risk

1 Total fat consumption should be no more than 30 of total
calories, with less than 10 coming from saturated fat For people
with heart disease or high LDL levels, the National Cholesterol
Education Program NCEP suggests total fat intake of 25 to 35,
with less than 7 coming from saturated fat

2 Reducing saturated and trans fat intake is critical for
controlling cholesterol

3 Fiber helps prevent cholesterol production and may interfere
with the absorption of dietary fat, among other benefits

3 The moderate use of alcohol may increase HDL cholesterol and may
reduce stroke risk

4 Other dietary elements that may reduce the risk of CVD include
omega-3 fatty acids, vitamin E, plant stanols and sterols, folic
acid, vitamin B-6, vitamin B-12, and soy protein On the other
hand, excessive consumption of salt can raise blood pressure and
thereby increase risk of CVD Studies suggest that potassium and
calcium help prevent and treat hypertension and also reduce the
risk of stroke

5 A study called Dietary Approaches to Stop Hypertension,
or
DASH, found that a diet low in fat and high in fruits, vegetables,
and low-fat dairy products reduces blood pressure

B A moderate amount of physical activity significantly reduces the risk
of CVD Both aerobic exercise and strength training are recommended

C The number-one controllable risk factor is tobacco use Abstaining
from cigarette smoking and avoiding ETS reduces the risk of CVD

D Blood pressure should be measured at least twice a year
E Cholesterol should be measured and managed

1 The NCEP recommends a lipid profile that measures total
cholesterol, HDL, LDL, and triglyceride levels These levels, along
with a persons other risk factors, help to determine his or her
LDL goal

2 For people with two or fewer risk factors, the NCEP sets an LDL
goal of less than 160 mg/dl Those with LDL levels below 160 should
maintain a healthy lifestyle Those with LDL levels of 160 or
higher should begin the lifestyle modifications known as
Therapeutic Lifestyle Changes TLC Those with LDL levels of 190
or higher may also need medication

3 For
people with more than two risk factors, the NCEP sets a goal
of less than 130 mg/dl For those with levels 130 or higher, the
NCEP recommends TLC and possibly medication

4 For people with heart disease or an equivalent condition, the
LDL goal is less than 100 mg/dl For people in this category, TLC
is recommended along with medication

F Developing effective ways to handle stress and anger reduces the
psychological and social risk factors for CVD

G Other medical conditions that may affect CVD risk must be controlled
and managed

V What is cancer?

A Cancer is an abnormal and uncontrollable growth of cells or tissue
that can lead to death if untreated

1 Although most cancers take the form of tumors, some do not, nor
are all tumors cancer

2 A tumor is a mass of tissue that serves no physiological
purpose

a Malignant tumor or neoplasm is synonymous with cancer A
malignant tumor can invade surrounding tissues, including blood
vessels and the lymphatic system

b A benign tumor is a mass of cells, enclosed in a membrane that

prevents them from penetrating other tissues Benign tumors
present no danger unless they cause pressure or otherwise
interfere with the function of surrounding tissues

3 All cancers begin with a change in a cell that makes it grow and
divide when it should not, leading to tumor formation or, in the
case of leukemia, changes in the blood

B Metastasis, the spreading of cancer cells, occurs because cancer cells
do not stick to each other as strongly as normal cells do

1 Metastasis occurs when cancer cells break away from the primary
tumor and invade nearby tissues or travel through the blood and
lymph systems to distant organs, where they create secondary tumors
or metastases

2 Metastasis makes it critical to discover cancer early, before
cells have a chance to spread Once the cells enter the blood or
lymphatic systems, it is very difficult to stop them from
spreading

C Malignant tumors are classified according to the types of cells that
cause them

1 Carcinomas, the most common form of cancer, start from the
epithelial tissues
that cover body surfaces, line internal tubes
and cavities, and form the secreting portion of glands
2 Sarcomas arise from connective and fibrous tissue such as bone,
muscle, cartilage, and membranes covering muscles and fat

3 Lymphomas are cancers of the lymph nodes

4 Leukemias are cancers of the blood-forming cells in bone marrow

5 Some cancers, such as certain types of skin cancer, are easily
detected early in their course, while others are difficult to
detect and rapidly lethal

D Cancer is the second leading cause of death in the United States, and
more than 13 million people in the United States are diagnosed each
year

1 About 38 will eventually die of their cancer

2 At current US rates, about one in two men and one in three
women will develop cancer at some point in their lives

3 When all factors are adjusted, the death rates from major
cancers are leveling off or decreasing Experts estimate that if
these trends continue, death rates may decline by 15 to 50 over
the next 20 years

4 Some cancers can be prevented:
90 of skin cancers and 87 of
lung cancers can be prevented by changing behavior patterns

a Dietary and other lifestyle factors can either cause or prevent
cancer

b Screenings and self-examinations are necessary preventive
measures

VI Common cancers

A Lung cancer is the most common cancer in the United States,
responsible for about 155,000 deaths per year

1 The major risk factor is tobacco smoke, accounting for 87 of
cancers

a Combining smoking with other environmental carcinogens can
multiply the risk by a factor of 10

b Environmental tobacco smoke is a human carcinogen-a risk for
others as well as the smoker-and causes 3000 lung cancer deaths
a year

2 Lung cancer is difficult to detect at an early stage

a Symptoms do not usually appear until the cancer has reached the
invasive stage

b Persistent cough, chest pain, and recurring bronchitis may be
the first symptoms

c A diagnosis can usually be made by chest X ray or sputum
examination Fiber-optic bronchoscopy allows direct
examination
of the lung passages A computer-assisted body imaging
technique, a spiral CT, may be able to detect lung cancer
earlier than chest X rays

3 Treatment for lung cancer depends on the type and stage of the
cancer

a If caught early, localized cancers can be treated with surgery
b Because only about 15 of lung cancers are detected before
they spread, radiation and chemotherapy are often used in
addition to surgery

c For cases detected early, 49 of patients are alive 5 years
after diagnosis; the overall survival rate is only 15

d Small-cell lung cancers, which make up about 20 of lung
cancers, can be treated fairly successfully with chemotherapy,
alone or in combination with radiation

e A large percentage of cases respond with remission, which in
some cases lasts for years

B Colon and rectal cancers are the second most prevalent cancers for men
and women combined

1 Age is a key risk factor, with more than 90 of cases diagnosed
in people age 50 and older

2 Heredity is
also a risk factor, with many cancers arising from
preexisting polyps, which may gradually develop into malignancies

a The tendency to form polyps appears to be determined by specific
genes, and 15 to 30 of colon cancers may be due to inherited
gene mutations

b Chronic inflammation of the colon as a result of disorders such
as ulcerative colitis also increases the risk of colon cancer

3 Lifestyle is also a risk factor for colon and rectal cancer

a Regular physical activity appears to reduce a persons risk,
while obesity increases risk

b Diets rich in red meat are thought to increase risk, although it
is unclear whether fat or some other component of meat is the
culprit

c A diet rich in fruits, vegetables, and whole grains is
associated with lower risk

d Excessive alcohol consumption and smoking may also increase
risk

e Hormone replacement therapy may reduce risk in postmenopausal
women

f Regular use of nonsteroidal anti-inflammatory drugs, such as
aspirin and ibuprofen,
reduces the risk of developing colon,
rectal, and other cancers of the digestive tract

4 Annual screening tests are recommended beginning at age 50,
earlier if one has a family history of the disease More thorough
screening tests are recommended at 5- or 10-year intervals

5 Surgery is the primary treatment for colon and rectal cancer
Radiation and chemotherapy may be used before surgery to shrink a
tumor or afterward to destroy any remaining cancerous cells

6 The survival rate is 90 for early detected colon and rectal
cancers and 62 overall

C Breast cancer is the most common cancer in women; one in nine American
women will develop it during her lifetime

1 Each year, about 210,000 American women are diagnosed with
breast cancer

2 More than 75 of breast cancers are diagnosed in women over 50
3 Even though there is a strong genetic factor in breast cancer,
only about 15 of cancers occur in women with a family history of
the disease

a Other risk factors include early onset of menstruation, late
onset of menopause,
having no children or having a first child
after 30, current use of hormone replacement therapy, obesity,
and alcohol use

b The common factor in many of these risk factors may be exposure
to estrogen

c Fats may be a dietary risk factor, with monounsaturated fats
linked with reduced risk, and certain polyunsaturated fats
linked with increased risk

d Dietary fiber and regular exercise may also have a protective
effect

e Both obesity and significant weight gain during adulthood are
linked to increased risk

4 The American Cancer Societys three-part program for early
detection includes:

a Monthly breast self-exam for all women over age 20

b A clinical breast exam by a physician every 3 years for women
age 20 to 39 and every year for women 40 and older

c Mammograms every year for most women over 40

5 If a lump is detected, it may be scanned by ultrasonography and
biopsied either surgically or by a needle

6 If the lump is cancerous, treatments range from lumpectomy to a

mastectomy Lymph nodes are examined to determine spread; radiation
or chemotherapy can be used to kill remaining cancer cells

7 Survival rates for postmenopausal women whose cancers are
detected early are 97 after 5 years The survival rate for all
stages is 86 at 5 years, 76 at 10 years, and 58 at 15 years

8 New strategies for treatment and prevention include selective
estrogen-receptor modulators SERMs and the monoclonal antibody
Herceptin

D Prostate cancer is the most common cancer in men and is the second
leading cause of cancer deaths in men, with more than 220,000 new
cases in the United States each year Of these, 75 of cases are
diagnosed in men over age 65

1 Risk factors include age, diet, lifestyle, genetic
predisposition, and family history of the disease

2 Early detection is the key to controlling prostate cancer; this
is accomplished through digital rectal exams and blood tests for
prostate-specific antigen PSA, although PSA results can be
unreliable Screening tests are recommended annually for men age 50
and over, earlier for
African Americans and those with a strong
family history of the disease

3 Treatment is usually surgical removal of the prostate Surgery
can result in incontinence and impotence Alternative treatments
include surgical implantation of radioactive seeds, external
radiation, hormones, cryotherapy, and anticancer drugs

4 The 5-year survival rate has improved to 97

E Cancers of the female reproductive tract can involve the uterus,
cervix, or ovaries
1 Cervical cancer is in part a sexually transmitted disease More
than 80 of cervical cancer results from infection by the human
papillomavirus, a group of related viruses that cause both common
warts and genital warts

2 Cervical cancer is associated with multiple sex partners and
unprotected sex, but the two most important factors seem to be
smoking and infection with genital herpes

3 Screening for cervical cancer is performed by means of the Pap
test, a highly effective procedure that allows cervical cells to be
examined for signs of abnormality

4 Cancer of the lining of the uterus
endometrium usually occurs
after age 55 Endometrial cancer is detectable by pelvic
examination and treated surgically With early detection, about 96
of patients survive 5 years or more If the disease spreads beyond
the uterus, the 5-year survival rate is less than 64

5 Ovarian cancer is difficult to detect and diagnose; there are
often no warning signs Women at high risk because of family
history or genetic factors should have thorough pelvic exams at
regular intervals

6 Women who were exposed to diethylstilbestrol DES prenatally
are at increased risk of reproductive tract cancers

F Skin cancers are easily detectable, and the most common forms are
highly curable

1 Exposure to ultraviolet rays of the sun, particularly during
childhood, is a primary cause of skin cancer Both sunburns and
suntans can lead to skin cancer UVA radiation from tanning lamps
and tanning salon beds has been linked to skin cancer

2 Those who are naturally dark-skinned have greater natural
protection than do those who are fair-skinned

3 Types of skin
cancer include:

a Basal and squamous cell carcinomas, which account for about 95
of the skin cancers diagnosed each year They are usually found
on areas of the body exposed to the sun and appear as pale,
waxlike nodules or red, scaly, sharply outlined patches They
are usually painless

b Melanoma, which is the most dangerous form because it spreads
rapidly It can occur anywhere on the body, but most commonly on
the back, chest, abdomen, and lower legs It starts at the site
of a preexisting mole, which may enlarge, change color, or
develop an irregular surface or border; it may itch, burn, or
bleed easily

4 Methods of preventing skin cancer include protecting against
sunlight by using sunscreens and protective clothing and avoiding
harsh sunlight especially at midday

5 Regular examination of skin and follow-up by a physician are
critical to early diagnosis Signs of melanoma in skin lesions
include asymmetry, border irregularity, color change, and diameter
greater than one-quarter inch

6
Treatment for skin cancer is surgical removal, often performed
in a physicians office using local anesthetic

G Oral cancer, including cancers of the lip, tongue, mouth, and throat,
is directly related to cigarette, pipe, and cigar smoking; excess
alcohol consumption; and smokeless tobacco use Treatment is usually
by surgery and radiation

H Although testicular cancer is relatively rare, it is the most
common cancer in men age 20 to 35

1 It is detectable by self-exam

2 It is much more common among white Americans and among men whose
fathers had testicular cancer Men with undescended testicles are
at increased risk

3 The 5-year survival rate is 95

I Other cancers include the following:

1 Pancreatic cancer, the fifth leading cancer killer, has no
effective cure It is difficult to detect in the early stages Risk
factors include smoking; being male, obese, sedentary, African
American, or over 60; having diabetes; and consuming a diet high in
fat and low in vegetables

2 Stomach cancer is relatively unusual in the United States It

tends to occur after the age of 50 and is twice as common in men as
in women It may be linked to diet and infection with the bacterium
Helicobacter pylori

3 Bladder cancer has few controllable risk factors, although
smoking, obesity, and a family history of the disease are mild risk
factors With early detection, more than 90 of cases are curable

4 Kidney cancer is most common in people over 50 Smoking,
obesity, and family history are risk factors

5 Most brain cancers develop for no apparent reason, although
ionizing radiation X rays is one of the few established risk
factors Some tumors are curable by surgery or by radiation and
chemotherapy

6 Leukemia can affect both children and adults It is
characterized by abnormal production of immature white blood cells
The rapidly growing cells displace red blood cell precursors

7 Lymphoma begins in the lymph nodes and spreads to almost any
part of the body There are two types: Hodgkins disease and non-
Hodgkins lymphoma NHL

8 Malignant plasma cells may produce tumors in several
sites, a
disease known as multiple myeloma MM Age is the major risk
factor Although treated with chemotherapy and slow in its
progression, the disease is usually fatal

VII Cancer causes-genetic, environmental, and lifestyle factors

A There are links between genes and cancer

1 Understanding DNA helps one understand the influence of genes on
cancer

a The nucleus of each cell in the body contains 23 pairs of
chromosomes, which are made up of coils of DNA

b Each chromosome contains thousands of genes, each of which
controls the production of proteins that build cells and make
them work Genes also act as switches to alter the ways a cell
works

2 DNA mutations are linked to cancer

a A mutation is any change in the normal sequence of nucleotide
bases in a gene It may involve a deletion or substitution of a
certain base
b Mutations may be inherited or caused by environmental
factors Damaging environmental agents, or mutagens, include
radiation, certain viruses, and chemical substances in the air

c A cell with a mutated gene may cease to behave normally It
usually takes several mutational changes to turn a normal cell
into a cancer cell

d Genes in which mutations are associated with the conversion of a
normal cell into a cancer cell are known as oncogenes Undamaged
oncogenes may control cell growth; they are called tumor
suppressor genes

e Mutational damages to these genes lead to rapid and uncontrolled
cell division, a precondition for cancer

3 Although some mutated oncogenes are hereditary, usually
mutational damage is caused by lifestyle factors

4 Cancer promoters, such as estrogen, accelerate the growth of
cells without affecting their DNA Because of the fast growth,
however, these cells may not be able to repair damage caused by
cancer initiators

B Foods contain both carcinogens and compounds that protect against
cancer

1 Saturated fats contribute to colon, prostate, and other cancers,
while monounsaturated fats may have a protective effect Omega-3
fatty acids appear to slow the growth of
colon cancer cells and may
protect against breast, prostate, and pancreatic cancers

a Dietary fats stimulate the production of bile acids

b These bile acids remove layers of cells from the intestinal
epithelium, which are replaced by new cells Newly formed,
rapidly growing cells are particularly susceptible to
carcinogens

2 Alcohol use is associated with increased incidence of breast
cancer and combines with tobacco to create a high risk of oral
cancer

3 Various cancer-fighting actions have been proposed for fiber,
but none of these actions has been firmly established

4 Studies have shown that a high level of consumption of fruits
and vegetables reduces the risk of many cancers, although the
reasons for this are unclear

5 Some dietary compounds may act directly against carcinogens or
prevent the development and spread of cancer in other ways

a Essential nutrients such as vitamin C, vitamin E, selenium, and
the carotenoids vitamin A precursors are anticarcinogens that
help block the initiation of
cancer by acting as antioxidants

1 Vitamin C may block the conversion of nitrates into
carcinogens

2 Folic acid may strengthen the immune function and inhibit
transformation of normal cells into malignant ones

3 Calcium inhibits the growth of cells in the colon

b Phytochemicals, found in plant foods, protect against
chronic diseases

1 Sulforaphane stimulates the liver and kidney to produce
higher levels of protective enzymes

2 Phytochemicals are found in fruits, vegetables, legumes,
and grains

C Increased physical activity is related to a reduction in cancer risk

1 Exercise reduces the risk of colon, breast, and ovarian cancers

2 Obesity, an independent risk factor for cancer, is also reduced

D Microbes, including viruses, bacteria, and parasites, account for
about 15 of the worlds cancers Viruses seem to be the main causes
of cancer

E Some carcinogens in the environment are natural, like the UV rays of
the sun, and others are not

1 Preservatives and other
additives in foods are sometimes
antioxidants, but others are potentially carcinogenic

a Nitrates and nitrites inhibit bacterial growth in meats and are
not themselves carcinogenic

b They can combine with dietary amines and become nitrosamines,
which are carcinogenic

2 Pollutants in urban air contribute somewhat to cases of lung
cancer, although effects are difficult to study because of the
overwhelming effects of smoking

a Environmental pollutants probably contribute to no more than 2
of cancer deaths

b Occupational exposure is probably responsible for about 5 of
cancer deaths

3 All sources of radiation are potentially carcinogenic

a Sources include medical X rays, radioactive substances, and the
UV rays of the sun The amount of radiation needed for medical
and dental X rays has been reduced

b Radon gas, found in some rocks and soils, can produce mutations
in the cells of the lung

c Sunlight works as a surface carcinogen-causing cancer in skin
cells

d The possible
effects of cell phone usage are still under study

VIII Detecting, diagnosing, and treating cancer

A Self-monitoring is essential to early detection

1 Things to notice include:

a A change in bowel or bladder habits

b A sore that does not heal

c Unusual bleeding or discharge

d Thickening or lump in breasts or elsewhere
e Indigestion or difficulty in swallowing

f An obvious change in a wart or mole

g Nagging cough or hoarseness

2 The American Cancer Society recommends routine cancer checkups
as well as specific screening tests for certain cancers

B Trends in diagnosis and therapy include much earlier detection, made
possible by sophisticated high-technology equipment, which frequently
replaces exploratory surgery

1 Magnetic resonance imaging MRI uses a huge electromagnet to
detect tumors by sensing vibrations of different atoms in the body

2 Computed tomography CT scanning uses X rays to examine the
brain and other parts of the body, constructing cross sections of
tissue that precisely show a tumors location
and shape

3 Ultrasonography helps in viewing tumors

C Cancer is treated with one or more of the following methods: surgery,
radiation therapy, and chemotherapy New techniques being explored
include bone marrow and stem cell transplants, protease inhibitors,
and gene therapy

D Survival of cancer is now the norm

1 Cancer survivors may face fear of a recurrence or prejudice from
health insurers

2 Psychological support is important during cancer treatment
There are many organized support groups for cancer survivors

IX Preventing cancer

A Many lifestyle choices can radically reduce cancer risk:

1 Avoiding tobacco

2 Controlling diet and weight

3 Exercising regularly

4 Protecting skin from sun

5 Avoiding environmental and occupational carcinogens

6 Following ACS recommendations for screening tests

B Regular self-exams and medical screening tests help increase the
chances of early detection Be aware of the early signs and symptoms
that could indicate cancer

Resource Outline

The
Cardiovascular System p 258
In the Book
Fig 12-1: The cardiovascular system p 259 IICD 12_1
Fig 12-2: Circulation in the heart p 260 IICD 12_2

Supplemental Information
CD: HealthQuest: Select Cardiovascular Health Begin exploring the topic
of cardiovascular health by clicking the Introduction button
CD: HealthQuest: Select Cardiovascular Health Select Wellness
Activities, What Is Your CVD Risk? Select Tutorial, Anatomy
Web: wwwIntelihealthcom Select Heart from the list of Featured Health
Areas At the Heart and Circulatory page, choose Explore Your Heart
for a dynamic tour of the heart and its many functions You can trace
the flow of blood through the heart, watch as the nerve conductions
travel its surface, see blood pressure rise and fall, and much more

Risk Factors for Cardiovascular Disease p 259
Supplemental Information
CD: HealthQuest: Select Cardiovascular Health Select Wellness
Activities; Heart Attack Risk
Web: Assessments: wwwmhhecom/catalogs/sem/hhp/faculty/labs Scroll down
to the Cardiovascular Labs; choose Arizona Heart Institute
Cardiovascular Risk Factor Analysis, Whats Your Heart Attack Risk?,
and
What Is Your Risk for Heart Disease?

Major Risk Factors That Can Be Changed p 259

Tobacco Use p 259

High Blood Pressure p 260
Supplemental Information
Web: wwwnhlbinihgov Visit the National Heart, Lung, and Blood
Institute web site to obtain more information on the DASH diet
for hypertension control and prevention

High Levels of Cholesterol p 261
In the Book
Table 12-1: Cholesterol Guidelines p 261

Physical Inactivity p 261

Obesity p 262

Diabetes p 262

Contributing Risk Factors That Can Be Changed p 262

High Triglyceride Levels p 262

Psychological and Social Factors p 262
In the Book
Mind/Body/Spirit Box: Anger, Hostility, and Heart Disease p 263

Major Risk Factors That Cant Be Changed p 262

Heredity p 263

Aging p 263

Being Male p 263
In the Book
Dimensions of Diversity Box: Gender, Ethnicity, and CVD p 264

Supplemental Information
Book: Taking Sides: Part 4: Sexuality and Gender, Issue 11: Does
Health Care Delivery and Research Benefit Men at the Expense of
Women?

Ethnicity p 263

Possible Risk Factors Currently Being Studied p 264
Web: wwwintelihealthcom At the InteliHealth home page, choose
Heart and Circulatory at the Diseases and Conditions menu At the
Heart and Circulatory page, see the News section for the latest
research on possible risk factors

Major Forms of Cardiovascular Disease p 266
In the Book
Fig 12-3: A statistical look at cardiovascular disease in the United
States p 266 IICD 12_3

Supplemental Information
Web: wwwmayohealthorg/ Select Condition Centers; choose Heart Disease
This Mayo Clinic Heart Resource Center web site features articles on
cardiac conditions, issues, treatment options, prevention, and medical
information You can also email a question to a Mayo heart health
expert

Hypertension p 266
In the Book
Table 12-2: Blood Pressure Classification for Healthy Adults p 267

Atherosclerosis p 267
In the Book
Fig 12-4: Stages of plaque development p 268 IICD 12_4

Heart Disease and Heart Attacks p 267
Supplemental Information
Video: Healthy Living: Foolish Pleasures, Foolish Heart; Coronary Heart
Disease Risk Factors

Web: Assessments: wwwmhhecom/catalogs/sem/hhp/faculty/labs Scroll
down to the Cardiovascular Disease Lab; choose Measuring Your Blood
Pressure and Measuring Your Resting Heart Rate

Angina p 267

Arrhythmias and Sudden Cardiac Death p 267

Helping a Heart Attack Victim p 268
In the Book
Take Charge Box: What to Do in Case of a Heart Attack, Cardiac Arrest,
or Stroke p 269

Supplemental Information
Web: wwwamericanheartorg Visit the American Heart Association web
site to obtain up-to-date information on helping victims of
heart attack

Detecting and Treating Heart Disease p 268

Stroke p 269
Supplemental Information
Web: wwwnlmnihgov/medlineplus/strokehtml MedLinePlus presents
comprehensive information and links about stroke

Types of Strokes p 269
In the Book
Fig 12-5: Types of stroke p 270 IICD 12_5

The Effects of a Stroke p 270

Detecting and Treating Stroke p 270

Congestive Heart Failure p 271

Other Forms of Heart Disease p 271
Supplemental Information
Web: wwwmayohealthorg/ Select Diseases and
Conditions; select
Heart This Mayo Clinic Heart Center web site features articles on
cardiac conditions, issues, and treatment options

Protecting Yourself Against Cardiovascular Disease p 272
Supplemental Information
CD: HealthQuest: Select Cardiovascular Health Select Wellness
Activities, Stages of Change, Contract for Change

Eat Heart-Healthy p 272
Supplemental Information
Web: wwwfdagov/opacom/lowlit/hlyhearthtml The FDA offers
information on eating for a healthy heart

Decreased Fat and Cholesterol Intake p 272

Increased Fiber Intake p 272

Moderate Alcohol Consumption For Some p 272

Other Dietary Factors p 272
In the Book
Critical Consumer Box: Functional Foods, Dietary Supplements, and
Cholesterol p 274

DASH p 273
Supplemental Information
Web: wwwnhlbinihgov Visit the National Heart, Lung, and Blood
Institute web site to obtain more information on the DASH diet
for hypertension control and prevention

Exercise Regularly p 273
Supplemental Information
Web: wwwynhhorg/cardiac/risk/exercisehtml Yale-New Haven Hospital

explains how exercise helps your heart

Avoid Tobacco p 273
Supplemental Information
Web: wwwynhhorg/cardiac/risk/smokinghtml Yale-New Haven Hospital
explains the damage that smoking causes to the cardiovascular
system

Know and Manage Your Blood Pressure p 273
Know and Manage Your Cholesterol Levels p 273

Develop Effective Ways to Handle Stress and Anger and Manage Medical
Conditions p 273

What Is Cancer? p 274
Supplemental Information
CD: HealthQuest: Select Cancer Select Introduction to begin exploring
the topic of cancer
CD: HealthQuest: Select Cancer Select Wellness Activities; select Stages
of Change Module; select Overview

Benign Versus Malignant Tumors p 274

How Cancer Spreads: Metastasis p 275

Types of Cancer p 275
In the Book
Fig 12-6: Cancer cases and deaths by site and sex p 275 IICD 12_6

The Incidence of Cancer p 276

Common Cancers p 276
Supplemental Information
Web: wwwcancerorg Select Cancer Info
Web: Assessment: wwwmhhecom/catalogs/sem/hhp/faculty/labs Select
Chronic Disease Lab; choose Are you at Risk for Skin, Breast, or
Cervical Cancer?
Web: wwwncinihgov The
National Cancer Institute site provides
comprehensive cancer resources, such as databases, research
information, trials information, legislation, CancerNet, and more
Web: wwwcancernewscom This web site consists of a collection of links
to a range of cancer information, from current news and media reports
to medical literature searches
Phone: 800 4-CANCER to contact the Cancer Information Service
Phone: 800 ACS-2345 to contact the American Cancer Society for more
information

Lung Cancer p 276
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Lung Cancer

Risk Factors p 276

Detection and Treatment p 276

Colon and Rectal Cancer p 276
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Digestive Tract Cancer

Risk Factors p 276

Detection and Treatment p 277

Breast Cancer p 277
Supplemental
Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Breast Cancer

Risk Factors p 277

Early Detection p 277
In the Book
Take Charge Box: Breast Self-Examination p 278

Supplemental Information
Web: Assessment: wwwmhhecom/catalogs/sem/hhp/faculty/labs Scroll
down to the Chronic Disease Labs; choose Breast Self-Exam

Treatment p 278

New Strategies for Treatment and Prevention p 278

Prostate Cancer p 278
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Prostate Cancer

Risk Factors p 278

Detection and Treatment p 279

Cancers of the Female Reproductive Tract p 279
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Gynecologic Cancer

Cervical Cancer p
279

Uterine, or Endometrial, Cancer p 279
Supplemental Information
Web:
wwwyourcancerriskharvardedu/hccpquizpl?funcd_startcancer_lis
tUterine Take the Uterine Cancer Questionnaire at the Harvard
Center for Cancer Prevention site

Ovarian Cancer p 280
Supplemental Information
Web: wwwnlmnihgov/medlineplus/ovariancancerhtml MedLinePlus
presents information and links about ovarian cancer

Other Female Reproductive Tract Cancers p 280

Skin Cancer p 280
Supplemental Information
CD: HealthQuest: Select Cancer Select Wellness Activities; select
Skin Cancer F/X Exploration
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Skin Cancer

Risk Factors p 280

Types of Skin Cancer p 282

Prevention p 282

Detection and Treatment p 282
In the Book
Fig 12-7: The ABCD test for melanoma p 282 IICD 12_7
Oral Cancer p 282
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select

Cancer from the Diseases and Conditions menu At the Major Types of
Cancer section, select Head and Neck Cancer

Testicular Cancer p 282
In the Book
Take Charge Box: Testicle Self-Examination p 283

Supplemental Information
Web: Assessment: wwwmhhecom/catalogs/sem/hhp/faculty/labs Scroll
down to the Chronic Disease Labs; choose Testicular Self-Exam
Web: wwwmskccorg/document/WICTESThtm Visit this site for more
information on testicular self-examination and testicular cancer

Other Cancers p 283
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Cancer Index
menu, select a cancer type

The Causes of Cancer p 284
Supplemental Information
CD: HealthQuest: Select Cancer Select Wellness Activities; select
Cancer: Whats Your Risk?
CD: HealthQuest: Select Cancer Select Wellness Activities; select Stages
of Change Module; select Assess Yourself

The Role of DNA p 284
Supplemental Information
Web: wwwcancergov/cancerinfo/genetic-testing-breast The National
Cancer Institute presents an
overview of genetic testing for breast
cancer risk

DNA Basics p 284

DNA Mutations and Cancer p 284

Cancer Promoters p 284

Dietary Factors p 285
In the Book
Fig 12-8: Percentage of all cancer deaths linked to risk factors p
285

Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Take Action
Now section, select Nutrition and Cancer

Dietary Fat and Meat p 285

Alcohol p 285
Supplemental Information
Web: wwwintelihealthcom The National Cancer Institute examines the
role of red wine in preventing cancer

Fiber p 285

Fruits and Vegetables p 285
Web: http://familydoctororg/handouts/301html The American Academy
of Family Physicians presents recommendations of food choices
for reducing the risk of cancer, including five servings of
vegetables and fruits a day

Inactivity and Obesity p 286

Microbes p 286

Carcinogens in the Environment p 286
Supplemental Information
CD: HealthQuest: Select Cancer Select Wellness
Activities; select
Cancer Risk: Environmental Exposures-Do They Increase Your Cancer
Risk?
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Take Action
Now section, select Cancer and the Environment

Ingested Chemicals p 286

Environmental and Industrial Pollution p 286

Radiation p 286

Detecting, Diagnosing, and Treating Cancer p 286
Supplemental Information
Phone: 800 4-CANCER The National Cancer Institute hotline
Phone: 818 508-5657 Vital Options: a support group for people age
17-40 living with cancer
Web: wwwcancerorg National Cancer Institute web site

Detecting Cancer p 287
In the Book
Table 12-3: American Cancer Society Screening Guidelines for the Early
Detection of Cancer in Asymptomatic People p 288

Diagnosing and Treating Cancer p 287
Supplemental Information
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Take Action
Now section, select Treatments
Web: wwwintelihealthcom At the InteliHealth home page, select

Cancer from the Diseases and Conditions menu At the Take Action
Now section, select A Natural Way to Beat Cancer?
Web: wwwcandlelightersaustincom A support group for children
living with cancer
Web: wwwintelihealthcom At the InteliHealth home page, select
Cancer from the Diseases and Conditions menu At the Take Action
Now section, select Coping with Cancer
Phone: 800 366-2223 A support group for children living with cancer
Phone: 818 508-5657 Vital Options: a support group for people age 17-
40 living with cancer

Preventing Cancer p 287
Supplemental Information
CD: HealthQuest: Select Cancer Select Wellness Activities; select Stages
of Change Module; select Explore the Stages and Contract for Change
Web: wwwnlmnihgov/medlineplus/smokinghtml MedLinePlus offers
extensive information about the role of tobacco in cancer
Web: wwwyourcancerriskharvardedu Learn about your risk for cancer at
this Harvard site

Summary p 288
In the Book
Tips for Today p 288
Summary p 289
Take Action p 289
Behavior Change Strategy Box: Modifying Your Diet for Heart Health and
Cancer Prevention p 290
Journal Entry Box
p 291
For More Information p 291

Classroom Activities

1 The prevalence of heart disease is easy to demonstrate This exercise
takes only a few moments of class time but is usually very effective Ask
for a show of hands from students with family members or close friends
who have had a heart attack Ask everyone to look around Then have
students raise their hands if any members of the family have other forms
of cardiovascular disease, including angina, hypertension, stroke, and
congestive heart failure Ask the students to look around again Usually
50 to 70 of students have their hands raised Ask for reactions You
may wish to ask whether any students have relatives or friends who would
be willing to share their experiences with the class A panel of people
with different ages and backgrounds may be developed Include people who
have not had cardiovascular problems but have relatives or friends who
have suffered These may be class members

2 If time permits, each student should get hands-on experience in
taking blood pressure If time and equipment do not permit, someone from
the college health service and/or
nursing department could take each
students blood pressure while the rest of the class observes This
should take about 4 minutes per student It should be accompanied by a
description of the procedure and an explanation of the underlying
mechanism; sometimes the physics department can help you produce a
fascinating presentation of medical physics circulatory and respiratory
mechanics

3 Ask students to take the Are You at Risk for CVD? assessment in the
textbook Have them plan a heart-healthy behavior change based on their
assessment score Encourage students to compare their risks with those of
other family members

4 Ask students to compare the incidence of cardiovascular disease among
different ethnic groups in the United States Discuss the findings in
class

5 Ask students to compile a list of restaurants with heart-healthy
choices on or near campus How does the list compare with the number of
restaurants with less-healthy menus? What are the cost differences?
Discuss in class

6 Your local branch of the American Cancer Society has a speakers
bureau of people who are willing to present information to the public on

various cancer-related topics Invite people of diverse ages and
diagnosed with different types of cancer to participate in a panel
discussion to address the following issues: What symptoms led to the
initial diagnosis of your cancer? What were your immediate reactions at
the time of the diagnosis and those of family members and friends? What
options for treatment of cancer did you choose? How did relationships
with family and friends change throughout the treatment and/or recovery
process? Did you try any forms of complementary or integrative medicine?
What is the current prognosis for your cancer? What words of advice and
wisdom would you like to share with the class?

7 There are monthly examinations for both breast and testicular cancer
that everyone should perform Have students list and discuss reasons that
some students might have for not performing these examinations Invite a
representative from the Student Health Center to present instruction on
both breast and testicular self-examination

8 Cigarette smoking is the single most important factor in the
development of lung cancer Ask students to discuss whether people who

smoke around children have any legal responsibility for exposing children
to secondhand smoke Should people who smoke be denied employment or
health, life, or disability insurance? Should smokers pay higher
insurance premiums than nonsmokers?

Additional Resources

Note: These items supplement the resources found at the end of each chapter
in the textbook

Films/Videocassettes

See page xx in the text for information about contacting suppliers to rent
or buy the following materials:

Cancer Prevention Test: Presented in a question/answer format, the cancer-
prevention test offers invaluable information about skin, breast, colon,
lung, testicular, and bone cancers and clarifies several common myths about
this disease Phoenix, 24 minutes, videotape

Cholesterol: What Can You Do?: The buildup of plaque in the arteries can
begin as early as 8 or 9 years of age Research has proven that reducing
blood cholesterol significantly reduces the chances of developing heart
disease This film discusses how to make healthy food choices Alfred
Higgins Productions, 21 minutes, videotape

A Harvest of Hope: Surviving Cancer: Television actress Loni Anderson
hosts
this new film, which examines the war on six different types of cancer-
breast, prostate, skin, colon, leukemia, and lung Researcher Dr Donnall
Thomas discusses risk factors, the importance of early detection,
nutrition, and wellness Films for the Humanities, 41 minutes, videotape

Heart Attack: Prevention: Through this low-key film, both causes and
prevention are shared in a nonthreatening way, motivating the viewer to
learn to live with the pressures of modern life In addition, personality
traits common to heart attack victims are discussed Phoenix, 19 minutes,
videotape

Heart Disease: Prevention and Rehabilitation: Noted physicians responsible
for many of the dramatic breakthroughs in heart disease present their views
on practical prevention techniques and rehabilitation methods AGC, 14
minutes, videotape

High Blood Pressure: This program describes essential hypertension, lists
its potential complications, and outlines the changes in lifestyle
necessary to control this condition AGC, 14 minutes, videotape

Independence from Cancer: This program, enhanced by superb computer
graphics, surveys the latest advances in the diagnosis and treatment of
cancer Films for the
Humanities, 53 minutes, videotape

Lung Cancer in Women: This newly released film discusses the importance of
prevention in dealing with lung cancer through diet, exercise, and a
healthy lifestyle Cutting-edge treatments that are benefiting patients are
also presented Films for the Humanities, 21 minutes, videotape

New Therapies for Cancer: This program examines the molecular course of a
body cell from its normal state to that of a metastasized cancer cell, then
looks at ways in which the risk of cancer can be significantly reduced
Films for the Humanities, 33 minutes, videotape

Not Just a Cancer Patient: This film focuses on several articulate teens
undergoing treatment for cancer The feelings and needs of the teenagers
are discussed thoroughly Fanlight, 23 minutes, videotape

Nutrition and Cancer: This film focuses on the relatively new field of
nutritional oncology and efforts to prove the relationship between cancer
and nutrition Films for the Humanities, 21 minutes, videotape

Ovarian Cancer: The Silent Killer: This film was a finalist in the AMA
International Health and Medical Film Competition and presents cancer
expert Dr Susan Blumental discussing why the disease defies
detection and
how tumors form and spread throughout its four stages Risk factors such as
heredity and ethnic origin are juxtaposed with childbearing and
breastfeeding-factors that may prevent the disease Films for the
Humanities, 18 minutes, videotape
Pictures from Camp: This award-winning film chronicles the summer camp
experiences of a group of kids, age 6 to 18, who have cancer Fanlight, 24
minutes, videotape

Prostate Cancer: This film received the FREDDIE award from the AMA
International Health and Medical Film Competition and features General
Norman Schwarzkopf speaking frankly about his own bout with prostate
cancer Symptoms of the disease and prevention strategies are presented
within the context of diet, heredity, and ethnic background Films for the
Humanities, 21 minutes, videotape

Wisdom of the Heart: Women and Heart Disease: Although most people think of
heart disease as a mans disease, it is in fact a leading killer of women
This compelling documentary challenges myths of womens immunity, shows how
heart disease manifests itself differently in women, and explains how it
can be prevented Filmakers, 58 minutes, videotape

Work of the Heart: Through animation and
live-action footage, the structure
and function of the heart are examined The film also illustrates how
cardiac muscle works and the role of the aorta, chambers, valves, and
pacemaker Insight Media, 21 minutes, videotape

Community Resources

For additional current information, films, and teaching aids, contact the
following resources local chapters where appropriate Note: Many
hospitals and businesses are instituting cardiovascular disease prevention
programs Ask about these programs at the resources below

American Cancer Society

American Heart Association

American Lung Association

American Red Cross

Blue Cross/Blue Shield

Cancer Information Service CIS

Hospitals

National Cancer Institute
800 4-CANCER
http://cisncinihgov

National Heart, Lung, and Blood Institute
Department of Health and Human Services
301 496-4236
wwwnhlbinihgov

Seventh-Day Adventist Church smoking cessation

State and county health departments hypertension screening

Additional sources of materials include:

American Cancer Society
800 227-2345
wwwcancerorg
American Institute for Cancer Research
800 843-8114
wwwaicrorg

Association of Community Cancer Centers
301 984-9496
wwwaccc-cancerorg

Cancer Connection
800 688-9777
wwwgillettecancerconnectorg

Internet Resources

Agency for Healthcare Research and Quality: AHRQs site links to
information on publications relevant to heart disease and stroke, such as
What You Should Know about Stroke Prevention, Managing Unstable Angina,
Living with Heart Disease: Is It Heart Failure?, and Recovering from
Heart Problems through Cardiac Rehabilitation
wwwahrqgov/consumer

American Association of Cardiovascular and Pulmonary Rehabilitation: This
site offers information about this professional organization and links to
both cardiovascular and pulmonary-related sites
wwwaacvprorg

American Cancer Society: This group offers a wide range of free material
on the prevention and treatment of cancer
wwwcancerorg

American College of Cardiology: This professional organization offers
information about its conferences, journal articles, and technical
information on this site
wwwaccorg

American Heart Association: This site offers information on hundreds of
topics related to the prevention and control of cardiovascular disease

wwwamericanheartorg

Cancer Care, Inc: This site offers help with medical information,
counseling and referrals, and free educational materials
wwwcancercareorg

Cardiology Compass: This site offers an index to cardiovascular
information on the internet
wwwcardiologycompasscom

DES Action USA: This site offers information about DES and the health
risks for DES daughters and sons
wwwdesactionorg

Franklin Institute/The Heart: An On-Line Exploration: This online museum
exhibit contains information about the structure and function of the
heart and describes how to monitor and maintain heart health
wwwfiedu/biosci/hearthtml

Heart Information Network: This site offers information for patients with
heart disease and others interested in learning how to identify and
reduce their risk factors
wwwheartinfoorg

Human Genome Project: This site offers information about the implications
of the project to map the entire human genome
wwwnhgrinihgov/HGP
National Cancer Institute: This site offers a range of reliable
information on cancer, including research, statistics, support services,
and answers to frequently asked questions
wwwncinihgov

National
Heart, Lung, and Blood Institute: This site offers information
on a variety of topics related to cardiovascular health and disease,
including cholesterol, smoking, obesity, and hypertension
wwwnhlbinihgov

National Stroke Association: This site provides information and referrals
for stroke victims and their families and offers a stroke risk
assessment
wwwstrokeorg

New York Online Access to Health NOAH/Cancer: This site offers
information about cancer-causes, symptoms, types, treatments, and
clinical trials-and links to related sites
wwwnoah-healthorg/english/illness/cancer/cancerhtml

Oncolink/The University of Pennsylvania Cancer Center: This site contains
information on different types of cancer-causes, symptoms, screening
tests, and prevention-and answers to frequently asked questions
wwwoncolinkupennedu

US Food and Drug Administration Center for Food Safety and Applied
Nutrition: This site offers information about keeping cholesterol under
control and using the new food label to prevent heart disease, as well as
facts about women and heart disease It also offers links to other
related agencies
wwwcfsanfdagov/dms/wh-hearthtml

Information about
clinical trials for new cancer treatments can be found at
the following sites:

NIMH Clinical Trials:
wwwnimhnihgov/studies/indexcfm

CancerNet: Other Information on Clinical Trials:
http://cancernetncinihgov/pdq/ctspcgeoshtml

See also the listings in Chapters 2, 12, and 13

Healthy People 2010 Objectives

3-1: Reduce the overall cancer death rate Target: 1599 cancer deaths
per 100,000 population

3-2: Reduce the lung cancer death rate Target: 449 deaths per 100,000
population

3-3: Reduce the breast cancer death rate Target: 223 deaths per
100,000 females

3-4: Reduce the death rate from cancer of the uterine cervix Target:
20 deaths per 100,000 females

3-7: Reduce the prostate cancer death rate Target: 288 deaths per
100,000 males

3-9: Increase the proportion of people who use at least one of the
following protective measures that may reduce the risk of skin
cancer: avoid the sun between 10 am and 4 pm, wear sun-
protective clothing when exposed to sunlight, use sunscreen with a
sun protective factor SPF of 15 or higher, and avoid artificial
sources of ultraviolet light

12-10:
Increase the proportion of adults with high blood pressure
whose blood pressure is under control Target: 50

12-11: Increase the proportion of adults with high blood pressure
who are taking action eg, losing weight, increasing physical
activity, or reducing sodium intake to help control their blood
pressure Target: 95

12-13: Reduce the mean total blood cholesterol levels among adults
Target: 199 mg/dL mean

12-14: Reduce the proportion of adults with high total blood
cholesterol levels Target: 17

12-15: Increase the proportion of adults who have had their blood
cholesterol checked within the preceding 5 years Target: 80