2015's Top Posts on Cancer News in Context

It's been another big year of cancer prevention news, and it started with a real splash way back in January with a headline-grabbing study in Science attributing most cases of cancer to simple "bad luck." Not surprisingly, we disagreed with that conclusion, and our post responding to the study - and the stories it generated - was one of the most popular on Cancer News in Context in 2015. Other popular posts ran the gamut of topics: from links between sugary sodas and earlier periods; to risk-reducing diet tips; to the on-going problem of tanning bed use by youth and young adults. 

As we get set for another eventful year, here are our top 5 posts from 2015, in order of popularity:

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February 3, 2015

Study Finds Periods Start Earlier in Girls Who Drink a Lot of Sugary Drinks. What Does This Mean for Breast Cancer Risk? 

A new study released last week in the journal Human Reproduction has found that regularly drinking sugar-sweetened beverages - like sodas and fruit drinks - may cause girls to start their menstrual periods at earlier ages.

The study, a spin off of the long-running Nurses' Health Study at Harvard University, followed around 5,000 9 - 14 year old girls for up to five years - tracking their food, beverage intake, and menstrual status along the way.  Researchers found a distinct link between regularly drinking sugary beverages and the age periods started (technically called, menarche).  Those girls who drank more than 1.5 servings of soda or fruit drink each day started their period on average at 12.8 years, about three months earlier than girls drinking 2 or fewer servings each week. Even after taking body mass index (BMI) into account, which is linked to age at menarche,  the same general association remained.

So, what does this have to do with cancer?

There's increasingly good data that early life plays a particularly important role in later adult breast cancer risk, something we've certainly written about here on CNiC.  This new study provides further evidence....

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Photo: Creative Commons Lic. (cropped): Flickr/zingersbs

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January 8, 2015

Setting the Record Straight on Cancer Prevention: Lifestyle Trumps "Bad Luck" 

It's been hard to avoid the headlines this past week touting the conclusions of a new study in the journal Science that cancer is a disease largely caused by "bad luck."  Some of these headlines have been sensationalized; some have been more measured.  Together, they've seemed nearly ubiquitous.  And in some ways that's been positive, demonstrating that cancer - and its causes and prevention - remain an important topic to both the public and the media.

Unfortunately, the conclusions of the paper - and the subsequent coverage they've received - seem to reach well beyond what the actually findings of the study support, and in doing so, have incorrectly called into question what decades of overwhelming evidence shows:  that over half of all cancers - and up to three quarters of some cancers - could be prevented by regular screening and healthy lifestyle choices.

The new study by Johns Hopkins researchers Cristian Tomasetti and Bert Vogelstein gathered data on the number of stem cell divisions that occur in various tissues in the body and compared these data to annual incidence rates of cancers in those tissues.  Stem cells divide to replace cells in tissue that die or are lost.  This maintains the tissue.  Some tissues need a lot of cell divisions for maintenance.  Others need less.  When cells divide, the DNA in cells also replicate and divide, opening up the chance for random mutations that could eventually lead to cancer.

The researchers found a strong correlation between tissues' number of stem cell divisions and cancer in those tissues, attributing 65% of cancers to these divisions, and the random DNA mutations that can occur with them.

While the study is well-designed and executed, it also has...

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August 31, 2015

Bottom Line of New Study: Colon Cancer is Quite Preventable

A large proportion of colon cancer is preventable with healthy lifestyle choices, even without taking into account the benefits of screening.  That's the finding in a new analysis from the large Nurses' Health Study released in print last week in Cancer Causes & Control.  The analysis, done by researchers from Stanford and Harvard Universities, calculated the percentage of colon cancers in women that could be attributable to a combination of lifestyle choices that have been found in previous research to be established risk factors for the disease: overweight/obesity, lack of physical activity, alcohol intake, smoking, low multivitamin use, and low calcium intake.

Comparing women who had only one or none of these risk factors with women having two or more, the researchers found that 37 percent of colon cancer cases in women could be avoided through healthy lifestyle choices.  This proportion was even higher when aspirin use was considered.  Though not a lifestyle choice, per se, long term aspirin use has been shown in many well-designed studies to lower the risk of colon cancer.  When aspirin use of just twice a week for six years or more was added to the analysis, the percentage of cancers estimated as preventable rose to 43 percent.

These percentages are quite significant and do not even take into account the further benefit of colon cancer screening, which in addition to catching cancer early can also prevent the disease by finding (and removing) pre-cancerous growths.

Though some other analyses have estimated...

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Photo: Creative Commons Lic. Flickr/thomasletholsen

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January 12, 2015

Preventing Skin Cancer: Tanning Beds Still Alluring, Still Very Risky

There was a nice piece in the New York Times this weekend on the risks of indoor tanning, particularly in youth. Focussing on the personal experiences of a handful of young women and their  parents, it does a very good job highlighting the well-established risks of skin cancer and deadly melanoma, the continued allure of tanning, and some promising advances in tanning salon regulation and rates of tanning by youth.

We've written a number of posts over the years here on Cancer New in Context (see below) about the dangers of tanning beds and the need for better policies to curb their use and protect youth. So, it's good to see the topic continuing to gain traction both in terms of awareness and in the willingness of state and federal government to take important tax and regulatory action to try to maintain the recent downward trend in tanning bed use.

In many ways, it's similar to the concerted efforts that have helped curb tobacco use over the past 50 years, a similarity not lost on 22 year-old Westfield State University student, Elizabeth LaBak, who was highlighted in the Times article:

“The tanning thing is like the smoking thing,” she said. “Everyone used to smoke. And then they said, ‘You’ll die of lung cancer.’ That’s what’s happening to tanning.”

As this quote sums up...

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Photo: Creative Commons Lic. Flickr/whatshername

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September 17, 2015

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...

>>continue reading

Photo: Creative Commons Lic. Flickr/Colin Brace

A Closer Look at Obesity, Breast Cancer, and Health Disparities

by Graham Colditz, MD, DrPH

Obesity is an established cause of postmenopausal breast cancer, with the International Agency for Research on Cancer (IARC) estimating that approximately 10 percent of postmenopausal breast cancer is due to excess weight (1). Overweight and obesity also increase the risk of mortality after diagnosis. One large analysis combining data from some 82 studies found that women who were obese in the months before being diagnosed had around a 40 percent higher risk of breast cancer mortality and total mortality compared to normal weight women (see Figure 1) (2).

Figure 1

Weight gain

Most women who are overweight or obese gain their weight predominantly in the adult years. We assessed the relation between adult weight gain and postmenopausal breast cancer after 26 years of follow-up in participants in the Nurse’s Health Study (3). Women who gained 22 pounds or more after menopause experienced an approximately 20 percent greater risk of breast cancer than women who maintained their weight after menopause. We also observed that weight gain of 5 pounds or more from age 18 on accounted for 15 percent of all postmenopausal breast cancer.

Though substantial weight gain is often something that happens over a relatively prolonged period, in the Nurses’ Health Study, we also assessed the potential impact of short-term recent weight gain on breast cancer risk (4). We looked at weight gain over 4 years, and the risk of cancer in the next 2 years. We found that short term weight gain increased the risk of premenopausal breast cancer, and that these risks were significant for two specific types of disease: ER+/PR- breast cancer and ER-/PR- breast cancer (see Figure 2). Compared to women who didn’t gain weight, the risk of ER+/PR- breast cancer was more than doubled with each 25 pounds gained over that period.

Figure 2

Why does this matter? Substantial weight gain in premenopausal years increases the risk of hard to treat breast cancer, such as ER-/PR- disease, and also conveys future cancer risk as women pass through into the postmenopausal years 4. While weight loss after menopause can substantially reduce breast cancer risk, perhaps by up to a half (see Figure 3) (3), avoiding weight gain is clearly preferable. Weight, once put on, can be hard to lose, and maintaining a lifelong healthy weight has the added benefits of improving quality of life and lowering the risk of many other cancers as well as other serious diseases, like diabetes, heart disease, stroke, and osteoporosis (5).

Figure 3

Prevalence and disparities in weight status

Weight gain, unfortunately, is a very common problem in the United States, and it is not one borne equally across society (6). While black and white boys show similar weight distribution from ages 5 to 17, black and white girls differ in weight starting around age 9, with black girls on average heavier than white girls. This difference continues to increase through age 17.

Weight gain through childhood and adolescence may reflect external circumstances – which can include factors like affordability of healthy food choices, availability of safe places to play/exercise, exposure to marketing of unhealthy foods, and parent/guardian time-constraints (7,8).

And many of the disparities in weight distributions in youth – and the social and physical environmental factors that help contribute to them – continue through the adult years.

Our recent analysis of national United States data (National Health and Nutrition Examination Survey) shows that African American women have had an overall higher prevalence of overweight and obesity compared to non-Hispanic white women over the past 20 years (see Figure 4) (9). The data also show that the prevalence of overweight and obesity in African American women exceeds that of non-Hispanic white women when looking at adults under age 50 and age 50 and over (see Figure 5). To be heavier as a group before age 50 implies continuing excess weight gain through the premenopausal years.

Figure 4 - Overall changes in weight status over the past 20 years. Source: Yang and Colditz, 2015

Figure 5 - Weight status by age – under age 50, age 50 and over. Source: Yang and Colditz, 2015

In a recent paper in the American Society of Clinical Oncology’s ASCO Post , I wrote about the excess rate of hard to treat breast cancers in African American women and that such hard to treat tumors are one likely reason that African American women experience higher rates of breast cancer mortality than do non-Hispanic white women. And growing data, already discussed, suggest that unhealthy weight may be a contributor to the risk for such hard to treat cancers.

So, while overweight is a key driver of breast cancer risk and poorer outcomes for all women, particular emphasis is needed on efforts that narrow the weight status and health disparities seen between races and ethnicities, improving outcomes across the board.

To successfully tackle the issue of overweight in such a way will require political will and multidisciplinary efforts that are focused not just on individual behaviors but also on the important physical, social, and healthcare environments that can be key barriers to or facilitators of individual actions on diet and physical activity.

It is a tall order but one certain to pay off many times over.

References

1. International Agency for Research on Cancer. Weight Control and Physical Activity. Vol 6. Lyon: International Agency for Research on Cancer; 2002.

2. Chan DS, Vieira AR, Aune D, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014.

3. Eliassen AH, Colditz GA, Rosner B, Willett WC, Hankinson SE. Adult weight change and risk of postmenopausal breast cancer. JAMA. 2006;296(2):193-201.

4. Rosner B, Eliassen AH, Toriola AT, et al. Short-term weight gain and breast cancer risk by hormone receptor classification among pre- and postmenopausal women. Breast Cancer Res Treat. 2015;150(3):643-653.

5. Willett WC, Dietz WH, Colditz GA. Guidelines for healthy weight. The New England journal of medicine. 1999;341(6):427-434.

6. Rosner B, Prineas R, Loggie J, Daniels SR. Percentiles for body mass index in U.S. children 5 to 17 years of age. J Pediatr. 1998;132(2):211-222.

7. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804-814.

8. Blumenthal SJ, Hoffnagle EE, Leung CW, et al. Strategies to improve the dietary quality of Supplemental Nutrition Assistance Program (SNAP) beneficiaries: an assessment of stakeholder opinions. Public Health Nutr. 2014;17(12):2824-2833.

9. Yang L, Colditz GA. Prevalence of Overweight and Obesity in the United States, 2007-2012. JAMA Intern Med. 2015.

We Are Family: Understanding Your Family History of Cancer

by Katy Henke

Family members share many things that can impact cancer risk: lifestyle choices, habits, physical environments and their genetic makeup. Of all of these, genetics can be particularly key.

Because of this, it’s important to understand your family history of cancer and how it may impact your risk for the disease. Some types of family history and related genetic mutations can greatly increase the risk of certain cancers, while other types can have an impact similar to common lifestyle risk factors - like being overweight.

So, take the opportunity over the holidays to talk with your family members about their health history. Jennifer Ivanovich, MS, MBA, CGC, a board certified clinical cancer genetic counselor at Siteman Cancer Center and Assistant Professor of Surgery in the Division of Public Health Sciences at Washington University School of Medicine, recommends asking some of the following questions:

• Has anyone in the family had cancer?

• If so, where did the cancer start or what was the specific cancer type?

• About what age was the person diagnosed? 

• Has the family member had genetic testing and, if so, what were the specific results? (Having a copy of the genetic testing results is always helpful).

There are many tools available to help chart your family health history. A doctor or genetic counselor is the the best source for understanding your family history of the disease and how it may affect your risk.

If your family history or genetics puts you at increased risk, your doctor may recommend special steps that can help you reduce or manage that risk.

A healthy lifestyle also remains important for people with a family history of cancer. While you cannot change your genes, shifting to healthier behaviors, such as quitting smoking and keeping weight in check, can improve your overall health and lower the risk of cancer and other important diseases.

Knowing that cancer runs in your family offers a great opportunity to focus on prevention. For tips on lowering cancer risk, check out  8IGHT WAYS to Stay Healthy and Prevent Cancer. Start with one or two changes, and build from there.

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To learn your risk for common diseases, visit Your Disease Risk calculator.

For more resources on family history, visit the CDC’s Family Health History website or the Surgeon General’s My Family Health Portrait website.

Photo: Pen to Paper by Dwayne Bent (CC License, CC BY-SA 2.0)

Unwrapping Holiday Weight Gain - and Ways to Prevent It

by Hank Dart

We’re in the middle of it now. The holiday season – that wonderful and stressful five-week stretch from Thanksgiving to New Year’s where at every turn, there seems to be food. And not just everyday food, but food of such amounts and enticing types that it can feel nearly impossible at times to refuse them.

Add the long nights, cold weather, and busy schedules that throw us off our normal exercise routines, and the stage can be set for entering 2016 with our clothes fitting just a bit tighter than they did earlier in the fall.

If this scenario feels all too familiar from holidays past, you can find some comfort in knowing you’re not alone. Studies have found that holiday weight gain is a very real thing that many people struggle with.

How much weight gain are we talking about?
Though it can vary greatly from person to person, typical weight gain over the holidays is around 1 to 1.5 pounds. But, many people gain considerably more, on the order of 5 pounds or more, says Dr. Samuel Klein, William H. Danforth Professor of Medicine and Nutritional Science at Washington University School of Medicine.

And the weight put on over the holidays makes up a large proportion of the weight that most people gain every year. A study in the New England Journal of Medicine found that of the weight that participants on average gained over the course of a year, just over half was put on during the holidays (1).

It’s like the party guest that never leaves. And that’s what makes holiday gains problematic, according to Klein: “People usually do not lose the weight they gain during the holidays and it is a major cause of yearly weight gain and increasing body weight in the United States.”

Of course, the amounts don’t sound like anything that’s really worth worrying about. A pound here. A pound there. But weight gain has a way of silently creeping up on people. And over the years, it can turn into noticeable amounts that can have a negative impact on both health and quality of life.

Assuming a gain of just one pound per year, for example, someone who is 5’9”, weighs 165 pounds, and has a “healthy” BMI of 24 would be well into the middle of the “overweight” category after 20 years (BMI of 27) and then crest into “obesity” after 40 years (BMI of 30). With the large majority of people in the United States already overweight or obese, these movements can happen even faster, not only because the starting BMI is higher but also because holiday weight gain is often larger in those who are already overweight.

“In general, [holiday] weight gain is proportional to BMI. People with higher BMI tend to gain more weight,” says Klein.

And findings from the New England Journal of Medicine study provide a good example of this. Of those participants who were overweight, 11 percent experienced “major holiday weight gain” of 5 pounds or more. In obese, participants, the proportion rose to 17 percent. In healthy weight participants, only 5 percent experienced a major gain.

How many extra calories does it take?
So, how much overeating does it take from Thanksgiving through New Year’s to cause the typical holiday weight gain? Surprisingly little it turns out.

In a paper in Physiology & Behavior, Dale Schoeller of the University of Wisconsin ran some numbers and concluded that it took just 55 extra calories a day to build up to the average holiday gain of about a pound (2). That’s around the amount in that cookie you grabbed on the way out the door at your work party or that dollop of whip cream you put on your pie.

What can we do about it?
Keeping weight in check is hard any time of year, let alone over the holidays when we’re thrown off our regular routines. But it’s far from impossible. A lot of people come through the holidays without gaining any weight, and some even harness the change in schedule to their advantage and are able to lose a few needed pounds.

Looking at all the meals, parties, and other holiday-themed gatherings that are part of the Thanksgiving to New Year’s season, there are some practical approaches that can help us keep excess calories, and weight gain, at bay.

Klein offers these practical tips for holiday events:

“Portion control”
One of the best ways to keep calories in check is to cut back on portion size. We’ve gotten really used to huge meals, huge snacks, and huge drinks. Put smaller amounts of food on your plate, or try simply choosing a smaller plate. Most of the time you’ll find that smaller amount is all you really wanted.

“Eat before going to parties so that you are less hungry”
Coming to a party when you’re feeling ravenous can lead to overeating. The better approach is to have a healthy meal or snack at home and then head to the festivities. This way, all those alluring high-calorie choices won’t hold quite as much sway.

“Stay as far away as possible from the food tables at parties”
This falls into the “out-of-sight., out-of-mind (and stomach)” category. Just giving yourself some distance from the food at an event can make it less likely that you’ll grab food mindlessly, even when you’re not hungry.

“Minimize alcohol intake”
Alcohol is a big part of many holiday gatherings, which is fine in moderation, of course. It’s a time of celebration. But, if you’re watching calories, it’s probably best to keep drinking to a minimum. Alcohol is an appetite stimulant and can quickly disrupt your best-laid plans to avoid eating too much.

“Keep a low-calorie or zero-calorie drink in your hand”
From eggnog to wine to sugary soda, the holidays are filled with high-calorie (and often alcoholic) beverages that can contribute to extra calories. When you get to an event, pick up a low-calorie drink – like fizzy water, coffee, or diet soda – so your host, or best friend, isn’t tempted to give you a high-calorie option.

“Bring a low-calorie dessert or food”
It’s good form to bring a small gift when you’re invited to a dinner party. And most of us default to a bottle of wine or six-pack of beer or sugary soda. If you’re watching calories, try bringing a low-calorie appetizer or dessert option instead – like a platter of vegetables or fresh fruit with a low-calorie yogurt dip. It may feel a little self-serving, but you can bet that others will appreciate it, too.

On top of these special tips for holiday events, it’s also important to keep up with the tried-and-true weight control strategies that apply year-round: exercise every day; keep screen time to a minimum; choose a diet rich in fruits, vegetables, and whole grains; and try to be aware of how much you’re eating. In the end, it’s the calories we burn and the calories we eat that really matter.

Crazy as they can be, the holidays always hold a special place on our calendars. With a little planning, and a few simple steps, we can keep them from making a lasting mark on our waistlines as well.


For more healthy tips - for the holidays and year-round, visit

8IGHT WAYS to Stay Healthy and Prevent Cancer 

Your Disease Risk

Siteman Cancer Center - Healthy Holiday Cookbook 

Photo: Cake cut by Rebecca Siegel (CC License, CC BY 2.0)

References

1. Yanovski JA, Yanovski SZ, Sovik KN, Nguyen TT, O'Neil PM, Sebring NG. A prospective study of holiday weight gain. N Engl J Med. 2000;342(12):861-867.

2. Schoeller DA. The effect of holiday weight gain on body weight. Physiol Behav. 2014;134:66-69.

Photo: Cake cut by Rebecca Siegel (CC License, CC BY 2.0)

8 Ways to Lower Colon Cancer Risk in One Simple Graphic

by Katy Henke

Colon cancer is the third most common cancer in the United States. The good news is that 75 percent of cases could be prevented with healthy lifestyle choices. These eight simple tips can help you lower your colon cancer risk and improve your overall health (PDF). For more information and prevention tips, visit 8ways.wustl.edu.

(PDF)