Primary liver cancer is associated with hepatitis, aflatoxin exposure and malnutrition. As you know, this is the most common cancer throughout the world.

Of course, AIDS is associated with a huge number of cases. That’s going up all the time and that is associated primarily with Kaposi’s sarcoma and lymphoma.

There will 186,000 new female breast cancers in the U.S. in 2006 and 46,000 deaths. There’s been no change over the last two or three years and as you know this is very hopeful and gratifying that maybe we’re finally going to start getting a handle on this and decrease this. At the present time, there are 20,000 less deaths than from lung in women. As we discussed, breast cancer, 186,000 and 45,000 deaths, no change.

High risk factors include family history, nulliparity, early menarche, infertility, first pregnancy after age 35. Negative risk factors include negative family history, first birth before age 20, surgical menopause before 40, pituitary insufficiency, early menopause and normal weight and low fat diet.

Now, caffeine, as you know, is associated with painful breasts and we seem to have an awful lot in this country of that and it’s associated with caffeine. If we use danazol, we can cut down the pain and discomfort by about 60% and the tenderness also. There’s no evidence that it does anything in terms of hyperplasia. However, if the patient has atypical hyperplasia, the incidence of cancer goes up about 4-fold.

The other thing we can mention is what about women who have osteoporosis. I’m sure you get this as a real problem all the time. What should we do about these? If we give them estrogens is that bad? Well, I think most of us who are in this business feel that that’s okay and if you use estrogen and progesterone at the same time, the incidence of developing the cancer is going to be so low that I don’t think it’s anything to worry about.

Now, the next thing as we come to a close in this area, if I came around and I said, “Hey, I can cut down the cancers that you’re seeing in your patients by 50%, would you like to do that?” Well, of course, everybody would just be enthralled if you could do that. If we look for lifestyle cancer control, you see in one group, the Mormons, all cancers are down one-third to one-half, lower save prostate. So in other words, we can cut it down by one-third to one-half and the diet is the same except no tea, coffee, tobacco or alcohol. That’s the only difference between the way these people eat and the difference with the cancers being reduced to one-half is really quite remarkable.

Some in terms of cancer control, asbestos and lung are associated, as you know, with being exposed to asbestos in the lung increases the likelihood. I know chloride, which is found in the chemical factories down in the south part of our country cause an increase in hemangiocarcinomas of the liver, dyes such as aniline dyes used by the Germans are associated with an increase in bladder cancer and you already discussed pesticides which are associated with an increase in lymphomas and leukemias.

Now viruses, again, you did discuss this a bit. Epstein-Barr is associated with lymphomas as you know. Papilloma viruses in the cervix cancer. Hepatitis B with hematoma, again, the most common cancer in the world, HIV, lymphomas and Kaposi’s sarcoma as we’ve already discussed.

The family physician is in a unique position to detect cancer based upon the evaluation of the family history, particularly as regards to breast, colon, endometrium and ovary. In the colon, we have approximately three types. As you know, familial polyposis in 100% of these patients eventually, ulcerative colitis in 25% over 25 years and this has to be a constant exposure. It can’t be just sporadic in order for it to be a real factor in this problem. The family cancer syndrome in 50%.