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Screening Tool Results
Who is the Nurse Navigator?
A Johns Hopkins Oncology Nurse Navigator is here to guide you through every step of your journey. From navigating risk reduction and screening to dealing with a cancer diagnosis, walking with a loved one through care or transitioning to life after treatment, your personal navigator provides advice and emotional support whenever you need it.
Personal History of Cancer
An individual is considered a cancer survivor from the time of diagnosis through the balance of his or her life. Your cancer affects you as well as your family member, friends, and caregivers.
Your survivorship care should be directed by your medical oncologist or primary care provider. If you are a cancer survivor and not established with a medical provider, your Naviance Managing Cancer at Work oncology nurse navigator would be happy to assist you to find appropriate resources in your area
Your cancer survivorship care should include:
- Age and gender appropriate screenings for breast, cervical, colon, lung, prostate, and skin cancer as discussed with your medical provider.
- Prevention of new and recurrent cancers and other late effects from treatment
- A surveillance schedule for cancer spread, recurrence, or secondary cancer. The surveillance schedule will be based on your specific cancer. The schedule will be modified based on your particular risk.
- Assessment of late psychosocial and physical effects
- Strategy for dealing with the consequences of cancer and cancer treatments
- And most importantly, coordination of care between your PCP and specialists to make sure that all of your cancer survivor needs are being met.
Reference
NCCN Guidelines: Survivorship for Cancer-Related Late and Long-Term Effects
Family History of Cancer
Having a family history of cancer usually means that more than one close blood relative on the same side of the family has had cancer.
Because of the prevalence of cancer, it is not unusual for more than one family member to develop cancer during their lifetime. Cancer can occur in more than one family member simply by chance or because of lifestyle or environmental factors.
A family history of cancer is caused by a person inheriting a faulty gene that causes an increased risk of developing cancer. The degree of which the risk of cancer is increased due to family history varies depending on the type of cancer.
Some signs related to family cancer syndrome such as:
- Same cancer running in the family
- Cancer occurring at a young age
- More than one type of cancer in a single person
- Cancer that occurs in both pair of organs (like both breasts)
- More than one childhood cancer occurring in siblings
- Cancer occurring in the sex not usually affected (like breast cancer in a man)
- Cancer occurring in many generations (like a grandfather, father, and son)
If you have a strong family history of cancer speak with your primary healthcare provider and consider speaking with a certified genetic counselor about whether genetic testing would be appropriate for you. Your Naviance Managing Cancer at Work oncology nurse navigator is also available to discuss your family history questions and can help you locate a certified genetic counselor in your geographical area.
Reference
American Cancer Society (2017). Family cancer syndromes
Prostate Cancer Screening
Starting at age 45, individuals at higher than average risk of prostate cancer should talk with a doctor about the uncertainties, risks, and potential benefits of testing so they can decide if they want to be tested. This includes those with close family members (father, brother, son) who had prostate cancer before age 65. Those with more than one close relative who had prostate cancer before age 65 are at even higher risk and should talk with a doctor about testing starting at age 40.
Prostate Cancer Screening
Starting at age 50, individuals at average risk of prostate cancer should talk with a health care provider about the uncertainties, risks, and potential benefits of testing so they can decide if they want to be tested.
Prostate Cancer Screening
Starting at age 45, Black and African-American individuals who have a prostate should talk with a doctor about the uncertainties, risks, and potential benefits of testing so they can decide if they want to be tested. Those with more than one close relative who had prostate cancer before age 65 are at even higher risk and should talk with a doctor about testing starting at age 40.
Prostate Cancer Screening
Overall health status, and not age alone, is important when making decisions about prostate cancer testing. Individuals who can expect to live at least 10 more years should talk with a health care provider about the uncertainties, risks, and potential benefits of testing so they can decide if they want to be tested. Medicare covers testing.
Testicular Cancer Screening
Report painless lump or an enlargement or hardening of the testicle. If you do notice any lumps or changes it is important to see a doctor immediately. Other signs of testicular cancer include: any enlargement of a testicle, a significant loss of size in one of the testicles, a feeling of heaviness in the scrotum, a dull ache in the lower abdomen back or groin area, a sudden collection of fluid in the scrotum, pain or discomfort in a testicle or in the scrotum, enlargement or tenderness of the breasts. Many individuals with testicular cancer do not feel ill and many times there is no pain involved. Individuals or their sexual partners, not doctors, find most testicular cancers as a painless lump or an enlargement or hardening of the testicle, this is why monthly regular self-exams are so important. If you do notice any lumps or changes it is important to see a doctor immediately.
Risk Factors include:
- Age: Young individuals between the ages of 15-35 are at the highest risk for testicular cancer. However, it can occur in individuals of any age.
- Race: Testicular cancer is 4.5 times more common in white individuals verses black individuals. The risk for Hispanics, American Indians and Asians falls between that of white and black individuals.
- Non-Descending Testicle (Cryptochidism): Normally, after birth, the testicles descend from inside the abdomen down into the scrotum. In some individuals one or both testicles fail to descend into the scrotum. Individuals with a history of a non-descending testicle are 3 to 17 times more likely to develop testicular cancer than individuals whose testicles descended normally. Surgery to correct the non-descended testicle (orchiopexy) may not reduce the risk of testicular cancer but may allow for better observation of the testicle for abnormalities.
- Gonadal Dysgenesis: Abnormal development of a gonad (testicle) which is usually part of a genetic syndrome increases the risk of testicular cancer.
- Klinefeter Syndrome: A genetic syndrome where males are born with an extra X chromosome increases the risk of testicular cancer.
- Personal or family history of testicular cancer: Having a father, brother or uncle with testicular cancer may slightly increase one’s risk of developing testicular cancer. Only a small number of testicular cancers occur in families. Most individuals with testicular cancer do not have a family history of the disease. Weaker evidence suggests that infertility, testicular atrophy, twinship or abnormal semen parameters may increase one’s risk for testicular cancer.
- Carcinoma in situ (CIS) also called intratubular germ cell neoplasia: The presence of carcinoma in situ in the testicle increases the risk for testicular cancer.
Testicular Cancer Screening
Report painless lump or an enlargement or hardening of the testicle. If you do notice any lumps or changes it is important to see a doctor immediately. Other signs of testicular cancer include: any enlargement of a testicle, a significant loss of size in one of the testicles, a feeling of heaviness in the scrotum, a dull ache in the lower abdomen back or groin area, a sudden collection of fluid in the scrotum, pain or discomfort in a testicle or in the scrotum, enlargement or tenderness of the breasts. Many individuals with testicular cancer do not feel ill and many times there is no pain involved. Individuals or their sexual partners, not doctors, find most testicular cancers as a painless lump or an enlargement or hardening of the testicle, this is why monthly regular self-exams are so important. If you do notice any lumps or changes it is important to see a doctor immediately.
Risk Factors include:
- Age: Young individuals between the ages of 15-35 are at the highest risk for testicular cancer. However, it can occur in individuals of any age.
- Race: Testicular cancer is 4.5 times more common in white individuals verses black individuals. The risk for Hispanics, American Indians and Asians falls between that of white and black individuals.
- Non-Descending Testicle (Cryptochidism): Normally, after birth, the testicles descend from inside the abdomen down into the scrotum. In some individuals one or both testicles fail to descend into the scrotum. Individuals with a history of a non-descending testicle are 3 to 17 times more likely to develop testicular cancer than individuals whose testicles descended normally. Surgery to correct the non-descended testicle (orchiopexy) may not reduce the risk of testicular cancer but may allow for better observation of the testicle for abnormalities.
- Gonadal Dysgenesis: Abnormal development of a gonad (testicle) which is usually part of a genetic syndrome increases the risk of testicular cancer.
- Klinefeter Syndrome: A genetic syndrome where males are born with an extra X chromosome increases the risk of testicular cancer.
- Personal or family history of testicular cancer: Having a father, brother or uncle with testicular cancer may slightly increase one’s risk of developing testicular cancer. Only a small number of testicular cancers occur in families. Most individuals with testicular cancer do not have a family history of the disease. Weaker evidence suggests that infertility, testicular atrophy, twinship or abnormal semen parameters may increase one’s risk for testicular cancer.
- Carcinoma in situ (CIS) also called intratubular germ cell neoplasia: The presence of carcinoma in situ in the testicle increases the risk for testicular cancer.
https://www.youtube.com/watch?v=KUtIlwLa_KY
Testicular self-exam
Colon Cancer Screening
Everyone at average risk should start testing at age 45. There are several testing options. Talk with a health care provider about which tests are best for you and how often testing should be done.
Colon Cancer Screening
Black or African American individuals at average risk for colon cancer should start testing at age 45. There are several testing options. Talk with a health care provider about which tests are best for you and how often testing should be done.
Colon Cancer Screening
Testing is recommended, and there are many testing options. Talk with a health care provider about which tests are best for you and how often testing should be done. Medicare covers testing.
Lung Cancer Screening
If you are age 55 or older, talk to a health care provider about your smoking history and whether you should get yearly low-dose CT scans to screen for early lung cancer. Screening may benefit if you are an active or former smoker (quit within the past 15 years), have no signs of lung cancer, and have a 30 pack-year smoking history. (A pack-year is 1 pack of cigarettes per day per year. One pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack-years.) You should discuss the benefits, limitations, risks, and potential costs of screening with a health care provider before testing is done. You also should find out how much the test will cost – not all health insurances cover it.
Lung Cancer Screening
If you have a smoking history, talk to a health care provider about it and whether you should get an annual low-dose CT scan to screen for early lung cancer. Screening may benefit if you are an active or former smoker (quit within the past 15 years), have no signs of lung cancer, and have a 30 pack-year smoking history. (A pack-year is 1 pack of cigarettes per day per year. One pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack-years.) You should discuss the benefits, limitations, and risks of screening with a health care provider before testing is done. Medicare covers testing.
Breast Cancer Screening
Report any changes in the way your breasts look or feel to a health care provider right away. Find out if you are at higher than average risk for breast cancer. If not, then testing is not needed at this time.
Breast Cancer Screening
Report any changes in the way your breasts look or feel to a health care provider right away. Starting at age 40, individuals with breasts should get mammograms every year. It’s important to know if you are at higher than average risk for breast cancer. If you are, talk to a health care provider about when you need to start getting mammograms and whether you need to get other tests along with your mammograms.
Breast Cancer Screening
Report any changes in the way your breasts look or feel to a health care provider right away. Individuals ages 50 to 54 should get mammograms every year. Individuals ages 55-64 should get mammograms every 2 years, or you can choose to get one every year. It’s important to know if you are at higher than average risk for breast cancer. If you are, talk to a health care provider about whether you need to get other tests done along with your mammograms.
Breast Cancer Screening
Report any changes in the way your breasts look or feel to a health care provider right away.You should get a mammogram every 2 years, or you can choose to get one every year. It’s important to know if you are at higher than average risk for breast cancer. If you are, talk to a health care provider about whether you need to get other tests done along with your mammograms
Cervical Cancer Screening
No test is needed before age 21. Starting at age 21 and through age 29 individuals should have a Pap test done every 3 years. HPV tests should not be done unless a Pap test is abnormal. Follow testing recommendations even if you’ve been vaccinated against HPV.
Cervical Cancer Screening
Starting at age 30, individuals should get a pap test every 3 years, or a pap test and HPV test every 5 years (the preferred approach). Follow testing recommendations even if you’ve been vaccinated against HPV. You don’t need testing after a hysterctomy that removed the uterus and cervix as long as it was done for reasons not related to cervical cancer.
Cervical Cancer Screening
Get a Pap test and an HPV test done every 5 years (preferred approach) or get just a Pap test every 3 years. Follow testing recommendations even if you’ve been vaccinated against HPV. You don’t need testing after a hysterectomy that removed the uterus and cervix as long as it was done for reasons not related to cervical cancer. Individuals with a history of a serious cervical pre-cancer should continue testing for 20 years after that diagnosis.
Cervical Cancer Screening
Get a Pap test and HPV test every 5 years (preferred approach) or Pap test alone every 3 years. No testing is needed after a hysterectomy that removed the uterus and cervix as long as it was done for reasons not related to cervical cancer. Individuals with a history of a serious cervical pre-cancer should continue testing for 20 years after that diagnosis.
Cervical Cancer Screening
No testing is needed if you’ve had regular cervical cancer testing with normal results during the previous 10 years. No testing is needed after a hysterectomy that removed the uterus and cervix as long as it was done for reasons not related to cervical cancer. Women with a history of a serious cervical pre-cancer should continue testing for 20 years after that diagnosis. Testing is covered by Medicare.
Tobacco Usage
There is no safe level of tobacco use or exposure. People who use any type of tobacco product are strongly urged to quit. Inhaling secondhand smoke can cause lung cancer in non smoking adults and living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20-30%. People who quit smoking, regardless of their age, have substantial gains in life expectancy compared with those who continue to smoke. Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.
Tobacco use causes many types of cancer, including cancer of the lung, larynx (voice box), mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia. People who use smokeless tobacco (snuff or chewing tobacco) have increased risks of cancers of the mouth, esophagus, and pancreas.
Your Naviance/Managing Cancer at Work oncology nurse navigator can help you find resources that are available for you or your loved ones to quit smoking
Stress Management
Stress is a necessary part of our lives and can have both positive and negative effects. The stress response is primarily determined by our perception of an event, transition, or problem. Finding a balance in our lives and managing our stress can be a challenge. An important first step is recognizing the degree to which we are affected by the stress in our lives and then move toward strategies to make it better. Some ways to look after your mental health:
- Do more of the things that make you feel great and help you to de-stress
- Spend time with friends
- Share what’s going on, especially if you’re feeling overwhelmed
Apparent links between chronic psychological stress and cancer could arise in several ways. For example, people under chronic stress may develop certain behaviors, such as smoking, overeating, or drinking alcohol, which increase a person’s risk for cancer. Or someone who has a relative with cancer may have a higher risk for cancer because of a shared inherited risk factor, not because of the stress induced by the family member’s diagnosis.
HPV
Human papillomaviruses (HPVs) are a group of more than 200 related viruses. More than 40 HPV types can be easily spread through direct sexual contact, from the skin and mucous membranes of infected people to the skin and mucous membranes of their partners. HPV infections are the most commonly sexually transmitted infections in the United States. The Centers for Disease Control and Prevention (CDC) estimates that more than 90% of men and 80% of woment who are sexually active will be infrected with at least one type of HPV at some point in their lives. Most high-risk HPV infections occur without any symptoms, go away within 1 to 2 years, and do not cause cancer. Some HPV infections, however, can persist for many years. Persistent infections with high-risk HPV types can lead to cell changes that, if untreated, may progress to cancer.
Although there is no treatment for the HPV virus there are treatments for the conditions that HPV can cause. Genital warts can be treated by a healthcare provider or with prescription medication. Cervical precancerous cells that are found by PAP and HPV testing treat the condition and prevent cancer and other HPV related cancers are also very treatable when diagnosed and treated early. The Pap test is a screening test, not a diagnostic test. It cannot tell for certain if you have cervical cancer. An abnormal Pap test result may mean more testing, sometimes including tests to see if cancer or a pre-cancer is present. The tests that are used include colposcopy (with biopsy), endocervical scraping and cone biopsies.
Can HPV infections be prevented? People who are not sexually active almost never develop genital HPV infections. In addition, HPV vaccination before sexual activity can reduce the risk of infection by the HPV types targeted by the vaccine.
Correct and consistent condom use is associated with reduced HPV transmission between sexual partners, but less frequent condom use is not. However, because areas not covered by a condom can be infected by the virus, condoms are unlikely to provide complete protection against the infection.The Food and Drug Administration (FDA) has approved three vaccines to prevent HPV infection: Gardasil®, Gardasil® 9, and Cervarix®. These vaccines provide strong protection against new HPV infections, but they are not effective at treating established HPV infections or disease caused by HPV.
Sun Safety: Skin Cancer Prevention Tips
Here are some skin cancer prevention tips:
- Do not burn or tan and avoid tanning beds. Ultraviolet (UV) light is known to cause skin cancer and wrinkling.
- Seek shade when the sun’s rays are the strongest between 10am and 4pm.
- Wear protective clothing UV protected clothing is now widely available or you can wear long sleeved shirt/blouse and long pants. Don’t forget the wide brimmed hat and sunglasses.
- Be generous with the sunscreen. Use the recommended 1 ounce of sunscreen for adequate protection over all exposed areas of the body. A good guide is to use enough sunscreen to fill a shot glass. Reapply the full 1 ounce every 2 hours.
- Use a broad spectrum sunscreen with Sun Protective Factor (SPF) 30 or higher for protection for ultraviolet A (UVA) and ultraviolet B (UVB) radiation. Apply 15 minutes before going outdoors and reapply every two hours.
- Practice extra caution near water, snow, and sand as these surfaces reflect the damaging rays of the sun, which can increase your chance of sunburn.
- Get your daily Vitamin D:
- Through a healthy diet –salmon, mackerel, beef or calf liver, egg yolks, milk, canned fish, yogurt, orange juice, fortified cereals and who knew Tofu!
- Take vitamin supplements with Vitamin D included. Not sure how much to take? Consult with your health care provider to find the dose that is appropriate for you.
Lastly, know and be comfortable with checking your skin at least once a month. Have a new or changing spot evaluated by your health care provider. Based on your personal and family history speak with your health care provider about having a professional skin exam scheduled regularly.
Reference
Mantle Field Radiation
Individuals who have had Hodgkin lymphoma are at risk for developing a second cancer and are found to have an increased risk of the following group of cancers: Leukemia and myelodysplastic syndrome, non Hodgkin lymphoma, Breast cancer, Lung cancer, Thyroid cancer, Head and Neck cancers, Stomach cancer, Colorectal cancers, Sarcoma,Gynecological cancers and Skin cancers.
The risk is linked to radiation treatments that were used to treat the Hodgkin lymphoma. It is especially important after completion of treatment for Hodgkin lymphoma that you see your health care provider regularly and have the necessary surveillance testing done to look for signs of a cancer recurrence or a new cancer.
Reference
Second Cancers After Hodgkin Lymphoma
Impact of Alcohol
The federal government’s Dietary Guidelines for Americans 2020-2025 defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men. Heavy alcohol drinking is defined as having more than three drinks on any day or more than eight drinks per week for women and more than four drinks on any day or more than fifteen drinks per week for men.
Drinking alcohol can increase your risk of cancer of the mouth, throat, esophagus, larynx (voice box), liver, and breast. The more you drink, the higher your risk. The risk of cancer is much higher for those who drink alcohol and also use tobacco.
Impact of being Overweight
People who are obese may have an increased risk of several types of cancer, including cancers of the breast, colon, rectum, endometrium, esophagus, kidney, pancreas, and gallbladder. Conversely, eating a healthy diet, being physically active, and keeping a healthy weight may help reduce risk of some cancers.
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