HOW TO PREVENT CANCERS

There is a great scene in the movie There's Something About Mary where the crazy hitchhiker is talking to Ted about his genius new idea - 7-Minute Abs.

"Think about it. You walk into a video store, you see 8-Minute Abs sittin' there, there's 7-Minute Abs right beside it. Which one are you gonna pick, man? "

I often think about this when talking to people about our 8 Ways to Stay Healthy and Prevent Cancer.  I often hear: "Why not 9 ways to prevent cancer?" "Why not 10 ways?"  Wouldn't that be even better?!? The 8 ways can sound so "simple" or "obvious" or "common sense" that it is easy to forget that there is an incredible depth of quality research behind them.

Yes, there are more than 8 things you can do to prevent cancer. But, the 8 ways were selected based on a scientific review of over 30 years of cancer prevention research to identify the biggest contributors to cancer risk and the ones with a strong body of convincing science behind them.

I recently saw an advertisement on a professional networking group I belong to for a seminar on cancer prevention. I was excited - how great that this group is bringing in an expert to talk about health and wellness - something we tend to forget to prioritize in the hustle and bustle of work, family and life. Imagine my disappointment upon clicking over and seeing that the seminar leader had no expertise in this area - no formal education, no experience conducting or reviewing research. This so-called "expert" merely had a laundry list a mile long of factors that prevent cancer - in her opinion. Many of those things have very little (or no) good science behind them. In fact, she listed things that have been shown to be not true.

Here's where I think the harm in this kind of post comes - we are all busy and most of us don't have time to do everything right every day. So we make choices about what to prioritize. If we mislead people about what can and what cannot prevent cancer, we send them down a path of prioritizing something with little or no impact instead of encouraging them to focus on the things where they are most likely to get a return on their investment (be it time or money or both).

That is what our 8 ways are about - identifying the factors that are going to reduce risk of several cancers, where there is a lot of quality science. The other important difference between the 8 ways and the "health tip" laundry lists you might see, is that our 8 ways are based on our evidence-based validated risk assessment tool Your Disease Risk. Again, we're using science to build science.

So while the 8 ways might seem like "simple health tips" they are really evidence-based medicine for prevention.

On the Internet, it's reader beware.  So it pays to take some time to learn how to assess what you're actually reading.  Surely, there are reputable organizations that have slightly different takes on the science than we do, but knowing who these groups are and what their background is helps determine what credence to give them.

For some tips on finding good health information online, see this piece we put together with the Komen Foundation: Using the Internet to Find Health Information.

It's no real surprise.  Not only are most of us not getting enough exercise to meet health guidelines, a large chunk of us aren't getting any physical activity at all.  New data from the Centers for Disease Control and Prevention (CDC) show that 25 percent of adults spend none of their free time exercising or doing any other type of physical activity.

This rate, though, can vary greatly from region to region, and even county by county.  The latest report shows that some counties had inactivity rates as low as 10 percent, while others had rates as high as four times that.

As the map below shows (Figure 1), states with the highest rates of inactivity were largely in the south, while states on the west and east coasts had generally lower rates.  Not likely by coincidence, this clustering of inactivity tracks very closely with poverty rates (Figure 2) and highlights the multi-layered issues that come into play when it comes to health and disease.

Figure 1 - Physical Inactivity

Figure 2 - Poverty

Poverty, education, income, health care access, and quality of infrastructure (like sidewalks and bike paths) all play an important role in the healthy choices we make.  Yes, it all comes down to a personal choice - choosing to get out the door for a walk or sit on the couch and watch TV - but the healthy choice is always easier to make when the people, places, and policies that surround us support that choice.

A few weeks back, we took our toddler to see Sesame Street Live - a groan-inducing rite of passage for many parents of toddlers. This year's subtitle was "Elmo's Healthy Heroes," and the show followed Grover in his efforts to locate his "superness," which he regained through 4 healthy habits: eating right (in this case, eating fruits and vegetables), exercising, taking a bath and sleeping. A good message. The irony came in that said event was at one of those big sports arena, which offered a kids meal for the event. Said kids meal contained: a hot dog, chips, a cookie, a crispy marshmallow rice bar and a juice. Now granted, there was a "healthy" kids meal option. It contained some sad (truly) looking celery sticks, a few slices of orange, an orange juice and one of those prepackaged peanut butter and jelly sandwiches that are crimped together with the crusts cut off. This was my first encounter with this particular food-like item and one I hope to not repeat (the peanut butter was of an unnatural consistency and there was about 5 times as much jelly as I think is reasonable for a sandwich all together on a really dry "bread"). My PB&J loving toddler ate about half and lost interest.

This got me thinking about the need for our behaviors to reinforce our words when it comes to raising kids who will make healthy choices and like healthy food. A number of food writers and bloggers (not to mention researchers, advocates and NGOs) have discussed that kids who participate in food growing and preparing are more interested in eating the food, even when it contains things previously considered "yucky". (For some resources on this, see this PDF from our colleagues at Planet Health & the Harvard School of Public Health)

With that in mind (and it being winter so we aren't growing anything), I wanted to make more of an effort to include my toddler in food preparations. I figured that the best way to start was to involve her in cooking something she DOES like. And my kid LOVES cake, which is, according to Cookie Monster post-2006, a “sometime snack.” That said, me being me, I wanted to find a cake that was healthier than the average standby. I found Martha Rose Shulman’s flourless carrot cake, which featured a few things I liked: it didn’t make a gigantic cake that would have us eating this “sometime snack” for days; it didn’t have a ton of sugar; it didn’t have any oil (other than what you use to grease the pan); it didn’t have white flour, relying on grounds almonds instead and instead; and it wasn’t covered in a sickly-sweet frosting. The last one being a significant “con” in my daughters eyes.

Sunday morning, we set up shop in the kitchen. It turns out the bags of whole almonds at the grocery store have 1 ¼ cups and the recipe calls for 1 ½ cups, so we tossed some sliced almonds we also had in the food processor. The recipe calls for turbinado (raw) sugar. We have white sugar and some demerara sugar so we mixed the two and hoped for the best.



Warning: pulverizing nuts in the food processor may scare the heck out of a small child.



but it looks tasty



(next time, I'd grind it a bit more, but we needed to cease the loud noise making!)

Toss in the flavor adding goodies













Shulman then has you grate carrots on the smallest holes of your grater. If I'm going to go through the trouble of getting the food processor out and washing all those parts, you better believe the carrots are getting grated in the food processor. So I dumped the almond meal mixture into a bowl, swapped in the grating attachment and we went to work. (My daughter didn't mind this noise - it wasn't quite as loud.)



Thankfully, we grated a lot of carrots as my daughter was quite interested in sampling at this stage and I was happy to oblige.



I tried to involve my daughter in as many of the steps as I could including measuring, pouring, grinding and mixing. Here she is adding the carrots to the beaten egg/sugar mixture (remember, this is healthiER food...)



When it comes out of the oven, it doesn't look super pretty



A quick shake of confectioners sugar solves this, but takes you one teensy step away from the healthy part of healthier. I like my desserts a bit pretty so I did it.



As you might expect with a toddler adventure, this one involved some clean-up, but we had so much fun it was well worth it.



The end result was fantastic. My whole family, including the most important voter, my daughter, LOVED it. I brought leftovers into the office, and it got good reviews there, too. This isn't the carrot cake you find in the dessert case at your local diner or coffee shop, but it is a tasty "sometimes treat" you can make with your kid.

• Required quantitative courses – The MPHS program has a unique depth of required quantitative methods courses. The quantitative curriculum emphasizes the role of epidemiology and biostatistics in approaching clinical effectiveness and outcomes research.
•  Applied coursework – The MPHS does not require a research thesis/capstone. Instead, the program makes innovative use of applied coursework to focus on the long-term application of skills. Using topics relevant to their careers and interests, the applied coursework allows MPHS students to practice the art of developing research study protocols, performing systematic reviews, designing epidemiologic studies and more. By developing these skills across a thematic research area of interest, students are well positioned to apply this knowledge to future studies as their careers advance.
• Focused concentrations – Three concentration options (Clinical Epidemiology, Health Services and Quantitative Methods) allow students to further hone their population health research skills to match clinical interests.

The CNiC team hasn't gone on a month long vacation (though that sure sounds nice with the snow we've had). We're just been busy with writing grants and papers and gearing up for some other exciting things around here. We'll be back with real content shortly, but in the meantime, here are some of what's been occupying us:

Our 8 Ways to Stay Healthy and Prevent Disease is going to be featured in an exciting new partnership with KSDK news beginning next month. I also hope we'll get to highlight our new Cancer Survivors' 8 Ways to Stay Healthy After Cancer.

The USDA released the new Dietary Guidelines. I've enjoyed reading the opinions of my colleagues on these. As our colleagues at AICR have pointed out, the guidelines include some things that are important for cancer prevention, including eating less, eating fruits and vegetables and managing portions. A few other favorites on the guidelines in general:

Michele Simon at Appetite for Profit
Harvard Nutrition Source
and of course,
Marion Nestle

Our ENERGY study is about to start our first wave of women in the weight control program. We are continuing to recruit, as are our colleagues in San Diego, Denver and Birmingham. This is a weight management program for overweight breast cancer survivors.

And I've learned that engaging a toddler in the cooking process, while great on many levels, is not conducive to food photography - and thus, prevention cooking posts!