Risk Factors

Preventing Cervical Cancer Through HPV & Pap Smear Screening

HPV Vaccine Cervical CancerIn the mid 20th century, Dr. George Papanicolaou published his initial research about abnormal cells in cervical scrapings and cervical cancer. The test that now bears his name, the “Pap” smear, is perhaps the most successful cancer screening test in modern medical history. Cervical cancer was the leading cause of cancer deaths in American women in the early 20th century; but since widespread screening began, cervical cancer rates have fallen by 70%. The Pap smear works by finding abnormal cells before symptoms of cervical cancer appear. Cervical cancer is prevented by treating pre-cancerous lesions of the cervix, known as cervical dysplasia. Gynecologists have a number of minor office surgeries to treat cervical dysplasia, such as freezing or removing the abnormal cells.

Despite this success, recommendations for cervical cancer screening and pap smears have changed dramatically in recent years. Many of these changes reflect a better understanding of the cause of cervical cancer. Almost all cervical cancers and cervical dysplasia are caused by a viral infection with human papillomavirus, or HPV. A majority of women have a HPV infection at some point in their adult lives. Most men and women infected with HPV will resolve the infections without any signs or symptoms. A small minority of women with an HPV infection will develop abnormal pap smears, cervical dysplasia and cervical cancer. HPV does the most damage when it is persistent. It will take years and maybe decades from initial HPV infection to develop cervical dysplasia and cervical cancer.

The American Cancer Society updated its cervical cancer screening guidelines in 2012. For women over 30 years of age, cervical cancer screening can include both an HPV test and a traditional Pap smear. More than 90 percent of women will have a negative HPV test and negative Pap smear. This is very reassuring news for these women. The combination of these two tests will detect nearly all cases of cervical dysplasia and cervical cancer. Furthermore, women who are negative for both tests are highly unlikely to develop cervical cancer in the next five years. The American Cancer Society and other professional organizations have recommended that women between the ages of 30 and 65 have a Pap smear and HPV test every five years to screen for cervical cancer.

HPV testing in women under 30 years old is not recommended. HPV infections are common in this age group, and cervical cancer is relatively rare in women under 30.

The “annual exam” is a time-honored tradition for gynecologists in the United States, based on Dr. Papanicolaou’s historic breakthrough in the 20th century. In this century, multiple new tests and screening strategies have been developed, as well as an HPV vaccine recommended for girls age 9 through 26, to protect against the two types of HPV that cause most cervical cancers (click here for more on the HPV vaccine).

These new guidelines reflect a better understanding of the cause of cervical cancer, and promise to further reduce the burden of cervical cancer in women worldwide.

Author: Kevin Ault, MD
Winship Cancer Institute member and Professor, Gynecology and Obstetrics, Emory University School of Medicine

Dr. Kevin AultAbout Dr. Kevin Ault
Dr. Ault is currently Professor of Gynecology and Obstetrics at the Emory University School of Medicine and a Winship Cancer Institute member. Dr. Ault’s research interests are based in infectious diseases and women’s health. He is an investigator in vaccine trials for both herpes simplex virus and human papilloma virus. His multidisciplinary research in the pathogenesis of infections due to chlamydia and gonorrhea has been supported by the National Institutes of Health. Board certified by the American Board of Obstetrics and Gynecology since 1995, Dr. Ault came to Emory in 2005 from the University of Iowa Hospitals and Clinics in Iowa City.



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6 Ways to Reduce your Risk of Cancer in the New Year

Walter J. Curran Jr., MD

It’s that time of year when we resolve to start fresh and break old habits, but did you know that some of the most common New Year’s resolutions could also help reduce your risk of cancer? Nearly 1.7 million Americans will be diagnosed with cancer in 2014 and many cases could be prevented by taking steps to decrease risk.

Here are six ways to cut your chances of developing cancer:

  1. Stop smoking or never start: cigarette smoking is the major cause of lung cancer and many other cancers. Doctors recommend you stay away from all tobacco products and byproducts, including second hand smoke. Winship Cancer Institute is offering a step-by-step program developed by the American Lung Association to help you quit. To register, click here.
  2. Watch what you eat and drink: obesity is increasingly proven to be a major risk factor for certain cancers. Eat more fruits, vegetables and whole grains. Limit red and processed meat consumption. Cut down on alcohol consumption; experts recommend no more than two drinks per day for men and one drink per day for women.
  3. Get physical: an active lifestyle is critical for your overall health and well-being, but studies show regular exercise can reduce the risk of a variety of cancers.
  4. Practice sun safety: protect yourself from the harmful effects of ultraviolet radiation by wearing sunscreen with SPF 30 or higher. Tanning beds and sunlamps are also associated with increased risk of skin cancer, so stay away.
  5. Get screened: early detection of certain cancers can make a difference in treatment and recovery. Women at average risk for breast cancer should have a clinical breast exam and mammogram every year starting at age 40. Cervical cancer screening is now recommended every five years for women at average risk between the ages of 30 and 65. Men and women 50 and older should begin screening for colorectal cancer with a colonoscopy or other early detection method approved by a physician.
  6. Know your family history: some cancers run in families, but before you ask for genetic testing, it’s important to know that most cancers are not linked to genes inherited from our parents. Your doctor can help you determine the right course of action.

When it comes to your health, being proactive about reducing cancer risk will help you not just in the New Year but for the rest of your life. What are some ways that you’ve resolved to get healthy this year?

By Walter J. Curran, Jr., MD, executive director, Winship Cancer Institute

About Dr. Walter Curran
Walter J. Curran, Jr. was appointed Executive Director of the Winship Cancer Institute of Emory University in September 2009. He joined Emory in January 2008, as the Lawrence W. Davis Professor and Chair of Radiation Oncology and Chief Medical Officer of the Winship Cancer Institute.

Dr. Curran, who is a Georgia Cancer Coalition Distinguished Cancer Scholar, has been a principal investigator on several National Cancer Institute (NCI) grants and is considered an international expert in the management of patients with locally advanced lung cancer and malignant brain tumors. He has led several landmark clinical and translational trials in both areas and is responsible for defining a universally adopted staging system for patients with malignant glioma. He serves as the Founding Secretary/Treasurer of the Coalition of Cancer Cooperative Groups and a Board Member of the Georgia Center for Oncology Research and Education (Ga CORE). Dr. Curran is the only individual currently serving as director of an NCI-designated cancer center and as group chairman of an NCI-supported cancer cooperative group, the Radiation Therapy Oncology Group.

Dr. Curran is a Fellow in the American College of Radiology and has been awarded honorary memberships in the European Society of Therapeutic Radiology and Oncology and the Canadian Association of Radiation Oncology. In 2006, he was named the leading radiation oncologist/cancer researcher in a peer survey by the journal Medical Imaging. Under Dr. Curran’s leadership Emory’s Radiation Oncology Department has been recently selected as a “Top Five Radiation Therapy Centers to Watch in 2009” by Imaging Technology News. Dr. Curran ranked among the top 10 principal investigators in terms of overall NCI funding in 2010 and among the top 20 principal investigators in overall NIH funding in 2010.

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Cancer Risk Dramatically Reduced Since Landmark Smoking Report Issued 50 years Ago

Dr. Fadlo KhuriFifty years ago this month, Dr. Luther Terry, Surgeon General of the United States, issued the landmark 1964 Surgeon General’s Report providing the first definitive proof that cigarette smoking causes both lung and laryngeal cancer. This announcement came after a committee of experts had worked for 18 months, reviewing more than 7,000 published papers and engaging 150 consultants.

The importance of this report and its findings cannot be overstated. Fifty years ago, we did not know that smoking definitely causes lung cancer and other diseases, only that smoking was associated with a higher risk of these diseases. Recognizing that the impact of tobacco on our national and, indeed, the world’s health was the major public health issue of the day, Dr. Terry assembled an unimpeachable panel of distinguished physicians and scientists. He chose individuals for the panel who were not only among the giants of medicine and science, but were also objective and could ensure the integrity of the report.

The report was based on what ranked as the largest and most careful review of the medical literature yet undertaken. Most importantly, the report was clear, evidence based and unequivocal. It showed beyond a shadow of a doubt that smoking caused both lung cancer and larynx cancer. The report concluded that cigarette smoking is 1) a cause of lung cancer and laryngeal cancer in men; 2) a probable cause of lung cancer in women; and 3) the most important cause of chronic bronchitis.

The impact of the report on public perception was astonishing. In 1958, only 44% of Americans believed that smoking seriously impacted health, according to a Gallup Poll. Ten years later, and four years after the report’s release, that number had climbed to 78%. The report also galvanized the anti-tobacco movement. Its findings have lent enormous credence to smoking cessation efforts over the last 50 years. In 1964, 52% of adult men and 35% of adult women smoked cigarettes. This had fallen to 21.6% of adult men and 16.5% of adult women by 2011.

Today, we are certain that tobacco causes some of the most widespread and devastating diseases in the world, including cancers of the lung, larynx (voice box), esophagus, mouth, throat and bladder, which together account for about 30% of the world’s cancer-related deaths. Tobacco is also a major cause of heart disease, emphysema and other diseases of the lungs and heart.

There have been several subsequent reports issued by the Surgeons General, the latest an eye-opening look at smoking behavior among the younger generation. This, like all prior reports, builds on that first landmark report from a great physician leader and his matchless panel of experts. The impact of their efforts on smoking in the US and the world is unquestionable. The debt that the world owes these 12 brave scientists has never been greater.

Author: Fadlo R. Khuri, MD, deputy director, Winship Cancer Institute

Want to learn more about the impact of the 1964 Surgeon General’s Report on smoking? View this video as Dr. Khuri further discusses the effect the report has had on the medical community.

About Dr. Fadlo Khuri
Fadlo R. Khuri, MD, deputy director of the Winship Cancer Institute of Emory University and Professor and Chairman of the Department of Hematology & Medical Oncology, Emory University School of Medicine, is a leading researcher and physician in the treatment of lung and head and neck cancers. He is Editor-in-Chief of the American Cancer Society’s peer-reviewed journal, Cancer.

Dr. Khuri’s contributions have been recognized by a number of national awards, including the prestigious 2013 Richard and Hinda Rosenthal Memorial Award, given to an outstanding cancer researcher by the American Association for Cancer Research.

An accomplished molecular oncologist and translational thought leader, Dr. Khuri has conducted seminal research on oncolytic viral therapy, developed molecular-targeted therapeutic approaches for lung and head and neck tumors combining signal transduction inhibitors with chemotherapy, and has led major chemoprevention efforts in lung and head and neck cancers. Dr. Khuri’s clinical interests include thoracic and head and neck oncology. His research interests include development of molecular, prognostic, therapeutic, and chemopreventive approaches to improve the standard of care for patients with tobacco related cancers. His laboratory is investigating the mechanism of action of signal transduction inhibitors in lung and aerodigestive track cancers.

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Lung Cancer: Not Just a Disease of Smokers

Cigarette smoking is the main risk factor for most patients who develop lung cancer; however, some patients who are diagnosed with lung cancer have never smoked a cigarette. Physicians today are seeing more non-smokers and light smokers with lung cancer. Why do these people get lung cancer?

We now understand that exposure to secondhand smoke can cause lung cancer, in fact, even passive exposure to tobacco smoke increases your risk for developing lung cancer. Secondhand smoke is responsible for 3,000 lung cancer related deaths a year in the United States, and there’s a 20 to 30% increased risk of developing lung cancer for nonsmokers living with a smoker. This is why so many cities have passed laws to limit smoking in restaurants, bars and clubs. Many workplaces are also becoming tobacco-free to protect the health of their employees.

Other environmental exposures besides tobacco smoke have been associated with lung cancer including chemicals used in some workplaces, such as asbestos, tar and soot and heavy metals like chromium, nickel and arsenic. There has also been an association with radon gas and lung cancer, especially in people exposed to high levels of radon, such as uranium miners. People who have been exposed to large doses of radiation, like atomic bomb survivors in Japan, also have a higher risk of lung cancer. It is still unclear how much of a factor air pollution plays in developing lung cancer.

Family history can also impact chances of being diagnosed with lung cancer. There is almost a two fold increased risk of lung cancer in a person with a family history and this risk is even higher if more than two relatives in a family have lung cancer. We still have not identified a particular gene that is passed on in these families that makes them more prone to lung cancer; however, at Winship Cancer Institute of Emory University, genetic testing is now given to every patient diagnosed with lung cancer to identify specific mutations in tumor tissue that may inform treatment decisions.

Research has identified genetic mutations in lung cancers from people who have never smoked or are/were light smokers. These mutations are not inherited, rather they originate in the lung tissue and create lung cancer. Interestingly enough, mutations in the epidermal growth factor (EGFR) and ALK genes have been found more frequently in lung cancer patients who never smoked. These patients can be treated with drugs that target these specific mutations.

Researchers at the Winship Cancer Institute are also involved in more extensive genetic testing of tumors to find other mutations that could explain why non-smokers develop lung cancer. Understanding more about these genetic changes and other factors will help us be able to treat all lung cancer, particularly those in non-smokers, with better, more personalized treatments.

About Dr. Pillai:

Dr. Rathi PillaiRathi Pillai, MD, is an Assistant Professor in the Division of Hematology and Medical Oncology. She joined the faculty after graduating from Emory University’s Hematology/Oncology fellowship program in 2013, where she served as chief fellow from 2012-2013. Dr. Pillai earned her medical degree from the University of Texas at Southwestern Medical School and completed her residency in internal medicine at Emory University. She is a member of the American Society of Clinical Oncology, American Association for Cancer Research, Eastern Cooperative Oncology Group, International Association for the Study of Lung Cancer, and the American College of Physicians. Dr. Pillai’s research interests are in novel therapies in lung cancer, including PD-1 targeted agents, and phase I drug development.

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Awareness of Symptoms Can Help Detect Ovarian Cancer Earlier

Ovarian Cancer Awareness MonthOvarian cancer used to be called the “silent killer” because it was thought the symptoms of this gynecological cancer often appeared too late to begin effective treatment. However, we now know certain symptoms do occur early enough to help catch the disease when it’s easier to treat.

Symptoms of ovarian cancer include:

  • Bloating
  • Pelvic or abdominal pain (below the stomach and above the hips)
  • Trouble eating
  • Getting full quickly
  • Urinary urgency
  • Urinary frequency

While ovarian cancer may not be silent, it may be more appropriate to call it devious since these same symptoms often are caused by more common, and less lethal, conditions such as irritable bowel syndrome.

In reality, ovarian cancer is rare, accounting for about 3% of all cancers in women. Statistics published by the American Cancer Society estimate a women’s lifetime risk of developing ovarian cancer is 1 in 72, and her lifetime chance of dying from it is 1 in 100. In comparison, a women’s lifetime risk of developing lung cancer is about 1 in 16 and 1 in 20 for colorectal cancer.

However, ovarian cancer is still the fifth leading cause of cancer-related deaths in U.S. women. Women experiencing these symptoms should see their gynecologist, especially if:

  • symptoms occur almost daily last for more than a few weeks and;
  • feel different from “normal”—in other words, the symptoms are more frequent or severe than usual.

Other symptoms of ovarian cancer can include:

  • Fatigue
  • Stomach upset
  • Back pain
  • Pain during intercourse
  • Constipation
  • Abdominal swelling along with weight loss

No one is truly sure what causes ovarian cancer; however, genetics and ovulation appear the biggest factors.

Ovarian cancer risk factors include:

  • Age— Risk increases as women age, particularly after menopause, until about the age of 75. Ovarian cancer in women under 40 is rare.
  • Reproductive history—Women who have never been pregnant, have suffered multiple miscarriages or have undergone multiple abortions appear to be at higher risk
  • Family and personal history of cancer— The risk of developing the disease can be as much as 50% higher in women whose mothers or sisters have had ovarian cancer. Risk also increases in women who have been treated for breast, uterine or colorectal cancer. In fact, women in this risk group may want to consider BRCA1 and BRCA2 testing. Mutations in these genes can indicate a higher risk.
  • Fertility treatments— Women who have taken fertility drugs to induce ovulation, such as clomiphene, tend to be at higher risk.
  • Lifestyle—Obesity and high-fat diets have been shown to increase risk.

On the other hand, risk seems to decrease for women who have:

  • Taken birth control pills
  • Given birth to one or more children, with each full-term pregnancy dropping the risk by about 10%
  • Breast fed
  • Undergone tubal ligation or a hysterectomy

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Genomic Testing for Lung Cancer: What Does it Mean for You?

Lung Cancer Awareness MonthYou may be surprised to learn that lung cancer is the leading cause of cancer deaths in both men and women in the United States.  However, in the past few years, tremendous progress has been made leading to improved outcomes for patients with lung cancer.  According to the Centers for Disease Control and Prevention, genomics is “the study of all the genes in a person, as well as the interactions of those genes with each other and a person’s environment.”  While 99.9% of everyone’s genetic makeup is identical, the difference in the remaining 0.1% helps inform researchers about disease. For patients with certain subtypes of lung cancer, we have now made genomic testing of tumors a routine part of care.  Understanding that each person has a unique genetic makeup allows for individualized treatment for patients with specific mutations in their tumor tissues.

Lung cancer is broadly divided into two types: non-small cell lung cancer and small cell lung cancer.  Approximately 85% of lung cancers are of the non-small cell lung cancer category, which consists of three major subtypes: adenocarcinoma, squamous cell carcinoma and large cell carcinoma.

Adenocarcinoma accounts for nearly 50% of all non-small cell lung cancers and has had an increasing rate of incidence in the United States over the past few years. During the same time, we have learned a lot about the biology of lung cancer overall. As a result, sophisticated tests are now available to identify specific mutations in tumors of patients with adenocarcinoma of the lung.  For example:

  1. A gene called epidermal growth factor receptor (EGFR) is mutated in nearly 15% of patients with adenocarcinoma.  After years of research, we now know that treatment for these patients involves an orally administered targeted drug, versus combination chemotherapy. These novel treatments result in significant improvement of symptoms, disease control and survival.
  2. Through other research, we now know that another group of patients with adenocarcinoma carries a mutation in a gene called ALK.  For these patients, an FDA-approved treatment option named crizotinib is used, which has been found to provide great benefits to these patients.

Since it has been identified that a person’s genetic makeup plays a significant role in not only understanding their overall health and disease occurrence, but also the ideal treatment method(s) they should receive, nowadays, almost every patient diagnosed with lung adenocarcinoma is genetically tested for specific mutations. The good thing about this test is that it can usually be performed from already collected specimens used to diagnose lung cancer, therefore eliminating the need for additional invasive procedures.

Highlights of this post

At the Winship Cancer Institute of Emory University, we have implemented a standardized molecular testing protocol for every patient diagnosed with lung adenocarcinoma.  As a result, in most circumstances, when an oncologist sees a patient for the first time, detailed molecular information is available on the tumor tissue, which helps inform treatment decisions.

Unfortunately, for certain mutations, there are currently no FDA-approved treatment options. Yet, as Georgia’s first and only National Cancer Institute –designated cancer center, Winship offers a number of innovative clinical trials for such patients, with the aim of identifying treatment options that provide the best likelihood of success.

Through research and clinical trials, investigators and physicians have discovered that understanding the genetic makeup of lung cancer patients is key. This knowledge allows for optimal, individualized treatment options that lead to overall improved outcomes for our patients.

Suresh Ramalingam MDAbout Dr. Ramalingam
Suresh Ramalingam, MD, is Associate Professor of Hematology and Medical Oncology and Director of the Translational Thoracic Malignancies Program for the Emory Winship Cancer Institute. He is a Georgia Cancer Coalition Distinguished Cancer Clinician and Scientist.

Prior to joining Emory, Dr. Ramalingam was at the University of Pittsburgh Cancer Institute. He specializes in lung cancer, esophageal cancer and other thoracic cancers and is actively involved in the scientific development of novel anti-cancer treatment agents.

Dr. Ramalingam serves as the principal investigator on several early phase clinical trials in lung cancers, many of which are sponsored by the NCI.  He is widely published in peer-reviewed scientific journals and serves as a reviewer for a number of medical journals.  Dr. Ramalingam is a member of the Thoracic Core Committee of the Eastern Cooperative Oncology Group and serves on the editorial board of the journal Clinical Lung Cancer.

He earned his medical degree at the University of Madras in India, and served as chief medical resident in Internal Medicine at Wayne State University in Detroit.  He later conducted his fellowship in hematology and oncology at the University of Pittsburgh Cancer Institute.

Dr. Ramalingam is a recipient of the prestigious “Clinical Research Career Development Award,” which is presented by the American Society of Clinical Oncology. He has been selected as one of “The Best Doctors in America” and has received numerous awards of excellence such as The University of Pittsburgh Leadership Award for Excellence in Clinical Trials Program Development.

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Which Sunscreen Is Best?

Which Sunscreen is Best?Most of us know that wearing sunscreen is one of the best ways to protect our skin from damaging UV rays and prevent skin cancer. But with the plethora of sunscreen options out there, choosing a sunscreen can be more complicated than it should be. If you feel overwhelmed by the seemingly limitless SPF and UV protection options, not to worry! A recent New York Times article addressed changes that the Food and Drug Administration (FDA) has ordered sunscreen companies to incorporate into future product labeling.

As the occurrence of melanomas and other skin cancers continue to rise, awareness around proper use of sunscreen is more important now than ever. Approximately one million new cases of skin cancer are diagnosed each year, making it the most common type of cancer in the United States. The three forms of skin cancer are distinguished by the types of cells affected: melanoma, basal cell and squamous cell. The most dangerous form of skin cancer is melanoma; however, if caught early, it can be treated.

To prevent the misuse and confusion caused by misreading of sunscreen labels, the FDA has mandated that the following be included on every sunscreen product:

  • Listing of “broad spectrum protection,” meaning the sunscreen has been proved to protect against both UVA and UVB rays
  • Any product with an SPF lower than 15 must carry a label warning that it will not protect against skin cancer
  • Products cannot claim to be waterproof, only water-resistant, and labels must note a time limit before the sunscreen is ineffective
  • Manufacturers can still sell sunscreens with SPFs that exceed 50; however, the FDA is evaluating whether or not they should remain on the market

According to the New York Times article, the FDA also warns against the use of sunscreen sprays and powders, stating that there is not enough data to support the efficacy of these products on preventing sun damage, and that consumers should be cautious of products with endorsements and seals of approval, as this typically means the manufacturer has donated money to become an endorsed member of an organization.

In a past online live chat hosted by Winship Cancer Institute of Emory University, Winship dermatologist, Suephy Chen, MD, addressed some frequently asked questions around the topic of sunscreen use and skin cancer prevention. One major takeaway from the chat: sunscreen should be applied every day, especially for people who have experienced sunburns or used tanning beds in the past. “The amount of sunscreen you use during the first (whole body) application of the day should be enough to fill a standard sized shot glass,” says Dr. Chen. She goes on to advise that “sunscreen should be reapplied every two hours or after you’ve perspired and/or have gotten in and out of the water.”

Remember, skin cancer is generally treatable if detected early. All the more reason to slop on the SPF! And if you haven’t done so lately, give your body a quick scan, and repeat this practice at least once a month. Get to know the pattern of your moles, spots, freckles, and other marks on your skin. If you notice any new moles or changes in shape or color to existing ones, please contact your healthcare provider.

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Cigarette Smoking Linked to 30% of All Cancers

Help Your Loved Ones Quit SmokingSmoking has long been linked to lung cancer, and most Americans have heeded the warnings that smoking causes lung cancer. According to the American Cancer Society, smoking is a direct cause of 80% of lung cancer deaths in women and 90% of lung cancer deaths in men.

But a fact that many don’t know is that cigarette smoke is also a contributor to 30% of all cancers. How could it be that cigarette smoke gets into organs other than the lungs? As it turns out, the actual smoke does not, but the carcinogens in tobacco smoke do get into your blood stream and thus into other parts of your body.

Some of the cancers linked to smoking are:

  • Lung Cancer
  • Head and Neck Cancers
  • Pancreatic Cancer
  • Stomach Cancer
  • Bladder Cancer
  • Kidney Cancer
  • Esophageal Cancer
  • Liver Cancer
  • Prostate Cancer
  • Breast Cancer
  • Skin Cancer
  • Cervical Cancer
  • Ovarian Cancer
  • Acute myeloid leukemia

Cigarette smoke contains more than 7,000 chemicals, and 69 of these are known to be causes of cancer. (carcinogenic).  These carcinogens damage genes that allow cell growth.  When damaged, these cells grow abnormally or reproduce more rapidly than do normal cells.

Secondhand smoke is also bad,  causing 49,000 deaths each year.  Secondhand-smoke exposure also has been found to be detrimental to cardiovascular health, particularly in children.

While smoking is the leading cause of preventable death in the United States, there is hope for smokers. Much of the damage to your body caused by smoking can be undone over time. Also, there are many successful programs to help you quit.

The best way to prevent smoking-related cancers is to never smoke, but by quitting at any time, you lower your risks of developing a smoking -related cancer.

Smoking Cessation Resources:

For information on smoking cessation, visit:

The Georgia Quit Line provides free counseling, a resource library, support and referral services for tobacco users ages 13 and older. Callers have the opportunity to speak with health care professionals who develop a unique plan for each individual.

About Joan Giblin, NP

Joan Giblin, Winship Cancer Institute

Joan Giblin, NP has a total of 43 years of nursing experience, 25 as a family nurse practitioner and 16 as an oncology nurse practitioner, where she is actively involved in patient care and clinical trials.

In 2011, Ms. Giblin assumed a new role as the director of the Winship Survivorship Program with primary responsibilities for developing the program as a resource for patients and a means to facilitate continued good health and quality of life for cancer survivors. Prior to this, she was the director of the Winship Call Center, the first point of contact for new cancer patients, and was instrumental in establishing protocols and procedures to streamline access to care at Winship.

Giblin’s experience as an oncology nurse practitioner gives her insightful perspective on the needs of cancer patients and cancer survivors. As a clinical nurse practitioner, she was part of the aerodigestive team, specializing in the care of patients with head and neck, lung and throat cancers.

Giblin’s current research is in the area of survivorship related to long-term and late effects of cancer treatment and adherence to follow-up care.

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Can Throat Cancer be Caused by HPV 16?

HPV Throat Cancer Michael Douglas

Michael Douglas recently brought HPV16-Related Throat Cancer into the forefront of many people’s minds this week when he commented that oral sex is a cause of throat cancer and the possible cause of his own throat cancer.

HPV, known to cause cervical cancer for many years, recently was also linked to a common head and neck cancer. HPV16 – related throat cancer typically affects otherwise healthy men between the ages of 50 and 60 who are non-smokers and non-drinkers.  The  symptoms are very unlike traditional oral cancers.  It first appears as a mass in the neck with no other symptoms.

Winship Cancer Institute Head and Neck Surgeon, Amy Chen, MD stated in an article in Prevention that “HPV16 has been found to be associated with one type of oral cancer at the base of the tongue and the tonsil, otherwise known as the pharynx.    Unfortunately at this time there are no screening tests for HPV of the throat.

The good news is the prognosis for cases of HPV16-caused throat cancer is good, so long as the patient is a non-smoker. Winship researchers and others are looking for ways to identify whether patients with HPV16-caused throat cancer need as much treatment as patients whose cancer is not caused by the virus.

More good news –  there is a vaccine available that can help young boys from developing the HPV16 -related throat cancer later in life.  It is recommended by the Centers for Disease Control (CDC) that all boys ages 11 – 21 receive a vaccine.  The vaccine can also help boys prevent cancers of the penis and anus.

Education about the disease and the vaccine available is crucial to help prevent this disease.  Spread the word to all your families about the importance of getting the vaccine.

About Amy Chen, MD, MPH, FACS

Amy Chen, MD, MPH, FACS, is a member of the Winship Cancer Institute of Emory University and Professor in the Department of Otolaryngology and Head and Neck Surgery in the Department of Hematology and Medical Oncology at the Emory University School of Medicine. She has a joint appointment at Emory’s Rollins School of Public Health, and she served as Director of Health Services Research in the Department of Surveillance and Health Policy Research of the American Cancer Society. Dr. Chen has been instrumental in developing a team approach to patient care. She developed and continues to lead the multidisciplinary head and neck tumor conference as well as the thyroid tumor conference. Dr. Chen began practicing at Emory in 2001.

Dr. Chen specializes in otolaryngology (ENT) and has been Board-Certified since 1999. She also completed a head and neck surgical oncology fellowship at MD Anderson Cancer Center. Her expertise is in upper aerodigestive tract cancers, parotid, and thyroid tumors. Dr. Chen also specializes in robotic surgery. Her other areas of clinical interest are head and neck cancer, laser surgery, melanoma, parathyroid surgery, skin cancer, thyroid surgery, and tongue malignancies.

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Breast Cancer Survivors at Higher Risk for Heart Disease

Heart Disease after Breast CancerAlthough many women who have survived breast cancer are worried about the chance of recurrence, recent research suggests that risk of a heart problem is greater or equal to the risk of breast cancer reoccurring. Chemotherapy and radiotherapy treatments for breast cancer can often be toxic to the heart muscle as well as to other organs. Chemotherapy side effects may increase the risk of heart disease, including weakening of the heart muscle (cardiomyopathy).

A significant proportion of women with breast cancer have one or more risk factors for heart disease at the time of breast cancer diagnosis that further increase the risk of cardiotoxicity, including smoking, obesity, lack of activity and high cholesterol. Additionally, if a woman had radiation therapy on the area of body that includes the heart, there may be an increased risk of cardiomyopathy, coronary artery disease and heart attack. The combination of radiation and chemotherapy can further increase a woman’s risk of heart damage. Thus, after second malignancies, heart disease is the leading cause of long-term morbidity and mortality among breast cancer survivors.

If you are a survivor of breast cancer, take control of your heart and breast health by following some simple guidelines:

  • Maintain a healthy weight
  • Avoid smoking
  • Limit alcohol intake
  • Manage stress!  – Stress can shut down your immune system, making it harder for you to fight off disease. It also can prevent the body from healing, which can put you at greater risk for heart disease.
  • Exercise! Get at least 30 minutes of physical activity 3 times a week.
  • Monitor and manage diabetes.
  • Eat healthy! Your diet should be low in fat and include generous amounts of fruits and vegetables.
  • Actively monitor your blood pressure and cholesterol levels. Work with your physician to reduce your blood pressure and cholesterol if they are high.
  • Get rest. Most people need 7 to 8 hours of sleep at night to heal and keep the immune system healthy.

Importantly, if you have received chemotherapy or radiation for breast cancer, it may be useful to follow up with a preventive cardiologist on a regular basis. If you experience significant problems such as shortness of breath or chest pain, report it immediately to your health care providers.

About Dr. Parashar

Dr. Susmita Parashar, Emory HealthcareSusmita Parashar, MD, MPH, MS is a Board certified cardiologist at the Emory Heart and Vascular Center and Assistant Professor of Medicine (Cardiology) at Emory University School of Medicine. Prior to joining the Division of Cardiology, Dr. Parashar was Assistant Professor of Medicine in the Division of General Medicine at Emory for 8 years. She applies her experience as a Board certified internist in providing a holistic care to patients.

She has received several grants and awards from the National Institutes of Health (NIH) and the American Heart Association to conduct research on women and heart disease. She has served as Emory principal investigator for large NIH – funded clinical research for heart attack patients. She was also invited to participate as a co-investigator for the NIH- fnded Cardiovascular Health Study for older adults.

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