Cancer Care

Mammograms help women keep ahead of breast cancer. How can women monitor their cervical health?

Having regular Pap smears is the best way to monitor cervical health. Screening should begin at age 21 or within three years of becoming sexually active. For women under 30, the American College of Obstetricians and Gynecologists recommend annual screening. For women aged 30 and over, the screening interval may be increased based on the woman's screening history. For women with a history of three consecutive normal Pap smears within a five-year period, the interval may be increased to every three years. The addition of an HPV test to Pap smears can also be considered for women aged 30 and over. If both tests are negative (that is, the Pap smear is normal and the HPV test is negative), the screening interval may then be increased to three years. 

• Women age 21 to 29 years - every three years
• Women age 30 to 65 years - every five years with an HPV test
• Women age 65 and older – no testing unless there is a history of moderate or severe cervical dysplasia or cervical cancer and they have had three negative Pap tests in a row

What can go wrong in the cervical area?

There are a number of infections that can affect the cervix, including: 

• Chlamydia
• Gonorrhea
• Trichomonas
• Herpes
• Human papilloma virus (HPV)

Some infections cause symptoms, for example, trichomonas can cause a discharge. Others, such as HPV, do not. We do not recommend routine screening of young women for HPV because the infection is common at that age. Some HPV infections result in genital warts and some lead to abnormal Pap smears, usually low-grade changes.

We do suggest screening for more serious abnormalities with Pap smears, however, because some women develop high-grade or potentially precancerous lesions and cervical cancer.

What happens if I have an abnormal screening test result?

After an abnormal Pap screening result, you may need additional testing, which can be as routine as a repeat Pap or an HPV test. It could also be as detailed as a colposcopy exam. If the follow-up tests show precancerous changes, you may need to have the abnormal cells removed.

Know that cervical cancer screening results may not always be accurate, just like any other lab test. Many factors can cause false results, including:

• Too few cells in the sample
• Too few abnormal cells to study
• An infection or blood that hides abnormal cells
• Douching or vaginal medications that wash away or dilute abnormal cells

To avoid false negatives, do not douche, have sex or use vaginal medications or hygiene products for two days before the test. Do not have a screening if you have your menstrual period.

How many American women are diagnosed with cervical cancer each year? How does that number change worldwide?

In the U.S., the Centers for Disease Control estimates that approximately 12,109 women were diagnosed with cervical cancer in 2011. Of that number, roughly 4,092 died of cervical cancer. Worldwide, cervical cancer is the second leading cause of cancer-related deaths in women, and in some parts of the world, it is the leading cause of such deaths. Of the 500,000 women diagnosed each year with cervical cancer worldwide, approximately half will die. Most women diagnosed with cervical cancer come from developing nations.

Are there known causes of cervical cancer?

It has been proven that oncogenic (cancer-causing) HPV infection is needed for cervical cancer to develop. That said, many women have oncogenic HPV infections, and the majority do not get cervical cancer. This shows us that other factors clearly play a role. One such factor would be immunosuppression, which means the body becomes incapable of controlling HPV infection.

Can anything be done to prevent those causes?

Yes. Two HPV vaccines are available to protect males and females against the types of HPV that cause most cervical, vaginal, and vulvar cancers. These are given in three doses and are recommended for girls age 11 and 12. Females age 13 through 26 who did not get any or all of the shots when they were younger should make an appointment to get the vaccine. Doctors recommend that females get the same vaccine brand for all three doses when possible. Even after having the HPV vaccine, women should still have regular Pap tests to screen for cervical cancer.

Other ways to reduce your chance of contracting cervical cancer include:

• Quitting smoking
• Using condoms during sex
• Limiting your number of sexual partners

How effective is the HPV vaccine?

Clinical trials show the vaccines provide close to 100 percent protection against precancers. Since the vaccine was first recommended in 2006, there has been a 56-percent reduction in HPV infections among teen girls in the US.

Who is giving the vaccine?

Pediatricians, family practitioners, internists, and gynecologists can give the vaccine.

Are there any side effects of the vaccine?

The most common side effects are:

• Pain at the injection site
• Swelling and redness at the injection site
• Low-grade fevers
• Headache after the injection

The vaccine does not contain live viruses and, as such, is not infectious nor can it cause cancer.

How prevalent is colorectal cancer (CRC)?

CRC is a common and lethal disease. In the United States, CRC is the third most commonly diagnosed cancer and the second leading cause of cancer death. Approximately 148,610 new cases of CRC are diagnosed each year in the United States, of which 106,680 are the colon and the remainder rectal cancers. Globally, the incidence of CRC varies ten-fold, with the highest incidence rates in North America, Australia, and northern and western Europe.

What are the risk factors?

Environmental and genetic factors can increase the likelihood of developing CRC. Consider the following, all of which elevate an individual's risk of developing CRC:

• Specific genetic disorders such as familial adenomatous polyposis (FAP) and hereditary nonpolyposis colorectal cancer.
• Personal history of sporadic cancers or adenomatous polyps, which increases the risk of large bowel cancer.
• Family history of colorectal cancer in a first-degree relative (parent, sibling, or child), which increases an individual's risk by 1.7 percent. The risk is further increased if two first-degree relatives have colon cancer or if the index case is diagnosed before 55 years of age.
• A family history of colonic adenoma, which appears to carry the same significance as a family history of CRC.
• Inflammatory bowel disease (IBD), such as ulcerative colitis and Crohn's colitis.
• Diabetes mellitus, insulin resistance, and chronic insulin therapy.
• Alcohol consumption increases risk modestly, particularly in those who consume alcohol in excess of 45 grams per day.
• Cigarette smoking.
• Ureterocolic anastomoses.
• Prior pelvic irradiation.
• Consumption of red or processed meats.

Can colorectal cancer be prevented? How?

Screenings can detect CRC when it can be treated. In the meantime, certain practices have been identified as protecting the body against CRC, including:

• Diet high in fruits and vegetables, and low in red meat, animal fat, and/or cholesterol.
• Folic acid, vitamin B6, and calcium.
• Regular physical activity and maintenance of normal body weight.
• Smoking cessation.
• Regular use of aspirin or nonsteroidal anti-inflammatory drugs.
• Hormone replacement therapy in postmenopausal women, although these drugs are not routinely recommended for chemoprevention of colon cancer due to the associated long-term risks.
• HMG-CoA reductase inhibitors (statins), although data is conflicting.

Are there symptoms of the disease?

Symptoms vary depending on the location of cancer within the colon or rectum, though there may be no symptoms at all. The most common presenting symptom is rectal bleeding. Cancers arising from the left side of the colon generally cause bleeding, and in their late stages may cause constipation, abdominal pain, and obstructive symptoms. On the other hand, right-sided colon cancer may produce vague abdominal aching or weakness, weight loss, and anemia from chronic blood loss.

Does it affect women more than men? Caucasians more than other ethnic groups?

Men tend to get colorectal cancer at an earlier age than women, but women live longer so they 'catch up' with men and, thus, the total number of cases in men and women is equal. In the United States, incidence rates of colon cancer declined by 3 percent between 1998 and 2000. During the period from 1996 to 2000, the average annual incidence rates per 100,000 population were 64.2 for men and 46.7 for women. Despite such data, during the same time period, the incidence rates for right-sided cancer increased, particularly in women. In addition, while tobacco and alcohol increase the risk of colorectal cancer, women who smoke are at a higher risk. Among women, CRC screening rates are still relatively low (30-40%) and are comparable to mammography rates 20 years ago. African Americans are at a much higher risk for colon cancer than other races. They have a significantly lower age at diagnosis and experience a larger number of polyps and cancer in the proximal colon. Their survival is reduced compared to Caucasians.

Does age play a role in incidences of colorectal cancer?

Age is a major risk factor for sporadic CRC. The lifetime incidence of CRC in patients at average risk is about 5 percent, with 90 percent of cases occurring after the age of 50.

Is colorectal cancer always fatal? What are the mortality rates?

Most colon and rectal cancers originate from benign wart-like growths on the inner lining of the colon or rectum called polyps. Not all polyps have the potential to transform into cancer. Those that do are called adenomas. It takes more than 10 years in most cases for an adenoma to develop into cancer. Screening identifies cancers earlier, before symptoms develop, which dramatically improves the chance of survival. Identifying and removing polyps before they become cancerous actually prevents the development of colorectal cancer. The pathologic stage at diagnosis remains the best indicator of long-term prognosis. The most important characteristics are the presence of distant metastases, local tumor extent, nodal positivity, and residual disease. Five-year survival rates vary from 93 percent for stage I to 8 percent for stage IV colon cancer. Five-year survival rates for rectal cancer tend to be somewhat lower.

What sorts of screenings are available?

The American College of Gastroenterology considers colonoscopy the preferred screening test, but the following tests are available:

• Annual fecal occult blood test. If this comes back positive, a colonoscopy should be done.
• Double-contrast barium enema. It is less effective than a colonoscopy and due to its limitations, not widely used for CRC screening.
• Sigmoidoscopy for an examination of the lower colon and rectum. If an adenoma is found, a colonoscopy should be performed. Sigmoidoscopy does not examine the entire colon nor is less reliable. Sedation is usually not used. It is performed every five years, often in conjunction with an annual fecal occult blood test.
• Colonoscopy. The entire colon and rectum are examined and polyps can be removed during the procedure, which is usually done under sedation.
• Computed tomographic (CT) colonography and magnetic resonance (MR) colonography, sometimes called "virtual colonoscopy." Both are fairly new methods and not yet established as reliable screening methods. If polyps are found, a colonoscopy with polypectomy should be performed.

Who should be screened? How often?

Screenings can detect CRC when it can be treated. For individuals at normal risk, screening tests should begin at age 50. The preferred approach is a screening colonoscopy conducted every 10 years. In addition, consider the following recommendations for screening:

• Physician experts with the American College of Gastroenterology issued new recommendations that CRC screening in African Americans begin at age 45.
• Colonoscopic surveillance needs to be performed at more frequent intervals for individuals at high risk for colon cancer (for instance, those with a personal history of CRC or adenomatous polyps, family history of CRC, HNPCC, FAP, or IBD).
• An alternate strategy consists of an annual stool test for blood and a flexible sigmoidoscopic exam every three to five years.

Does screening hurt?

Screening colonoscopy is done under conscious sedation using a combination of painkiller and sedative are given intravenously. Patients are usually comfortable during and after the colonoscopy. The day before the procedure, the patients need to take a bowel preparation, which is available in different forms and well-tolerated. Complications including perforation and major bleeding are unusual, about one to two per 1,000 procedures.

How is gynecologic cancer defined and why isn't it talked about more?

Gynecologic cancer largely applies to the malignancies of the female reproductive system which includes the:

• Breasts
• Uterus
• Cervix
• Ovaries
• Fallopian tubes
• Vagina
• Vulva
• A few others such as molar pregnancies and choriocarcinoma

Malignancies of the breast have received more awareness - and rightfully so - but there is a similar need to heighten the awareness of gynecologic cancers.

Who is most at risk for gynecologic pelvic malignancies?

In general, malignancies are more common as people age, but gynecologic pelvic malignancies can affect women - and young girls - of all ages. All cases of gynecologic cancer should be looked at individually.

How many women are diagnosed with gynecologic cancer each year?

Pelvic gynecologic cancers are relatively less frequent, but still a very significant health problem for women. Cancers of the endometrium (uterus), ovary, cervix, and other areas constitute approximately 70,000 cases each year in the United States, compared to 180,000 women who develop breast cancer. In many countries, however, cervical cancer is the most common, and an even bigger health care problem. Pap smear screenings, which diagnosis precancerous changes on the cervix, are a major factor in limiting this problem in the US.

What are the survival rates for women with gynecologic cancer?

The survival rate with all cancers depends on the type of malignancy, the stage, and its unique biology. Many gynecologic pelvic malignancies - endometrial/uterine cancer, for example - are cured completely. Surgery alone is curative for most women with endometrial cancer, but radiation and occasionally chemotherapy can be called for. Likewise, cervical cancer is usually cured by surgery and/or radiation. It may be surprising to learn there are many types of ovarian cancer. Some are entirely curable by surgery and chemotherapy while others are not, though treatments for all types of ovarian cancers can greatly extend life, and the quality of life, for years.

What are the early warning signs of gynecologic cancer?

Having regular gynecologic examinations is not something anyone looks forward to, but its benefits are substantial in terms of diagnosing cancer at a time when it is early and curable. It is often said that ovarian cancer is the “silent killer” of women because there are no early signs, though there are ongoing efforts to diagnose ovarian cancer earlier. As far as “screening tests” for other gynecologic malignancies, mammography, pap smears and endometrial biopsies (to evaluate any type of abnormal uterine bleeding) are readily available and highly useful.

How important is a family history in diagnosing gynecologic cancer?

Genetics plays a significant role in the development of malignancy. One of the cruder assessments of genetic risk is family history. Long before DNA was understood, it was clear that malignancies of certain types seem to occur more frequently in certain families. Today, a combination of better genetic understanding coupled with family history analysis can be very important. It is well known, for example, that certain breast, ovarian, and other gynecologic cancers are associated with both genetic defects and family history, even when those defects are not understood. Women who do have a family history of any of these malignancies should tell their physicians.

What types of treatments are used in fighting gynecologic cancers?

There are literally hundreds of treatment possibilities depending on the specific medical circumstances. There are dozens of types of ovarian cancers, each with its own biologic behavior and susceptibility to various treatments. Multiple treatments apply to all cancers and patients need to seek guidance from a multidisciplinary cancer team to understand their choices. As for treatments in general, surgery, increasingly done through the laparoscope, along with chemotherapy and radiation continue to represent the main therapies against gynecologic cancers. Improved therapies coupled with new medications can lessen and even prevent side effects, in turn drastically improving the quality of life for women undergoing chemotherapy.

What strides are being made to combat gynecologic cancer?

Cancer research is ongoing and from all directions, though it is an incredibly complex and diabolical set of diseases. Cancer cells change in ways that often make them resistant to treatments, despite the best efforts. That said, treatments are increasingly effective at managing even the most difficult malignancies, so even if a cure is not possible, increased quality of life is almost always possible. The most typical gynecologic pelvic malignancies remain curable through increasingly less invasive means and the use of minimally invasive procedures such as laparoscopy, allows patients to have curative surgery, making recovery easier. Radiation therapy is increasingly more precise, minimizing side effects without reducing overall effectiveness. There also is great optimism about better therapies through both biological agents and new genetic approaches, which may well be standards of care in the next five years.

The World Cancer Research Fund, together with the American Institute for Cancer Research (AICR) issued the report “Food, Nutrition and the Prevention of Cancer” describing the impact of nutrition and exercise on the prevention of cancer. We asked Lauren Talbert, RD, CSO, LDN, of the Program in Women’s Oncology at Women & Infants to talk about the report.

In the report, more than 7,000 studies related to food, nutrition, and cancer were reviewed by 21 world-renowned experts including world-famous scientists, researchers, and physicians. The goal was to review all the relevant research, using the most thorough methods, in order to generate a comprehensive series of recommendations on food, nutrition, and physical activity.

10 recommendations to reduce your risk of cancer?

• Be as lean as possible without becoming underweight.
• Be physically active for at least 30 minutes every day.
• Avoid sugary drinks.
• Limit consumption of energy-dense foods (particularly processed foods high in added sugar, low in fiber, or high in fat).
• Eat more of a variety of vegetables, fruits, whole grains, and legumes (such as beans).
• Limit consumption of red meats (beef, pork, and lamb) and avoid processed meats.
• Limit alcoholic drinks to two a day for men and one for women, if at all.
• Limit consumption of salty foods and foods processed with salt (sodium).
• Don’t use supplements to protect against cancer.

Special population recommendations include:

• It is best for mothers to breastfeed exclusively for up to six months and then add other liquids and foods.
• After treatment, cancer survivors should follow the recommendations for cancer prevention.
• Do not smoke or chew tobacco.

There’s been increased mention of “energy-dense” foods. What are they?

One of the 10 recommendations is to limit energy-dense foods and avoid sugary beverages. Energy density measures the amount of energy (calories) per weight of the food. Processed foods such as cookies, chips, fried foods, and desserts are examples of energy-dense foods. These foods often contain large amounts of fat or added sugar and tend to be more “energy-dense” than fresh foods such as fruits or vegetables. For example, half a cup of Ben and Jerry’s Coffee Health Bar Crunch ice cream contains 290 calories, 27 grams of sugar, and 18 grams of fat. This is clearly an example of an energy-dense food when compared to half a cup of sliced fresh strawberries that contains 27 calories, 4 grams of sugar, and 0.2 grams of fat. The best way to limit energy-dense foods is to increase the proportions of plant foods (fruits, vegetables, whole grains, and beans) in your diet. You should also avoid sugary drinks. Because of their water content, drinks are less energy-dense than foods. Sugary drinks provide “extra” calories to the diet and consuming more calories than required causes weight gain.

The report urges people not to use supplements to protect against cancer. What sort of supplements do they mean?

Dietary supplements are also known as vitamins. Evidence from the reviewed studies showed that high-dose nutrient supplements, for example taking a Vitamin C pill daily, can be either protective against cancer or cause cancer. The problem is that the studies are conflicting and the balance of risks and benefits cannot confidently be predicted in the general population. It’s always best to consume nutrients from their natural state, in fresh foods, rather than in a processed form. Instead of taking a Vitamin C pill, eat an orange.

You have boiled these 10 recommendations down to something that is more realistic, with three goals. What are they and why have you chosen to focus on them?

AICR’s recommendations for cancer prevention have been simplified into three guidelines. These guidelines explain how the choices we make about food, physical activity, and weight management can reduce our chances of developing cancer. The three guidelines are closely related to each other:

1. Choose mostly plant-based foods, limit red meat and avoid processed meat.
2. Be physically active every day for 30 minutes or more.
3. Aim to be a healthy weight throughout life.

It is easier to understand and follow three goals rather than 10 recommendations. The three goals were created as realistic guidelines you can think about and gradually adopt when making everyday choices related to diet and exercise. Following any one of these guidelines is likely to reduce your chance of getting cancer, but following all three offers the greatest protection.

You’ve actually diagrammed the whole grain into three parts to show its nutritional value. Can you describe those parts and their value?

A whole grain is the entire edible part of any grain. It contains the bran, endosperm, and germ. The bran is the outer layer of the grain and is often high in B vitamins and fiber. As you may recall, bran cereal is known for being high in fiber. The endosperm is the inner part of the grain that contains most of the carbohydrates. There is a small amount of vitamins and minerals in the endosperm. The germ provides nourishment to the seed. It’s rich in antioxidants, Vitamin E, fiber, and B vitamins.

What happens when the whole grains are refined? How can people be sure they are getting the best type of grain for their nutritional needs?

When grains are refined, the bran and the germ are removed resulting in a depletion of many nutritious compounds. It’s always best to choose whole grains to increase your intake of fiber and nutrients that may lower cancer risk. When reading labels, be sure to choose foods that list whole or whole-grain before the grains name as the first ingredient. Do not rely on color to identify a whole grain as ingredients such as molasses or caramel coloring may have been used during processing. The following terms do not necessarily indicate a whole grain either:

• Wheat flour
• Stoneground
• 100 percent wheat
• Seven grain
• Multigrain
• Pumpernickel
• Enriched
• Fortified
• Organic
• Bran

Examples of whole grains include:

• Brown rice
• 100 percent whole-wheat bread
• Whole wheat pasta
• Quinoa
• Popcorn
• Oatmeal
• Bran cereal

There is evidence connecting red meat to the increased risk of colorectal cancer. Should people become vegetarian or vegan?

There is convincing evidence that red meat (beef, lamb, and pork) increases the risk of developing colorectal cancer. Also, most vegetables and fruit are rich in fiber, and fiber probably protects against colorectal cancer. Furthermore, evidence shows that eating more vegetables and fruits probably protects against cancer of the mouth, pharynx, larynx, esophagus, and stomach. A typical American meal features red meat, such as an 8-ounce steak with mashed potatoes or a cheeseburger with fries. The recommendation to limit red meat helps leave more room for plant-based foods such as vegetables, fruits, whole grains, and beans to be included in the diet. If you do consume red meat, it’s recommended that you limit consumption to 11 ounces, or roughly two servings, a week. Red meat is generally high in calories and fat so choose lean cuts to help control calorie intake. In terms of cancer risk, people do not need to become vegetarian or vegan as no evidence connects fish or poultry to increased cancer risk. In fact, poultry and fish can be a valuable source of nutrients, particularly protein, iron, zinc, and Vitamin B12.

What about processed meat?

Processed meat is defined as meat that is preserved by smoking, curing, salting, or adding other chemical preservatives. Examples include:

• Bacon
• Sausage
• Ham
• Lunch meats
• Hot dogs

Similar to red meat, the evidence is convincing that processed meats can increase your risk of colorectal cancer; however, the risk is considerably greater. If you are concerned with avoiding colorectal cancer and stomach cancer, it’s best to try to eliminate processed meat from your diet. For lunch, try a tuna sandwich or buy lunch meat that contains no nitrates or nitrites. Also, try to look at processed meats as something you save for a special occasion, maybe ham at a holiday meal or a hot dog at a baseball game. Once you start to include more plant-based foods in your diet, it will be easier to avoid foods such as red meat and processed meat.

What are your suggestions for meal planning?

When planning a meal, think first about plant-based foods. Visualize your breakfast plate, for example, and aim to cover one-third with a whole grain, one-third with fruit, and one-third with a protein. An example could be eggs with 100 percent whole-wheat toast and an orange or 100 percent whole-grain cereal with milk and fresh berries. A good rule of thumb for your lunch or dinner plate is to cover half of it with vegetables, one-quarter with whole grains or beans, and one-quarter with lean protein such as poultry or fish. An example of, dinner could be a chicken and vegetable stir-fry over brown rice with a side salad. Ask yourself these questions: What vegetables or fruits will I include? How can I incorporate a whole grain or beans into the meal? If you are looking for a recipe, check out aicr.org for some tasty ideas.

You note that as Americans have become more sedentary, cancer rates have increased. Is there a proven relationship here? Are there known benefits of exercise with cancer risk?

In early hunter-gathering societies, physical activity was necessary for survival. Today, if we are hungry, we have drive-thru fast-food restaurants and vending machines. More people are spending their leisure time sitting in front of computer or television screens instead of being active. Cancer rates have increased as the population has become more sedentary. Research has proven that regular physical activity protects against cancer. It’s important to make sure it’s part of your daily routine just like brushing your teeth. Sometimes we may be too tired at night to brush but we do it anyway because we want to avoid cavities. The same goes for exercise. Sometimes you may not feel like doing it, but the benefits both physically and mentally are well worth it. Research has shown that physical activity protects against colon cancer, post-menopausal breast cancer, and cancer of the uterine lining (endometrium).

What’s interesting is that regular exercise reduces cancer risk alone, not including reduced risk with weight loss that is often seen with exercise. You may wonder how exercise decreases the risk of certain cancers. In terms of breast and endometrium cancer, exercise may prevent cancer by lowering the levels of hormones in the body that elevate cancer risk. Regular exercise keeps your digestive system working well and more rapid passage of waste through the colon may be associated with a lower incidence of colorectal cancer.

What types of cancer are affected by higher BMI?

BMI or body mass index is one tool used to measure body fat. It measures weight in relation to height. To calculate your own BMI, go to aicr.org/bmi. There are four ranges of BMI:

1. Underweight is less than 18.5
2. Normal weight is 18.5-24.9
3. Overweight is 25-29.9
4. Obese is 30 or greater

In the US, two-thirds of the population is considered overweight or obese. Scientists have found convincing evidence that greater body fat raises the risk of cancer of the esophagus, pancreas, colon, and kidney. Also greater body fat probably raises the risk of gall bladder cancer.

Does any type of physical activity help?

Of course. Physical activity is any form of movement that uses muscles. Basically, you are physically active any time you are not sitting or laying down. Each day, we make several choices related to physical activity:

• Elevator or stairs
• Park close or far away
• Walk my dog or let it out in the backyard

The more physically active you are the better. There are three terms used to describe the intensity of physical activity: light, moderate and vigorous. An example of light exercise is weeding the garden. Leisurely cycling would fall into the moderate category. Running a 10-minute mile would be considered a vigorous level of intensity.

What about the people who say they are too tired, too busy, too broke, or too out of shape to exercise?

The good thing about exercise is that it actually increases energy levels, doesn’t have to be expensive, it’s never too late to start and everyone can do it at their own pace. Just as regular physical activity reduces the risk of cancer, the opposite is true also. These people may want to ask themselves if they are too tired, too busy, too broke, or too out of shape to enjoy a longer life? Research does show that people who are more active live longer. Exercising can be as simple as waking up a few minutes early and going for a walk or meeting a friend for a walk instead of lunch. It’s important to first identify your barrier and develop a strategy to overcome the barrier. “If you can find a path with no obstacles, it probably doesn’t lead to anywhere.” A great inexpensive way to increase physical activity is to purchase a pedometer and track your daily steps. This way, you can quantify your goals such as aiming to walk 5,000 or 10,000 (the recommended amount) steps a day. The bottom line is if you truly want to increase your activity level, you can. The key is to find something that you find enjoyable and that you look at as fun rather than a chore. Maybe dance lessons or learning a new sport may be in your future.