CANCER

Riding the subway in New York rarely gives me occasion to cheer, but I did a few weeks ago.

Among the many advertisements was a poster of a ghoulish old hag with dark-ringed eyes, wrinkles, and blood red lips wrapped around a cigarette. The poster parodied ads showcasing stunning models exuding health while hawking tobacco products that kill women. I loved it.

Women smoke -- in large numbers -- so it's no surprise that lung cancer (not breast cancer!) is the largest cancer killer of women. Smoking also is a major cause of heart disease.

Women sometimes erroneously believe smoking is not dangerous because doctors have not advised them to quit. This is not because doctors believe smoking is healthy; more likely it is because they view commenting on the habit as interfering with their patients' private lives.

But this needs to change because smoking is not only harmful to women, but to their children as well. Recent studies have linked smoking with Sudden Infant Death Syndrome, birth defects such as cleft palate and chronic breathing problems.

But the good news is that you reap tremendous benefits by quitting smoking. According to a recent U.S. Surgeon General's report, after one year, ex-smokers cut the extra risk to their hearts in half. After 15 years, their risk was the same as non-smokers. Need help figuring out how to quit smoking? Here are some tips from The Women's Heart Book:

• Contact the American Cancer Society, the American Lung Association or the American Heart Association for free information on how to quit.
  
  
• If you are interested in a smoking cessation support group, remember that some studies show that women tend to be more successful in smaller groups.
  
  
• Get involved in a regular exercise program to help you avoid putting on weight and to deal with stress.
  
  
• Give yourself incentives. Set aside the money you've spent on cigarettes and indulge in something frivolous when you've saved enough. If you backslide, donate the money to your local lung or heart association or favorite charity. This incentive could provide the extra "oomph" you may need to stay with the program.
  
  
• Studies have shown that the nicotine patch is most successful when combined with support programs. But nicotine in any form is dangerous, so if you have heart disease, check with your doctor. And never wear the patch while you smoke. This double jolt of nicotine can put you at risk for a heart attack.

As a child, my family always rented a cottage at the shore. I remember flying kites, playing in the Long Island Sound, spending hours in the sun. I loved it, but paid a price with many a sunburn.

We now know that experiencing even one blistering sunburn as youngsters can increase our risk of skin cancer as adults.

And skin cancer is on the rise. Each year, more than a half-million Americans are diagnosed with it. Although skin cancer is largely curable, it can be disfiguring. And there is a particularly deadly type, melanoma, which can kill.

A major cause of skin cancer is exposure to the ultraviolet rays of the sun. With this in mind, use these tips to help you enjoy the sun more safely.

1. Avoid the sun between 10 a.m. and 3 p.m., when it is the strongest.
   
   
2. When outdoors, wear a hat with a wide brim and tightly woven clothing that covers most of your skin.
   
   
3. Use a sunblock with a protection factor of at least 15. Apply at least an hour before going into the sun and again after swimming or sweating. But don't let these products give you a false sense of security -- you should still limit your sun exposure.
   
   
4. Avoid tanning parlors. Although their proprietors claim that getting a tan this way is "protective," the American Medical Association does not agree.

Remember, too much sun exposure not only increases your risk of skin cancer, but is a direct cause of aging and wrinkling as well -- reason enough not to bake in the sun.

Women living in New York will be more aware of ovarian cancer thanks to fellow resident Ginnie Lupi, a cancer survivor who combined her personal experience with her skill as a lobbyist to win new legislation to combat this deadly female threat.

About 26,700 new cases of ovarian cancer are diagnosed annually and nearly 14,800 women die from it. The mortality rate is so high because ovarian cancer is difficult to diagnose until it has spread. This is usually because warning signs of ovarian cancer are vague and can be easily overlooked by women or misdiagnosed by doctors.

Lupi, who was 35 when she was diagnosed, has been fighting ovarian cancer for 18 months. But she also transformed her personal battle into political triumph. Thanks to her efforts, the New York State Legislature created an ovarian cancer advisory committee to develop a public awareness campaign which will get materials to the health care community and into the hands of women. Lupi won funding to pay for the campaign.

According to Lupi, other activists have already contacted her in hopes of taking this campaign nationwide. Ginnie Lupi shows how one woman can make a difference.

There are three types of easy-to-find foods that might help prevent cancer:

Fruits and vegetables — Studies repeatedly find that women who eat at least five servings of fruits and vegetables each day have a lower risk of cancer. Why? Produce is very high in vitamins called antioxidants. These include beta carotene (which the body converts to Vitamin A), Vitamin E and Vitamin C.

Fruits and vegetables also contain scores of micronutrients which may also be protective.

Fiber — Nothing could be less glamorous than fiber, which is, after all, just the indigestible part of fruits, vegetables and grain. But over the past 20 years, researchers have amassed an impressive array of evidence that fiber helps prevent colon cancer. For more fiber, eat high fiber cereal, bran flakes, rye crisp crackers, popcorn, toasted wheat germ, granola, high-fiber bread and beans.

Soy — This soybean substance may lower the risk of a host of diseases — including breast cancer — because soy contains flavonoids, which are a source of phytoestrogen, a substance which chemically resembles estrogen.

Researchers speculate this chemical may block receptor cells which can promote cancer. Soy products include tofu, a solid cake of curdled soy milk; tempeh, a thin cake made from fermented soybeans; isolate soy protein; soy flour; soya powder; textured soy powder and soy milk. Soy sauce is salty, though, so use it sparingly.

Most of us think that men are the only ones who have to worry about colorectal (colon and rectal) cancer.

Wrong. The truth? Colorectal cancer is an equal-opportunity killer. Want proof?

About 65,900 women develop colorectal cancer annually.

Colorectal cancer is one of the top three cancer killers of women, along with lung cancer and breast cancer.

Colorectal cancer kills 27,500 — twice as many women as ovarian cancer. That women die at all of colorectal cancer is tragic, because when caught early, it is a very curable disease.

You're at risk if you: are over 55, have a family history of the disease or polyps, suffer from inflammatory bowel disease, are overweight, eat a high-fat/low-fiber diet, smoke or are African-American.

Eighty percent of colorectal cancers occur in women over 65; in contrast, only three percent arise in those younger than 40 (and most are probably due to heredity).

But lifestyle also plays a role. Eating a diet rich in fruits, vegetables and fiber and getting regular exercise are thought to prevent this disease. Hormone replacement therapy also appears to reduce risk, as does taking aspirin in a preventative manner, although more research on both these topics is needed.

The health care community has developed effective screening tests for colorectal cancer, but physicians are sometimes unaware of them . . . and patients don't request them. But early detection is key to preventing colorectal cancer.

Screening tests include:

The Digital Rectal Exam

Fecal Occult Blood Test

Flexible Sigmoidoscopy

For more information about these tests and how to prevent colorectal cancer, contact your local affiliate of the American Cancer Society or call 1-800-ACS-2345.

October is Breast Cancer Awareness Month. Each year, about 184,300 American women are diagnosed with breast cancer while 44,300 women die from it. Early detection is important; mammography is one of the best tools for that.

Those who can't afford a mammogram can call the American Cancer Society at 1-800-ACS-2345 to learn about the free or discount programs available especially during October, but throughout the year as well.

If you smoke, do yourself a big favor this year by quitting. The American Cancer Society estimates that lung cancer will kill 64,300 women this year, compared to breast cancer, which will take a toll of 44,300.

The rate of lung cancer in women is soaring. From 1960 to 1980, it leaped six-fold in women, according to the American Journal of Public Health. This correlates with the rate women have taken up smoking over the decades.

One of the biggest problems with lung cancer is that it has no symptoms in the early stages, so, unlike breast cancer with its lumps, it often isn't detected until it’s too late.

The first warning sign of lung cancer, typically, comes when the cancer has already spread, most often to the brain. Usually there’s no pain or shortness of breath. If there’s a cough, it’s often confused with the chronic "smokers cough."

There's no test similar to a mammogram that can detect early lung cancer. Although some experts advocate annual chest x-rays for smokers, the major health organizations do not recommend them, contending there’s no proof they lower the death rate.

Furthermore, once lung cancer does develop, it’s very difficult to treat. Chemotherapy, so effective in other forms of cancer, often proves futile.

Tragically, lung cancer is too often considered a man's disease. More men than women have quit smoking and teenage girls remain one of the only groups taking up the habit.

If you're looking for the best New Year's Resolution to give yourself, kick the habit. Here are resources that can help:

Book: How Women Can Finally Stop Smoking by Robert Klesges, Ph.D. and Margaret DeBon, M.S., Hunter House Publishers, 1994.

Organizations: The Office on Smoking and Health, National Center for Chronic Disease Prevention & Health Promotion, 770- 488-5705. National Cancer Institute, 800-4-CANCER. American Cancer Society, 800-ACS-2345.

Web sites:

• http://www.lungusa.org
• http://www.quitnet.org

After losing her grandmother, aunt and cousin to ovarian cancer, Ceil Sinnex founded the Ovarian Cancer Prevention and Early Detection League. She enlisted top experts as advisors, including the late Gilda Radner's specialist, Dr. M. Steven Pivar.

Through the quarterly newsletter Ovarian Plus, Sinnex pushes for more funding to fight the disease that will develop in nearly 26,700 women this year, taking the lives of more than half that number. The newsletter also reports on research and other relevant news. For more information, visit the web site at http://www.monitor.net/ovarian.

"I see you got some color," said my friend approvingly, glancing at my tanned arm. I winced. As a health writer, I know the sun causes skin cancer, wrinkles and even contributes to deadly melanoma. But I can't help but like that "healthy" glow I see in the mirror.

And that's the problem. Our attitudes about the health-giving qualities of sunbathing persist, yet sun exposure is to blame for the climbing cases of skin cancer. According to the American Cancer Society, about one million cases of basal or squamous cell skin cancer are diagnosed each year.

Although these types of cancer are highly curable, their treatment can require disfiguring surgery. This number doesn't include the estimated 41,600 cases of melanoma annually, a very deadly form of cancer which can spread to other organs. The incidence of melanoma has increased 4 percent since 1973.

The risk factors for skin cancer include increasing age, having a family history of skin cancer or melanoma, and race, with whites and light-skinned minorities being more vulnerable than African-Americans.

But the major risk factor is sun exposure. Most of us love the feel of sunshine on our skin, but it's a source of radiation, which can set into motion changes within our body that result in skin cancer. Skin cancer is not the only problem caused by sun. Exposure to sun is also considered the main cause of skin wrinkling and "age spots."

The dramatic climb in skin cancer cases comes despite the increasing use of sunscreens. But research presented this winter at the American Association for the Advancement of Science showed that sunscreen doesn't stop skin cancer.

This doesn't mean sunscreens are worthless; most experts agree you should use them. The problem is that people who use sunscreens stay out too long because they erroneously believe they are protected.

It's unrealistic to think that we're going to break off our summertime love affair with the sun. So here are some tips for "safe sunning:"

• Avoid the sun between 10 a.m. and 3 p.m., when dangerous ultraviolet rays are the longest.

• Wear a hat with a wide brim and tightly woven clothing that covers most of your skin.

• Chose a sunscreen with an SPF of at least 15 and one labeled "broad-spectrum." This means it screens out both types of the sun's harmful ultraviolet rays. Don't let using sunscreen lull you into a false sense of security. Enjoy the sun, but don't bake in it.

• Apply the sunscreen 10 to 15 minutes before going out in the sun. If you get wet, reapply. Sunscreens aren't waterproof.

• Don't use tanning parlors. The idea that you can get a "protective tan" is a myth.

Teach your children these safe sun facts as well. Remember, the current epidemic of skin cancer we baby boomers are experiencing was born when we frolicked on the beach years ago.