Siteman Cancer Center's Program for the Elimination of Cancer Disparities Celebrates 10 Years

by Katy Henke

2015 marked 10 years for The Program for the Elimination of Cancer Disparities (PECaD). PECaD, a National Cancer Institute-funded program, works to eliminate cancer disparities through cancer prevention and treatment. To celebrate 10 years of accomplishment and collaboration in the community, PECaD hosted an evening of achievement on September 15, 2015, presenting updates, overviews and recognition to those who have been involved with the organization throughout the years.

Dr. Graham Colditz welcoming attendees to the celebration.

 During the celebration, individuals were updated on the three community partnerships that have active participation in the community, addressing breast cancer, prostate cancer, and colorectal cancer. The partnerships were able to recognize key individuals for their participation and dedication in helping promote cancer education and prevention. A tribute was also included for those individuals who PECaD has lost throughout the years.

The evening  recognized recent community research fellows training graduates as well. This PECaD program aims to engage community members in a 15-week curriculum that focuses on teaching community members the basics of community-based participatory research in order to help underserved populations. Throughout PECaD’s existence, over 100 community members have completed this course, which has led to pilot projects in the community continuing the PECaD mission.

PECaD focuses on strengthening community partnerships to help reduce cancer disparities by working with individuals, organizations, cancer survivors, and advocates as well as researchers to create awareness, promote prevention, screenings and education, and provide resources to the community. In collaboration with  the Siteman Cancer Center, PECaD attends community outreach events, provides training to clinicians and community members as well as continues cancer disparities research and quality improvement efforts.

In 10 years of community engagement and support, PECaD has grown exponentially - and continues to do so. Over the past year alone, among other accomplishments (see infographic), PECaD has placed 17 billboards with cancer prevention messages, developed new partnerships with community organization, published 30 scientific papers, and trained community members as research fellows.

 

(full size PDF)

PECaD is funded by the NCI (U54 CA153460), the Foundation for Barnes-Jewish Hospital, Washington University School of Medicine and the Siteman Cancer Center. Click Here to learn more about PECaD.

Physical Activity and Cancer Prevention: "Step It Up!" Walking Campaign

by Katy Henke

In early September 2015, Vivek Murthy, MD, the Surgeon General of the United States, began a national campaign to increase the amount of physical activity Americans engage in each day (see video below).  The campaign, called Step It Up!, works not only to get Americans walking more but also to help facilitate walking by increasing the number of safe and reliable walking paths in people's cities and neighborhoods (see video below).

Convincing evidence shows that exercise can lower the risk of breast, colon, and uterine cancers (1). Many national organizations, such as the Centers for Disease Control (2), recommend at least 30 minutes of moderate to vigorous physical activity at least 5 days per week to help prevent cancer.

Even if walking's not your thing, there are many other ways to take part in the Step It Up! campaign while reducing your cancer risk. Choose any physical activity you enjoy, such as gardening, cycling, or dancing. And try doing these activities with someone else to keep you motivated.

For long lasting health effects, make your exercise routine a habit in your household. Set aside time each day to ensure you are able to make exercise a health priority. If you feel overwhelmed at exercising that much at one time, break up your routine into 10 minutes, three times a day in order to meet your goal. For those adults who have children, walk with them to school in the morning and encourage outside activities when appropriate. Healthy habits can start at a young age too, and help reduce their risk of cancer.

In addition to helping prevent cancer, regular exercise has other great benefits, including (3):

• Helping with weight control
• Reducing the  risk of cardiovascular disease, type 2 diabetes
• Strengthening  muscles and bones
• Improving  mental health and mood
• Improving ability to complete daily tasks

To learn more:

Step It Up! walking campaign 

8IGHT WAYS to Stay Healthy and Prevent Cancer.

Photo: Flickr/pensiero (CC license)

References

1. World Cancer Research Fund; Continuous Update Project. Cancer Prevention & Survival: Summary of global evidence on diet, weight, physical activity & what increases or decreases your risk of cancer. September 2015 Edition. http://www.wcrf.org/sites/default/files/CUP-Summary-Report.pdf

2.  Center for Disease Control and Prevention. How much physical activity do adults need? 2015 Jun 4. http://www.cdc.gov/physicalactivity/basics/adults/.

3.  Center for Disease Control and Prevention. Physical activity and health. 2015 Jun 4. http://www.cdc.gov/physicalactivity/basics/pa-health/.

Eating to Lower Cancer Risk: Replacing Superfoods with Science

by Graham Colditz, MD, DrPH

Article originally appeared in the Washington University - Institute for Public Health Blog

When it comes to cancer, there are few topics as supercharged as diet. A quick search of “diet and cancer” in Google News alone returns over 3 million stories. And yet, however large these numbers are, they don’t fully capture the passion that many people feel about the food/cancer link. There’s something special, elemental even, about making sure the food we eat is as safe and as healthy as possible – for us and for our loved ones.

Yet, however motivated people are to make healthy food choices, there are a lot of mixed signals out there on what to eat to lower cancer risk. Magazines and websites often tout “superfoods” and “cancer-busters” that rarely match up with official eating recommendations, and even these official recommendations seem to change month to month with the release of new – and often seemingly contradictory – study results.

Trying to decide what to eat can be an exercise in frustration, a sentiment captured perfectly in findings from a 2007 paper on public beliefs about cancer prevention. In this national sample survey, over 70 percent of respondents agreed with the statement that “there were so many recommendations about preventing cancer that it’s hard to know which ones to follow” (1).

The reality, though, is that when all the evidence on the links between diet and cancer are looked at together, clear and simple messages rise to the surface. These messages contain no “superfoods” or “cancer-busters” and, so, may not always lead the headlines. But what they may lack in headline-grabbing flash, they more than make up for by being recommendations based in solid science. And that’s really what matters.

Watch the calories
We see them listed everywhere and so have become inured to them in a way, but calories really matter when it comes to cancer risk. In fact, they’re probably the single most important aspect of diet when it comes to preventing cancer. Consistently eating too much can lead to weight problems. And, among other health risks, obesity is an established risk factor for at least eight different cancers and is responsible for 120,000 cases each year in the United States (2,3).

Over two-thirds of the nation is either overweight (BMI 25 – 29.9) or obese (BMI 30 or over), and studies consistently demonstrate that people have difficulty recognizing if they – or their children – are an unhealthy weight. Add to this the increasingly sedentary lifestyles that go along with modern society, and it takes a concerted effort by most people to moderate calories and keep weight in check over the course of their lives (4). These simple tips can help keep calories and weight in control:

• Avoid sugary drinks, like sodas, energy drinks, and sports drinks. Even 100% juice should be kept to small amounts each day.
• Focus on eating mostly plant-based foods, like whole grains, fruits, and vegetables. 
• Be a more mindful eater. Start with smaller portions, eat slowly, and try to eat only when truly hungry. 
• Fit physical activity into each day. More is almost always better, but any amount is better than none. 
• Weigh your self on most days. It’s easy, keeps surprise weight gain at bay, and helps you make diet/activity adjustments in a timely manner.

Limit food from animals
You don’t need to go full vegetarian – unless you want to – but there’s compelling data that eating fewer animal-based foods can lower the risk of colon cancer, prostate cancer, and possibly breast cancer (5-7). Try to eat fewer than three servings of red or processed meat each week, and choose more plant-based sources of protein and fat, like nuts, beans, and vegetables.


Focus on fruits, vegetables, and whole grains
The data linking fruits and vegetables as a whole with lower cancer risk aren’t as strong as you might think, but there are still a lot of compelling reasons to eat more plant-based foods when you look at individual cancers and specific foods (4,8). For example, diets rich in fruits and vegetables have been shown to lower lung cancer risk. Tomatoes and tomato-based foods have been shown to lower the risk of prostate cancer (8). Diets with a low glycemic load – which typically have fewer refined grains and sugars – lower the risk of endometrial cancer (9). And diets high in fiber can lower the risk of colon cancer 5. Growing data also suggest that eating higher amounts of vegetable protein in youth (from sources like soy, nuts, and vegetables) may improve breast health and lower the risk of adult breast cancer (10). Shoot for at least five servings of fruits and vegetables each day, and at least three servings of whole grains. Keep refined grains (like white bread and white rice) to a minimum.


‪Drink alcohol in moderation, if at all
‪
Often lost in the messages about the heart-health benefits of moderate drinking are its related cancer risks. Moderate alcohol intake has been shown to increase the risk of colon cancer, with just a few drinks a week increasing breast cancer risk 5. Drinking in youth and young adulthood seems particular hazardous for later adult breast cancer risk (figure) (11).

Older adults who likely stand to benefit from the heart-health benefits of moderate drinking (less than one drink a day for women and less than two for men) probably don’t need to stop drinking. Those adults who don’t drink, though, shouldn’t feel the need to start. Without saying, youth should completely avoid alcohol, and college-aged adults should minimize alcohol and avoid binge drinking, which can lead to problem drinking and other risky behaviors.

‪ Data source: Liu et al, 2013 11

Consider a daily multivitamin.
‪
Though it remains a topic of debate, a daily multivitamin is a cheap and potentially powerful nutrition insurance policy (4). When added on top of a healthy diet, the vitamins and minerals in a daily multivitamin may provide added protection against a number of chronic diseases, including cancer. Calcium and vitamin D have been found in key studies to lower the risk of colon cancer. Folate may also lower colon cancer risk, as well as lower the excess risk of breast cancer in women who regularly drink alcohol (12,13). Choose a simple 100% Daily Value (DV) multivitamin, and avoid “mega” vitamins.


‪The Bottom Line
The food we eat can have an important impact on cancer risk. Key goals are to keep calories in check, eat more plant-based foods, limit red and processed meats, and avoid too much alcohol. A daily 100% DV multivitamin can be a good nutrition insurance policy.

Photo: Flickr/Colin Brace

Key references

1 Niederdeppe, J. & Levy, A. G. Fatalistic beliefs about cancer prevention and three prevention behaviors. Cancer Epidemiol Biomarkers Prev 16, 998-1003, doi:10.1158/1055-9965.EPI-06-0608 (2007).

2 American Institute for Cancer Research. Updated Estimate on Obesity-Related Cancers, <http://www.aicr.org/cancer-research-update/2014/march_19/cru-updated-estimate-on-obesity-related-cancers.html> (2014).

3 Renehan, A. G., Tyson, M., Egger, M., Heller, R. F. & Zwahlen, M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371, 569-578, doi:S0140-6736(08)60269-X [pii]10.1016/S0140-6736(08)60269-X (2008).

4 Willett, W. C. & Stampfer, M. J. Current evidence on healthy eating. Annu Rev Public Health 34, 77-95, doi:10.1146/annurev-publhealth-031811-124646 (2013).

5 World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity, and Cancers or the Colon and Rectum. (2011).

6 Michaud, D. S. et al. A prospective study on intake of animal products and risk of prostate cancer. Cancer Causes Control 12, 557-567 (2001).

7 Colditz, G. A., Bohlke, K. & Berkey, C. S. Breast cancer risk accumulation starts early: prevention must also. Breast Cancer Res Treat 145, 567-579, doi:10.1007/s10549-014-2993-8 (2014).

8 World Cancer Research Fund/American Institute for Cancer Research. (2007).

9 World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Report. Food, Nutrition, Physical Activity, and Endometrial Cancer. (2013).

10 Berkey, C. S. et al. Vegetable protein and vegetable fat intakes in pre-adolescent and adolescent girls, and risk for benign breast disease in young women. Breast Cancer Res Treat 141, 299-306, doi:10.1007/s10549-013-2686-8 (2013).

11 Liu, Y. et al. Alcohol intake between menarche and first pregnancy: a prospective study of breast cancer risk. J Natl Cancer Inst 105, 1571-1578, doi:10.1093/jnci/djt213 (2013).

12 Zhang, S. et al. A prospective study of folate intake and the risk of breast cancer. JAMA 281, 1632-1637, doi:joc81167 [pii] (1999).

13 Zhang, S. M. et al. Plasma folate, vitamin B6, vitamin B12, homocysteine, and risk of breast cancer. J Natl Cancer Inst 95, 373-380 (2003).

Still Important To Be a Quitter - Looking at Cessation and Lung Cancer Screening

In 2008, scandal struck the world of cancer screening.  A rare occurrence, to be sure. About two years after the release of a groundbreaking study showing that low-dose CT scans could catch lung cancer early and save lives in smokers, it was revealed that the study's principal investigator had close ties to the tobacco industry.

That revelation threw into deep suspicion the study results. It seemed to many that findings showing that lung cancer could be successfully caught in early stages and treated would greatly benefit the tobacco industry because many smokers would not feel a pressing need to quit.  "Why can't I just keep smoking and rely on screening to catch any issues and fix them," the logic might go.  

As we've written about previously, the study results were eventually replicated by other researchers and the principal investigator largely exonerated. And low-dose CT is quickly becoming a standard screening test for many with a history of heavy smoking.

But one key concern voiced during that tumultuous period may now be coming true.  As highlighted in a New York Times story this week, a small study of smokers found that lung cancer screening may actually be providing many of them a disincentive to quit smoking.

If such attitudes translate nationwide, even partially, it could be a major public health concern.  While effective lung screening can lower the number of deaths from lung cancer, that is all it does.  But smoking causes many different cancers and raises the risk of heart disease, stroke, and diabetes.  Stopping smoking lowers the risk of all of these, and the benefits only increase over time.

The figure below shows that screening lowers the risk of dying of lung cancer by around 20 percent after six years.  Stopping smoking does the same after about five years. As the years off cigarettes stack up, though, deaths from lung cancer drop dramatically, by over 80 percent after 15 - 20 years of cessation.  Even more notable, perhaps, deaths from all causes also drops shortly after stopping smoking, with the benefits increasing year after year of cessation.

It is a clear picture of the benefits of smoking cessation.

While there is no doubt that CT screening for lung cancer is an important tool, it should not be used in place of effective efforts at cessation.  They should go hand-in-hand.  The power of cessation to lower the risk of cancer, heart disease, stroke, and other chronic diseases is unmatched.  Stopping smoking is the single best thing any one person can do for his or her health.

Smokers need to know that and to be encouraged and supported to quit.   Equally, if not more, important is the dedication of governments, communities, and health systems to cessation.  It's easy to feel that we've won the war against tobacco.  But the reality is that a large proportion of the population still smokes. To continue to make strides and reduce the burden of tobacco-related diseases, we need to devote time, training, and resources at a level in line with cessation's potential impact.