death from colon/rectal and breast cancers were 61% and 33% lower, respectively (Thomson et al., 2014). In smokers and nonsmokers, closer adherence to the guidelines resulted in a lower overall risk of cancer (Thomson et al., 2014). The American Cancer Society (ACS) has recommended that a healthy adult weight is one in which the body mass index (BMI) is 18.5 to 24.9 (ACS, 2016). Being overweight is clearly linked to an increased risk of breast, colon/rectal, and pancreatic cancer. It is associated with an elevated risk of prostate cancer (ACS, 2016) and an increase in overall mortality (Thomson et al., 2014). The incidence of colon/rectal cancer is highly associated with an elevated BMI, physical inactivity, and poor diet. Higher consumption of fruits and vegetables is associated with a reduced risk of cancer (ACS, 2016). Guidelines for alcohol consumption are to limit alcoholic drinks to one a day for women and two a day for men. Alcohol consumption is known to increase the risk of cancers of the breast, colon/rectum, liver, pancreas, and others. Alcohol interacts with tobacco to substantially increase the risk of cancers of the breast, colon/rectum, liver, mouth, larynx, and esophagus relative to risk posed by either alcohol or tobacco use alone (ACS, 2016). Guidelines for physical activity are to engage in 150 minutes of moderately vigorous or 75 minutes of vigorous activity per week (ACS, 2016). Meeting the ACS guidelines for physical activity has been shown to be strongly associated with a lower incidence of colon/rectum cancer and a lower risk of all-cause mortality (ACS, 2016). Being physically inactive (sedentary) is associated with an elevated risk of breast (Friedenreich & Cust, 2008), colon/rectal (Harriss et al., 2009), ovarian (Patel, Rodriguez, Pavluck, Thun, & Calle, 2006) and prostate cancer as well as an elevated risk Early warning signs and symptoms of patients at risk There are few warning signs associated with the onset of cancer. Unfortunately, the onset of pain or bleeding is generally associated with advanced stages of cancer. However, the acronym CAUTION can be used as a gross screen for the presence of cancer. The letters stand for: ● C hanges in bowel or bladder habits. ● A sore that does not heal or an unusual lesion/rash anywhere. ● U nusual discharge or prolonged bleeding anywhere. ● T hickening or lumps anywhere. ● I ndigestion or difficulty swallowing. ● O bvious change in a wart or mole. ● N agging cough, hoarseness, or a change in voice. Additional warning signs and symptoms as well as screening questions for detecting the potential presence of cancer (and the need for referral to a physician) include constant, intense pain that does not demonstrate aggravating nor relieving factors (i.e., nothing make the pain better or worse). Unexplained weight loss of 10% or more is a significant finding since most patients in pain tend to gain weight with a reduction Common sites of new cancer Basal and squamous cell cancers are the most common forms of cancer; however, these forms of skin cancer rarely metastasize and are rarely life-threatening (ACS, 2013b, 2017; Jemal et al., 2010). After basal and squamous cell skin cancers, the most common site for new cases of cancer (primary cancer) in males in the United States is the prostate gland while cancer of the lung/ bronchus is second (see Table 15). In females breast cancer is the most common site of new cancer while cancers of the lung/bronchus are a distance second. Cancers of the colon/rectum are the third leading site for new cancers in both males and females.
of obesity, cardiovascular disease, hypertension, diabetes, and osteoporosis (ACS, 2016; Byers et al., 2002). The amount of sitting time, regardless of activity level, raises the risk of obesity, type 2 diabetes, some forms of cancer, and earlier mortality (ACS, 2016). Tobacco and tobacco products are known carcinogens (Goodman et al., 2018). There is scientific evidence linking the use of tobacco to cancers in 18 different organ sites (Viswanath, Herbst, Land, Leischow, Shields, & Writing Committee for the AACR Task Force on Tobacco and Cancer, 2010) and to an increased incidence of leukemia (Fernberg et al., 2007). Tobacco use is associated with an increased incidence of cancer in the lungs, cervix, kidneys, pancreas, and esophagus. The increased incidence has been shown to occur regardless of the manner in which the tobacco was consumed; cigarette, pipe, cigar, or chew, and included secondhand smoke. Combining tobacco with alcohol substantially increases the risk of cancers of the breast, colon/rectum, liver, mouth, larynx, and esophagus relative to the risk posed by either alcohol or tobacco use alone (ACS, 2017). In smokers and nonsmokers, closer adherence to the other ACS guidelines resulted in a lower overall risk of cancer (Thomson et al., 2014). The ACS states that the risk of cancer is reduced with a healthy lifestyle and healthy behaviors (ACS, 2016). Factors that increase the risk of cancer include an elevated BMI, sedentary behavior, excess alcohol consumption, and tobacco use. These risk factors are easily identifiable by therapists and the presence of one or more of these negative factors should prompt therapists to consider screening for specific oncological conditions associated with those risk factors. in their physical activity. A simultaneous loss of appetite and/or undue fatigue are significant findings. The development of idiopathic weakness that presents proximally and symmetrically, especially in a patient with a history of cancer, should be considered highly significant (Goodman et al., 2018). In addition, a recent change in two or more deep tendon reflexes in the presence of idiopathic weakness in a patient with a history of cancer is considered to be a highly significant finding. The rapid onset of digital clubbing of the fingernails (10 to 14 days) is highly suspicious (Goodman et al., 2018). Once again, the presence of a single risk factor, sign, or symptom is rarely significant and cause for referral to another healthcare provider; rather, the presence of an atypical cluster of signs and symptoms in the company of one or more risk factors should prompt the therapist to consider referring the patient to a physician for follow-up. The top three non-skin cancers (breast/prostate, lung/bronchus, and colon/rectum cancers) constitute approximately 50% of the new cancer cases in females and 42% of new cancer cases in males in the United States each year (ACS, 2017; Jemal et al., 2010). The lung/bronchus, colon/rectum, prostate, pancreas, and liver/ intrahepatic bile duct are the top five sites for cancer leading to death in males. These sites account for slightly more than 50% of all cancer deaths in males in the United States each year (see Table 16; ACS, 2017; Jemal et al., 2010). [The top five forms of cancer leading to death in females (lung/ bronchus, breast, colon/rectal, pancreas, and ovarian) result in approximately 60% of all cancer deaths in females (ACS, 2017).
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