Everything You Should Know About Cancer Risk and Screenings During National Cancer Prevention Month
Cancer epidemiologist breaks down common myths around cancer risk, screening guidelines, and how to boost health equity.
By Katherine Gianni
According to data from the American Cancer Society, cancer continues to be the second leading cause of death in the United States behind heart disease. Some of the most common risk factors include smoking, excessive alcohol consumption, and exposure to ultraviolet (UV) radiation. However, cancer researchers have determined that many of these threats are preventable through education and specific lifestyle choices.
To learn more about cancer prevention, we turned to Dr. Etienne Holder, a postdoctoral associate with Boston University’s Black Women’s Health Study. Dr. Holder’s research primarily focuses on the etiology and epidemiology of breast cancer. Other areas of research interest include molecular epidemiology, modifiable risk factors and health disparities in cancer, and survivorship. She discusses four major misconceptions around cancer risk, cancer-related health disparities, and the best questions for patients to talk through with their health care providers.
February is National Cancer Prevention Month. From your perspective, what questions should people be asking their healthcare providers about cancer and reducing their risk?
By attending regular doctor’s visits, people can be assured they will be on track for routine screening depending on their age and other risk factors such as family history. These visits are a good time to check-in with your doctor to make sure you are maintaining a healthy lifestyle. The recommended screenings are a way to detect cancer early and start treatment early for a better prognosis (or outcome).
If people are at higher risk for certain cancers, it would be good to ask your healthcare provider about preventive measures such as lifestyle changes you can implement to reduce your risk or whether earlier or more frequent screening may be important.
Are there any myths or misconceptions about cancer risk?
Myth #1: Cancer is contagious.
Cancer is not a contagious disease that can be spread from person to person. Some viruses and bacteria can lead to cancer in some people like the human papillomavirus (HPV) and hepatitis B and C. While these viruses can be spread from person to person, the cancer they cause cannot.
Myth #2: If someone in my family has cancer, I will get it too.
Different cancers vary in genetic risk; however, only 5 to 10% of cancers are considered hereditary. The vast majority of cancers caused by genetic mutations are non-hereditary (meaning it’s not passed down through your genes), but rather a result of mutations that occur due to things like exposure to radiation, environmental factors, or natural aging processes.
Myth #3: Using deodorants or antiperspirants can cause breast cancer.
There is no scientific evidence to support this claim. So far, the best scientific studies have found no evidence linking these products to breast cancer or changes in breast tissue.
Myth #4: Only smokers get lung cancer.
There are other factors that can lead to lung cancer besides smoking, although smoking is a top risk factor. In fact, about 10–15% of lung cancers occur in non-smokers. Other factors that increase risk of lung cancer include exposure to secondhand smoke or radon.
What are some common cancer screening guidelines?
The general cancer screening guidelines are for people at average risk. Here are example screening guidelines for some of the most common cancers in the U.S. according to the U.S. Preventive Services Task Force. The breast cancer screening recommendations include yearly mammograms for women 45 years of age and older. Colorectal cancer can be screened a few different ways including stool tests and colonoscopies. Colonoscopies should be conducted every 10 years after age 45. Prostate cancer is also a common cancer, and it is suggested that prostate-specific antigen (PSA)-testing occur periodically for men 55 to 69 years of age.
Lastly, lung cancer screening should occur yearly for people ages 50 to 80 years who are current smokers, who have a 20-pack/year (i.e., 1 pack of cigarettes per day for 20 years) or more smoking history, or who quit within the past 15 years. Again, these are the general guidelines for people with average risk. These guidelines typically change if your risk is higher, so it is important to talk with your healthcare provider about any potential family history, lifestyle factors, or environmental exposures that could put you at an increased risk for cancer.
You work alongside fellow researchers and faculty members at BU’s Black Women’s Health Study. What is the history of the study as it relates to cancer research, and what are your focus areas?
The Black Women’s Health Study (BWHS) is a long-standing, U.S.-based cohort study which began in 1995 with 59,000 self-identified Black women. Participants complete bi-annual questionnaires which provide us with information on lifestyle factors, reproductive history, and anthropometrics, among other data. As our participants age, we are able to learn about how experiences throughout their life are related to certain conditions, like cancer, that often occur later in life. Through self-reports of cancers confirmed by medical record review and linking to state cancer registries and the National Death Index, we are able to conduct research that gives us insight into factors associated with cancer risk and survival. The BWHS investigators are currently working on examining the influence of genetic, lifestyle, and environmental factors in relation to cancers of many organ sites.
I am a postdoctoral associate with the BWHS focused on examining the association between psychosocial stressors and neighborhood-level factors with breast cancer survival, and further elucidating the relationship between high mammographic density in breast cancer risk among Black women. I am also working on a multi-site study to further characterize racial disparities of monoclonal gammopathy of undetermined significance (referred to as MGUS) which is a precursor to multiple myeloma, a blood cancer.
What are the factors that contribute to cancer-related health disparities? How can we work to increase equity in this area?
The causes of cancer-related health disparities are complex. Social determinants of health are important contributing factors — race/ethnicity, specifically racism and discrimination experienced as an identifying member of a minoritized group, socioeconomic status which often determines where you live or work, and access to quality health care — all of which impacts cancer burden. By improving conditions where people live or by ensuring all healthcare facilities are operating at a high standard based on national benchmarks, we can get closer to equity. These steps are part of larger systemic and institutional structures that need reform.
Are there any new projects or research initiatives you are working on now?
I am focused on my various breast cancer and MGUS projects at the moment. I am excited to be part of a passionate team that strives for excellence in our contributions to the field of cancer research and Black women’s health. I look forward to making a positive impact in the field of cancer research and hope my work will eventually inform interventions to reduce risk and improve survival for Black women.