HOW TO PREVENT CANCERS

I’ve had enough awkward cocktail party conversations by this point in my career to realize that once you say you work in cancer prevention, most people think those of us on this side of things live austerely and subsist on nothing but nuts, twigs and grass. I can’t speak for all prevention researchers, but for me, that doesn’t capture things at all.

Most of the time, I try to eat “well” and prepare “healthy” food for my family. That means lots of fruits and vegetables, not much red meat and using whole grains instead of “white” grains. But everyone in my house enjoys a good dessert, including me.

Usually, when it comes to dessert, my philosophy is to go at the preparation without holding anything back – that means cream and butter when called for and sugar. Because as far as I’m concerned, dessert isn’t dessert without a sugar of some kind (and that includes maple sugar, honey and brown sugar, not just the good ol’ white stuff). And I don’t feel guilty about this because we keep our portions small and dessert is an occasional treat, not a nightly occurrence.

So I was intrigued when reading about the White House Pastry Chef , Bill Yosses, in the New York Times (story/recipe). Yosses has a formidable task as pastry platters seem to be present at every meeting in the White House. And because the White House is home to two VIK’s (Very Important Kids), Yosses tried to create a kid friendly sweet treat to replace cookies. The result is a granola-like fruit and oat bar.

Granola is certainly no health food – it has plenty of sugar on top of the oats and dried fruit. But it is healthier food – an alternative to a cookie or cupcake when you want something sweet with a bit less guilt.

So I decided to give Yosses’ recipe a whirl and have it taste-tested by two very different audiences – my toddler and husband, who are both very traditional when it comes to dessert (i.e. a dessert should clearly be dessert) and a small dinner party of public health professionals.

Yosses’ recipe has several opportunities for adaptation so here’s what I did after prepping my 9 inch square baking pan with oil brushed parchment.

Toasted 2 c of rolled oats with ½ cup of pumpkin and sesame seeds in the oven at 350 for 8 minutes. My seed blend was mostly pumpkin seeds.




Chop up 1 ½ c of dried fruit.



Mine was a mix of apricots


Cherries


Dried blueberries, dried mission figs and candied ginger


After the oats and seeds were done, I tossed them with the dried fruit and 1 teaspoon of ground cardamom.



Combine in a saucepan ½ c honey, 1/3 c dark brown sugar, 1/3 c maple syrup, pinch of salt and 6 T of canola oil and stir until combined and sugar is dissolved.

Pour over the oat, seed, fruit mix and stir to combine.
Spread in the pan and even the top.


Bake for 25 minutes. Remove from oven and place on rack to cool completely.


 Using paper overhang, remove from pan and cut into bars.

The reviews

The bars were pretty sticky and hard to cut, but the bits that stuck to the paper tasted pretty good. The cardamom flavor was a nice break from the usual granola flavors but a bit strong. When I sampled the final product, I liked it. It certainly isn’t going to bring the same result in a dinner party guest as those whoopie pies I made last month, but these have some redeeming value, and Chef Yosses’ goal wasn’t to make a decadent dessert. I’m sure his whoopie pies would put mine to shame.

My daughter was very excited that mama was baking, but when I handed her a bite she looked puzzled. While she loves fresh blueberries and will eat close to her body weight in one sitting after a normal sized meal, she has never been a fan of blueberries IN other food – blueberry bagels are not appealing, nor are blueberries in pancakes. She took one look and asked if the bar had blueberries in it. When I confirmed her suspicion, she asked me to remove them. As you can probably guess from the pictures above, that isn’t really feasible. When informed of this, she handed the bar back and went back to her coloring book. My husband had a slightly better response – he at least tried it. His review: “It’s alright. I wouldn’t crave it.” He too found the cardamom flavor a bit strong.

In the interest of allowing my “study participants” to be fully aware of the circumstances, I shared my “experiment” with my dining companions before dessert was served. The assessment of the guests was similar to mine – they liked the flavor combination, but thought it would be better with a bit less cardamom. They, however, thought it was a perfectly good dessert.

The verdict

All in all, I’d say there is no surprise why so many folks are impressed with Mr. Yosses. The bars are a great alternative to cookies and I think would be a great thing to take to a school function where kids and parents have traditionally expected a dessert, but a healthier alternative might be appreciated. I would have been thrilled to get these as our post-game treat during my adolescent soccer career instead of a packaged store cookie, but my husband would probably have picked the chocolate cream sandwich cookie from the store. I think they’d also make a great alternative to the cookie plates that sometimes appear at 3pm meetings and lectures around some hospitals and universities. And I’m sure they’d be a welcome addition to a BBQ or pot-luck, though some folks may choose the slice and bake cookies first.

Often on CNiC we highlight the power of data and how valuable it can be in providing key information about the causes of cancer and the success, or failure, at interventions designed to prevent or treat it.

This week, New York State released the first set of maps that allow individuals to map cancer cases and align them with various locations, like power plants and waste storage facilities (map). While data and maps can be powerful and fascinating tools (my personal favorite this week is the Die-Hard baseball fan graphic), the New York maps fail to account for some key data points.

In the past, this type of map was used to identify potential locations of “cancer clusters” – areas where people felt the number of cancer cases was particularly high. But, when researchers looked closer, nearly all of these cancer clusters were explained by other factors that also tended to cluster in these areas. For example, cancer is a disease of age – age is one of the strongest risk factors for the most common cancers. As a result, areas where there is a high prevalence of older adults, will have more cases of cancer. Similarly, breast cancer rates are higher in Ashkenazi Jewish women, so a town or county that has a high number of Ashkenazi Jewish women, like certain suburbs of New York City, should be expected to have a higher rate of breast cancer than a town or county further upstate where there are fewer Ashkenazi Jewish women.

Cancer is also a disease that develops over many years, unlike infectious diseases like the flu or acute incidents like salmonella poisoning. Mapping of diseases can be extremely valuable in those instances as it can identify a possible geographic location for the outbreak (i.e., a grocery store selling tainted chicken or the mapping of the 2003 SARS outbreak). But in the case of cancer, the location where an individual lives at the time of diagnosis may have little to do with the relevant exposures or risks for when the cancer developed. As we noted in an earlier CNiC post, we are increasingly finding a role for early life exposures in cancer risk. Cancer maps like those from New York provide little to no context for such risks.

As a result, any mapping of this kind is a useful tool in the context of a much larger and more detailed investigation of cancer rates, but should be used with extreme caution, if at all, otherwise.

For more on this, check out the National Cancer Institute's Cancer Cluster Page

Coverage of the President’s Cancer Panel report this week draws attention to environmental contaminants as a potential cause of cancer (report). While this is an area of much public interest and certainly an important part of comprehensive health policy, it is a strange focus for a report that is meant to influence the nation’s approach to cancer control and prevention. The excitement and fear this report is likely to stir up could direct efforts away from combating known lifestyle factors that have a much larger effect on cancer risk than environmental contaminants (see figure). Current evidence shows that pollutants cause just 1 - 4 percent of all cancer, while obesity and tobacco each cause 20 percent and 30 percent, respectively. Even when occupational exposures are added in, lifestyle factors trump environmental factors by at least a factor of six.


At a time when we know we’re in the midst of an obesity epidemic and we know that we’re not as physically active as we should be and we know that 20 percent of the population still smokes, why focus so much effort exploring a topic we also know has such a modest impact on risk? At its worst, it plays into the hands of tobacco companies and food manufacturers by deflecting discussions of harsher regulations onto other fields. If we acted with passion to remove causes of cancer as is proposed in the report for plastics, then clearly tobacco products would have been banned decades ago.

It’s only natural for humans to search for a magic bullet, that one thing that can easily fix it all – easily erase our cancer risk. Better studying and controlling environmental pollutants is an easy projection for this. But, the evidence clearly shows this would be no magic bullet. More than half of all cancer can be prevented with what we know today, and pollutants make up only a small part of this.

Below we summarize the known causes of cancer.