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What does it take to live to 100 in relatively good health? Are there common psychological traits? A study looked at 29 rural Italians aged 90 to 101 and their 51 younger family members to try to answer that question. They found that the elderly  participants had worse physical health but better mental well-being than their younger family members.

The older adults had a positive attitude or positivity (resilience and optimism), they worked hard, and had strong bonds with family and religion. They also had a strong need for control (family members called them "domineering") and a love of the land. The researchers summarized: "Exceptional longevity was characterized by a balance between acceptance of and grit to overcome adversities along with a positive attitude and close ties to family, religion, and land, providing purpose in life." From Science Daily:

Common psychological traits in group of Italians aged 90 to 101

In remote Italian villages nestled between the Mediterranean Sea and mountains lives a group of several hundred citizens over the age of 90. Researchers at the University of Rome La Sapienza and University of California San Diego School of Medicine have identified common psychological traits in members of this group. The study, publishing in International Psychogeriatrics, found participants who were 90 to 101 years old had worse physical health, but better mental well-being than their younger family members ages 51 to 75.

"The main themes that emerged from our study, and appear to be the unique features associated with better mental health of this rural population, were positivity, work ethic, stubbornness and a strong bond with family, religion and land." There were 29 study participants from nine villages in the Cilento region of southern Italy. 

"The group's love of their land is a common theme and gives them a purpose in life. Most of them are still working in their homes and on the land. They think, 'This is my life and I'm not going to give it up,'" said Anna Scelzo, first author of the study with the Department of Mental Health and Substance Abuse in Chiavarese, Italy. Interview responses also suggested that the participants had considerable self-confidence and decision-making skills. "This paradox of aging supports the notion that well-being and wisdom increase with aging even though physical health is failing," said Jeste, also the Estelle and Edgar Levi Chair in Aging and director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego.

"We also found that this group tended to be domineering, stubborn and needed a sense of control, which can be a desirable trait as they are true to their convictions and care less about what others think," said Scelzo. "This tendency to control the environment suggests notable grit that is balanced by a need to adapt to changing circumstances." [Original study.

Rural village in the region of Cilento,  Italy. Credit: Wikipedia.

This is interesting, that blood pressure naturally starts lowering in the 14 to 18 years prior to death in people 60 years or older - whether they are healthy, have hypertension, have heart disease, take hypertension medicines or not.

The researchers analyzed 20 years of medical data for patients in the United Kingdom, and while everyone's blood pressure dropped for more than a decade before death, the decreases were "steepest in patients with hypertension, dementia, heart failure, and late-life weight loss". From Science Daily:

Blood pressure declines 14 to 18 years before death

Blood pressure in the elderly gradually begins to decrease about 14 or so years before death, according to a new study published today in the Journal of the American Medical Association Internal Medicine. Researchers from UConn Health and the University of Exeter Medical School in the U.K. looked at the electronic medical records of 46,634 British citizens who had died at age 60 or older. The large sample size included people who were healthy as well as those who had conditions such as heart disease or dementia.

They found blood pressure declines were steepest in patients with dementia, heart failure, late-in-life weight loss, and those who had high blood pressure to begin with. But long-term declines also occurred without the presence of any of these diagnoses.

Doctors have long known that in the average person, blood pressure rises from childhood to middle age. .... Some studies have indicated that blood pressure might drop in older patients and treatment for hypertension has been hypothesized as explaining late-life lower blood pressures. But this study found blood pressure declines were also present in those without hypertension diagnoses or anti-hypertension medication prescriptions. Further, the evidence was clear that the declines were not due simply to the early deaths of people with high blood pressure. [Original study.]

Interesting study results - being overweight (a higher body mass index or BMI) is linked to dementia more than 20 years later, but in the few years before dementia onset body mass index (BMI) is lower in those who develop dementia than in those who don't develop dementia. The researchers hypothesize that 2 processes are going on:  A higher BMI (overweight or obese) in mid-life is harmful (a direct effect), and then there is weight loss during the preclinical dementia phase. Bottom line: best is a normal weight in mid-life to try to prevent dementia later on in life. From Science Daily:

Obesity increases dementia risk

People who have a high body mass index (BMI) are more likely to develop dementia than those with a normal weight, according to a new UCL-led study. The study, published in the Alzheimer's & Dementia journal, analysed data from 1.3 million adults living in the United States and Europe. The researchers also found that people near dementia onset, who then go on to develop dementia, tend to have lower body weight than their dementia-free counterparts.

"The BMI-dementia association observed in longitudinal population studies, such as ours, is actually attributable to two processes," said lead author of the study, Professor Mika Kivimäki (UCL Institute of Epidemiology & Health). "One is an adverse effect of excess body fat on dementia risk. The other is weight loss due to pre-clinical dementia. For this reason, people who develop dementia may have a higher-than-average body mass index some 20 years before dementia onset, but close to overt dementia have a lower BMI than those who remain healthy."

In this study, researchers from across Europe pooled individual-level data from 39 longitudinal population studies from the United States, the United Kingdom, France, Sweden, and Finland. A total of 1,349,857 dementia-free adults participated in these studies and their weight and height were assessed. Dementia was ascertained using linkage to electronic health records obtained from hospitalisation, prescribed medication and death registries.

A total of 6,894 participants developed dementia during up to 38 years of follow-up. Two decades before symptomatic dementia, higher BMI predicted dementia occurrence: each 5-unit increase in BMI was associated with a 16-33% higher risk of this condition (5 BMI units is 14.5 kg for a person 5'7" (170 cm) tall, approximately the difference in weight between the overweight and normal weight categories or between the obese and overweight categories). In contrast, the mean level of BMI during pre-clinical stage close to dementia onset was lower compared to that in participants who remained healthy. [Original study.]

There are health benefits to having a dog, based on results from studies and testimonials from dog owners. Now a study of millions of Swedes found  that dog ownership is associated with a lower risk of cardiovascular disease (CVD) in single-person households and a lower risk of death from cardiovascular or other causes ("all cause mortality") in general. Owning a hunting dog breed had the strongest association with cardiovascular health. Some of these health benefits are due to dogs providing companionship, affection, and increased physical activity (all those walks) of their owners. And of course there's sharing of microbes. From Science Daily:

Dog ownership linked to lower mortality rate

A team of Swedish scientists have used national registries of more than 3.4 million Swedes aged 40 to 80 to study the association between dog ownership and cardiovascular health. Their study shows that dog owners had a lower risk of death due to cardiovascular disease or to other causes during the 12-year follow-upA total of more than 3.4 million individuals without any prior cardiovascular disease in 2001 were included in the researchers' study linking together seven different national data sources, including two dog ownership registers. 

"A very interesting finding in our study was that dog ownership was especially prominent as a protective factor in persons living alone, which is a group reported previously to be at higher risk of cardiovascular disease and death than those living in a multi-person household. Perhaps a dog may stand in as an important family member in the single households. The results showed that single dog owners had a 33 percent reduction in risk of death and 11 percent reduction in risk of cardiovascular disease during follow-up compared to single non-owners. Another interesting finding was that owners to dogs from breed groups originally bred for hunting were most protected," says Mwenya Mubanga, lead junior author of the study and PhD student at the Department of Medical Sciences and the Science for Life Laboratory, Uppsala University.

"These kind of epidemiological studies look for associations in large populations but do not provide answers on whether and how dogs could protect from cardiovascular disease. We know that dog owners in general have a higher level of physical activity, which could be one explanation to the observed results. Other explanations include an increased well-being and social contacts or effects of the dog on the bacterial microbiome in the owner," says Tove Fall, senior author of the study and Associate Professor in Epidemiology at the Department of Medical Sciences and the Science for Life Laboratory, Uppsala University. "There might also be differences between owners and non-owners already before buying a dog, which could have influenced our results, such as those people choosing to get a dog tending to be more active and of better health." [Original study.]

A large study by researchers at the State University of NY, of 65,869 postmenopausal women found that those who have a history  of gum or periodontal disease also have an overall higher risk of cancer. The women with a history of periodontal disease also had an increased risk for several specific cancers: breast, esophageal, gallbladder, lung and melanoma cancers. This cancer and gum disease association occurred in both nonsmokers and smokers.

How is periodontal disease "promoting" cancer? How it occurs is still unclear, but one theory suggests the gum disease bacteria are in the saliva, which is swallowed, and so the bacteria get into the gut, esophagus, or lungs. Or bacteria from diseased gum tissues get into "systemic circulation" and so get to distant sites in the body.  One of the researchers pointed out that "Certain periodontal bacteria have been shown to promote inflammation even in tiny amounts, and these bacteria have been isolated from many organ systems and some cancers including esophageal cancers."

From Medscape: Gum Disease and Increased Link to Many Cancers

Brushing, flossing, and regular dental checkups appear to do much more than maintain a healthy smile. Now, a large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gallbladder, and melanoma skin cancers.

The study authors note that these results add to the growing body of evidence from smaller studies and studies in men that link periodontal disease to total cancer risk. The Centers for Disease Control and Prevention (CDC) estimate that 47% of adults 30 years of age and older in the United States have some form of periodontal disease, ranging from mild to severe. At age 65 years and older, however, 70% of adults have moderate to severe periodontal disease, according to the CDC.

The study involved almost 66,000 postmenopausal women in the United States, who were enrolled in the ongoing Women's Health Initiative Observational Study (WHI-OS). During a mean follow-up of 8.32 years, the team identified 7149 cancers and found that periodontal disease history was associated with a 14% increased total cancer risk. When analyses were limited to 34,097 never-smokers, there was also an increased risk for overall cancer.

An association between periodontal disease and site-specific cancers was observed in breast, lung, esophageal, gallbladder, and melanoma skin cancers. There was a borderline association with stomach cancer, the study authors report, and periodontal disease was not associated with cancers of the pancreas; liver; lower digestive tract organs; or lip, oral cavity, and pharynx combined. Similarly, there was no association with genitourinary and lymphoid and hematopoietic malignancies.

For the study, the investigators looked at periodontal disease information in 65,869 women aged 54 to 86 years at 40 US centers. Mean age was 68 years. Most women were non-Hispanic whites with some college education. All participants answered the question "Has a dentist or dental hygienist ever told you that you had periodontal or gum disease? (No/Yes)" between 1999 and 2003 on the annual Year-5 WHI-OS follow-up questionnaire. Cancer outcomes were documented through September 2013 with a maximum 15-year follow-up period.

 Women who reported a history of periodontal disease were also more likely to report a history of smoking, secondhand smoke exposure, alcohol use, hormone therapy (estrogen plus progestin), and a cancer diagnosis, the study authors report. At the same time, no significant differences were observed in body mass index, physical activity levels, or history of diabetes between women with periodontal disease and those without. [Original study.]

It's reassuring to see that there are positive things one can do to maintain brain health as one ages. With normal aging, the brain typically shrinks a little with each passing decade  - starting from about the age of 40. But one recent Australian study, which reviewed the results of many other studies, found that exercise slows down this shrinkage in humans, specifically in the left hippocampus. That is, that aerobic exercise had a significant positive effect on the volume of the left hippocampus. This matches the result of animal studies.

The researchers pointed out that some studies found increases also in other parts of the human brain from exercise (e.g. in the white matter), but that they did not look at and review those studies. [See posts on research.] The good news is that positive effects were from exercise programs generally lasting less than 12 months. But it is unknown which type of exercise is best, or whether it is general "activity level and movement" that is most important. Bottom line: Get out there and move, move, move for brain health. And for cardiorespiratory fitness. It's all linked and it's all good. From Medical Xpress:

Exercise maintains brain size, new research finds

Aerobic exercise can improve memory function and maintain brain health as we age, a new Australian-led study has found. In a first of its kind international collaboration, researchers from Australia's National Institute of Complementary Medicine at Western Sydney University and the Division of Psychology and Mental Health at the University of Manchester in the UK examined the effects of aerobic exercise on a region of the brain called the hippocampus, which is critical for memory and other brain functions.

Brain health decreases with age, with the average brain shrinking by approximately five per cent per decade after the age of 40. Studies in mice and rats have consistently shown that physical exercise increases the size of the hippocampus but until now evidence in humans has been inconsistent.

The researchers systematically reviewed 14 clinical trials which examined the brain scans of 737 people before and after aerobic exercise programs or in control conditions. The participants included a mix of healthy adults, people with mild cognitive impairment such as Alzheimer's and people with a clinical diagnosis of mental illness including depression and schizophrenia. Ages ranged from 24 to 76 years with an average age of 66. The researchers examined effects of aerobic exercise, including stationary cycling, walking, and treadmill running. The length of the interventions ranged from three to 24 months with a range of 2-5 sessions per week.

Overall, the results – published in the journal NeuroImage– showed that, while exercise had no effect on total hippocampal volume, it did significantly increase the size of the left region of the hippocampus in humans.

"When you exercise you produce a chemical called brain-derived neurotrophic factor (BDNF), which may help to prevent age-related decline by reducing the deterioration of the brain," Mr Firth said. "Our data showed that, rather than actually increasing the size of the hippocampus per se, the main 'brain benefits' are due to aerobic exercise slowing down the deterioration in brain size. In other words, exercise can be seen as a maintenance program for the brain.".... Interestingly, physical exercise is one of the very few 'proven' methods for maintaining brain size and functioning into older age.

A recent study looked at 2 specific antioxidant levels in a variety of mushroom species. Mushrooms are an excellent source of nutrients, such as riboflavin and other B vitamins, selenium, copper, potassium, dietary fiber, as well as high levels of antioxidants ergothioneine (ERGO) and glutathione (GSH). The study found the highest levels of these antioxidants in yellow oyster and porcini mushrooms.

Ergothioneine (ERGO), which is found throughout the human body, is a critical antioxidant that acts with other antioxidants to protect against oxidative stress in the mitochondria (in our cells). What foods are good sources of ERGO? Mushrooms have the highest levels, but other foods with high ERGO content include red beans, black beans, kidney beans, oat bran, liver, and king crab.

Glutathione (GSH) is produced by the body and found in every cell - thus the major antioxidant within cells. It also helps the liver remove chemicals (detoxification) of a wide range of toxins, drugs, pollutants, and carcinogens, and maintenance of immune functioning. Low GSH levels are associated with increased risks for cancer, cardiovascular diseases, arthritis and diabetes. So you want to maintain optimal tissue levels of GSH (through dietary intake) because it is so critical for maintaining health. What foods are good sources of GSH? Mushrooms, and many fresh (raw) fruits and vegetables, including asparagus, avocados, potatoes, spinach, squash, tomatoes. Also fresh, uncooked meats and dairy products (raw milk) and eggs. From Science Daily:

Mushrooms are full of antioxidants that may have antiaging potential

Mushrooms may contain unusually high amounts of two antioxidants that some scientists suggest could help fight aging and bolster health, according to a team of Penn State researchers. In a study, researchers found that mushrooms have high amounts of the ergothioneine and glutathione, both important antioxidants, said Robert Beelman, professor emeritus of food science and director of the Penn State Center for Plant and Mushroom Products for Health. He added that the researchers also found that the amounts the two compounds varied greatly between mushroom species.

Beelman said that when the body uses food to produce energy, it also causes oxidative stress because some free radicals are produced. Free radicals are oxygen atoms with unpaired electrons that cause damage to cells, proteins and even DNA as these highly reactive atoms travel through the body seeking to pair up with other electrons. Replenishing antioxidants in the body, then, may help protect against this oxidative stress.

According to the researchers, who report their findings in a recent issue of Food Chemistry, the amounts of ergothioneine and glutathione in mushrooms vary by species with the porcini species, a wild variety, containing the highest amount of the two compounds among the 13 species tested. The more common mushroom types, like the white button, had less of the antioxidants, but had higher amounts than most other foods, Beelman said....Mushrooms that are high in glutathione are also high in ergothioneine, for example. Cooking mushrooms does not seem to significantly affect the compounds, Beelman said.

"It's preliminary, but you can see that countries that have more ergothioneine in their diets, countries like France and Italy, also have lower incidents of neurodegenerative diseases, while people in countries like the United States, which has low amounts of ergothioneine in the diet, have a higher probability of diseases like Parkinson's Disease and Alzheimer's," said Beelman. "Now, whether that's just a correlation or causative, we don't know." [Original study.]

The following study looked at genes and longevity. Researchers from the University of Edinburgh analysed genetic information from more than 600,000 people along with records of their parents' lifespan.

They found that the following factors were correlated with longevity: not smoking or giving up smoking, a higher educational attainment, openness to new experiences, and good cholesterol levels. On the other hand, the following factors were correlated with reduced longevity ("were negatively correlated"): genetic susceptibility to coronary artery disease (CAD), smoking, lung cancer, diabetes, and higher body fat. For example, 1 year of education adds 11 months to expected lifespan, and gaining weight reduces life-span (lose 2 months for every 2.2 lbs extra weight), while losing extra weight increases it. From Science Daily:

Learning and staying in shape key to longer lifespan, study finds

People who are overweight cut their life expectancy by two months for every extra kilogramme [2.2 lbs.] of weight they carry, research suggests. A major study of the genes that underpin longevity has also found that education leads to a longer life, with almost a year added for each year spent studying beyond schoolOther key findings are that people who give up smoking, study for longer and are open to new experiences might expect to live longer.

Scientists at the University of Edinburgh analysed genetic information from more than 600,000 people alongside records of their parents' lifespan. Because people share half of their genetic information with each of their parents, the team were able to calculate the impact of various genes on life expectancy. Lifestyle choices are influenced to a certain extent by our DNA -- genes, for example, have been linked to increased alcohol consumption and addiction. The researchers were therefore able to work out which have the greatest influence on lifespan.

They found that cigarette smoking and traits associated with lung cancer had the greatest impact on shortening lifespan. For example, smoking a packet of cigarettes per day over a lifetime knocks an average of seven years off life expectancy, they calculated. But smokers who give up can eventually expect to live as long as somebody who has never smoked. Body fat and other factors linked to diabetes also have a negative influence on life expectancy.

The study also identified two new DNA differences that affect lifespan. The first -- in a gene that affects blood cholesterol levels -- reduces lifespan by around eight months. The second -- in a gene linked to the immune system -- adds around half a year to life expectancy. Data was drawn from 25 separate population studies from Europe, Australia and North America, including the UK Biobank -- a major study into the role of genetics and lifestyle in health and disease.  [Original study.]

A number of recent studies have suggested that as people age, the community of gut microbes (gut microbiota or gut microbiome) becomes less diverse than in younger people. And note that greater gut microbial diversity is generally viewed as healthy and good. However, now a study done in China finds a different result. The study examined the gut microbes of more than 1000 very healthy people, from ages 3 to over 100, and found that the gut microbial communities were very similar among very healthy people in their mid 30s to over 100 years in age.

Whether this is cause or effect is unknown. But the researchers speculate that the similarities in the gut microbiota among people from their 30s to 100+ is a consequence of an active healthy lifestyle and diet. And it suggests that somehow changing an elderly person's gut microbial community (if it's not "normal") to that of a 30-year-old might help promote health. From Science Daily:

'Ridiculously healthy' elderly have the same gut microbiome as healthy 30-year-olds

In one of the largest microbiota studies conducted in humans, researchers at Western University, Lawson Health Research Institute and Tianyi Health Science Institute in Zhenjiang, Jiangsu, China have shown a potential link between healthy aging and a healthy gut.

With the establishment of the China-Canada Institute, the researchers studied the gut bacteria in a cohort of more than 1,000 Chinese individuals in a variety of age-ranges from 3 to over 100 years-old who were self-selected to be extremely healthy with no known health issues and no family history of disease. The results showed a direct correlation between health and the microbes in the intestine. ....The study, published this month in the journal mSphere, showed that the overall microbiota composition of the healthy elderly group was similar to that of people decades younger, and that the gut microbiota differed little between individuals from the ages of 30 to over 100.

"The main conclusion is that if you are ridiculously healthy and 90 years old, your gut microbiota is not that different from a healthy 30 year old in the same population," said Greg Gloor, the principal investigator on the study and also a professor at Western's Schulich School of Medicine & Dentistry and Scientist at Lawson Health Research Institute. Whether this is cause or effect is unknown, but the study authors point out that it is the diversity of the gut microbiota that remained the same through their study group.

"This demonstrates that maintaining diversity of your gut as you age is a biomarker of healthy aging, just like low-cholesterol is a biomarker of a healthy circulatory system," Gloor said. The researchers suggest that resetting an elderly microbiota to that of a 30-year-old might help promote health. "By studying healthy people, we hope to know what we are striving for when people get sick," said Reid. [Original study.]

Centenarian in Bama County, China. Credit: National Geographic.

For years medicine has viewed cancer as a "malignant seed" and looked for ways to kill these seeds before they spread throughout the body (metastasis). This past week two provocative articles stresses that we should also look at the "environments" that the cancer cells grow in - that some environments in the person nourish and encourage the growth of cancer, while other environments suppress the growth of cancer and don't allow its spread.

This is a very different approach to cancer, but it also makes sense. Studies find that small cancers can just sit there harmlessly or regress on their own - even breast and prostate cancers, but it raises the questions: Why? Why do they regress or are suppressed in some people, but grow malignantly in others? What is different about those people and their bodies?

Researchers are starting to do research along these lines - that is, looking at the environment that cancer may or may not grow in. Yesterday's post discussed amazing research showing that cancer tumors are continuously shedding cancer cells in a person's body, but only in some people do they actually take root and grow. It's as if some people have environments that encourage growth of cancer, while other people have environments that do not.

Today's article, besides discussing the micro-environment in which cancer grows, also discusses the role of inflammation in cancer and how things causing inflammation (e.g., smoking, inactivity, poor diet) are also associated with cancer. So some micro-environments are good for cancer, and some are not. Some of the research I've posted in the past has tried to see if influencing the person's environment with "lots of exercise and activity"(here and here), or vitamin D levels in the body, or a person's diet somehow prevents or keeps cancer in check. From Nautilus:

The Problem with the Mutation-Centric View of Cancer

To better understand and treat cancer, physicians need to stop oversimplifying its causes. Cancer results not solely from genetic mutations but by adapting to and thriving in micro-environments in the body. That’s the point of view of James DeGregori, a professor in the Department of Biochemistry and Molecular Genetics at the University of Colorado School of Medicine.... In our conversation, DeGregori expanded on how a renewed focus on micro-environments and Darwinian evolutionary pressures can benefit cancer research.

How should we study the origins of cancer? My lab has been researching the origins of cancers for the last 15 to 17 years. We’re trying to understand cancer from an evolutionary viewpoint, understanding how it evolves. A lot of people think about cancer from an evolutionary viewpoint. But what sets us apart is that we’ve really come to understand cancer by the context these cells find themselves in.

What’s an example of such a context? While other people will think about aging as the time for mutations to cause advantageous events [for cancer] in cells, we see aging as a very different process. It’s not about the time you get mutations—you get many mutations when you’re young. It’s the tissue environment for the cells that changes dramatically as we age. Those new tissue environments basically stimulate the evolution. So the evolution isn’t a process that’s limited by the mutation so much as a process that is limited by micro-environment changes.

Instead of just attacking the cancer, we should be altering the micro-environment to disfavor the cancer. What we’ve shown is that you could take the same oncogenic mutation and put it into young cells in a young environment and it’s not advantageous [for cancer]. It doesn’t cause expansions and it doesn’t cause the cancer. You make that same mutation in old tissue and it can be adaptive for cancer.

When we’re young, our tissues are relatively constant and well maintained. If you look at the tissues of a 20-year-old and a 35-year-old, or maybe even a 40-year-old, you wouldn’t notice much of a difference. It’s not like we age linearly. It’s only after 45 or 50 that we start to really go downhill. Then that downhill accelerates. As those changes happen, our tissues are no longer presenting that same environment to our cells. What I argue is that we evolve stem cells, or the cells that are continuously making our tissues, to be well adapted to the youthful environment and not to be well adapted to an aged environment.

I’ve been criticized as putting forward a straw man because, essentially, they don’t really talk about micro-environment. But to me that’s the whole point—there’s a major factor that should be considered, and I would say not just “should.” You can’t really model cancer without it and yet they’re not taking it into account. In other words, the difference between a smoker and a nonsmoker isn’t just that the smoker has more mutations. The difference is the smoker’s lung—and I’m sure you’ve seen pictures of the charred blackened lungs of a smoker—and that presents a completely different environment for cells with mutations.

How can your ideas change the way doctors treat cancer? Mostly we now target the cancer cells. That’s changing somewhat. Immune therapies are in some ways targeting the environment. It’s almost like a predator strategy. Instead of just attacking the cancer, we should be altering the micro-environment to disfavor the cancer. If you just attack the cancer, you immediately select for resistance, which is what they see in the clinic so often. You can get a person into remission, but it’s keeping them in remission that’s the hard part. Cancer that comes back is inevitably worse than the cancer you started with.

.... If we can understand what factor about a smoker’s lung, or an old person’s lung, leads to more cancer, then we could modulate that factor to basically prevent the cancers from occurring in the first place. If it’s inflammation, for all we know maybe there are even dietary interventions that will reduce inflammation in the lungs. All the things we know that are associated with cancer are also associated with increased inflammation. Everything we know that basically leads to longer, healthier lives, is known to modulate inflammation. Exercise reduces it. Good diet reduces it. Not smoking, not exposing yourself to too much sun.

 Cancer cells. Credit:Wikipedia, National Cancer Institute