integrated cancer prevention

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  1. 1. 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
  2. 2. 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
  3. 3. 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
  4. 4. Normal Cancer Surgery Chemotherapy Radiation How we treat cancer
  5. 5. 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?
  6. 6. 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
  7. 7. 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
  8. 8. What affects how we move along this spectrum? Genetics & family history Exposures: tobacco, carcinogens, infections Nutrition & body weight Exercise Stress & social connectedness
  9. 9. The role of genes Deterministic? Or predictive?
  10. 10. Maybe it depends Genes may put us at increased risk, but lifestyle and environment play a huge role as well
  11. 11. 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 its 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
  12. 12. Food and gene expression and cellular function
  13. 13. 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
  14. 14. When we eat this
  15. 15. 2000 Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 54 person) 2010 1990 No Data 10.6 Source: www.cdc.gov/diabetes 2009 BRFSS Data
  16. 17. And this Death rates from cancer by state, 2011 Source: www.cdc.gov:
  17. 18. 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:
  18. 19. 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:
  19. 20. 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, 111 :
  20. 21. 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, 111 :
  21. 22. But heres 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, 111 :
  22. 23. 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
  23. 24. 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.
  24. 25. Nutritional recommendations to prevent cancer: Its actually not complicated: Whole foods (not processed) Mostly plants Not too much (Thank you, Michael Pollan!) Source Michael Pollan In Defense of Food
  25. 26. Like this: Yum!!
  26. 27. Exercise
  27. 28. 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
  28. 29. 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
  29. 30. 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
  30. 31. Social connectedness
  31. 32. 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
  32. 33. 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
  33. 34. 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
  34. 35. Integrated cancer prevention: putting it all together
  35. 36. 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
  36. 37. 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
  37. 38. 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
  38. 39. 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 c