Before it Starts

Leap consults the experts to find answers to your questions about an herbal remedy, screening and exercise for cancer prevention

Q: What are the cancers that are routinely screened for in Alberta? Why?

Alberta Health Services’ (AHS) website “Screening for Life” explains cancer-screening practices in our province. Who should be screened and what type of cancer to search for is determined by age and sex since most tests are done on people who don’t have cancer symptoms. Screening is meant to point out early signs of the disease and abnormal cell changes (not cancerous yet, but could become so over time) because early detection makes treatment more effective.

AHS health promotion specialist Fazilah Shariff, MSW, says current screening programs are restricted to breast, cervical and colorectal cancers because not enough evidence yet shows that screening for other cancer types, across large populations, effectively reduces the number of cancer diagnoses or deaths. “However,” Shariff says, “tests for cancers such as prostate, skin or ovarian cancer may still be useful on an individual basis, depending on your personal history.”

Risks to screening include false positives, and Shariff stresses the importance of speaking with your healthcare provider about your concerns to be able to make a better-informed and personalized plan regarding cancer screening. See for more information.

Q: After my mammogram, they called me back in for a breast ultrasound. What’s the difference? What were they looking for?

Both tests are useful in different ways, explains radiologist Maureen Hutson, MD, F.R.C.P., of Edmonton’s Medical Imaging Consultants. While mammography has proven useful in screening

for breast cancer, ultrasound has not been established as a routine method to screen for breast cancer, instead it is useful for evaluating breast tissue.
“A mammogram is performed using X-rays to ‘see through’ the breast tissue,” Hutson says. “Usually only two views of each breast are
performed, but sometimes the technologist has to perform some extra X-ray views so that the tissue of the breasts can be adequately assessed.”

An ultrasound differs because sound waves are used to create images of tissue instead of X-rays. “Ultrasounds can show differences between solid tissue, including normal tissue and solid nodules, and fluid-filled tissue such as cysts. It can also evaluate breast ducts,” she says.

Hutson says it’s likely the radiologist who read the specific mammogram in question probably saw a rounded nodule or area of distorted tissue in one of the breasts. Other reasons for more testing include when your family physician indicates there is a palpable abnormality in one breast or nipple discharge.

In these situations, as a radiologist, Hutson would want to further assess the area with a breast ultrasound in order to look for a possible solid nodule, fluid-filled cyst or duct abnormality. If once of those three findings appears in an ultrasound, a radiologist may recommend a needle biopsy of the area under the guidance of ultrasound to evaluate for any early signs of breast cancer.

Hutson says it’s important to remember that most patients recalled for further imaging after a mammogram typically have normal or benign findings. “The radiologist is just being very careful to not miss a finding which could indicate very early, and therefore, very treatable breast cancer,” she says.

Q: Are the health benefits the same for mild-to-moderate exercise as they are for moderate-to-intense?

“The exact type, dose and timing in life when exercise is most beneficial for reducing the risk of developing chronic diseases, such as cancer, is not entirely known,” says Dr. Christine Friedenreich of the University of Calgary’s Faculty of Medicine and Faculty of Kinesiology. She says evidence shows that all types of physical activity (e.g., occupational, household and recreational) are beneficial for reducing risk but sustaining recreational activity for longer durations more beneficial.

Evidence of the benefits to increasing the frequency and duration – the dose – of an activity has already been found to lower breast cancer risk.

“A moderate-intensity activity reduces breast cancer risk by 15 per cent and vigorous activity by 18 per cent,” Friedenreich says. “With respect to the duration of activity needed to reduce breast cancer risk, there is a clear dose-response effect with an eight per cent risk reduction with two to three hours per week; 14 per cent for three to four hours per week; and 28 per cent for 6.5 hours per week or more.”

At what point in life does physical activity become most associated with cancer risk reduction? Friedenreich says, sustained lifelong activity offers the greatest benefits however, activity later in life is also very beneficial even if it is preceded by lower levels of activity. “The evidence on physical activity and cancer prevention is particularly strong for colon, breast and endometrial cancers,” she says. “There is also considerable evidence that activity may reduce the risk of prostate, ovarian and lung cancers.” It’s never too late to start moving and reduce your risk of cancer.

Q: My husband is taking saw palmetto from the health food store for an enlarged prostate. Is it safe?

Saw palmetto is a palm tree found in the West Indies and in coastal regions of the southeastern United States, the berries of which are used in herbal remedies, explains Dr. Linda E. Carlson, Enbridge research chair in psychosocial oncology and associate professor at the University of Calgary.

“Native Americans used the herb to treat problems of the urinary tract, such as trouble urinating or frequent nighttime urination,” she says.

Clinical studies have shown saw palmetto relieves some symptoms of benign prostatic hyperplasia (BPH), or enlarged prostate, such as difficult and frequent urination. To clarify, she says that BPH is not prostate cancer and saw palmetto has not been shown to lower prostate cancer risk – although more research is needed in this area.

Saw palmetto supplements are very popular in Europe where doctors often prescribe them for BPH treatment. Also popular in the U.S. and Canada, they are not approved for use as BPH treatment here. Although uncommon, side effects can include headache, nausea, vomiting, upset stomach, dizziness, constipation or diarrhea, trouble sleeping and fatigue. Its long-term effects and safety have not been studied in detail, but many men use it without incident.

“Men who have symptoms that might be caused by BPH, such as difficult, frequent or urgent urination, should see a doctor as soon as possible rather than treating themselves with saw palmetto alone,” Carlson says. “These symptoms can also result from prostate cancer or other serious conditions, and self-treatment with saw palmetto alone could delay diagnosis and treatment.”

Ask our experts questions about general health, cancer prevention and treatment. Please submit them via email to Remember, this advice is never a substitute for talking directly to your family doctor.

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