Integrated Cancer Prevention

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Lifestyle Matters: An Integrated Approach to Cancer Prevention Lisa Nelson, MD Family Practice Associates Medical Director, The Nutrition Center Director of Medical Education, Kripalu School of Yoga & Health

Transcript of Integrated Cancer Prevention

Page 1: Integrated Cancer Prevention

Lifestyle Matters:

An Integrated Approach to

Cancer Prevention

Lisa Nelson, MDFamily Practice Associates

Medical Director, The

Nutrition Center

Director of Medical

Education, Kripalu School of

Yoga & Health

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Changing the paradigm

The doctor of the future will give

no medicine, but will interest his

patients in the care of the human

frame, in a proper diet, and in

the cause and prevention of

disease.

—Thomas Edison

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Normal Cancer

This model assumes that cancer comes out of the

blue. While the diagnosis may feel like that, in

actuality it takes years for most cancers to develop.

How we think about cancer

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Normal Cancer

Surgery

Chemotherapy

Radiation

How we treat cancer

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But what role does lifestyle play in the

development and treatment of cancer?

By changing what we eat and how we move,

can we reduce our likelihood of developing

cancer?

Could changing our diet & exercise patterns

help us even if we do get diagnosed with

cancer?

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Here is a different model for cancer

development & progression

Healthy cells

Dysplasia

Cancer in situ Dissemination

Distant

metastases

Local

disease

• Notice the arrows go in both directions

• This model shows that what we do– in terms of

lifestyle, screening and treatment– can affect

which direction we move on the spectrum

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Here is a different model for cancer

development & progression

Healthy cells

Dysplasia

Cancer in situ Dissemination

Distant

metastases

Local

disease

• The truth is, most cancers take years to develop

• By changing our lifestyle and adopting prevention

strategies, we can affect our likelihood of

developing cancer, and slow its progression

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What affects how we move along

this spectrum?

• Genetics & family history

• Exposures: tobacco, carcinogens, infections

• Nutrition & body weight

• Exercise

• Stress & social connectedness

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The role of genes

Deterministic…?

Or predictive?

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Maybe it depends

Genes may put us at increased risk, but lifestyle and

environment play a huge role as well

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The science of genetics vs

epigenetics

Only 5-10% of cancers are caused by inherited genetic

defects

That means that most cancers are due to changes that occur

during our lifetime

The science of epigenetics shows us that it’s not just the DNA

sequence (or gene) that determine our health, but how and if

these genes are expressed

Our lifestyle & our environment can change gene expression

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Food and gene expression and cellular function

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Food synergy: an operational concept for understanding nutrition. David R.J acobs Jr., Myron

D. Gross, and Linda C. Tapsell. AJCN 2009;89 (S)S-6S.Courtesy Annie Kay MS, RYT, RD

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When we eat this…

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2000

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2010

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

We get this

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And this: Diabetes in pandemic proportions

0 - 6.3

6.4 - 7.5

7.6 - 8.8

8.9 - 10.5

> 10.6

Source: www.cdc.gov/diabetes 2009 BRFSS Data

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And this…

Death rates from cancer by state, 2011

Source: www.cdc.gov:

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Obesity is associated with increased

risk of the following cancer types:

• Esophagus

• Pancreas

• Colon and rectum

• Breast (after menopause)

• Endometrium (lining of the uterus)

• Kidney

• Thyroid

• Gallbladder

Source: National Cancer Institute www.cancer.gov:

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One study estimated that in 2007 in

the United States, about 34,000

new cases of cancer in men (4

percent) and 50,500 in women (7

percent) were due to obesity alone.

Source: National Cancer Institute www.cancer.gov:

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But obesity might be more of a symptom

of the underlying conditions that cause

cancer, rather than the cause itself.

One study that looked at markers for

metabolic syndrome (a condition that

includes abdominal obesity, high blood

pressure, high triglycerides and insulin

resistance) is a better indicator of

cancer risk than obesity alone.

Source: International Journal of Epidemiology, 2015, 1–11 :

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In that study, metabolic risk score was

associated with increased risk of the

following cancers in men and women:

• Esophagus

• Pancreas

• Colon and rectum

• Breast (after menopause)

• Endometrium

• Kidney

• Thyroid

• Gallbladder

• Liver

• Cervical

• Oral

Source: International Journal of Epidemiology, 2015, 1–11 :

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But here’s the good news: metabolic

syndrome is highly depending on the

foods we eat and whether or not we

exercise.

By changing our lifestyle, we can

reduce our risk of cancer, just like we

can reduce our risk of developing heart

disease or Type 2 diabetes

Source: International Journal of Epidemiology, 2015, 1–11 :

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CV disease and cancer: common cause?

Incidence Rate of Cardiovascular Disease According to the Number of Ideal Health Behaviors and Health Factors

Age-, sex-, and race-adjusted incidence rate of cardiovascular disease according to the number of ideal cardiovascular health

behaviors (nonsmoking, body mass index, physical activity, healthy diet score) and health factors (total cholesterol, blood pressure,

glucose), ARIC (Atherosclerosis Risk in Communities), 1987 to 2007.

Figure Legend:

Source: J Am Coll Cardiol. 2011;57(16):1690-1696. doi:10.1016/j.jacc.2010.11.041

Community Prevalence of Ideal Cardiovascular Health, by the American Heart

Association Definition, and Relationship With Cardiovascular Disease

Incidence

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It showed that healthy behaviors lower risk

of both cardiovascular disease and cancer

There was an inverse association between the number of ideal cardiovascular health metrics and cancer incidence.

Participants meeting goals for 6-7 ideal health metrics (weight, blood pressure, diet) had 51% lower risk of cancer than those meeting goals for 0 ideal health metrics.

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Nutritional recommendations to prevent

cancer:

It’s actually not complicated:

Whole foods (not processed)

Mostly plants

Not too much

(Thank you, Michael Pollan!)

Source Michael Pollan In Defense of Food

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Like this:

Yum!!

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Exercise

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Exercise can reduce your risk of the

following cancers:

Colon

Breast

Endometrial

Prostate

Lung

Excellent data on secondary

prevention (recurrence) for

breast and colon as well

http://www.cancer.gov/cancertopics/factsheet/prevention/physicalactivity

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Yoga helps too!

Yoga improves mood in women

undergoing radiation and chemo and for

fatigued in breast cancer patients

Yoga also reduces anxiety in breast

cancer patients undergoing radiation and

chemo

Gentle yoga can be considered for the

treatment of sleep disruption that many

cancer patients experience

Source: SIO Clinical Practice Guidelines on the Use of Integrative Therapies

as Supportive Care in Patients Treated for Breast Cancer

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Meditation as adjunct therapy

Meditation, particularly mindfulness

based stress reduction, is

recommended for treating mood

disturbance and depressive

symptoms in breast cancer patients

Meditation can also improve quality of

life and reduce anxiety in breast

cancer patients

Source: SIO Clinical Practice Guidelines on the Use of Integrative Therapies

as Supportive Care in Patients Treated for Breast Cancer

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Social connectedness

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Social support and overall mortality

Strong relationships are good for us!

A meta-analysis of 148 studies and over 300,000 people

showed

A 50% increased likelihood of survival from all causes

for participants with stronger social relationships

Source: Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk:

A Meta-analytic Review. PLoS Med 7(7): e1000316. doi:10.1371/journal.pmed.1000316

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Stress does the opposite

Study of over 4000 men with prostate cancer in Sweden

Mean follow up 51 months

Men in the highest tertile of stress (self-reported) had a 66% increased risk of mortality than those in the lowest tertile

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Women with breast cancer need support

Women who went through their breast cancer diagnosis

and treatment alone were 4 times more likely to die of

their disease than women who were supported by 10 or

more friends or family members

Source: Journal of Clinical Oncology 24 no 7 (2006): 1105-11

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Integrated cancer prevention:

putting it all together

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Prostate Cancer Lifestyle Trial

This landmark study followed 93 patients with early stage prostate cancer over 2 years. The control group went about life as usual. The intervention group:

Followed a plant based diet

Got regular exercise

Did yoga (gentle asanas)

Learned mindfulness stress reduction

Attended weekly group support

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After one year:

PSA scores had decreased by 4% in intervention group, but increased by 6% in control group

6 patients in the control group needed radical prostatectomy, radiotherapy, or androgen deprivation but none in the lifestyle intervention required treatment

Changes in serum PSA and LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle.

Prostate Cancer Lifestyle Trial

Sources:Urology. 2008 Dec;72(6):1319-23. doi: 10.1016/j.urology.2008.04.050.

Epub 2008 Jul 7; J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70

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After 2 years:

13 of the 49 control patients (27%) vs only 2 of the 43 intervention group (5%) had undergone conventional prostate cancer treatment

Three of the treated control patients but none of the treated experimental patients had a PSA level of >or=10 ng/mL

Prostate Cancer Lifestyle Trial

Sources:Urology. 2008 Dec;72(6):1319-23. doi: 10.1016/j.urology.2008.04.050.

Epub 2008 Jul 7; J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70

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Bottom line:

Lifestyle changes can actually slow down the progression of prostate cancer. This is big news!

Imagine how these same measures could help improve prevent cancer from developing in the first place?

What other cancers might this type of intervention be helpful for?

Prostate Cancer Lifestyle Trial

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Integrated prevention and treatment

of cancer

Lifestyle matters!

Eat a whole foods, plant based diet

Exercise most days of the week

(150 min/week)

Reduce stress and increase social

connection

“Be kind to yourself and others

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Other resources

National Cancer Institute www.cancer.gov

www.cdc.gov

Institute for Responsible Nutrition

http://www.responsiblefoods.org

Physicians Committee for Responsible

Medicine http://www.pcrm.org/health

The Nutrition Center

www.thenutritioncenter.org

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Thank you!