A Great Day to Be a Quitter

Thinking about giving up smoking but not sure where – or when – to start? Today is your day!

In celebration of World No Tobacco Day, we at Penn Medicine are here to help you stop smoking for good. Even giving up this dangerous habit for one day can dramatically improve your health.

If you’re ready to stub the smokes and want to try to quit on your own, here are a few tips to helping you take the first steps towards successfully quitting.*

Set a date: Whether you choose to quit smoking today, tomorrow, or the third Tuesday next month, pick a date to quit and stick to it. Having a start date will keep you focused on your goal and can help you plan ahead.

1. Voice your decision: Quitting tobacco and smoking isn’t an easy process, so don’t think you have to do it alone! Tell your friends and family that you are quitting (let them know when your start date is) and ask for their encouragement to keep you on track.
2. Plan for the bad days: Breaking the smoking habit is not an overnight thing – you’re likely to have bad days along the way. The difference between picking back up or maintaining your goal is identifying your challenges and smoking triggers and having a plan for coping with them.
3. Get it out of sight: When you’re ready to quit, remove all cigarettes and other tobacco products from your home, workplace, and car, to keep temptation at bay.
4. Talk to a professional: Be honest with your doctor about your decision and talk about getting help to quit smoking.
5. Get help at Penn's Comprehensive Smoking Treatment Program, which provides state-of-the-art and individualized treatment to help smokers quit safely and comfortably. Specialists at the center offer treatment that is respectful and supportive, without guilt or pressure.

Learn how you can get help to quit smoking at Penn.

Watch Frank Leone, MD, MS, director of the Comprehensive Smoking Cessation Treatment Program at Penn talk about how Penn can help you quit smoking. 

*Tips for quitting tobacco and cigarette smoking were taken from the website, Smokefree.gov.

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Cancer-Fighting Recipe: Pan Roasted Baby Artichokes with Pistachios, Lemon And Black Quinoa Recipe

This is an easy, tasty, yet unique recipe packed full of cancer fighting phytochemicals. Artichoke hearts, named the 4th vegetable highest antioxidants, contain an antioxidant called rutin that can induce cancer cell death and reduce cancer cell growth.

Pistachios are second on the list right under red wine for containing a significant amount of the cancer fighting and heart healthy phytochemicals.

Lastly, all the hype about quinoa is for a good reason! Not only does it contain all the essential amino acids that your body needs, but it also has anticancer and anti-inflammatory properties! Enjoy this dish solo or paired with a piece of baked fish.

Enjoy!

Pan Roasted Baby Artichokes with Pistachios, Lemon And Black Quinoa Recipe

Serves 2

lngredients:

• 1 can artichokes hearts
• 1 half medium shallot
• 1/2 c. shelled pistachio nuts
• Juice and zest of 1 lemon
• 1 c. quinoa cooked
• 3 tbsp olive oil
• Salt and pepper to taste

Directions:

1. lf you haven't cooked your quinoa, start that first. Remember that it expands to four times its original volume when cooked, so you don't need to make a lot.
2. Whisk 1/4 c. olive oil, lemon juice and a pinch of salt in a large mixing bowl.
3. Drain and rinse the artichoke hearts. Slice them into quarters then submerge the artichoke instantly in the olive oil and lemon juice mixture. Artichokes quickly oxidize and turn black when exposed to air. The acid from the lemon juice will prevent this from happening. Stir the mixture regularly to be sure none are exposed to air for too long.
4. Thinly slice your shallot. Heat 1 tbsp olive oil in a deep pan on medium high heat. When the oil swirls easily in the pan add the shallots and pistachio nuts. When the shallots begin to brown, add the zest and stir. Cook the mixture for another minute or two until the shallots have almost completely caramelized.
5. Add the artichokes and liquid to the pan and salt and pepper to taste. Turn the artichokes so their faces are touching the surface of the pan and allow them to brown and the liquid to reduce. Stir the artichokes every few minutes until the liquid is
6. almost completely reduced and all surfaces of the artichokes start to brown. lf the pan dries before the artichokes have finished cooking, add 1/8 c. of water to prevent the shallots and nuts from burning.
7. The artichokes are done cooking when they are tender all the way through. At the last minute, toss in the quinoa and mix well.

Make sure to scrape the caramelized bits of shallot and zest into the quinoa. Adjust salt and pepper and remove from heat.

Nutrition Facts
1 servinq: 500 Calories, 37g Fat,4g Saturated Fat,40g Carbohydrates, 10g Fiber, 167mg Sodium, 13g Protein

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Pancreatic Cysts: Diagnosis and Treatment

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses pancreatic cysts.

In recent years, the number of pancreatic cysts detected has increased significantly. Most of these are found “incidentally,” meaning that they show up on imaging studies done for other reasons, not because they are causing any symptoms.

The question, according to Vinay Chandrasekhara, MD, Penn gastroenterologist, is “what to do about them?” The key to answering that question lies in determining the type of cyst, and what its potential is for becoming cancerous. Based on that, about half of all pancreatic cysts will require close monitoring or treatment.

The primary difference is between neoplastic cysts—which have the potential to be or become cancerous and non-neoplastic cysts which are largely the result of inflammation and rarely, if ever, become malignant. Dr. Chandrasekhara recently spoke a the 2nd Focus on Pancreatic Cancer Conference and noted there are very specific features that doctors look for when they make this determination. He also noted that, in most cases, this requires a procedure known as a guided aspiration, in which the doctor is able both to visualize the cyst and try to withdraw fluid from it for examination under the microscope.

“What to do about them” depends on the type of cyst, its size and stability. Many patients with worrisome cysts undergo surgery, while others have follow up surveillance to determine if the cyst is growing or changing.

For patients, a pancreatic cyst can be a source of concern or uncertainty. The best approach is to have pancreatic cysts diagnosed, evaluated, followed and if necessary, treated in a center that has experience in this area.

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Cancer-Fighting Recipe: Asparagus with Curry Butter

This recipe is teaming with cancer-fighting ingredients which happen to fight aging as well. Asparagus contains glutathione, an important antioxidant found in all tissues of the body. This antioxidant helps to detoxify and eliminate toxins such as heavy metals and pesticides from the body, which can contribute to aging and toxin induced diseases such as cancer.

Limonene a compound found in citrus fruits such as the lemons used in this recipe boosts the body's production of glutathione.

Although, this recipe uses only a small amount of butter, feel free to replace the butter with olive oil if you are a heart conscious cook.

Asparagus with Curry Butter

Serves 4

Ingredients:

2 teaspoons butter, melted
1 teaspoon curry powder
1/2 teaspoon lemon juice
1/4 teaspoon salt, or to taste
2 teaspoons extra-virgin olive oil
1 shallot, finely diced
1 bunch asparagus, (about 1 pound), trimmed and cut into 1-inch pieces

Directions:

Combine butter, curry powder, lemon juice and salt in a small bowl.
Heat oil in a large nonstick skillet over medium heat. Add shallot and cook, stirring, until softened, about 2 minutes. Add asparagus and cook, stirring, until just tender, 3 to 5 minutes. Stir the curry butter into the asparagus; toss to coat.

Nutrition facts per serving (1/2c): 67 calories; 5 g fat ( 2 g sat , 2 g mono ); 5 mg cholesterol; 6 g carbohydrates; 3 g protein; 2 g fiber; 161 mg sodium; 262 mg potassium.

Nutrition Bonus: Folate (40% daily value), Vitamin A (25% dv), Vitamin C (15% dv).
Recipe from Eating Well: March/April 2009 www. Eatingwell.com

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Genetic Risk and Pancreatic Cancer Prevention

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2013- Focus on Pancreatic Cancer Conference. In this blog, she discusses genetic factors that may put someone at higher risk for pancreatic cancer.

Anil Rustgi, MD

Of the 40,000 new cases of pancreatic cancer diagnosed each year, approximately 10 percent, or 4,000 of these have a hereditary or familial basis, according to Penn expert, Anil Rustgi, MD, chief of gastroenterology. Patients are anxious to identify family members who are risk for the disease, and take steps to minimize those risks or prevent them from developing pancreatic cancer.

It is important to note that having pancreatic cancer does not necessarily mean that your family is at increased risk. Dr. Rustgi points out that there are very specific conditions linked to higher rates of this disease. They include:

• Hereditary pancreatitis: This is an inherited condition. It occurs early in life, even in childhood, and is characterized by nausea and pain. As the condition becomes more chronic, patients develop severe diarrhea and diabetes. Smoking and alcohol use make the symptoms worse. Having this condition, which is caused by a specific genetic mutation, increases the risk of developing pancreatic cancer by 35%.
• FAMM: Familial atypical mole and multiple melanoma syndrome. This is a rare condition, also caused by a specific genetic mutation. If a patient has two or more family members with melanoma, or one member with multiple melanomas and pancreatic cancer, family members should be tested for this condition.
• BRCA 1 and 2: These genetic mutations are more often associated with breast cancer, but are now being linked to other cancers as well, including pancreatic, ovarian and prostate cancer.

There are several other rare genetic syndromes associated with an increased risk of pancreatic cancer. All of these, according to Dr. Rustgi, are amenable to genetic testing, counseling and intervention.
The GI Genetics Program at Penn can help patients understand their level or risk, establish the source of that risk, educate patients and family members on the best approaches to targeted screening and intervention. It can also identify patients and families who are NOT at increased risk for pancreatic cancer.

Learn more about your risk for gastrointestinal cancer at the GI Cancer Risk Evaluation Program.

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Does Insurance Cover BRCA Genetic Testing?

Last week’s op-ed piece by Angelina Jolie has brought to the forefront BRCA testing, and choices women make regarding their BRCA status and preventative measures against breast and ovarian cancer.

It also raises the question: Is BRCA testing only for men and women who are of means? Who can afford genetic testing for BRCA?

Is BRCA testing covered by insurance?

BRCA testing is usually covered by insurance if the patient meets certain criteria. There are different types of BRCA testing, ranging in cost from $475 to $4000. Genetic counselors are helpful in determining what type of testing is indicated. Testing is less expensive once a mutation has been identified within a family.

Insurance coverage and criteria varies by insurance plan, and genetic counselors are excellent at determining whether insurance is likely to cover the testing. Insurances more readily cover testing of people with a personal history of cancer and ideally, testing in a family starts in an individual who has had a BRCA-related cancer at a young age.

This first person to undergo testing in the family has complete sequencing of both the BRCA1 and BRCA2 genes. This costs about $3300 and if no mutation is found, an additional $700 test looking even more closely at both genes may be necessary. For individuals of Jewish ancestry, a simpler test can often be performed that looks at just the common BRCA mutations within that population, for a cost of $575. Lastly, once an individual in a family test positive, other family members typically only require testing for a single mutation which is a simpler test that costs about $475.

There are also options for individuals who lack insurance coverage of genetic testing. Uninsured individuals may be eligible for free testing via the laboratory. Under-insured individuals can apply for financial assistance through an organization called Cancer1Source and depending on where they are tested, may have access to institutional earmarked charity funds.

Another insurance question that often arises is whether a positive result will make it harder for an individual to get health insurance. Legislation passed in 2008 bars discrimination based on genetic test results for the majority of health insurance companies and plans. This legislation extends to protect people from discrimination based on genetic test results in the realm of employment. It is important to note that no such protections are in place for things like life and long-term disability insurance, so some consider putting these in place before testing is performed.

Learn more about BRCA testing at the Basser Research Center for BRCA.

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CNN.com, People Magazine Interviews Susan Domchek, MD for Angelina Jolie Piece

Basser in People Magazine:

Susan Domchek, MD executive director of the Basser Research Center for BRCA in the Abramson Cancer Center, was interviewed by People magazine  regarding Angelina Jolie’s BRCA news.

The article highlights "seven things to know" about the BRCA gene mutation from information on survivorship, genetic inheritance, testing and treatment options.

We invite you to read the article in full at People.com here.

Basser on CNN.com:

Dr. Domchek also provided expert Q&A content for CNN.com, providing information on the BRCA gene mutation, testing and the benefits and risks of mastectomy and oophorectomy.

For the latest information on BRCA research, 
screening and clinical trials from 
The Basser Research Center for BRCA,
visit the official webpage.

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