Download HOW YOUR LIFESTYLE CAN CAUSE OR PREVENT CANCER

4/30/2017
Lifestyle and Cancer Prevention
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LIFESTYLE AND CANCER
PREVENTION
CANCER SCREENING
SEMINAR
Prevention & Early Detection
Imam Reza Hospital
Ali Soroush
Department of Sports Medicine and
Rehabilitation, KUMS
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CONTENTS
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Cancer as a Global Health Concern
Healthy Lifestyle
Unhealthy Lifestyle
Lifestyle Risk Factors For Cancer
Avoidable Cancer Risk Factors
Recommendations
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REMEMBER!
“IT IS TRUE THAT WE ALL HAVE TO DIE
FROM SOMETHING, BUT THAT
SOMETHING CAN BE OLD AGE”
THE GOAL IS TO LIVE A LONG,
FIRST-CLASS LIFESTYLE, FREE OF
DISEASE
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Cancer?
Cancer is one of the prevalent
non-communicable diseases in
developed and under-developed
countries
Bektas M, Kudubes AA. Developing scales for the assessment of fatigue in
Turkish pediatric oncology patients aged 13-18 and their parents. Asian Pac J
Cancer Prev. 2014;15(22):9891–8
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Cancer Statistics
Cancer is the #1 cause of death
among working-age adults in the
United States.
One-third are caused by tobacco use
 One-third are related to overweight/obesity,
physical inactivity, and nutrition

“Two-thirds of cancer deaths can be preventable”
--John Seffrin, CEOAmerican Cancer Society
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Is cancer a big killer?
Cancer kills more people than AIDS,
malaria and TB combined
 Preventable and curable cancers will
continue to kill millions of people
worldwide

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WHAT IS CANCER ?

A COMPLEX BIOLOGICAL PROCESS THAT
MAY TAKE 10-40 YEARS BEFORE IT
MANIFEST
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IT IS INFLUENCED BY YOUR LIFESTYLE

STARTS OUT WITH DAMAGE TO A CELL
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CAN BE CAUSED BY BOTH EXTERNAL AND
INTERNAL FACTORS
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STAGES OF CARCINOGENESIS
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INITIATION – DNA DAMAGED BY CARCINOGEN
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PROMOTION - CELL REPLICATION
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PROGRESSION - INCREASED GROWTH
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METASTASIS - TUMOR SPREAD
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Prevention of cancer!

A cost-effective long-term strategy

30-40% of cancers can be prevented

One-third of cancers can be cured
through early diagnosis and treatment
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PRINCIPLES OF CANCER
PREVENTION
1. DECREASE EXPOSURE TO CARCINOGENS
2. CHANGE INTERNAL ENVIRONMENT OF THE
BODY SO THAT IT DOES NOT SUPPORT
CARCINOGENESIS
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MOST IMPORTANT WEAPON TO
PREVENT CANCER
Lifestyle!
Wright et al. Beliefs about weight and breast cancer: an
interview study with high risk women following a 12 month
weight loss intervention. Hereditary Cancer in Clinical Practice
(2015) 13:1
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WHAT IS LIFESTYLE ?
HOW WE LIVE OUR LIVES EVERYDAY
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THE POWER OF LIFESTYLE
TO PREVENT CANCER
70% REDUCTION IN CANCER RISK
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HEALTHY DIET
HEALTHY BODY WEIGHT
REGULAR PHYSICAL ACTIVITY
STOP SMOKING
REDUCE STRESS
ALCOHOL CONSUMPTION
…
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SCIENTIFIC OBSERVATION
(1970’s)
23 COUNTRIES WITH HIGH AND LOW CANCER RATES
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THE MORE ANIMAL PRODUCTS PEOPLE CONSUMED, THE
GREATER THEIR RISKS OF COLORECTAL, BREAST, OVARIAN
AND PROSTATE CANCER
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THE MORE FRUITS, VEGETABLES, WHOLE GRAINS AND FISH
PEOPLE CONSUMED, THE LOWER THEIR RISKS OF CANCER

PEOPLE WHO MIGRATED TOOK ON THE CANCER RISK OF
THE COUNTRY TO WHICH THEY MIGRATED
DOLL AND ARMSTRONG INT J CANCER, 1975:15, 617
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WORLD CANCER RESEARCH FUND
(1997)
INTERNATIONAL PANEL OF EXPERTS
COMPREHENSIVE REVIEW OF 250 CASE CONTROL
AND COHORT STUDIES
OVERALL CONCLUSION:
“THE GREATER THE CONSUMPTION OF FRUITS AND
VEGETABLES THE LOWER THE RISKS OF CANCER
OF THE MOUTH, PHARYNX, ESOPHAGUS,
STOMACH, COLON, RECTUM AND LUNG”
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Cancer Risk Factors
While you can’t change your genetics,
there are many things you can do to lower
your risk for cancer.
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Preventable risk factors
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Tobacco
Obesity
Physical inactivity
Alcohol
Sun exposure
Infections
Pollution
……
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ETIOLOGY
 The etiology of cancer is multifactorial,
with genetic, environmental, medical, and
lifestyle factors
 Most cancer is caused by genetic
mutations
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RISK FACTORS!
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Old age
Unhealthy lifestyle (Western lifestyle), Poor diet,
lack of physical activity, or being overweight
Environmental factors, defined broadly to include
tobacco use, diet, sunlight and infectious diseases.
Occupational carcinogens
Radiation
Family history of cancer (Genetic susceptibility)
Alcohol
Chemicals and other substance
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Risk Factor/ Cancer Type
Cancer Type
Risk Factor
Lung Cancer
Tobacco smoke
Radon
Asbestos and other substances
Air pollution
Breast
Radiation
Genetic changes (Inherited mutation)
Colorectal
Cancer polyp
Genetic alteration
Diet
Cigarette smoking
Ulcerative colitis or chon's disease
Prostate
Diet
Certain prostate changes
Race Africans Americans
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Risk Factor/ Cancer Type
Cancer Type
Risk Factor
Liver
Hepatitis viruses (HCV.HBV)
Pancreas
Smoking
Diabetes
Being male
Chronic pancreatitis
Kidney
Tobacco smoking
High blood pressure
Von-Hippel-Lindau syndrome (VHL)
Leukemia
Radiation
Chemotherapy
Certain disease (Down syndrome)
Human T cell leukemia virus
Myelodysplatic syndrome
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Risk Factor/ Cancer Type
Cancer Type
Risk Factor
Bladder
Occupation
Certain infection
Tobacco smoking
Race Twice as often as Africans Americans
Treatment with cyclophosphamide or arsenic
Uterine
Endometrial hyperplasia
Race Africans Americans
Hormonal replacement therapy
Obesity
Melanoma
Dysplastic nevi
Fai skin
Weakened immune system
Sever blistering/Sunburn
UV irradiation
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Source:http://ishwaryatechnosolutions.com/cancer.aspx
Avoidable Cancer Risk
Having a healthy diet, being physically active, and
maintaining a healthy weight may help reduce cancer
risk.
Eat well: A healthy diet includes plenty of foods
that are high in fiber, vitamins, and minerals.
Also, a healthy diet means limiting foods high in
fat
Be active and maintain a healthy weight
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LIFESTYLE PA IS RECOMMENDED
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THE CANCERS ASOCIATED
WITH DIET AND OVERWEIGHT
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BREAST (POSTMENOPAUSAL)
UTERUS
ESOPHAGUS
COLORECTAL
KIDNEY
PROSTATE
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At Present, There Are No
Nutritional Risk Factors for
 Brain
Cancer
 Leukemias
 Ovarian cancer
Source: American Cancer Society, accessed
2005
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Nutrition in the Etiology of Cancer–
cont’d
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Complex relationship
Dietary carcinogens: naturally occurring and
added in food preparation and preservation
Inhibitors of carcinogenesis: antioxidants,
phytochemicals
Enhancers of carcinogenesis
Latency period between initiation and promotion
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Energy Intake, Body Weight,
Obesity, and Physical Activity
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Energy restriction inhibits cancer and extends
life span in animals
Positive associations between overweight and
cancers
Overweight increases risk of cancer recurrence
and decreases survival
Physical activity is inversely associated with
cancer
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Nutrition and Cancer Etiology
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Fat
Protein
Soy and phytoestrogens
Carbohydrates: fiber, sugars, and
glycemic index
Fruits and vegetables
Nonnutritive sweeteners
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Color Code System of Vegetables
and Fruits
Color
Phytochemical
Vegetables and
Fruits
Red
Lycopene
Red/purple
Anthocyanins,
polyphenols
α-, β-carotene
Tomatoes and tomato
products, pink grapefruit,
watermelon
Berries, grapes, red
wine, prunes
Carrots, mangoes,
pumpkin
Cantaloupe, peaches,
oranges, papaya,
nectarines
Spinach, avocado,
honeydew, collard and
turnip greens
Cabbage, broccoli,
Brussels sprouts,
cauliflower
Leeks, onion, garlic,
chives
Orange
Orange/yellow
β-cryptoxanthin,
flavonoids
Yellow/green
Lutein, zeaxanthin
Green
Sulforaphanes, indoles
White/green
Allyl sulphides
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Data from Heber D: Vegetables, fruits and phytoestrogens in the prevention of diseases, F Postgrad Med 50:145, 2004.
Guidelines for Cancer Prevention
1.
2.
3.
4.
5.
6.
Choose a diet rich in a variety of plant-based foods.
Eat plenty of vegetables and fruits.
Maintain a healthy weight and be physically active.
Drink alcohol only in moderation, if at all.
Select foods low in fat and salt.
Prepare and store food safely.
And always remember . . . Do not use tobacco in any form.
From American Institute for Cancer Research: Simple steps to
prevent cancer, Washington, DC, 2000, AICR.
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Fat
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High intake of total and saturated fat is associated with
increased risk of breast, colon, lung and prostate
cancers
High fat diets are associated with obesity, which is
linked with cancer of the colon, rectum, esophagus,
gall bladder, breast, endometrium, pancreas, and
kidney
Higher omega-3 vs omega 6 may reduce risk of breast
cancer
Low fat diet (<20% fat) may reduce risk of recurrence
of breast cancer
Trabert B, et al, 2015. Metabolic syndrome and risk of
endometrial cancer in the united states: a study in the
SEER-medicare linked database. Cancer Epidemiol
Biomarkers Prev;24(1):261-7 .
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Serum Cholesterol Levels
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Abnormal serum cholesterol levels have
been assigned as a risk factor for cancer
But some studies show a discrepant result
Mandal CC, et al. 2016. Is cholesterol a mediator of cold-induced cancer?
Tumour Biol.
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β-carotene and α-carotene
and lower breast cancer risk
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The
data
indicate
that
higher
concentrations of plasma β-carotene and
α-carotene are associated with lower
breast cancer risk of estrogen receptornegative (ER-N) tumors.
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Bakker MF, et al.2016. Plasma carotenoids, vitamin C, tocopherols, and retinol
and the risk of breast cancer in the European Prospective Investigation into
Cancer and Nutrition cohort. Am J Clin Nutr.
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Vitamin D
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Experimental evidence has suggested
that vitamin D may be protective
against tobacco-related cancers through
the inhibition of the formation of tumors
induced by tobacco carcinogens
Deschasaux M, et al. 2015. Prospective associations between vitamin D status, vitamin Drelated gene polymorphisms, and risk of tobacco-related cancers.Am J ClinNutr. 2015
Nov;102(5):1207-15.
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Vitamin D
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So ensuring sufficient serum 25hydroxy vitamin D concentrations
might play an important role in
decreasing the risk of bladder cancer
Zhao Y, et al. 2015. Comparative efficacy of vitamin D status in reducing the
risk of bladder cancer: A systematic review and network meta-analysis.
Nutrition.pii: S0899-9007(15)00475-X.
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Vitamin D
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Vitamin
D
deficiency
appears
to
predispose individuals to increased risk of
developing a number of cancers
The current findings support the
application of 1,25D3 in cancer prevention
and treatment

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Ma Y, et al. 2016.Mechanistic Insights of Vitamin D Anticancer Effects.Vitam
Horm;100:395-431.
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Energy Intake and Physical Activity
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Total energy intake is strongly associated
with breast cancer in postmenopausal
women
Physical activity may have a protective
effect
Women who spent an average 3.8 hours per
week in physical activities had lower risk of
colon, reproductive cancers
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Lifestyle and Cancer
Prevention
Chan DS,et al, 2014. Body mass index and survival in women
with breast cancer-systematic literature review and metaanalysis of 82 follow-up studies. Ann Oncol;25(10):1901-14.
Obesity and Cancer: Mechanisms
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Adipose tissue is an active endocrine organ
Mechanisms by which adipose tissue may
influence cancer risk
- Production of sex steroid hormones (e.g., estrogen,
androgen)
- Effects on insulin sensitivity and production of insulinlike growth factors
- Actions on other hormones in adipose tissue (e.g.,
leptin, adiponectin)
- Increases in oxidative stress and chronic low-grade
inflammation that affect the body’s immune response
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Protein
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Difficult to isolate effects of protein, since ↑
protein diets are ↑ in fat and ↓ in fiber
Low protein diets seem to reduce the risk
while the risk is increased by very high protein
intakes
Increased meat intake is associated with
increased risk of colon cancer and advanced
prostate cancer
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Fiber
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Fiber-rich diets are associated with a
protective effect in colon cancer
Higher intakes of vegetables were
inversely associated with colon cancer
risk in several studies
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Carbohydrate and Glycemic Index
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High glycemic-index diet associated with
increased risk of cancers including
ovarian, endometrial, breast, colorectal,
pancreas, and lung
Limit processed foods and refined sugars
and emphasize whole grains and low GI
foods
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Fruits and Vegetables
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Fruits and vegetables found to be
associated with lower risk in 128 of 156
dietary studies
Increased consumption of fruits and
vegetables is associated with lower risk of
cancers of the oral cavity, esophagus,
stomach, colon, rectum, and bladder
Evidence less strong for hormone-related
cancers such as breast and prostate cancer
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Fruits and Vegetables
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Low in energy, good sources of fiber,
vitamins, minerals
Good sources of antioxidants (vitamins C, E,
selenium)
Good sources of phytochemicals such as
carotenoids, flavonoids, plant sterols, allium
compounds, indoles, phenols, terpenes)
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Calcium and Cancer Risk
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Several studies suggest that foods high in
calcium may reduce the risk for colorectal
cancer and that calcium supplements may
reduce the formation of colorectal polyps
Bottom line: get calcium through food sources
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Lycopene and Cancer Risk
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Lycopene is a red-orange carotenoid found in
tomatoes and tomato-based foods
Several studies show that consuming tomato
products reduces the risk of some cancers
Source: American Cancer Society, accessed 2005
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Preserved Meats and Cancer Risk
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preserved meat increases risk of colorectal
and stomach cancers
It could be due to nitrites
Nitrites can be converted in the stomach to
carcinogenic nitrosamines, which may
increase the risk of stomach cancer
Vegetables and fruit retard the conversion of
nitrites to nitrosamines
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Cooked Meat and Cancer Risk
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Frying, broiling, and grilling meats at
high temperatures creates chemicals
that might increase cancer risk
Use techniques such as braising,
steaming, poaching, stewing and
microwaving
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Soy and Cancer Risk
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Soy contains several phytochemicals
(phytoestrogens) which have weak estrogen activity
and appear to protect against hormone-dependent
cancers in animal studies
High doses of soy supplement may increase the risk
of estrogen-responsive cancers, such as breast or
endometrial cancers
Breast cancer survivors should consume only
moderate amounts
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Coffee and Tea
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Coffee has been investigated as a
possible risk factor for a variety of
cancers
Regular drinking of green tea and
other sources of polyphenols may
reduce the risk of stomach cancer
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Hyperinsulinemia and Cancer
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Increased BMI may promote hyperinsulinemia
and metabolic syndrome
Insulin resistance/hyperinsulinemia, higher
estrogen levels, and insulin-like growth factor I
may act synergistically to promote tumor
growth
Gen kinger JM, et al. 2015. Central adiposity, obesity during early adulthood, and pancreatic cancer mortality
in a pooled analysis of cohort studies. Ann Oncol. 2015 Nov;26(11):2257-66.
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Food Safety and Cancer
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Naturally occurring carcinogens (aflatoxins
in peanuts, safrol in plant oils, tannins in
grains and grapes, benzopyrene formed by
smoking meat and fish)
Naturally found in plant foods like celery,
parsley, figs, mustard, pepper, citrus oils
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American Cancer Society Guide to
Nutrition and Activity
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Choose whole grains in preference to processed
(refined) grains and sugars.
Choose whole grain rice, bread, pasta, and cereals.
Limit consumption of refined carbohydrates,
including pastries, sweetened cereals, soft drinks,
and sugars.
Choose fish, poultry, or beans as an alternative to
beef, and lamb.
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Say Researchers
“Our Chairs Are Killing Us”
Physical inactivity is annually responsible for more than 3
million deaths worldwide
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Lifestyle and Cancer
Prevention
Physical Activity for Cancer Prevention
A combination of aerobic AND resistance training
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Lifestyle and Cancer
Prevention
The Activity Pyramid
Lifestyle activity is at
the base of the
pyramid because it is
something that
everyone can do on a
regular basis.
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Lifestyle and Cancer
Prevention
PA RECOMMENDATIONS
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PA recommendations
Walking as a PA recommendation
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Lifestyle and Cancer
Prevention
Benefits of Increasing Post-Diagnosis PA
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Need to encourage cancer survivors to maintain (if active
prior to diagnosis) or increase physical activity after
diagnosis.
Physical activity is associated with numerous benefits
– Decreasing adverse side effects of surgery and treatment
– Improving quality of life and fatigue
– Improving fitness, functional capacity, and
body composition
– Decreasing serum hormones and growth
factors
– Improving cancer-specific survival and
all cause survival
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Stay physically active
•
•
Adults: Get a least 150 minutes of
moderate intensity or 75 minutes of
vigorous intensity activity each week,
spread throughout the week
Children and adolescents: Get 60
minutes/day of moderate to vigorous
physical activity each day, with vigorous
activity at least 3 days/week
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Physical activity and Cancer: Critical for weight
control, growth hormone regulation, stress
management, counteract fatigue, support
immune system , etc:

New Guidelines from the Dept of Health & Human
Services
Minimum 150 min moderate, or 75 min vigorous
to reduce risk of chronic disease
 Ideally aim for more – and necessary if weight loss
and maintenance of loss is the goal – 300 min of
moderate or 150 minutes of vigorous.

Physical activity linked to lower risk of breast, prostate
and colorectal cancer
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PA and Gastric Cancer
The study concluded that a
regular physical activity may be
protective against stomach cancer
risk
Abioye AI, et al. 2015. Physical activity and risk of gastric cancer: a meta-analysis of
observational studies. Br J Sports Med. 2015 Feb;49(4):224-9.
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Physical Activity during
Chemotherapy
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A systematic review indicates that
training during chemotherapy may
help in preventing the decrease in
muscle strength and endurance
capacity
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Van Moll C,et al, 2016. The effect of training during treatment with
chemotherapy on muscle strength and endurance capacity: A
systematic review. Acta Oncol. 12:1-8..
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Quality of Life and PA
The patients who met public health
physical activity recommendations
had significantly higher quality of life
(QoL) than those not meeting the
guidelines.

Murnane A, et al. 2015. Adolescents and young adult cancer survivors: exercise habits,
quality of life and physical activity preferences. Support Care Cancer.;23(2):501-10.
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Maintain a healthy weight
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•
•
•
•
Know your body mass index (BMI):
Below 18.5=underweight
18.5 to 24.9=normal weight
25.0 to 29.9=overweight
30.0 and above=obese
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BMI and Cancer Risk!
BMI is statistically significant
associated with colon cancer risk in
men
 Overall BMI attained at adulthood was
associated with colon cancer risk.

Steins Bisschop CN,etv al. 2014. Weight change later in life and colon and rectal cancer risk
in participants in the EPIC-PANACEA study. Am J Clin Nutr;99(1):139-47.
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Obesity

Obesity can induce a suitable micro environment for
the development of tumors, mainly by enhancing
the levels of oxidative stress and the concentrations
of hormones such as leptin, insulin and prolactin. all
together, these factors increase the probability of
cancer development.
Herrera-Covarrubias ,et al, Obesity as a risk factor in the development of
cancer, Rev Peru Med Exp Salud Publica. 2015
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Tobacco
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Tobacco kills more than 5 million people a year, an
average of one person every six seconds
It accounts for one in ten adult deaths worldwide
Tobacco use, particularly smoking, is the single
biggest cause of cancer in the world
Responsible for many type of cancers including
lung, mouth, throat, nose and sinuses, liver,
pancreas, stomach, cervix, breast, bowel, kidney
and bladder.
van Osch FH, et al. 2015. Significant Role of Lifetime Cigarette Smoking in Worsening
Bladder Cancer and Upper Tract Urothelial Carcinoma Prognosis: A Meta-Analysis. J Urol.
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Smoking and head and
neck cancers
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The data suggest that cigar and pipe
smoking are independently
associated with
increased risk of head and neck
cancers
Wyss A,et al. 2013. Cigarette, cigar, and pipe smoking and the risk of head and
neck cancers: pooled analysis in the International Head and Neck Cancer
Epidemiology Consortium. Am J Epidemiol.;178(5):679-90.
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Stopping smoking
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Numerous studies have shown that stopping
tobacco use and creating smoke free
environments greatly reduces the risk of
cancers and other short and long term health
risks
Stop smoking, chewing and sniffing tobacco
Try to avoid exposure to passive smoke
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Alcohol consumption
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Alcohol abuse has a major impact on public
health
It is ranked as the fifth leading risk factor for
premature death and disability in the world
However, trends indicate an increase in
alcohol consumption in recent decades,
mostly in developing countries
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Excessive alcohol intake
Can lead to:
 Weakening of heart muscle
 Hemorrhagic stroke
 Cirrhosis of the liver
 Pancreatitis
 Certain cancers
 Trauma
 Suicide
 Homicide
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Alcohol consumption
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Alcohol associated with carcinogenesis in
cancers of the mouth, pharynx, larynx,
esophagus, lung, colon, rectum, liver and
breast
Appears to act synergistically with tobacco
Malnutrition associated with alcoholism may
also be implicated
Chuang SC,et al, 2015. Alcohol consumption and liver cancer risk: a meta-analysis. Cancer
Causes Control.;26(9):1205-31
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Alcohol and cancer
recurrence and mortality
The data support that heavy alcohol
use increases the risk of cancer
recurrence and mortality

Mayadev J, et al.2015.Alcohol Abuse Decreases Pelvic Control
and Survival in Cervical Cancer: An Opportunity of Lifestyle
Intervention for Outcome Improvement. American Journal of
Clinical Oncology.
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Stop Alcohol
 Stop
or Limit alcohol
intake
 < 1 drink/day for women
 < 2 drinks/day for men

Women who consume 1 drink or more/day
have an increased risk of breast cancer
(10-40% increased risk)
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Drinking alcohol


The more alcohol a person consumes,
the higher the risk
Adequate folate intake (400mcg/d) may
reduce the increased risk of breast
cancer associated with alcohol use
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Drinking alcohol and
smoking

People who drink heavily in
combination with smoking are even at
higher risk for most of these cancers.
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THE POWER OF LIFESTYLE
TO PREVENT CANCER
70% REDUCTION IN CANCER RISK with




HEALTHY NUTRITION
EXERCISE ONE-HOUR DAILY
STOP SMOKING
REDUCE STRESS
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PRINCIPLES OF CANCER
PREVENTION
1. DECREASE EXPOSURE TO CARCINOGENS
2. CHANGE INTERNAL ENVIRONMENT OF THE
BODY SO THAT IT DOES NOT SUPPORT
CARCINOGENESIS
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Weight, Diet, PA and Cancer Prevention
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AICR GLOBAL REPORT RECOMMENDATIONS
Take home messages





Be as lean as possible without becoming
underweight
Be physically active
Avoid sugary drinks
Eat more of variety of vegetables, fruits,
whole grains and legumes such as beans
Stop or limit consumption of red and avoid
processed meat
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AICR GLOBAL REPORT RECOMMENDATIONS
(Cont)
Take home messages






If consumed at all, limit alcohol drinks
Limit consumption of salty foods
Don’t use supplements to protect
against cancer
Breastfeeding (reducing breast cancer
in mom and obesity in child)
Stop smoking
Get screened for cancer
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Have a healthy lifestyle
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