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Questions and Answers A Guide to Fitness and Wellness 4th Edition

Gary Liguori │ Sandra Carroll-Cobb

©McGraw-Hill Education. All rights reserved. Authorized only for instructor use in the classroom. No reproduction or further distribution permitted without the prior written consent of McGraw-Hill Education.

CHAPTER 11

Chronic Diseases

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COMING UP IN THIS CHAPTER

Identify the major types of cardiovascular disease, cancer, and diabetes

Assess your personal risk factors for these chronic diseases

Describe screening, diagnosis, and treatment options

Plan steps to reduce your risk for these diseases

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TABLE 11-1 ESTIMATED PREVALENCE AND ANNUAL MORTALITY FROM CARDIOVASCULAR DISEASE, CANCER, AND DIABETES

	PREVALENCE	MORTALITY
CARDIOVASCULAR DISEASE	86,500,000	800,937
CANCER	14,483,830	595,690
DIABETES	29,100,000	74,488

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Cardiovascular Disease

Question: What is cardiovascular disease? How many people die from it?

Cardiovascular disease (CVD) is a broad collection of many diseases that affect the heart (cardio) or blood vessels (vascular), or both

Deaths due to CVD have declined in the last 20 years

Still responsible for one in every three U.S. deaths

By 2030, over 40% of the U.S. population is projected to have some form of CVD

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Types of Cardiovascular Disease, 1

Question: Heart attacks and strokes affect different parts of the body, so why are they always lumped together?

CVD is a group of diseases that affect the heart and/or blood vessels

Heart attacks, strokes, coronary artery disease, hypertension, heart failure, and peripheral artery disease

Strokes are one of the most common forms of CVD

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FIGURE 11-1 PERCENTAGE BREAKDOWN OF U.S. DEATHS FROM CARDIOVASCULAR DISEASE

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Types of Cardiovascular Disease, 2

Question: What type of cardiovascular disease kills the most people?

Coronary artery disease (CAD)

Usually caused by atherosclerosis

Buildup of plaque, creating an occlusion

Can lead to arteriosclerosis—general hardening, or loss of elasticity, in the arteries

When atherosclerosis occurs in coronary arteries, CAD results

In an artery leading to the brain—stroke

In an artery in a limb—peripheral artery disease

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Types of Cardiovascular Disease, 3

CAD often has no symptoms as it develops

Once developed, it may reveal itself as:

Angina pectoris: chest pain as result of reduced blood supply to heart

Heart attack, or myocardial infraction (MI)

Blood supply in a coronary artery is blocked, depriving the heart of oxygen

Arrhythmia: a change in the normal pattern of the heartbeat

Cardiac arrest: sudden loss of responsiveness, pulse, and blood pressure

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FIGURE 11-2 ATHEROSCLEROSIS AND HEART ATTACK

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Types of Cardiovascular Disease, 4

Question: Is stroke caused by a blocked artery or burst artery?

Stroke: when the blood (and oxygen) supply to a part of the brain is suddenly interrupted

Two major types:

Ischemic stroke: caused by a blocked artery

Hemorrhagic stroke: caused by a burst blood vessel

Transient ischemic attacks (TIAs)

“Mini-strokes”; caused by temporary blockage and typically do not cause lasting damage

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FIGURE 11-3 STROKE

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Types of Cardiovascular Disease, 5

Question: Can I really get CVD in my arms and legs?

Peripheral artery disease (PAD) occurs in the limbs, most commonly the legs

It may cause leg pain when walking, leg numbness or weakness, and coldness or paleness of the limb

Unless treated, it may lead to infections and amputation of the affected limb

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Types of Cardiovascular Disease, 6

Question: If my blood pressure goes up naturally when I exercise, why is high blood pressure so bad?

Temporary increases in blood pressure are OK

Sustained high blood pressure (hypertension) is not OK

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Types of Cardiovascular Disease, 7

Blood pressure is the force of blood pumping against blood vessel walls

Systolic blood pressure (top number)

Force produced when the heart contracts

Diastolic blood pressure (bottom number)

Force between beats when the heart is at rest

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Types of Cardiovascular Disease, 8

Question: For blood pressure, how high is too high?

The recommended blood pressure is less than 120/80

Hypotension: low blood pressure

Less common

Systolic pressure below 90 or diastolic pressure below 60, or both

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TABLE 11-2 BLOOD PRESSURE CLASSIFICATION FOR ADULTS AGE 18 AND OLDER

CATEGORY	SYSTOLIC (TOP NUMBER)		DIASTOLIC (BOTTOM NUMBER)
NORMAL	LESS THAN 120	AND	LESS THAN 80
PRE-HYPERTENSION	120–139	OR	80–89
HYPERTENSION, STAGE 1	140–159	OR	90–99
HYPERTENSION, STAGE 2	160+	OR	100+

©Ingram Publishing/Fotosearch RF

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Types of Cardiovascular Disease, 9

Question: Is heart failure the same as a heart attack?

Heart attack can lead to heart failure

The heart is unable to pump a sufficient volume of blood

Often causes shortness of breath, fatigue, and fluid buildup

May compromise the ability of the kidneys to eliminate fluid

Heart failure complicated by fluid buildup is referred to as congestive heart failure

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Types of Cardiovascular Disease, 10

Question: What can be done to eliminate a heart murmur?

Heart murmur refers to a variety of conditions

Most have no ill effects, and no treatment is needed

Result of inherited defects, infections, heart disease

May be related to heart valve function

Mitral valve prolapse (MVP)

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Types of Cardiovascular Disease, 11

Question: What causes varicose veins, and how can I avoid them?

Varicose veins are a product of improper valve function

Blood accumulation, twisting, and enlargement of affected veins

Caused by aging, hereditary, or hormone changes

The best prevention is exercise and avoidance of excess weight

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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control, 1

Question: Is there any way you can reverse genetically predisposed heart problems?

You can’t reverse your familial predisposition to CVD, and some risks factors are not modifiable

It is important to know your family health history/ genetic predispositions

CVD that may be caused by inherited traits include certain forms of cardiomyopathy; arrhythmia; aneurysm; and Marfan syndrome

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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control, 2

Question: Why does getting older make a person more likely to have CVD?

The prevalence of CVD rises with age

This is due to the wear and tear on the heart and blood vessels

Leads to structural and functional alterations, i.e. hypertension

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FIGURE 11-4 PREVALENCE OF HIGH BLOOD PRESSURE AMONG ADULTS AGE 20 AND OVER, BY AGE AND SEX

©Hywit Dimyadi/123RF

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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control, 3

Question: Why do more men have heart attacks than women?

Men are more likely to develop and die from CVD at a younger age

There is no single clear reason for the difference

Women are more likely to die from a heart attack

On the horizon: studies that examine heart physiology and rhythms, and hormone fluctuations

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FIGURE 11-5 INCIDENCE OF CARDIOVASCULAR DISEASE AMONG ADULTS AGE 20 AND OVER, BY AGE AND SEX

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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control, 4

Question: How does ethnicity affect cardiovascular disease? What group or groups are most at risk?

Studies have found different rates of CVD and associated risk factors among different ethnic groups

The reasons are complex but include socioeconomic and biological factors

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Assessing Your Risk for Cardiovascular Disease: Factors You Cannot Control, 5

African Americans

Higher prevalence of CVD, hypertension, and stroke

Asian Americans and Latinos

Lower prevalence of heart disease than other groups

American Indians and Alaska Natives

Highest prevalence of stroke as a group

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Cardiovascular Disease Prevention, 1

Some CVD risk factors are modifiable

Avoid tobacco

Keep alcohol use moderate and avoid drugs

Manage stress in healthy ways

Have regular screenings

Reduce elevated blood pressure

Maintain healthy cholesterol and triglyceride levels

Control diabetes

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Cardiovascular Disease Prevention, 2

Question: Are people who can eat all they want and not gain weight still at risk for cardiovascular disease?

Body weight and food choices are only part of what affects CVD risk

Genes, age, biological sex, and ethnicity also count

Physical activity is an important factor in reducing one’s risk

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Cardiovascular Disease Prevention, 3

Question: If you have excellent cardiovascular fitness but CVD runs in your family, do you have a greater risk than someone with no family history of CVD?

Many factors must be looked at to assess CVD risk

Among the factors: age, sex, smoking and drinking habits, and eating patterns

You are a sum of your risk factors

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Cardiovascular Disease Prevention, 4

Question: What types of food should I avoid and eat to help prevent cardiovascular disease?

The best food plan for CVD prevention is balanced and moderate

Fiber-rich foods, low-fat dairy products, and seafood

Limit excess calorie intake from added sugars, fats, and processed foods

Keep alcohol intake moderate

Limit salt intake

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Cardiovascular Disease Prevention, 5

Question: If I’m overweight, is my risk a lot higher?

Added weight puts stress on the heart

People with excessive body fat are more likely to develop CVD even with no other risk factors

Increased physical activity and a balanced diet are key

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Cardiovascular Disease Prevention, 6

Question: Smoking causes cancer, not cardiovascular disease—right?

Avoid tobacco

Smoking not only raises cancer risk but also significantly increases risk for cardiovascular disease

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Cardiovascular Disease Prevention, 7

Smoking:

Affects fatty buildup (HDL and LDL levels)

Increases heart rate

Contributes to arrhythmias

Elevates blood pressure, reduces the oxygen level in the blood, and may trigger blood clots

The body slowly begins to heal as soon as someone quits

The risk of CVD falls by 50% just 1 year after quitting

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Cardiovascular Disease Prevention, 8

Question: Does alcohol affect cardiovascular disease? What about other drugs?

Keep alcohol use moderate, and avoid drugs

No more than 2 drinks per day for men or 1 drink per day for women

The effects of alcohol use can be positive or negative

Alcohol use is associated with a small increase in HDL and reduced clot formation

Excessive drinking can lead to high blood pressure, arrhythmia, stroke, sudden cardiac death, and obesity

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TABLE 11-3 DRUGS AND RELATED CARDIOVASCULAR DISEASE COMPLICATIONS

ANABOLIC STEROIDS (NONMEDICAL USE)	Steroid abuse can lower HDL and raise LDL; can increase the risk of atherosclerosis, hypertension, stroke, and heart attack; and may also cause blood clots and enlargement of the ventricles of the heart.
CAFFEINE	Probably safe in moderate amounts, according to the American Heart Association. Research studies on the links between caffeine and CVD have yielded conflicting results.
COCAINE	Use can lead to overstimulation of the heart, resulting in increased risk for heart attack, stroke, high blood pressure, heart failure, blood clots, enlargement of the heart, and infections of the heart lining. Further complications may include aneurysm and aortic dissection (splitting of the inner wall of the aorta), both of which can be fatal.
HEROIN	Injection use can cause permanent damage to veins, making users more susceptible to blood vessel blockages and blood clots, heart attack, and stroke.
INHALANTS	Some types can cause rapid and irregular heart rhythms, leading to heart failure; other types reduce the oxygen-carrying capacity of the blood and harm the heart muscle.
MARIJUANA	Use increases heart rate and blood pressure and reduces the oxygen-carrying capability of the blood, which can strain the cardiorespiratory system. Some research suggests that heart attack risk is nearly five times greater within 1 hour of smoking. Marijuana smoke contains some of the same harmful chemicals as cigarette smoke, and research points to a possible increased risk for heart attack and stroke among heavy users and older users.
METHAMPHETAMINE	Use increases heart rate and blood pressure and can lead to atherosclerosis, heart attack, stroke, or heart failure.

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Cardiovascular Disease Prevention, 9

Question: Is stress a major factor in cardiovascular disease?

Manage stress in healthy ways

There is likely a connection between stress and cardiovascular disease

The acute stress response is associated with elevated blood pressure and heart rhythms

Over time, the hormones associated with uncontrolled stress may alter glucose and blood-fat levels

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Cardiovascular Disease Prevention, 10

Question: How often do I have to get my blood pressure and cholesterol checked?

Have regular screenings for:

Blood pressure

Cholesterol and triglycerides

Triglycerides

Diabetes

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Cardiovascular Disease Prevention, 11

Question: What can I do to lower my blood pressure?

Reduce elevated blood pressure

Hypertension is a type of cardiovascular disease that is a risk factor for other types of CVD

Keeping your blood pressure in check can help prevent CVD and complications from many conditions

Eat a balanced, low-sodium diet, engage in physical activity, maintain healthy weight, limit alcohol, and avoid smoking

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Cardiovascular Disease Prevention, 12

Question: How does cholesterol in the foods I eat affect my cholesterol levels?

The connection between the foods you eat and the fats (lipids) in your blood are complex

Cholesterol is a waxy substance that occurs naturally in all cells of the body

Low-density lipoprotein (LDL)—bad cholesterol

High-density lipoprotein (HDL)—good cholesterol

Triglycerides

High levels are closely associated with CVD

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TABLE 11-4 CHOLESTEROL AND TRIGLYCERIDE CLASSIFICATION

	RISK CATEGORY
TOTAL CHOLESTEROL LEVEL
LESS THAN 200 MILLIGRAMS/DECILITER	Desirable
200–239 MILLIGRAMS/DECILITER	Borderline high
240 MG/DL AND ABOVE	High blood cholesterol
LDL CHOLESTEROL LEVEL
LESS THAN 100 MILLIGRAMS/DECILITER	Optimal
100–129 MILLIGRAMS/DECILITER	Near or above optimal
130–159 MILLIGRAMS/DECILITER	Borderline high
160–189 MILLIGRAMS/DECILITER	High
190 MILLIGRAMS/DECILITER AND ABOVE	Very high
HDL CHOLESTEROL LEVEL
LESS THAN 40 MILLIGRAMS/DECILITER (MEN) OR 50 MILLIGRAMS/DECILITER (WOMEN)	Higher risk
60 MILLIGRAMS/DECILITER AND ABOVE	Lower risk
TRIGLYCERIDE LEVEL
LESS THAN 150 MILLIGRAMS/DECILITER	Desirable
150–199 MILLIGRAMS/DECILITER	Borderline high
200–499 MILLIGRAMS/DECILITER	High
500 MILLIGRAMS/DECILITER AND ABOVE	Very high

Note: These values apply to healthy adults. For people with heart disease or diabetes, the targets for LDL cholesterol and triglycerides may be lower.

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Cardiovascular Disease Prevention, 13

Question: Why does diabetes affect the heart?

People with diabetes are two to four times more likely to develop cardiovascular disease

Elevated blood glucose levels can harm the cardiovascular system

Metabolic syndrome: the cluster of conditions that puts people at risk for both heart disease and type 2 diabetes

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TABLE 11-5 METABOLIC SYNDROME

TRAITS/MEDICAL CONDITIONS	DEFINITION
LARGE WAIST CIRCUMFERENCE	40 inches (102 centimeters) or more in men 35 inches (88 centimeters) or more in women
ELEVATED LEVELS OF TRIGLYCERIDES	150 milligrams/deciliter or higher
LOW LEVELS OF HDL (GOOD) CHOLESTEROL	Below 40 milligrams/deciliter in men Below 50 milligrams/deciliter in women
ELEVATED BLOOD PRESSURE LEVELS	Equal to or higher than 130/85 millimeters of mercury
ELEVATED FASTING BLOOD GLUCOSE LEVELS	100 milligrams/deciliter or higher

©Stockbyte/Getty Images RF

*Metabolic syndrome is defined as having three or more of the traits/conditions listed.

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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease, 1

Question: Would I know if I had CVD?

Some forms of CVD have no visible symptoms

Testing is required

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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease, 2

Question: Does cardiovascular disease hurt? Would it affect my everyday activities?

Symptoms vary depending on the type of CVD

Signs to watch out for:

Chest pain

Fatigue

Shortness of breath

Leg pain

Palpitations

Light-headedness and fainting

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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease, 3

Question: How can you tell if a person is having a heart attack or a stroke?

Look for signs

Chest and upper body discomfort (including jaw, neck, arms, back, stomach)

Shortness of breath

Cold sweat, nausea, light-headedness

Prompt treatment is crucial

Call 911

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TABLE 11-6 WARNING SIGNS OF HEART ATTACK AND STROKE

HEART ATTACK WARNING SIGNS

STROKE WARNING SIGNS

Chest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. Discomfort in other areas of the upper body: Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach. Shortness of breath: Often comes along with chest discomfort, but it also can occur before chest discomfort. Other symptoms: Breaking out in a cold sweat, nausea or light-headedness.

When looking for signs of stroke, think FAST. Face: Ask the person to smile. Does one side of the face droop? Arms: Ask the person to lift both arms. Does one arm drift downward? Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange? Time: If you observe any of these signs, call 911 immediately.

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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease, 4

Question: When are you supposed to use CPR?

Cardiopulmonary resuscitation (CPR)

Artificial blood circulation and respiration

For victims of cardiac arrest

Doesn’t usually restart the heart but can temporarily maintain circulation

Resuscitation usually requires defibrillation

AEDs

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TABLE 11-7 TESTS FOR DIAGNOSING AND MONITORING CARDIOVASCULAR DISEASE

ELECTROCARDIOGRAM (ECG OR EKG)	Electrodes are placed on the skin to detect the heart’s electrical signals, which are recorded; the test can show problems with heart rate or rhythm and detect underlying damage to the heart.
EXERCISE STRESS TEST	An electrocardiogram is performed while the person is exercising on a treadmill or stationary bike; the test monitors the response to exercise and detects problems with the cardiovascular system during physical effort.
CORONARY ANGIOGRAPHY	A catheter is threaded though an artery, typically in the leg, and dye is injected into the arteries of the heart; special X-rays are then used to identify blockages. A similar procedure can be done to visualize the brain’s blood vessels.
BLOOD TESTS	In addition to checking cholesterol and glucose levels, blood samples can be analyzed for enzymes and proteins in the blood that indicate heart-muscle damage.
CHEST X-RAY	Ionizing radiation creates pictures of the heart, lungs, and blood vessels that can be used to determine the size and shape of the heart as well as to detect fluid buildup or damage.
ECHOCARDIOGRAM	A small device called a transducer transmits ultrasound waves into the chest, which are converted into computerized images of the heart; the test can show the heart’s size, structure, and motion, as well as blood volume and speed and direction of blood flow.
NUCLEAR SCAN; POSITRON EMISSION TOMOGRAPHIC (PET) SCAN	In both tests, small amounts of radioactive tracer materials are injected into the bloodstream; special imaging equipment monitors blood flow to the heart, as well as the heart’s efficiency in pumping blood, and checks for heart-muscle damage.
COMPUTED TOMOGRAPHY (CT) SCAN	A special X-ray machine takes cross-sectional images that are used to create three-dimensional models of organs. Scans can be used to detect problems in blood vessels in both the heart and the brain.
MAGNETIC RESONANCE IMAGING (MRI)	A special scanner uses radio waves, magnets, and a computer to create images of organs and tissues; MRIs can evaluate the condition of the heart and blood vessels and detect the presence and size of aneurysms and malformed blood vessels that are potential causes of hemorrhagic stroke.
ELECTROENCEPHALOGRAM (EEG)	Electrodes are placed on the scalp, and the electrical activity of the brain is monitored for any indications of problems.

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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease, 5

Question: What kinds of medicine and help are available?

Lifestyle changes are the first line of defense

Other treatments include:

Medications

Coronary angioplasty and the placement of a stent

Coronary bypass surgery

Pacemakers

Heart valve repair or replacement

Heart transplant

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Symptoms, Diagnosis, and Treatment of Cardiovascular Disease, 6

Question: How likely is it that someone will survive and recover from CVD? Is there a cure for it?

Many forms of CVD are treatable

It is necessary to learn to manage CVD

Prevention is best

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Cancer, 1

Question: What is cancer? What is the difference between malignant and benign tumors?

Cancer is a broad category of disease, characterized by the uncontrolled growth of cells

Tumors are abnormal clumps of cells

Benign means noncancerous

Polyps

Malignant tumors are known as cancer

Metastasize: spread

Primary tumor and secondary tumors

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FIGURE 11-6 NORMAL CELL DIVISION VERSUS CANCER CELL DIVISION

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Cancer, 2

Question: How many Americans have cancer?

About 14.5 million Americans with a history of cancer are alive today

Each year:

1.68 million new diagnoses

596,000 deaths

The number of new cases occurring each year has begun to decline slightly

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Types of Cancer, 1

There are hundreds of types of cancer, most falling into one of these general groupings:

Carcinoma: in the skin or tissue lining or covering

80 to 90% of all cases

Sarcoma: in connective or supportive tissue

Lymphoma and myeloma: in the immune system

Leukemia: in blood-forming tissues

Central nervous system cancers: in the tissues of the brain or spinal cord

Melanoma: in cells in the top layer of skin

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Types of Cancer, 2

Question: What is the most common type of cancer? Which type is most severe?

The most frequently diagnosed cancers in the U.S. are basal cell carcinoma and squamous cell carcinoma

Noninvasive and highly curable

Lung cancer is the leading cause of cancer death

Lung, liver, and pancreatic cancers have a poor survival rate

Diagnosis typically doesn’t happen until the disease is advanced

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TABLE 11-8 MOST FREQUENTLY DIAGNOSED CANCERS IN THE UNITED STATES, 2016 ESTIMATES

SITE OR TYPE	ESTIMATED NEW CASES	ESTIMATED DEATHS	5-YEAR SURVIVAL RATE, ALL STAGES
LUNG AND BRONCHUS	224,390	158,080	18%
PROSTATE	180,890	26,120	99%
BREAST*	249,960	40,890	91%
COLON AND RECTUM	134,490	49,190	66%
BLADDER	76,960	16,390	79%
MELANOMA	76,380	10,130	93%
NON-HODGKIN LYMPHOMA	72,580	20,150	72%
THYROID	64,300	1,980	98%
KIDNEY	62,700	14,240	74%
LEUKEMIA (ALL TYPES)	60,140	400	62%
UTERINE CERVIX	990	120	69%
UTERINE CORPUS (ENDOMETRIUM)	60,050	10,470	83%
PANCREAS	53,070	41,780	8%
ORAL CAVITY AND PHARYNX	48,330	9,570	66%
LIVER	39,230	27,170	18%
STOMACH	26,370	10,730	30%
BRAIN AND OTHER NERVOUS SYSTEM	23,770	16,050	35%
OVARY	22,280	240	46%

*Male breast cancer is rare, accounting for about 1 percent of all breast cancers; risk factors include increased estrogen levels, radiation exposure, heavy drinking, and a family history of breast cancer.

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Assessing Your Risk for Cancer, 1

Question: What are my chances of getting cancer?

Cancer risk is viewed in two ways:

Lifetime risk: probability of dying from cancer in your lifetime

Relative risk: extent of the relationship between a risk factor and a specific kind of cancer

Specific risk factors: heredity/genetics; age; gender; ethnicity; exposure to cancer-causing agents

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Assessing Your Risk for Cancer, 2

Question: If someone in my family has cancer, am I likely to get it too?

Heredity/genetics:

All cancers involve genetic mutation (damage)

Most are random

Only 5 to 10% are linked to inherited mutations

In evaluating your own risk, consider:

How many family members have had a particular type of cancer

Whether any were diagnosed at a young age

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Assessing Your Risk for Cancer, 3

Question: Is cancer common in young adults? What types of cancer should I worry about now, when I’m 20?

The likelihood of being diagnosed with cancer rises with age

Genetic mutations and environmental factors build up

Increased exposure/decreased ability to repair damaged cells

Testicular cancer is an exception

Although uncommon, it is more prevalent in men aged 15 to 34

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Assessing Your Risk for Cancer, 4

Question: Are men or women more likely to get cancer?

Men are more likely to develop cancer

Half of all men will develop cancer at some point in their life; one-third of all women

Data are inconclusive as to why

Lifestyle factors

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Assessing Your Risk for Cancer, 5

Question: What groups are most at risk for cancer?

Cancer is more common in African Americans

Other ethnicities have lower overall cancer rates but higher rates of specific cancers

Many factors contribute

Low incomes; limited access to health care and insurance

Cultural dietary factors and preferences for early marriage and childbirth

Genetics

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Assessing Your Risk for Cancer, 6

Question: What’s a carcinogen?

A carcinogen is any substance that causes cancer

Radiation: X-rays, radon, sunlight, and tanning beds

Certain hormones and viruses

Asbestos

Tobacco

Solvents

Pesticides

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Cancer Prevention, 1

Question: Is there a way to keep from getting cancer?

Avoid tobacco

Pay attention to your diet, physical activity, and body weight

One-third of all cancer deaths are due to poor nutrition and physical activity and/or excess body weight

Drink alcohol in moderation

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Cancer Prevention, 2

Be aware of infectious agents

Prevent with vaccination, antibiotic treatments, and lifestyle choices

Avoid unnecessary radiation

X-rays, radioactive substances, sunlight

Be cautious with sunlight and sun lamps, and avoid tanning booths

UV rays can lead to melanoma

Minimize stress

Be careful about chemical exposure

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Symptoms, Diagnosis, and Treatment of Cancer, 1

Question: When am I supposed to get all those cancer tests—and does everyone really need them?

Early cancer screening is critical

Screening tests performed before any symptoms appear can help find cancer in its earliest and most treatable stage

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TABLE 11-9 CANCER SCREENING GUIDELINES FOR THE EARLY DETECTION OF CANCER IN AVERAGE-RISK ASYMPTOMATIC PEOPLE, 1

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TABLE 11-9 CANCER SCREENING GUIDELINES FOR THE EARLY DETECTION OF CANCER IN AVERAGE-RISK ASYMPTOMATIC PEOPLE, 2

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Symptoms, Diagnosis, and Treatment of Cancer, 2

Question: What are symptoms of cancer?

General symptoms to watch for: CAUTION

Changes in bowel or bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in breast or elsewhere

Indigestion or difficulty swallowing

Obvious change in wart or mole

Nagging cough or hoarseness

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FIGURE 11-7 ABCDES OF MELANOMA

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Symptoms, Diagnosis, and Treatment of Cancer, 3

Question: What tests will a doctor do to figure out if a symptom really means cancer?

There is no single test to diagnose cancer

Possible tests include:

Biopsy

Imaging procedures

Tumor marker or lab tests

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Symptoms, Diagnosis, and Treatment of Cancer, 4

Question: What does it mean when they say that someone has stage IV cancer?

When someone is diagnosed with cancer, the type of cancer and stage of development will be identified

Stage: I–IV (stage I, early; stage IV, advanced cancer that has spread)

In situ—found only in the layer of cells where it began

Prognosis

Typically decreases as the stage increases

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FIGURE 11-8 STAGES AND SPREAD OF CANCER

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Symptoms, Diagnosis, and Treatment of Cancer, 5

Question: Once someone has cancer, what’s the best way to treat it?

Chemotherapy: drugs to kill cancer cells or inhibit their growth

Radiation therapy: use of high-energy rays to kill or damage cancer cells in an attempt to keep them from growing and/or spreading

Local rather than a systemic treatment

Surgery: removal of malignant tissue

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Diabetes, 1

Question: What is diabetes?

Diabetes mellitus is a metabolic disorder characterized by problems with the body’s production or use of insulin

Causes glucose to build up in the blood stream, resulting in high blood sugar, or hyperglycemia

Because cells can’t obtain sufficient glucose, the body loses its main source of energy

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Diabetes, 2

Question: What’s bad about high blood sugar?

Prolonged hyperglycemia can cause damage to nerves, blood vessels, and other organs

Untreated, it can lead to ketoacidosis

Long-term complications include higher rates of CVD and lower life expectancy

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FIGURE 11-9 POSSIBLE COMPLICATIONS OF DIABETES

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Diabetes, 3

Question: Can blood sugar be too low?

Hypoglycemia or low blood sugar occurs when glucose levels in the blood are low

Relatively rare

Danger is to the brain because without glucose, brain cells die

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Diabetes, 4

Question: Who is most likely to develop diabetes?

Diabetes is more common in older adults

The number of cases among children and teens is growing

An estimated 86 million American adults have pre-diabetes

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Types of Diabetes, 1

Question: Are some kinds of diabetes more dangerous than others?

There are three primary types of diabetes:

Type 1 diabetes: an autoimmune disease attacking and destroying the insulin-producing cells of the pancreas

Type 2 diabetes: the pancreas produces insulin, but cells don’t respond properly to the insulin

Insulin resistance

Gestational diabetes: high glucose levels during pregnancy

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Types of Diabetes, 2

Question: Can you have high blood sugar without having diabetes?

Before developing type 2 diabetes, people often develop pre-diabetes, impaired glucose tolerance

Higher than normal glucose, but not high enough to be classified as diabetes

Can suffer the same complications as those with diabetes

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FIGURE 11-10 NORMAL GLUCOSE METABOLISM, TYPE 1 DIABETES, AND TYPE 2 DIABETES

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Assessing Your Risk for Diabetes, 1

Question: What causes diabetes?

Different types have different causes

Type 1: autoimmune condition

Genetic and viral factors are suspected to be the primary trigger

The exact cause is unknown

Develops most often in children

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Assessing Your Risk for Diabetes, 2

Type 2: causes unknown; risk factors include:

Age 45 or older

Overweight; not physically active

A family history of diabetes

High blood pressure or high cholesterol

Gestational diabetes

Blood glucose levels that are higher than normal

African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino genetic heritage

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Assessing Your Risk for Diabetes, 3

Type 2: causes unknown; risk factors include:

Polycystic ovary syndrome

Dark, thick, velvety skin around the neck or in the armpits

Blood vessel problems affecting the heart, brain, or legs

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FIGURE 11-11 LIFETIME RISK OF DIABETES BY BMI AT AGE 18

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Assessing Your Risk for Diabetes, 4

Question: If both my dad and my grandfather have diabetes, will I get it too?

A family history of diabetes is a risk factor in the disease

Positive lifestyle choices can delay or prevent the onset of diabetes

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Assessing Your Risk for Diabetes, 5

Question: I keep hearing that more and more people are getting diabetes. Why is that?

As a nation, we are getting fatter, and obesity is a key risk factor for type 2 diabetes

The risk is greater for those who are overweight at a young age

Lifestyle choices related to diet and exercise are key to prevention

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Diabetes Prevention

Question: Does eating too much sugar cause diabetes?

Eating anything in excess can cause obesity, a key risk factor

Sugar itself does not directly cause diabetes

Diabetes is related to genetics and lifestyle choices

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Symptoms, Diagnosis, and Treatment of Diabetes, 1

Question: How would I know if I had diabetes?

Symptoms to watch for:

Increased thirst

Increased hunger after eating

Dry mouth

Frequent urination

Unexplained weight loss or weight gain

Fatigue

Blurred or decreased vision

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Symptoms, Diagnosis, and Treatment of Diabetes, 2

Symptoms to watch for:

Numbness or tingling in hands or feet

Slow-healing sores or cuts

Itching of the skin, most often around the vaginal or groin area

Frequent yeast infections

Impotency

Loss of consciousness (in rare cases)

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Symptoms, Diagnosis, and Treatment of Diabetes, 3

Question: Do I need to be tested for diabetes even if I don’t have any symptoms?

Adults over the age of 45 should be tested every 3 years

If at high risk, early and more frequent testing is required

A1C test

Fasting plasma glucose test (FPG)

Oral glucose tolerance test (OGTT)

Urinalysis

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FIGURE 11-12 CRITERIA FOR DIAGNOSING DIABETES

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Symptoms, Diagnosis, and Treatment of Diabetes, 4

Question: I have a friend who has to give herself shots. Does everyone with diabetes have to do this?

Type 1: requires daily doses of insulin

Self-injections

Pumps

Type 2: oral medication and lifestyle strategies

Gestational: lifestyle strategies and insulin in some cases

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Symptoms, Diagnosis, and Treatment of Diabetes, 5

Question: What about those ads for diabetes supplies? Besides taking medication, what does someone with diabetes have to do?

Self-management of diabetes is crucial

Learn how to self-test glucose levels

Understand signs of diabetes complications

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Putting it All Together for Chronic Disease Prevention

Get regular physical activity

Eat a balanced diet

Don’t smoke, or stop if you do

Consume alcohol only in moderation

Give your health history to your health care provider up front

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TABLE 11-10 TOP LIFESTYLE CHOICES FOR PREVENTING CHRONIC DISEASE, 1

	BENEFITS FOR CARDIOVASCULAR DISEASE	BENEFITS FOR CANCER	BENEFITS FOR DIABETES
GET REGULAR PHYSICAL ACTIVITY	Reduces cholesterol. Lowers high blood pressure. Decreases weight.	Reduces incidence of and mortality from all-site cancer and some site-specific cancers.	Helps control blood glucose, weight, and blood pressure. Raises “good” cholesterol and lowers “bad” cholesterol. Helps prevent heart and blood flow problems.
EAT A BALANCED DIET	Helps lower blood pressure and cholesterol levels. Helps prevent obesity, diabetes, heart disease, and stroke, especially when the individual eats lots of fresh fruits and vegetables, cuts out added salt, and consumes less saturated fat and cholesterol.	Increases intake of antioxidants and dietary fiber, especially through consumption of generous amounts of fruits and vegetables. Limits fat, sugar, and sodium, which are believed to be linked to some cancers.	Prevents or delays development of type 2 diabetes in high-risk individuals by reducing fat and calorie intake and contributing to weight loss.
DON’T SMOKE, OR STOP IF YOU DO	Lowers the risk of high blood pressure, heart disease, and stroke; heart attack risk decreases soon after quitting.	Prevents organ damage.	Prevents increases in blood glucose, cholesterol, and blood pressure, all of which can contribute to diabetes.

* See “More to Explore” section at the end of the chapter for a tool to record and track your family health history.

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TABLE 11-10 TOP LIFESTYLE CHOICES FOR PREVENTING CHRONIC DISEASE, 2

	BENEFITS FOR CARDIOVASCULAR DISEASE	BENEFITS FOR CANCER	BENEFITS FOR DIABETES
CONSUME ALCOHOL ONLY IN MODERATION	Can decrease risk of heart disease if consumption is limited to about 1 drink/day for women and 1–2 drinks/day for men; 1 drink equals 1 can of beer, a glass of wine, or a shot of liquor, according to the American Heart Association.	Decreased risk of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast if individuals who drink limit intake to no more than 2 drinks/day for men and 1 drink/day for women; 1 drink equals 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits, according to the American Cancer Society. Lowers breast cancer risk in women, especially those at high risk.	According to still-controversial research, decreased risk of diabetes for individuals who drink a moderate amount of alcohol (about 1 drink/day for women and 1–2 drinks/day for men; 1 drink equals 1 can of beer, a glass of wine, or a shot of liquor). However, weigh the consequences: Drinking alcohol also has negative health risks such as high blood pressure and increased weight. It is not recommended that individuals begin drinking if they do not already consume alcohol.
GIVE YOUR FAMILY HEALTH HISTORY TO YOUR HEALTH CARE PROVIDER UP FRONT*	Helps health care providers care for patients since family health history is an important part of cardiovascular disease risk assessment.	Helps health care providers care for patients since family health history is an important part of cancer risk assessment.	Helps health care providers care for patients since family health history is an important part of diabetes risk assessment.

* See “More to Explore” section at the end of the chapter for a tool to record and track your family health history.

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