HOW TO PREVENT CANCERS

It may not fall into the "shocking" category, but a new Harvard study by our colleagues at the Nurses' Health Study has provided further insight into the links between smoking and breast cancer (study).  To date, many studies have had waffling results on the subject.  Some showing smoking raising risk; some showing it not affecting risk at all; and some even showing it lowering risk.

This new study by Xue et al is a longer followup to an earlier Nurses' Health Study report and included over 110,000 women who were tracked over a 30 year period.  The main finding from this study was that smoking likely has some affect on breast cancer risk, but even with heavy smoking, the risk isn't as high as with other cancers linked to smoking (like lung, oral, and esophageal cancer, to name just a few). Greatest risk came from heavy smoking before giving birth to a first child, which raised risk by about 18 percent compared to never smoking.  The broad analysis comparing those who have ever smoked  to those who have never smoked showed a small six percent increase in risk.

Not surprisingly, heavy smoking after menopause showed a small protective effect against breast cancer.  After menopause, blood estrogen levels drive a lot of breast cancer risk, and for multiple reasons, smoking stems estrogen levels, which in turn could lower risk after menopause. Increases in risk, though, from smoking before menopause outpaced any small drop in risk from smoking afterward. 

So what do these results mean?  While there are still some open questions about the link between smoking and breast cancer, they certainly add one more reason to avoid smoking and to support policies that lead to that end.  Adding breast cancer to the list, there are no fewer than 12 different cancers caused by or directly linked to cigarette smoking.  Heart disease, diabetes, stroke, chronic bronchitis, emphysema, osteoporosis, and a number of other important conditions belong on the list as well.  With the decline in US smoking rates stalling - leaving just over 20 percent of the population regular smokers (previous post) - it's important that we keep our guard up against tobacco use.  It's been a long fight, and we've gained a lot of ground, so it's easy to feel that we've done what we can and move on to some new health promotion venue.  But, really, smoking still deserves a great deal of attention. The potential health gains from further lowering smoking rates are huge and should not be downplayed just because we've made some strides and have been working on the issue a long time.

It is a good morning exercise for a research scientist to discard a pet hypothesis every day before breakfast. It keeps him young.
-Konrad Lorenz

This week's news brought a story that remind me that sometimes, the best science involves letting go of previously held hypotheses.

Access to quality, health food, particularly fruits and vegetables, is something that has occupied a good deal of news space in recent years. And with good reason. If people can't get healthy food, all the health education in the world telling them to eat it isn't going help. The result has been a lot of attention on food deserts - the lack of supermarkets in certain neighborhoods. How pervasive are these food deserts and what do the food options look like in these areas? Jim Griffioen takes a powerful look at this in his hometown of Detroit over at Urbanophile. He shows, in great detail, the incredible depth and breadth of quality locally owned food purveyors within Detroit. He also points out that a quick Google search locates a number of smaller chain grocery stores. Does Detroit have a Whole Foods or Super Target? No, but Griffioen argues they don't need one. I have been reading his personal blog for some time and one of my favorite series has always been his photos of the family's "haul" from Detroit's Eastern Market. The photos highlight an incredible diversity of delicious looking produce and food that is locally grown or produced. Kudos to Griffioen for pushing journalists and researchers to examine these questions in more detail - and draw new conclusions when the data indicates it.

Cancer News in Context: How are those New Years' Resolutions?

Cancer News in Context: Untapped Benefits of Physical Activity and ...

There is an impressive density of research on the role of diet in cancer prevention, leading to numerous reports, such as that from the American Cancer Society or the World Cancer Research Fund, but only relatively recently has the research community turned to study the role of lifestyle, including diet, in cancer survivors.  Despite this, there is a solid body of quality research on lifestyle in survivors, such that evidence based guidelines are available for numerous behaviors including diet and exercise .

The challenge always comes in implementing these guidelines, and unfortunately, despite the wealth of data showing dietary choices matter for health (not just cancer, but heart disease and diabetes, as well as weight), many hospitals still have cafeterias populated with too many deep fried choices and salads comprised mainly of sad-looking white lettuce.

It was my great delight, then, to open Sunday's New York Times and read about the great lengths the culinary staff at Memorial Sloan Kettering Cancer Center goes through to provide food that is both tasty and nutritious to their patients.  What is truly remarkable, tough, are the efforts Chef Pnina Peled and her team go through to provide food that meets the preferences and cravings AND dietary restrictions of the cancer patients at the hospital. Kudos to all of them and may they serve as an example to hospitals everywhere

Full disclosure: I haven't read "The 4-Hour Workweek" or "The 4-Hour Body." I tend to hear about the latest "best selling" health book and let it zip in one ear and out the other. My take on making healthy choices is that they take a little time (though not a lot as Mark Bittman admirabily reminds us about cooking) and a little work, but they are feasible. Quick fixes, gimicks (e.g., cleanses), shticks just aren't my thing.

But, since no less than 3 people have mentioned Tim Ferriss' book to me this week and the NY Times has a review today, it seemed a brief comment might be worth posting.

I'm going to take Dwight Garner at his word on the tips included in Ferriss' book. My sense is that the book takes scientifically sound ideas (e.g., self monitoring) and turns them on their head and takes them out to the extreme (e.g, weighing feces). No less than two colleagues of mine have had a similar take on the book - there are valid strategies buried in there, and they aren't new, but those strategies don't sell books. So, Ferriss has surrounded them with a bunch of gimmicks that make headlines (as surely his "humanitarian" efforts with the yoga instructor are meant to, and do).

For my money, I'd rather buy a pedometer, a bathroom scale and a notepad to track my activity, weight and diet.

If you needed another reason to lace up your sneakers and keep your New Years' resolution to be active, this week offered 2:

1) Our team published, in collaboration with colleagues at the American Cancer Society, research on the role of physical activity in colon cancer and colon cancer mortality. There is a strong and consistent body of evidence showing physical activity reduces colon cancer risk. This new study examined whether the consistency of physical activity matters.

We often get this question at CNiC - can I start now? Is it too late? What we found is that consistent physical activity does matter for colon cancer mortality. Does this mean if you haven't been active before now it is too late and you shouldn't bother starting? Absolutely not. It is important to look at this study in the context of the previous work and see the big picture -- physical activity matters for colon cancer risk and mortality. Starting earlier seems to be better, but it doesn't appear it is ever too late to start either.

And of course, the other thing to remember is that physical activity isn't just beneficial for colon cancer - it reduces risk of other cancers AND heart disease AND stroke AND diabetes AND osteoporosis. And physical activity improves the quality of life as well - you FEEL better.

2) Providing another reason to be active - colleagues of ours published a report on the benefit of physical activity after a prostate cancer diagnosis. Among men diagnosed with non-metastatic prostate cancer, those who were physically active after diagnosis were less likely to die and less likely to die of prostate cancer. Overall mortality risk was reduced with activity equivalent to 30 minutes a day of brisk walking. The study suggested more vigorous physical activity may be necessary to reduce risk of prostate cancer specific death.

When the days are short and the temperatures cold, it can be hard to find the motivation to be physically active, even for our team. As we've said before - anything that gets you up and moving is good - even short breaks. And if you think you don't have time, remember our tips. Physical activity is a place where you get enormous "bang for your buck!"

We're not big gamers here at CNiC, but there was a fascinating episode of WNCY's radio program On the Media last week devoted solely to the topic, which had some very interesting, if also unsettling, things to say about the ways gaming culture may eventually impact the real-life choices we all make.

In one segment (embedded below), Carnegie Mellon professor, Jesse Schell, spent some time envisioning a time in the not-too-distant future where our lives could become one big game of racking up automatic points - 10 points for brushing our teeth, 100 points for walking to our next meeting (with a bonus for reaching target heart rate) - which could effect our insurance premiums and even tax credits. 

Clearly, it's a Big Brother scenario that smacks of the dark sides of Minority Report, but with a number of recent articles on "incentivizing" healthy lifestyles, most recently in the New York Times (story), it seemed to be a future worth thinking about.  Exactly where things will go 5, 10, or 20 years from now, no one knows.  But Schell's vision does not seem too far-fetched, so maybe it's worth a little energy to begin to think about how we could work to influence the positive aspects of such a future while minimizing its negatives.

Jesse Schell enters into the segment at 5:05.