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PowerPoint Slides English Text Mandarin Chinese Translation Cancer Prevention: Part 1

VideoTranscript 癌症预防：第 1 部分视频文本

Professional Oncology Education Cancer Prevention: Part 1 Time: 26:20?

专业人员肿瘤教学讲座癌症预防：第 1 部分时间： 26:20?

Sally Scroggs, MS, RD, LD

Manager, Health Education Cancer Prevention Center The University of Texas, MD Anderson Cancer Center

德克萨斯大学 MD Anderson 癌症中心癌症预防中心健康教育主管


Cancer Prevention: Part ICancer Prevention: Part ICancer Prevention: Part ICancer Prevention: Part I

Cancer Prevention: Part ICancer Prevention: Part I


Manager, Health Education

Cancer Prevention Center

Hello, I am Sally Scroggs and I am the Health Educator for the Cancer Prevention Center at University of Texas MD Anderson Cancer Center.

大家好，我叫 Sally Scroggs，是德克萨斯大学 MD

Anderson 癌症中心癌症预防中心的健康教育专家。

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ObjectivesObjectivesObjectivesObjectives

• Upon completion of this lesson, participants will

be able to:

– Discuss lifestyle modification strategies for risk

reduction.

– List types of prophylactic surgical interventions used

to prevent malignancies.

– Identify chemoprevention strategies for several

common cancers.

Today, I am going to talk to you about cancer prevention. This is Part I. The objectives that we are going to be covering are discussing: lifestyle modification strategies for risk reduction. Life. The other two objectives will be covered in Part II.

今天，我将要向大家介绍癌症预防。本次讲座是这一主题的第一部分。我们的目的是讨论：降低风险的生活方式调整策略。其他两个目的会在第二部分进行讨论。


Cancer Mortality RateCancer Mortality RateCancer Mortality RateCancer Mortality Rate

Fewer Americans dying of cancer

• Better treatment

• Cancer prevention activities

Fewer Americans being diagnosed with cancer

• Related to cancer prevention activities

- Tobacco cessation

- Colorectal cancer prevention through removal

of precancerous polyps

I am going to start out with cancer mortality rates and good news is that fewer Americans are dying of cancer. And, yes, this is due to better treatment modalities, but also to cancer prevention activities. The even better news is, or more exciting news, is that we are now seeing fewer Americans being diagnosed with cancer, and, again, this is due to aggressive cancer prevention activities, for example, there are fewer people smoking now. There are less people starting to smoke. So, this can have an impact on decreasing the cancer diagnosis, but also we now have screening activities, for example, removing --- being able to remove precancerous polyps during a colonoscopy, which further has a result of decreasing risk.

首先我要讨论癌症死亡率。好消息是美国死于癌症的人数有所减少。其中的原因是治疗方法有所改善，但也要归功于癌症预防措施。更好的消息，或者说更为激动人心的消息是，现在在美国被诊断患有癌症的人数有所下降。这同样要归功于积极的癌症预防措施，比如说现在吸烟的人少了，开始吸烟的人也少了，这可减少癌症诊断例数。但同时我们还有筛查措施，例如，在结肠镜检查期间切除癌前息肉，从而进一步降低癌症风险。

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Cancer ControlCancer ControlCancer ControlCancer Control

• Cancer Treatment

• Cancer Prevention

– Primary Prevention

• Reducing the incidence of cancer through health promotion

and cancer risk reduction

– Secondary Prevention

• Cancer screening and early detection to identify cancer

cases early before signs or symptoms develop

– Tertiary Prevention

• Survivorship activities to monitor for and prevent recurrence

and late effects of treatment

Cancer control certainly encompasses cancer treatment, but also a part of cancer control is cancer prevention. And we can divide it into three different areas: primary prevention, secondary prevention, and tertiary prevention. And we will be covering these in detail.

癌症控制当然要包括癌症治疗，但也包括癌症预防。我们可以将其分为三个不同的方面：初级预防、二级预防和三级预防。我们将详细讨论这些内容。


Risk Assessment

The first that I am going to discuss is risk assessment. So, this is the starting point of cancer prevention. And what we do is come up with target recommendations on an --- for an individual for their level of risk for each specific cancer type.

首先我要讨论的是风险评估。风险评估是癌症预防的起点。风险评估的目的是针对每个特定癌症类型的风险，为个人制定目标建议。

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Risk AssessmentRisk AssessmentRisk AssessmentRisk Assessment

• Qualitative Risk Assessment

- Identifying risk factors

• e.g. smoking

• Quantitative Risk Assessment

- Use of computerized models to estimate cancer risk

• e.g. breast (Claus, Gail, BRCAPRO)

We can do this qualitatively and quantitatively. Mostly, it is qualitative. So, for example, we know that, if a person is smoking, that they are going to be at higher risk for lung cancer and head and neck cancers. But, also quantitatively, in a few cases now, we have computerized risk assessment models that can estimate an individual’s risk of developing cancer. An example would be the risk assessment tool that can estimate a woman’s risk of developing breast cancer. A couple of these are computerized.

风险评估可以是定性和定量评估。多数时候是定性评估。例如，我们知道如果某人吸烟，其罹患肺癌和头颈部癌症的风险就会升高。但我们也可以进行定量评估。在数种情况下使用计算机化的风险评估模式，能够估测某人罹患癌症的风险。其中的一个例子是评估女性罹患乳腺癌风险的评估工具。其中两三项评估实现了计算机化。


Breast Cancer Risk Assessment ToolBreast Cancer Risk Assessment ToolBreast Cancer Risk Assessment ToolBreast Cancer Risk Assessment Tool

This is an example of the Gail model. It is also called the Breast Cancer Risk Assessment Tool. In this assessment you can --- you can find this on the National Cancer Institute’s web page, but it is also on the breastcancerprevention.com web page. And, this model estimates a woman’s risk of developing breast cancer based on some identifiable factors, and these factors include age. They include the age of the first menstrual cycle. It also includes the age of the first live birth of a child, family history of breast cancer in first-degree relatives, and also the individual’s breast biopsy history [excuse me] including any biopsy identified as atypical hyperplasia. So, the model estimates a woman’s breast cancer risk for over the next five years and over her lifetime. Increased risk is defined as a five-year risk of 1.7 or greater.

这是 Gail 模型示例，也称为乳腺癌风险评估工具。可以在美国国家癌症研究所的网页和

breastcancerprevention.com 网页中找到此项评估。该模型根据包括年龄在内的某些可识别因素，评估女性罹患乳腺癌的风险。可识别因素包括初潮年龄，首次活产生育的年龄，直系亲属的乳腺癌家族史和该人士乳腺活检历史，还包括确定为不典型增生的任何活检。该模型估测女性在接下来的五年内以及终生的乳腺癌风险。风险升高是指五年风险为 1.7 或更高。

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Risk Reduction StrategiesRisk Reduction StrategiesRisk Reduction StrategiesRisk Reduction Strategies

• Health Promotion- Diet

- Lifestyle modification

• Prophylactic surgical interventions

• Chemoprevention

Once we have identified an individual’s risk, then we can provide them with strategies to reduce the risk of developing cancer.

一旦确定了个体的风险，我们就能为其提供降低癌症罹患风险的策略。


American Institute of Cancer Research GuidelinesAmerican Institute of Cancer Research GuidelinesAmerican Institute of Cancer Research GuidelinesAmerican Institute of Cancer Research Guidelines

1. Choosing mostly plant foods, limit red meat

and avoid processed meat.

2. Be physically active everyday in any way for

30 minutes or more.

3. Aim to be a healthy weight throughout life.

2007 World Cancer Research Fund/ American Institute for Cancer Research Expert Report: Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective

I am going to start out with what you can do to make lifestyle changes and I am going to be using the American Institute for Cancer Research information. Where they --- it is the most comprehensive research we have to date where they looked at over 7,000 studies. And they came up with about eight guidelines, two special recommendations. And then they --- this slide is a grouping of the main message from those guidelines, which includes choosing mostly plant-based foods and limiting red meat, avoiding processed meat, being physically active every day for 30 minutes or more, and aim for a healthy weight throughout life. And I am going to go into more detail.

我首先会介绍可以做出哪些生活方式的改变，并且将使用美国癌症研究所提供的信息。这是迄今最为全面的研究信息，借鉴了 7000 多项研究的结果，制定了大约八项指南，两项特别建议。这张幻灯片对这些指南的主要内容进行了分类，包括选择以植物为主的食物，限制红肉摄入，避免摄食加工过的肉类，积极运动，每天运动 30 分钟或更长时间，以及终生保持健康的体重。接下来我会详细介绍。

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Summary of “Convincing” and “Probable”Judgements

World Cancer Research Fund/American Institute for Cancer Research.Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR, 2007

First of all, I would like to show you a summary of the research. And, this is a very good patient education tool. It has the cancer sites across the top. And then, on this left side, it has different elements, for example, in food and also physical activity, body weight. As you can see, colorectal cancer --- it is convincing that body fatness and abdominal fatness increases risk. And yet physical activity convincingly decreases risk. So, there are both things that we can do that can protect, but there also maybe things that can increase the risk of cancer. So, again, you can look at what an individual’s specific cancer risks are, maybe from family history, or their individual history, and give them specific guidelines on what they can do to be proactive and make some changes for reducing their risk of cancer.

首先我想给大家看一下研究总结。这是一个非常好的患者教育工具。顶部横向是癌症部位。左侧为各类因素，例如食物、身体活动、体重。大家可以看到，已经确定身体肥胖和腹部肥胖会增加结直肠癌的患病风险，而身体活动是确认的风险降低因素。所以说我们可以做有些事来保护自己，而有些可增加患癌的风险。我们可以查看个人的具体癌症风险，这些风险可能来自家族史或个人史，并向个体提供具体的指南，指导其积极应对跟调整来减少罹患癌症的风险。


American Institute for Cancer Research American Institute for Cancer Research American Institute for Cancer Research American Institute for Cancer Research Guidelines Include:Guidelines Include:Guidelines Include:Guidelines Include:

• Maintain a healthy weight throughout life

• BMI 21-23

• Avoid weight gain and increases in waist circumference,

especially post-menopausal for females

The first guideline --- and this is the first for both the American Institute for Cancer Research and for the American Cancer Society, putting emphasis on the risk factor with cancer and obesity. So, the first one is maintaining a healthy weight throughout life. And one way to assess this with your patients is using body mass index. And typically the body mass index healthy range is 8.5 to 24.9. The American Institute for Cancer Research narrowed that to 21 to 23; and this is a reflection of if individuals, even ethnic populations, who are at higher risk of heart disease or diabetes with excess weight would also be at higher risk for the cancer sites that are associated with obesity. So, there are other ways to measure abdominal fatness, which we just saw was related to colorectal cancer. It is also related to increased risk with post --- with breast cancer for postmenopausal females. So weight gain, increase in waist circumference, and even hip-to-weight --- waist-to-hip ratio can also be used to assess body fatness

第一项指南名列美国癌症研究所和美国癌症协会指南的首位，其重点是癌症和肥胖的风险因素。所以第一项是终生保持健康体重。评估患者体重的一个方法是使用身体质量指数。通常身体质量指数的正常范围是

8.5 到 24.9。美国癌症研究所将这一范围缩小到了

21 到 23；这表示体重过重的个人乃至某些少数族裔整体，除了罹患心脏病或糖尿病的风险增高之外，在与肥胖相关的癌症部位罹患癌症的风险也会升高。还有其他方法来测量我们刚才看到的与结直肠癌症相关的腹部肥胖。这还与绝经女性乳腺癌风险升高有关。所以说，体重增加、腰围增粗，甚至是腰臀围比增加也可用于评估身体肥胖程度和风险。

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and risk.


Obesity and CancerObesity and CancerObesity and CancerObesity and Cancer

Convincing Increased Risk

• Breast (among

postmenopausal women)

• Colon

• Endometrium

• Esophagus

• Kidney

• Pancreas

Probable Increased Risk

• Gallbladder

Limited-suggestive Increased Risk

• Liver

The American Institute for Cancer Research uses convincing, probable, and limited suggestive risks to determine severity. And for obesity right now, there are eight different cancer sites that are associated with obesity. And, you can see that there --- it is convincing that it increases the risk, again, breast (postmenopausal women), colon, endometrial cancer, esophageal cancer, kidney, and pancreatic cancer.

美国癌症研究所使用确定风险、可能风险和限制性提示风险来判定严重程度。就肥胖而言，目前有八种不同的癌症部位与肥胖有关。大家在这里可以看到，已经确定肥胖会增加罹患乳腺癌（绝经女性）、结肠癌、子宫内膜癌、食道癌、肾癌和胰腺癌的风险。


Adopt a Physically Active Lifestyle

• Be moderately physically active for at least 30

minutes every day

• As fitness improves, aim for at least 60 minutes of

moderate activity or 30 minutes of vigorous activity

every day

The next guideline, again both for the American Institute for Cancer Research and the American Cancer Society, is being physically active. The guideline is be moderately physically active for at least 30 minutes every day and then, as fitness improves, aim for at least 60 minutes of moderate activity or 30 minutes of vigorous activity every day. There is --- there are some studies that are identified through the American Cancer Society that indicate 45 minutes of activity most days of the week can reduce the risk of both colon cancer and breast cancer.

美国癌症研究所和美国癌症协会均提出的第二项指南是积极运动，指南要求每天适度运动至少 30 分钟。之后随着身体健康程度的改善，每天适度运动至少

60 分钟，或剧烈运动 30 分钟。美国癌症协会确定的一些研究显示，每周几乎每天都运动 45 分钟可以降低罹患结肠癌和乳腺癌的风险。

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Consume a Healthy Diet with an Emphasis Consume a Healthy Diet with an Emphasis Consume a Healthy Diet with an Emphasis Consume a Healthy Diet with an Emphasis on Plant Sources and Limit Red Meatson Plant Sources and Limit Red Meatson Plant Sources and Limit Red Meatson Plant Sources and Limit Red Meats

• Eat 5 or more servings of vegetables and fruits per day

• Choose whole grains instead of processed grains and sugar

The next guideline focuses on dietary intake. And I think most of us have heard the Eat 5 a Day, which actually behaviorally that is the minimum amount of fruits and vegetables one would want to eat in a day. And it is split up: three vegetables and two fruits. And that is because typically most Americans have between three to four servings a day. So, the 5 a day is meeting the minimum amount. Sometimes you will hear seven. Sometimes you will hear nine. So, it is typically five to nine servings of fruits and vegetables a day --- is something you can do to be proactive in reducing your cancer risk. It is estimated that you can reduce your risk as much as 20% by just having the five fruits and vegetables per day. It is also important to choose whole grains instead of processed grains and sugars including avoiding sugary drinks.

下一项指南侧重于饮食摄取。我想我们当中的多数都听说过“每天 5 份”。这实际上是指一个人每天应食水果和蔬菜的最低量。具体可分为：三份蔬菜和两份水果。而大多数美国人通常每天进食三到四份果蔬。所以每天 5 份果蔬是最低量。有时大家会听到七份，有时大家会听到九份，所以通常每天进食五到九份水果和蔬菜就可以积极降低患癌风险。据估测，仅仅每天进食五份水果和蔬菜就可降低风险达 20%。同样重要的是选择全麦食品，不要选择经过加工的谷物制品和糖，包括避免饮用含糖饮料。


Limit Intake of Red Meat and Avoid Processed MeatLimit Intake of Red Meat and Avoid Processed MeatLimit Intake of Red Meat and Avoid Processed MeatLimit Intake of Red Meat and Avoid Processed Meat

Public Health Goal

• Population average consumption of red meat* to be no more than 300 g (11 oz) a week, very little if any of which to be processed

Personal Recommendation

• People who eat red meat to consume less than 500 g (18 oz) a week, very little if any to be processed

* “Red meat refers to beef, pork, lamb, and goat…”

USDA 2006 Average Per Capita Weekly Consumption: Red meat - 36 oz., Beef – 20 oz.

I wanted to give you one example of the --- how specific the guidelines are for the American Institute for Cancer Research. So, I chose to use the red meat as this example. They give a public health goal and then they give a personal recommendation. I am going to focus on the personal recommendation in the presentation, which indicates that people, who eat red meat --- and let us clarify what red meat is. It is beef. It is pork, lamb, and goat, for example. People should have just over or not more than just over a pound, 18 ounces a week and the very little of any of it to be processed. So, is this something that you should discuss with your patients? Well, I looked at the per capita consumption of red meat in the United States and actually just the beef alone is over what is recommended to take in weekly. Beef alone in the United States is estimated to be 20 ounces a week. Red meat total is 36 ounces a week. So, obviously, this is something you can address with your patients

我想给大家一个范例，看看美国癌症研究所指南的具体程度。以红肉为例，美国癌症研究所提供了公共卫生目标以及个人建议。我在本次讲座中将主要介绍个人建议，具体是针对吃红肉的人士。让我们先来明确红肉的定义。红肉包括牛肉、猪肉、绵羊肉和山羊肉等。每周进食的红肉应该限制在一磅多一点，即 18 盎司，而且其中很少量是经过加工的肉类。那么有必要与患者讨论这一点吗？我查看了美国的人均红肉摄食量，实际上光是牛肉一项就超出了每周建议量。在美国，仅仅牛肉的人均每周摄食估计值是 20 盎司。红肉总量是每周 36 盎司。所以很明显，大家应该与患者讨论这一点来降低患癌风险。

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and could make a difference in reducing cancer risk.


Meat and Cancer RiskMeat and Cancer RiskMeat and Cancer RiskMeat and Cancer Risk

Red Meat

• Colorectum *

• Endometrium ♦• Esophagus ♦• Lung ♦• Pancreas ♦* Convincing increased risk♦ Limited–suggestive increased risk

Processed Meat

• Colorectum *

• Endometrium ♦• Esophagus ♦• Lung ♦• Prostate ♦• Stomach ♦

If you look at the risk factors --- or if you look at the convincing increased risk for red meat, colorectal cancer is convincing and also for processed meat, colorectal is --- it is convincing. The others are limited suggested increased risks, but still the evidence is there that they play a role with cancer at a number of sites. They could not even come up with a limited amount of processed meats, which is why it says limit or avoid processed meats altogether. And this has to do with the heme iron that is in red meats that is associated with increasing the known carcinogen of N-nitroso compounds production. So, even if there are nitrates or nitrites in the food that is processed with the iron, you can still produce more of those in the gut, which increases risk. Also, red meat increases bile acids, which can irritate the colon and set the stage for cancer there.

如果我们观察红肉的确定增加风险，可以确定结直肠癌风险增加，而且经过加工的肉类也确定会造成结直肠癌风险增加。在其他癌症情况下红肉是限制性提示风险因素，但是仍然有证据提示红肉会促成一系列部位的癌症。指南甚至没有规定经过加工的肉类的限制摄食量，所以应该限制或完全避免摄食经过加工的肉类。这与红肉内含有的血红素铁有关，因为血红素铁会造成产生更多的致癌物亚硝基复合物。因此当食物里已经含有硝酸盐或亚硝酸盐，人的机体仍然会在有铁的情况下，于肠道内产生更多的硝酸盐或亚硝酸盐，从而增加患癌风险。所以红肉会增加胆汁酸，而胆汁酸会刺激结肠，使得人体更容易罹患结肠癌。


If you Drink Alcoholic Beverages, If you Drink Alcoholic Beverages, If you Drink Alcoholic Beverages, If you Drink Alcoholic Beverages, Limit ConsumptionLimit ConsumptionLimit ConsumptionLimit Consumption

• Women - 1 drink/day

• Men- 2 drinks/day

• 1 Drink means:

– 12 ounces of regular beer

– 5 ounces of wine

– 1.5 ounces of liquor

• Convincing increased risk for: mouth, pharynx, larynx,

esophagus, breast, colorectum (men)

• Probable increased risk for: liver, colorectum (women)

Alcohol is --- also needs to be discussed. And typically the guidelines for cancer risk reduction mesh very well with the recommendations for heart disease and diabetes, but this is one place where they deviate. So, you would need to look at your patient’s individual risk factors. If cancer is more of a risk factor, then you would want to talk specifically about limiting consumption of alcohol if they drink at all. The recommendations are not more than one drink per day for women and not more than two drinks per day for men. And then it is also important to discuss portion sizes. The convincing risk is associated with head and neck cancers, breast cancer. It is convincing that alcohol increases the risk for colorectal cancer in men, and then probable increased risk for liver cancer with alcohol, and then probable increased risk with colorectal cancer with women.

我们还需要讨论酒精。一般而言，癌症风险降低指南与预防心脏病和糖尿病的建议相辅相成，但是这里是两者不一致之处。所以需要查看患者个人的风险因素。如果存在癌症风险因素，则需要在患者饮酒的情况下，专门讨论限制饮酒量。建议女性每天不超过一杯，男性每天不超过两杯。而且同样重要的是要讨论份量。确认的风险与头颈部癌、乳腺癌有关。已经确定酒精会增加男性罹患结直肠癌的风险，可能会增加罹患酒精性肝癌的风险，可能会增加女性罹患结直肠癌的风险。

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Tobacco CessationTobacco CessationTobacco CessationTobacco Cessation

Health Care Professionals Role in Smoking Cessation:

• Ask patients if they smoke

• Assess patients attitude towards smoking and quitting

• Advise cessation clearly and unequivocally

• Assist with a cessation plan

• Arrange follow up to support choice of cessation

I am now going to talk to --- address another lifestyle behavior that you --- your patients have control over and this is tobacco cessation. Health care professionals often don’t realize the important role. We take it for granted that patients know that they shouldn’t smoke, but you really need to ask the patients. A lot of my patients have said. “Well, no one has ever told me that I needed to stop before.” So, first of all, asking. These are actually the 5 A’s. Asking and then discussing with the patient what their attitude is towards smoking at this time. Giving advice to the patient on how you can quit, helping them develop a plan, and then finally arranging support. This can be from you or your staff or a follow-up phone call.

接下来我要讨论患者可以控制的另一种生活习惯，这就是戒烟。医务人员常常意识不到讨论戒烟的重要作用。我们想当然地认为患者明白自己不应该吸烟，但是确实有必要询问患者。我的许多患者说：“可是以前没有谁告诉过我要戒烟呀。”所以说，首先要询问。我们有 5 A 原则。询问，然后与患者讨论他们此时对吸烟的态度。为患者提供戒烟的建议，帮助他们制定计划，最后安排获得辅助。可以由各位或你们的工作人员，或者在后续电话中完成这些工作。


Tobacco CessationTobacco CessationTobacco CessationTobacco Cessation

The quit plan involves:

• Identifying daily triggering behaviors

• Uncovering motivation for the behaviors

• Adopting alternative coping strategies

• Tobacco cessation medications

• Social Support

Quitting involves a plan of, you know, starting out with identifying daily triggers. These are habits that they have formed with smoking. An example may be having a cigarette with the first cup of coffee in the morning and talking to them about how they can start working on breaking that habit, for example, using a different mug or having tea instead of coffee, as they work on changing that behavior. Uncovering motivation for the behaviors; are they using nicotine for stress? Are they using it for depression? Giving them alternative coping strategies. And we also have tobacco cessation medications that can ease the withdrawal symptoms. Also, discussing social support: what can help them? What can hurt them? And how to ask for social support from family members and people that they work with and from you as the healthcare provider.

戒烟需要有计划地进行，首先要确认日常触发吸烟的因素。有些已形成的生活习惯与吸烟有关，例如早晨喝第一杯咖啡时吸一支烟。与患者讨论如何开始打破这一习惯，例如换个咖啡杯或者不喝咖啡改喝茶。揭示这些行为习惯背后的动因：患者是因为有压力而使用尼古丁吗？患者是否因为抑郁而使用尼古丁？向患者提供应对压力和抑郁的其他策略。我们也有戒烟药物来帮助缓解戒断症状。还可以讨论社会支持：什么有助于他们？什么会对他们造成危害？如何从家人和同事以及医务人员那里寻求社会支持。

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Cessation CounselingCessation CounselingCessation CounselingCessation Counseling

• Assess readiness to change

• Provides problem-solving guidance to develop

a plan to quit and overcome common barriers

• Provides social support

• Motivational interviewing

• The 5 R's (relevance, risks, rewards,

roadblocks, repetition)

Cessation counseling can come from a trained counselor where they can address the readiness to change. What all is going on with this individual in their life right now? Is this a good time to have them quit or are we just going to be setting them up for yet another failure? So helping provide problem-solving guidance to develop a plan to quit, to overcome some of the common barriers; looking at where their social support is; and then helping with motivational interviewing; looking at the 5 R’s. Is this relevant? What are the risks? Coming up with rewards, identifying roadblocks, and then repeating the positive behaviors, so that they replace the other habits for smoking.

经过培训的咨询师可以提供戒烟咨询，前提是判断是否已经做好戒烟准备。这位人士的生活中目前在发生些什么事情？现在是其戒烟的好时机吗？还是戒烟注定会失败？帮助解决制定戒烟计划所遇到的问题，克服某些常见的障碍因素，查看他们社会支持的来源，然后安排激发戒烟动力的访谈，查看这些 5 R 因素是否有相关性？有哪些风险？制定奖励措施，识别遇到的障碍，然后重复积极的行为，以替代其他与吸烟相关的习惯。


MedicationsMedicationsMedicationsMedications

• Nicotine replacement therapy

– Nicotine substitutes (gum, patches, lozenges, inhalers)

– Reduce nicotine levels gradually

• Antidepressants

– Bupropion reduces withdrawal symptoms

• Nicotine blocking drugs – Varenicline

– Activates nicotine receptors in the brain to reduce severity

of cravings and withdrawal symptoms

– If patients smoke while taking Varenicline, reduces the

sense of satisfaction from smoking

The medications now to --- first of all to gradually decrease nicotine, would be nicotine replacement therapy. And you work with the patient individually. You may have to try a number of these before you find out what works. They may try the patch and then have an allergy reaction to it. The lozenges may work better. There actually is some research identifying different types of the --- of characteristics in a person’s personality that may make the inhaler more successful for them. Again, this is where cessation counselors can help you. They can actually lessen the severity of the withdrawals by reducing nicotine levels gradually. Also, there is

research with Zyban that helps --- shows that this antidepressant can reduce withdrawal symptoms associated with smoking cessation. And a newer drug on the market is Chantix

TM. This drug actually

works in two ways. It activates the nicotine receptors in the brain to reduce the severity of cravings with withdrawal symptoms. And then, if the patient smokes while they are taking Chantix

TM, they

在所有的戒烟药物中，第一类是能逐渐降低尼古丁需求的药物，即尼古丁替换疗法。需要针对患者的具体情况，可能必须尝试不同的药物，找到有效疗法。患者可能尝试了贴片，然后对贴片产生过敏反应。可能锭剂的效果更佳。实际上有些研究显示，鉴于患者不同的个性特征，可能会使用吸入剂的成功率更高。戒烟咨询师同样可在这些方面为各位提供帮助。戒烟咨询师实际上可以逐渐减少尼古丁水平，从而降低戒断症状的严重性。另外采用 Zyban 的研究还显示，使用 Zyban 这种抗抑郁剂可减少与戒烟相关的戒断症状。另外市场有售的一种新药叫 ChantixTM。这种药物实际上通过两种途径发挥效用。它会激活大脑里的尼古丁受体，减轻与戒断症状有关的对香烟的渴求。

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do not get the fix that they are used to because the nicotine receptors in the brain have already been activated by the drug, so they don’t get that reward. So it is looking at these different medications and in combination individually to help the patient with cessation.

另一方面，如果患者在使用 ChantixTM

的同时吸烟，则不会得到以前会产生的满足感，因为大脑里的尼古丁受体已经被 ChantixTM

激活，所以吸烟不会产生快感。所以可以查看不同的戒烟药物并且按照个体情况联合使用，帮助患者戒烟。


When Smokers QuitWhen Smokers QuitWhen Smokers QuitWhen Smokers Quit…………....

• 20 minutes after quitting: heart rate and blood pressure drop

• 12 hours after quitting: CO level in blood drops to normal

• 2 weeks to 3 months after quitting: circulation improves

• 1 to 9 months after quitting: coughing and shortness of

breath decrease

• 1 year after quitting: risk of CHD is half that of a smoker's

• 5 years after quitting: stroke risk is reduced to that of

a non-smoker

• 10 years after quitting: lung cancer death rate is half that

of a smoker

• 15 years after quitting: risk of CHD is that of a non-smoker's

When smokers quit, it is important for them to know that they immediately start the healing process. Twenty minutes after quitting, their heart rate and blood pressure drops, but you can see this continues on out 5, 10, 15 years from stopping smoking. A lot of the people that I have worked with will keep this type of information in their pocket or in their purse. And when they are having a craving they can pull this out to remind them why they are going through this difficult activity.

在吸烟者戒烟时，有必要让他们知道戒烟后他们的身体会立即开始痊愈过程。戒烟后二十分钟，心率和血压即开始下降，而且会持续至戒烟后 5、10 和 15 年。我的许多患者都将此类信息存放在自己的口袋或钱包内。当他们有吸烟的冲动时，可以拿出来看，提醒自己为什么要经历戒烟之苦。

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Preventing Skin CancerPreventing Skin CancerPreventing Skin CancerPreventing Skin Cancer

• Avoid the sun between 10 a.m. and 4 p.m.

• Cover up with protective clothing

• Cover head with wide-brimmed hat, shading face,

ears, neck

• The shorter your shadow, the more damaging the

sun rays

• Use sunscreen, at least SPF 30

So, next, on to another lifestyle behavior that you can change is reducing your risk of skin cancer. Skin cancer is the number one cancer among Americans and there are some simple behaviors that you can practice that can reduce your risk. One of them is avoiding the sun between 10 a.m. and 4 p.m. That is particularly when the sunrays are the most intense in the Southern climate as well. Covering up with protective clothing is a difficult one to sell to patients often. But with the new synthetics that are breathable, these --- this clothing can actually be more comfortable then having the sun hit their skin directly. Baseball caps are still very popular for both males and females, but you need to remind them that this does not cover their ears or their necks, and a wide brim hat would be more appropriate. One way to tell how intense the rays are is looking at your shadow and, if your shadow --- the more shorter it is, the more damaging the rays are. We recommend that you use a minimum of sunscreen of 30.

接下来是另外一种可以改变来降低皮肤癌风险的生活习惯。皮肤癌是美国罹患人数最多的癌症，然而形成几种简单的习惯就可以降低患皮肤癌的风险。其中一项是在上午 10 点和下午 4 点之间避免日晒。特别是在南方阳光最为强烈的时候尤为如此。患者通常很难接受用防护性衣物遮盖皮肤。但新开发的合成衣料透气性好，穿这类衣料实际上比让皮肤直接接受日晒感觉更为舒适。棒球帽仍然很受男性和女性的欢迎。但是需要提醒他们，棒球帽不能遮盖耳部和颈部。宽檐帽会更好。判断阳光强烈程度的一个方法是观察你的影子。影子越短，阳光的灼伤力越强。我们建议使用防晒系数至少为 30 的防晒霜。


Sun Protection Factor (SPF)Sun Protection Factor (SPF)Sun Protection Factor (SPF)Sun Protection Factor (SPF)

• Measures the effectiveness of a sunscreen in

filtering out UV rays

• SPF 30 means that if you are exposed to noonday

summer sun, the sunscreen protected skin

would take 30 times longer to burn than the

unprotected skin

• Choose a sunscreen with UVA and UVB protection

• Generously apply sunscreen 20 to 30 minutes before

going outside

• Reapply as indicated

So this sunscreen, the SPF, is the sun protective factor, and this measures the effectiveness of a sunscreen in filtering out ultraviolet rays. So, for example, a SPF of 30 would mean that, if you are exposed to noonday summer sun, the sunscreen-protected skin would take 30 minutes longer to burn than the unprotected skin. So, what ideally you would want to choose the sunscreen that protects both UVA now and UVB. So generously apply, which is actually about an ounce or two tablespoons, if you are covering your entire body with sunscreen. And to help get it absorbed to the skin, you need to apply it at least 30 minutes before going out and then repeat as indicated. And the type that you are using will let you know if it is water-resistant, water-repellent, and how often it

SPF 是防晒霜的防晒系数，用来测量防晒霜滤除紫外线的有效性。例如，SPF 为 30 表示在夏日中午阳光下，涂用防晒霜进行保护的皮肤与未经保护的皮肤相比，被晒伤前的时间要长 30 分钟。选择的防晒霜最好是能保护 UVA 和 UVB。涂抹时要足量。如果要全身涂用防晒霜，大概需要一盎司或两茶匙。为帮助皮肤吸收防晒霜，需要在出门之前至少 30 分钟涂用，之后按照说明重复。使用的防晒霜类型会说明是防水型、抗水型，需要多久重涂一次。

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needs to be reapplied.


UV ExposureUV ExposureUV ExposureUV Exposure

UVA rays

• Contribute to skin cancer formation (tanning beds)

• Penetrate skin layers more deeply

• Remain intense throughout the year

• Contribute to premature aging, harmful to eyes and immune system

UVB rays• Cause damage to DNA of skin cells, increasing risk

• Most likely to cause sunburns

• Primary contributor to premature aging and wrinkling

• Vary in intensity throughout the seasons

There are different ultraviolet rays. We now know that UVA rays also contribute to skin cancer formation. This is the ray that is most common in tanning beds, which is why you want to tell your patients to avoid tanning beds. It penetrates skin layers more deeply. It remains intense throughout the year and it contributes to premature aging, which mentioning this is actually a motivation factor for a lot of people. It is also harmful to eyes and the immune system. The UVB rays, we have known for a long time, cause damage to DNA of skin cells, increasing the risk of skin cancer. It is the one that is most likely to cause sunburns. It is the primary contributor to premature aging and wrinkling, and this is the one that varies with intensity being more intense during the summer seasons.

紫外线有不同种类。我们现在知道 UVA 射线也会促进皮肤癌的产生。这是日光浴床最常见的射线。因此需要告知患者避免使用日光浴床。这种射线会穿透更为深层的皮肤，而且一年四季都较为强烈，而且会导致早衰，这一点会成为很多人的动力因素。UVA 射线也对眼睛和免疫系统有害。我们早就了解到 UVB 射线会损伤皮肤细胞 DNA，增加罹患皮肤癌的风险，对 UVB 射线有所。UVB 射线是造成晒伤的最常见因素，而且是造成早衰和皱纹的主要因素。UVB 射线在夏季更为强烈。


UVA UVA UVA UVA and and and and UVB ProtectorsUVB ProtectorsUVB ProtectorsUVB Protectors

• UVA and UVB – titanium dioxide, zinc oxide,

Photoplex with avobenzone, benzophenones

(oxybenzone)

• UVA – ecamsule

• UVB – PABA, salicylates (ocytl salicylate)

So, looking at the physical and chemical ingredients in your sunscreen is important. Telling your patients, if they only have the PABA or the Mexoryl

TM, they are getting protection for only UVB

or UVA. So what they want to look for is one that provides titanium dioxide, zinc oxide, and they have changed these physical components. They don’t leave --- they are not just white now. So, they’re --- they are --- more people will use them now than just the lifeguards with the zinc oxide on their nose. The

Photoplex with Parsol protects for UVA and UVB, as does oxybenzone. So, what is most important is that you get a sunscreen that has both UVA and UVB protectors.

查看防晒霜的物理和化学成份十分重要。如果防晒霜内只含有 PABA 或 MexorylTM，则告诉患者他们只得到了对 UVB 或 UVA 的保护作用。他们应该选购含有二氧化钛、氧化锌的防晒霜。而且防晒霜的物理成份有所变化。防晒霜的颜色现在不再只有白色。现在有更多的人使用防晒霜，而不只是救生员在鼻子上涂抹氧化锌。含有 Parsol 的 Photoplex 可以提供对

UVA 和 UVB 的保护，氧苯酮也同样可以。所以你使用的防晒霜务必要含有 UVA 和 UVB 的保护剂。

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ABCDEFABCDEFABCDEFABCDEF’s for Skin Self Exams for Skin Self Exams for Skin Self Exams for Skin Self Exam

• Asymmetry

– One half unlike the other half

• Border

– Irregular or poorly defined border

• Color

– Varied from one area to another

– Shades of tan, brown, black, red

• Diameter

– The mole is larger than 6 mm across

– (about 1/4 inch the size of a pencil eraser)

• Elevation

– The mole is raised

• Feeling

– The sensation around the mole has changed, itchy, painful

We commonly hear about the ABCs for skin self-exam. Now they have been expanded to the ABCDEF and I would like to go over these. The A is asymmetry. It means there is not a mirror image; one half of the mole does not look like the other half of the mole. The B is border: irregular or poorly defined border. Color: the color is not the same; it varies. It goes from shades of tan to brown to black to red. Diameter: if the diameter of the mole becomes larger than the size of a pencil eraser. Or elevation: if the mole is flat and it raises. Or if, all of a sudden, there is feeling in the mole and there has not been before, such as itching or it becomes painful. These would be of concern and these are things that you can teach your clients about. And they can --- the patient can be taught these and look for these between clinical exams and then schedule an appointment or bring them to the provider’s attention at their follow-up visit.

我们经常听说过皮肤自检的 ABC 原则。现在这一原则扩展为了 ABCDEF。我想介绍一下相关内容。A 代表 asymmetry（不对称），表示并非镜像对称；痣的两半并没有沿中线相互对称。B 是指 border（边界）：边界不规则或边界不清。Color（颜色）：颜色不一，略有变化，可以是不同程度的褐色、棕色，黑色或红色。Diameter（直径）：痣的直径大于橡皮擦的尺寸。或 elevation（凸起）：痣与周围平齐还是凸出表面。或者痣突然出现了未曾有过的感觉，例如发痒或感觉疼痛。这些是需要留意的事情，应该教授患者注意观察。可以告诉患者这些原则，让他们在临床检查之间观察有无上述现象，然后预约就诊或在后续就诊时告知医生自己观察到的现象。


Risk Reduction: Reduce Risk of HPV InfectionRisk Reduction: Reduce Risk of HPV InfectionRisk Reduction: Reduce Risk of HPV InfectionRisk Reduction: Reduce Risk of HPV Infection

• Reduce risk of human papilloma virus infection

- Delay onset of sexual activity

- Maintain a monogamous relationship

- Use barrier contraception

Next, I am going to switch to what you can do to reduce the risk of cervical cancer and cervical dysplasia. This can be done by delaying the onset of sexual activity, as the cervix is more susceptible to HPV at younger ages. Maintaining a monogamous relationship; well, that would reduce exposure. And barrier contraception may also reduce the transmission of HPV infections.

接下来我要把话题转到如何降低宫颈癌和宫颈非典型增生的风险。可以采取的措施包括延迟发生性行为的年龄，因为年轻时宫颈对 HPV 更为敏感。保持单一性伴侣关系，这样就会降低接触风险。屏障避孕方法也可以减少传播 HPV 感染。

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Risk Reduction:Risk Reduction:Risk Reduction:Risk Reduction:Hormone Hormone Hormone Hormone Therapy Therapy Therapy Therapy ((((HTHTHTHT))))

• Prior to starting HT, women should be

counseled regarding risk vs. benefits of therapy

and non-hormonal alternatives

• If HT is initiated, use minimum dose needed to

control menopausal symptoms

• Consider occasional trials off of HT to reassess

benefits derived

For individuals who are considering hormone therapy, we want them to fully understand the risks and benefits of therapy and also understand that there are non-hormonal alternatives. What we recommend is, particularly for people who are at high risk for breast cancer, that they consider these other options. And, if they are going to start hormone --- hormone therapy, that it be initiated with minimum doses needed to control menopausal symptoms. And then, from time-to-time challenge the hormone therapy. So, take a --- what is considered a trial off of the hormone therapy to re-assess if the individual is getting the benefits that they are hoping to get from the medication.

对于考虑接受荷尔蒙疗法的人士，我们希望她们充分理解荷尔蒙疗法的风险与益处，并了解有非荷尔蒙的替代治疗方法。我们建议考虑使用此类方法，尤其是对于罹患乳腺癌风险较高的人士。如果他们开始使用荷尔蒙疗法，则荷尔蒙的起始剂量应采用能够控制绝经症状的最低水平。之后应不时质疑对荷尔蒙疗法的使用。也就是说考虑试着停用荷尔蒙疗法，以便重新评估患者使用荷尔蒙的益处是否达到预期。


Risk Reduction StrategiesRisk Reduction StrategiesRisk Reduction StrategiesRisk Reduction Strategies

• Health Promotion

- Diet

- Lifestyle modification

• Prophylactic surgical interventions

• Chemoprevention

This concludes my presentation. This is Part I of Cancer Prevention. I have addressed health promotion, diet, lifestyle modifications.

我的讲座到此结束。这是癌症预防的第一部分。我讨论了健康宣传、饮食、生活方式的调整。

17


SummarySummarySummarySummary

Being proactive about health choices can

significantly reduce the incidence of cancer

through diet and lifestyle modifications!

And, in summary, there are things that you can do to be proactive about health choices. You can significantly reduce the incidence of cancer through diet and lifestyle modification. Thanks for your attention. I hope this gave you new information. Please let us know how we are doing with this part of the program. And please contact us if you have any questions. Thanks.

总而言之，可以采取一些主动措施来作出健康选择。可以通过饮食和生活习惯的调整显著降低癌症发病率。感谢大家的参与。我希望各位在本次讲座中有所收获。请告诉我们你对本次课程这一部分的看法。如果有任何疑问，请和我们联系。谢谢。

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