Get Off My Case

In my inbox this morning, via ASCO‘s “Cancer in the News” feed:

The UK’s Telegraph (5/6, Beckford) reported that as “many as 20,000 British women could avoid developing” breast cancer “each year, if they took more exercise, drank less and ate better.” Latest figures “suggest that 47,600 women developed breast cancer in 2008,” and the World Cancer Research Fund estimates that estimates that “42 per cent of these cases…would be preventable if women developed healthier lifestyles.” The WCRF’s “10 Recommendations for Cancer Prevention include being ‘as lean as possible without becoming underweight’; keeping fit; limiting consumption of fatty, salty and sugary food and drink; eating fruit, vegetables and pulses; eating less red meat and processed meat; drinking less and choosing a balanced diet rather than vitamin supplements.”

This follows numerous reports that women may develop breast cancer or suffer recurrences because they eat too much, drink too much, work too much or fret too much. (But don’t relax and put down your vacuums, girls – there’s striking evidence that household chores can reduce your risk!)

Of course it’s wise from a general medical perspective – think in terms of heart disease, osteoarthritis, type 2 diabetes and other ailments prevalent in our too-developed world – to be slender instead of fat, exercise regularly and eat a balanced diet.

I’m tired of the press trumpeting poorly-done trials that feed into a stereotypic conception of how women should behave. Yes, diet and stress could play a role in any hormone-driven disease, but so do a lot of things. As for alcohol, maybe consumption is a surrogate for wealth and living in a place like the U.S. where people drink freely, where breast cancer rates are unseemly.

We should be sure of the facts before pronouncing these fatal flaws in our ways of existence and being. Plenty of women feel badly about their tumors and disfigurement without this added layer of insult.

And what did you eat for dinner last night, big brother?

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  • Elaine….thank you for this post! Don’t we already have ENOUGH cancer guilt, and now we have to step it up in the household chores department as well????

    But seriously, the mainstream media has a lot to answer for in terms of how it reports the breast cancer realm. Selective reports about lifestyle messages and meaningless “good news” statistics reports aren’t getting us anywhere in the fight to stem mortality from this disease. How about some balanced reporting about the challenges that remain, and a focus on the kinds of research that are still needed and how far we still have to go? Maybe then we might be able to gather enough support to actually move this gravy train forward.

    • Anna, Thanks for commenting here. I agree about media cov­erage of BC risks and selective reporting of research, along with bursts of hype that seems inex­plicable from my oncologist’s perspective.

    • This point seems right on, and typifies how people might confuse correlation with causation. If you have a link/reference for a par­ticular study on the subject of education and BC risk, I’d be interested in seeing that.

  • I get so tired of reading that about lifestyle changes reducing your risk for cancer. The studies just say that doing x will reduce your risk, but they never give a percentage by which doing x will reduce your risk. Without that how can you make a decision if it is really worth it to make a change? I think part of the reason such statistics are not given is people don’t understand the difference between absolute and relative risk.

    So eating broccolli will reduce my risk of developing cancer. Fine – tell me by how much (in relative terms) so I can decide it is worth while.

  • Lisae, Broccoli’s benefits remain elusive, a point I’ve considered here previously and mainly figuratively. Still, I suspect it’s good for us, in general at least.

  • Love this rant, Elaine, but arrrgh! The mass media love to over hype the simplest of things… correlation does not equal causation and some of these platitudes may be well meaning, but how many friends and family members do we all know who are slim, eat healthily, drink in moderation, exercise etc etc.

    Recently at the AACR annual meeting, out of 5000 excellent abstracts on cancer research, the media latched onto gastric cancer and beer as well as strawberries and oesophageal cancer. In the latter, the study was a small, less than 30 people, who ate freeze dried strawberries – certainly not the ripe luscious fruit the media plastered all over the news for several days. Sigh.

    Still, I loved this recent quote from Francis Collins at the NIH: “Anecdotes are not the plural of data” – so apt.

  • Ealine, broccoli was just an example. . .

    I’ll have to read what you said about broccoli, – a very good veggie. in any case.

  • As someone who’s been through breast cancer and does everything I can to make myself as healthy as possible, I’m sorry to say that I disagree with your stance on this!

    My oncologist recommended the book “Anti-Cancer: A New Way of Life” written by David Servan-Schreiber, MD, PhD. He challenges traditional oncology for its ongoing rejection of nutrition as a treatment and preventive measure with regard to cancer. He, himself, is a cancer survivor as well.

    I’ve been disappointed to find that many oncologists are not aware of this book and its empowering effect. For me, reading this book and realizing their was more that I could do, was the turning point of my despair over diagnosis. It helped to mobilize me, and countless others. Approaching my health with an awareness of nutrition and other lifestyle approaches definitely does not make me feel guilty.

    Also, there’s more research than you may be aware of–my dear friend, a physician, tells me often of her lack of knowledge of nutritional and holistic approaches. She spends all her time reading necessary journals and is not exposed to other points of view. She views this as a weakness in medicine.

    I hope you take the time to read Servan-Schreiber’s “Anti-Cancer” book. Even just read the review!!

  • Thanks for posting this, Elaine. I just love this blame-the-victim nonsense disguised as medical advice. I’m a physical therapist, and the year I was diagnosed, I was fit, at my ideal weight, happy, active, didn’t drink or smoke, and loved my job. And got it anyway.

    So much for that. Cancer happens. We humans like to think we can control everything, but guess what? We can’t. I see plenty of people in my practice every day who did nothing to bring on the Parkinson’s disease, multiples schlerosis, osteoporotic fractures, autombobile accidents, pneumonia, and cancers that they suffer through. I suppose it was Gabby Gifford’s fault for getting in the way of that gunshot to her head, too. She should have known better!


  • Kathi,
    Thanks so much for your comments here and on the last post. What can I say, except that I am very appreciative of physical therapists; they’ve helped me to walk, stand up straighter, and use my right arm after it was broken.

  • I’m in the middle on this one. The types of foods people eat, whether they contain pesticides, animal fats, antibiotics, trans-fats, sugars, etc. surely do impact overall health and may increase susceptibility to cancers. Folic acid has been found to mitigate the risks associated with alcohol consumption. Weight gain is associated with an increased risk of breast cancer. Exercise helps people to maintain weight, decreases cortisol levels, which in turn reduce risk of chronic illnesses. Yet, people who eat right, exercise, and have otherwise healthful behaviors can still get cancer. How does one make sense of this?

    I think the complexity of the situation gets lost in most media reports about diet and cancer. They are often simplified. Some are based on horrible studies. And the message is either one of “be happy, cancer is in your control;” or “poor you, you brought this on yourself.” Neither message is helpful.

    Food should be nourishing. It should help our immune systems to fight off disease. Clearly, the role of food in health and illness needs further study, but this is where researchers can’t just give the experimental group broccoli and the control group NO broccoli and expect a clear result. Foods work together. Diets are complex. Simplifying it too much is, I think, where much of the research on diet has failed. Food for thought!

  • Gayle,
    Thanks for your thoughts on this.

    As a doctor and as a patient, and probably even more so as a mom, I’m a firm believer in each person’s accepting (and taking) responsibility for their health. So yes, I agree that people should do what’s reasonable – including eating a balanced diet, using alcohol in moderation, exercising regularly, etc.

    But a lot of the lay literature, and some of the weaker medical articles on this, are bogus. Take Dr. Servan-Schreiber’s “anti-cancer” book, as mentioned above. In that, he recommends red wine as a good thing for keeping tumors away. But it seems like he advocates this because it fits with his personal lifestyle preferences. As an oncologist, I understand that the effects of red wine – if it does anything either way – would likely depend on the tumor type, the amount ingested, and the individual patient. It’s not simple.

    Same goes for diet, as you describe in your note. I’ll skip a long discourse on the immune system here, but that too could go either way, in terms of “boosting it” and the effects on a cancer.

    As you well know, plenty of women get BC or suffer recurrences even though they’ve done everything “right” by some book. And I’ve known who, then, felt really bad, like they weren’t good or strong enough to beat their cancer, a thought that can be psychologically devastating at the end of life.

    • Yes. Separating the forest from the weeds is challenging. So much gets lost in reporting. I’ve heard so many diagnosed say. “I’ve done everything right, but…” – feeling personally responsible at some level for causing their cancer. Across the board there is a need for solid bodies of evidence to support preventive efforts, diagnostics, and interventions. I’m glad you’re pressing the issue.

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