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Reducing your Risk of Cancer

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Published on August 30, 2012

Cancer affects more than 1.6 million new patients every year. How can you reduce your risk of becoming one of them? Dr. Diljeet Singh, program director for cancer prevention and integrative medicine at Banner MD Anderson Cancer Center, discusses what you can do to reduce your risk. Dr. Singh discusses a multitude of factors and emphasizes the importance of diet, exercise, and stress management. Dr. Singh also weighs in on obesity and the link to increased risk for recurring cancers. Of course, no lifestyle can guarantee that you won't develop cancer, so regular screenings and a robust dialog with your physician can help support early detection and treatment for some cancers.

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Transcript | Reducing your Risk of Cancer

Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello.  I’m Andrew Schorr for Banner MD Anderson Cancer Center.  And any of us who think about cancer want to prevent it if we can.  What can we do, what can we do with our doctor so that it does not happen to us. 

We’re going to talk about that with someone who is really in the know, and that’s Dr. Diljeet Singh.  She’s a gynecologic oncologist.  She’s also the director for cancer prevention and integrated medicine at Banner MD Anderson Cancer Center in Gilbert, Arizona.  Thank you so much for being with us, Dr. Singh.  

Dr. Singh:

Happy to be here. 

Andrew Schorr:

Dr. Singh, so all of us want to do everything we can so it doesn’t happen to us.  So let’s start with our lifestyle.  Tell us some of the things that we can do just every day that can lower our risk—that have been proven to lower our risk. 

Dr. Singh:

I think there’s a lot of important things.  Diet is very, very important, and we know that making sure, getting enough fruits and vegetables is important.  Trying to get your protein from healthy protein sources, so some plant sources like beans and lentils and tofu and things like that.  And then fish—having fish as a source of protein in your diet also.  And then getting your fats from healthy places too.  We know there are certain fats that are more healthy, what we call the Omega-3 fats, that come in olive oil and nuts and fish, that those are better for us and may reduce our risk of cancer.  So diet. 

And then the second thing I think of is physical activity.  There’s lots and lots of evidence that sort of—even a small amount of physical activity like 20 to 30 minutes three to four final times a week can decrease your risk of cancer and your risk of heart disease. 

And then the third thing I think of is the big category of stress management/social support.  There’s lots of evidence that people who manage their stress have decreased risk of cancer.  And stress is a funny thing.  Lots of people I talk to say, you know, I don’t have any stress, but as we think about it, like driving is stressful.  Driving turns on our stress nerve system and turns off our healing nervous system, so really small things like taking deep breaths, like laughter, like praying, like meditation, all of those things I think of as stress management.  And for a lot of people, working out is kind of a two-for; they get physical activity, and they get stress management out of it. 

Andrew Schorr:

Now, I know that when people are stressed they also can sometimes eat for comfort.  So where does obesity come in?  Is obesity a bad guy when it comes to cancer? 

Dr. Singh:

Absolutely.  Obesity is a really bad guy in three major ways.  So one is there’s probably some things about obesity itself that increases the risk of a lot of cancers, uterine cancer, postmenopausal breast cancer, colon cancer, gallbladder cancer, liver cancer.  And we keep adding to the list the more and more we study this. 

The other thing we know is that once people get cancer if they’re obese or even overweight that their chances of getting through surgery and chemo and radiation and all the other things that enable us to help people survive cancer, is harder.  All those things are harder if you’re overweight or obese.

And then the third thing is being obese increases your risk of a cancer coming back even if you successfully beat it sort the first time around.  So at all three places, obesity and being overweight are bad guys. 

Andrew Schorr:

I want to go back to diet.  So is someone who eats a steak or some beef like that with animal fat all the time more at risk than someone who is a strict vegetarian, or do we want to be in the middle somewhere?  What’s your thought about that? 

Dr. Singh:

I think we want to be in the middle somewhere.  You know, animal fats and animal products are a complicated thing.  For the longest time the way we raised our cattle or didn’t raise it, when cattle were grass fed, they were—the healthy fat I was talking about, the Omega-3s, they were Omega-3 dominant.  And as we changed the way we raised our cattle, that’s the thing that started making red meat bad for us.  As the healthy fats, the Omega-3s, got to be less and less a part of animal fat and the Omega-6s, the not healthy ones, increased, suddenly they became less healthy. 

So I think that on the other hand it’s very, very hard to get all the protein you need being a strict vegetarian.  There’s lots of evidence that protein is an important part of sort of normal metabolism and cell repair and all those things.  So I do think somewhere in between is good. 

Andrew Schorr:

Now, what about the way we cook our food?  So for instance in Arizona people might well many months of the year want to grill out a steak, and I’ve read reports sometimes that charcoal and things like that might be carcinogenic.  So what about that, or even if we fry or use different oils, does that make a difference? 

Dr. Singh:

So that’s all about fat content to some extent, the frying and using different oils.  So we can get around that by thinking of different ways to prepare it.  Now, the grilling meats and sort of that blackened thing that we see really does seem like there’s solid evidence to say that that is some kind of carcinogen.  Other really interesting data though is that if you marinate your meats and vegetables or whatever you’re grilling in red wine vinegar or vinegar solutions that it seems to decrease the negative effects we see.  So it gets kind of complicated because we don’t know the exact details of why, but I do say, if possible marinate whatever you’re going to grill beforehand, and then if you can sort of have things not get so blackened and try to avoid that blackened effect, you’re going to do better.  And then keep your eye out as we learn more and more about this.  I think we are going to figure out exactly what part of that process makes the risk of cancer higher and where those carcinogens come from and figure out ways to avoid that. 

Andrew Schorr:

What about alcohol use? 

Dr. Singh:

Alcohol use is complicated, and alcohol use is different for men and women.  The bulk of the data shows that probably, in men, a glass of red wine a day or so is good when it comes to cardiac protection.  The tricky part is breast cancer risks go up with alcohol use, and so especially in women I really sort of stick to saying a couple glasses of red wine a week are probably the healthiest thing to do.  But again, just like we were talking about meat, it’s all about moderation, right?  Anybody who is drinking a lot every day, there’s a lot of things that are not good for their health.  So I think that for now you sort of take the moderation message, and then in women sort of realize that there’s risks that are different than men. 

Andrew Schorr:

I want to ask you about one area where I’m willing to bet that you’ll say moderation does not apply, and that’s tobacco use. 

Dr. Singh:

I knew you were going to say that.  Yes.  Absolutely.  No tobacco is the answer on that one.  But I will say for people who are smokers, don’t give up.  The less you smoke the better, and if you can quit, over time you can get yourself back to the same level of risk as someone who—close to the same level of risk of someone who never smoked.  So absolutely.  Tobacco is one of those, none is the best, but less is better than more. 

Andrew Schorr:

Okay.  So less is better.  And exercise, you don’t have to feel like you have to run a marathon or maybe even walk all 18 holes of the golf course.  Whatever you do is to the good for exercise. 

Dr. Singh:

Absolutely, although one of the tricky parts is—for some people when they exercise they’re not actually getting the cardio part of the exercise.  So lots of us sort of say, okay, like if I walk for 20 minutes, right, doc, and they’ll walk for 20 minutes, but if you’re sort of chatting on the phone and strolling you’re not going to get the same benefit.  So I tell people if you’re going to do your 20 to 30 minutes of walking or running or whatever it is, you should be doing it enough—you should be a little out of breath enough that you can’t be talking on the phone. 

And for people who are just starting up an exercise plan I usually say do what we call intervals where you walk faster for five minutes and then sort of more of a normal pace and kind of go back and forth.  And even if maintaining five minutes of fast is hard, do a minute at a time and work your way up until you get to that—where you can do the whole 20 minutes at that higher pace.  =

Andrew Schorr:

All right.  Another big area of lowering your risk of developing cancer is screening.  So I’ve been through it a few times, many viewers have, and that is, for example, colonoscopy where I know the doctor is looking for precancerous polyps.  You’d endorse that of course. 

Dr. Singh:

Absolutely.  I think the two cancers that we’re really good at preventing are cervical cancer and colon cancer.  With colon cancer, exactly right.  We pick up precancerous changes and remove them before they even become cancer, or occasionally we pick up early cancer.  So following your healthcare provider’s recommendations for colonoscopy is really important.

Cervical cancer— it’s amazing.  Now we have a vaccine that if you get it at the right ages you substantially decrease your risk of even getting precancer.  Then pap smears and HPV tests are very good at picking up precancers.  Then we treat those before people even develop cancer. 

Some of the other screening that we do is more targeted on trying to pick up early cancers.  Mammography specifically and then breast awareness, both of those are targeted on trying to pick things up early when they’re curable. 

Andrew Schorr:

So anyone who has developed cancer, and we have about 12 million cancer survivors in the US, does not want a recurrence or develop another cancer.  All these things we talked about, healthy diet, exercise, that all applies to someone who has had cancer previously to try to lower their risk again.  Am I right? 

Dr. Singh:

Absolutely.  I mean, it’s one of the things that’s harder to study, but it makes sense that diet— and we’ve seen evidence that the combination of diet and exercise clearly decreases the chance of breast cancer coming back, decreases the chance of colon cancer coming back.  But probably for all cancers, again, it’s one of those things where you need to talk to your healthcare provider to figure out what your individual risks are, but there’s lots of things for cancer survivors that we can do that decrease the risk of the cancer coming back or getting a new, different cancer.  We know people who have lung cancer are at risk for getting a new lung cancer or at risk for getting head and neck cancers, so there’s different things we would do depending on what somebody—what somebody’s cancer was to make them at less risk for having it come back or getting a new one. 

Andrew Schorr:

Dr. Singh, I know this last area I’m going to ask you about is complicated, but many people take supplements.  They go to the health supplement store, and there are all sorts of claims, this will reduce your risk of cancer, this will reduce that risk.  What’s your overall feeling about that, and how can people get information that’s specific to their situation? 

Dr. Singh:

Ultimately a one-on-one consultation with a healthcare provider who has a really good understanding of this is the individualized answer to that. 

The general answer is think about whole foods.  If you can get your antioxidants from the fruits and vegetables you eat, if you can get your Omega-3 fats from the things you eat, from the fish, from the nuts, from olive oil, all of those things are better than supplements.  Supplements are really complicated, and some of the research shows that there actually is an increased risk of cancer associated with, for example high doses of synthetic beta carotene.  Even regular multivitamins, over-the-counter multivitamins have definitely not been shown to decrease the risk of cancer, and there are some cancers that they may increase the risk of, like lung cancer.  So I really push people to at least in general stay away from supplements. 

On the other hand, if there are things you’re missing from your diet, and if you talk with your provider together you guys figure out that there’s specific low vitamins or other things you need, then supplementation makes sense. 

One of the tough ones is vitamin D.  Most of where we get our vitamin D, some of it’s from diet, but a lot of it is from sun exposure, and in general I really encourage people to use sunscreens because of the risk of skin cancer.  So vitamin D is one of those things that lots of people do need to supplement.  But again, talk to your provider, get a vitamin D blood level, and then based on that people should figure out what kinds of supplements you should be taking. 

Andrew Schorr:

But as an integrative medicine specialist you study all this, and so that would be a discussion that someone could have for example with you. 

Dr. Singh:

Absolutely.  Absolutely. 

Andrew Schorr:

Thank you for helping us understand what we can do to lower our risk and then have a dialogue with our doctor.  Dr. Diljeet Singh, Banner MD Anderson Cancer Center, and the director of the cancer prevention integrative medicine program, thank you so much for being with us. 

Dr. Singh:

Thank you. 

Andrew Schorr:

Thank you, our audience, for joining us on Patient Power.  Remember, knowledge can be the best medicine of all. 


Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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