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For those who need convincing that lifestyle can contribute to development of cancer or its prevention, new medical research has once again supported the importance of lifestyle choices. A report from Australian researchers (with similar findings as a study in the US) stated: an estimated 38% of cancer deaths and 33% of cancer diagnoses could have been prevented with healthy lifestyle choices.

And what were the lifestyle choices that are linked to cancer?  The researchers list 20 separate things (in 8 broad groups) that are known to cause or are linked to cancer. They are: tobacco smoke (smoking or second-hand smoke), dietary factors (low-intake of fruit, non-starchy vegetables, and dietary fiber; and high intake of red and processed meat), overweight/obesity, alcohol, physical inactivity, solar ultraviolet radiation, certain infections (they list 7 infections, such as human papillomavirus, hepatitis B, hepatitis C), and reproductive factors (lack of breastfeeding, menopausal hormone therapy use, combined oral contraceptive use). Note that they found that the #1 most important lifestyle factor is tobacco smoke - and it accounted for about 23% of all preventable cancer deaths in Australia. From Medscape:

One Third of Cancer Deaths Could Be Prevented by Lifestyle

As we head into the festive season, many are looking forward to the tradition of "Eat, drink, and be merry." But as another research paper shows that more than a third of cancer deaths could be prevented by lifestyle, maybe a qualifier should be added:"celebration in moderation." The latest statistics come from Australia, where researchers note that 44,004 cancer deaths occurred in 2013. But an estimated 38% of these deaths and 33% of cancer diagnoses could have been prevented with healthy lifestyle choices, says a research team led by Louise Wilson, MEpi, at the QIMR Berghofer Medical Research Institute and the University of Queensland, Brisbane.

These cancer diagnoses and deaths were seen in Australians of all ages and are directly attributable to 20 known modifiable risk factors within eight categories that are established causes of cancer, the study authors say. The report is published in the February 2018 issue of the International Journal of Cancer.

Smoking was the leading cause of preventable cancer death in Australia in 2013 and accounted for 23% of all cancer deaths. ...Three other categories of modifiable risk factors — poor diet, overweight/obesity, and infections — accounted for 5% of cancer deaths each. In a fifth category, alcohol-related cancer accounted for 2.4% of deaths. Physical inactivity factors were responsible for 0.8% of cancer deaths, overexposure to ultraviolet radiation for 3.2% of cancer deaths, and, in the eighth category, reproductive or hormonal factors were linked to 0.4% of cancer deaths.

In the diet category, risk factors include low intake of fruit, nonstarchy vegetables, and dietary fiber and high intake of red and processed meat. In the infection category, seven cancer-causing agents, including human papillomavirus (associated with cancer of the vulva, vagina, penis, anus, oral cavity, and oropharynx) and Helicobacter pylori (noncardia stomach cancer), are included. Lack of breastfeeding, use of menopausal hormone therapy, and use of combined oral contraceptive use (breast and cervical cancer) are listed as preventable risk factors in the reproductive category.

These findings are in keeping with other research on the role of modifiable lifestyle-related risk factors in cancer prevention. As previously reported by Medscape Medical News, results from a large cohort study in the United States led researchers to conclude that 20% to 40% of cancer cases and related mortality could be prevented by not smoking, maintaining a healthy weight, and exercising regularly. In another report, results from a national online survey undertaken by the American Society of Clinical Oncology showed that, like their Australian counterparts, most US adults don't know alcohol and obesity are major risk factors for cancer[Original study.]

A dividing lung cancer cell. Lung cancer is associated with smoking. Credit: National Institute of Health (NIH). 

 

There used to be alternative medicine, but it has evolved to what is now called integrative medicine. There are integrative centers even at some if the most prestigious medical institutions in the USA (Harvard, Mayo Clinic,etc). Integrative medicine is part of the medical establishment, so there is an emphasis on treatments that can be scientifically investigated, and conventional medical treatments are also used as needed. But there is a concern with wellness, with looking at the whole body, at prevention and treating chronic diseases (such as heart disease and diabetes) that take years to develop and are tied to the ways people think, feel, and live their everyday lives (so they look at stress, diet, lifestyles).

What I especially like is the quote taught in medical schools: “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half.” That alone is a good reason for a person to take responsibility for living the most healthy lifestyle that they can (to focus on wellness and prevention), rather than depending on medicines for "treatments" and "cures". Excerpts from The Atlantic:

The Evolution of Alternative Medicine

Back in the 1990s, the word “alternative” was a synonym for hip and forward-thinking.... That was the decade when doctors started to realize just how many Americans were using alternative medicine, starting with a 1993 paper published in The New England Journal of Medicine. The paper reported that one in three Americans were using some kind of “unconventional therapy.” Only 28 percent of them were telling their primary-care doctors about it.

Enough Americans had similar interests that, in the early 1990s, Congress established an Office of Alternative Medicine within the National Institutes of Health. Seven years later, that office expanded into the National Center for Complementary and Alternative Medicine (NCCAM), with a $50 million budget dedicated to studying just about every treatment that didn’t involve pharmaceuticals or surgery—traditional systems like Ayurveda and acupuncture along with more esoteric things like homeopathy and energy healing.Some thought the NCCAM’s work was too far outside the mainstream....

In an email, Briggs confirmed that her center’s mission has shifted over the years...”That change became more pronounced a few months ago, when Congress removed the word “alternative” from the NCCAM’s name, redubbing it the National Center for Complementary and Integrative Health (NCCIH). 

The idea of alternative medicine—an outsider movement challenging the medical status quo—has fallen out of favor since my youth. Plenty of people still identify strongly with the label, but these days, they’re often the most extreme advocates, the ones who believe in using homeopathy instead of vaccines, “liver flushes” instead of HIV drugs, and garlic instead of chemotherapy. In contrast, integrative doctors see themselves as part of the medical establishment. “I don’t like the term ‘alternative medicine,’” says Mimi Guarneri, a longtime cardiologist and researcher who founded the Academy of Integrative Health and Medicine as well as the integrative center at Scripps. 

After visiting the NIH center and talking to leading integrative physicians, I can say pretty definitively that integrative health is not just another name for alternative medicine. There are 50 institutions around the country that have integrative in their name, at places like Harvard, Stanford, Duke, and the Mayo Clinic. Most of them offer treatments like acupuncture, massage, and nutrition counseling, along with conventional drugs and surgery.

The actual treatments they use vary, but what ties integrative doctors together is their focus on chronic disease and their effort to create an abstract condition called wellness. In the process, they’re scrutinizing many therapies that were once considered alternative, subjecting them to the scientific method and then using them the same way they’d incorporate any other evidence-based medicine.

It’s hard to talk about integrative health without using abstract terms like wellness, vitality, and healing...For a long time, though, the medical profession was so busy treating acute illness that it didn’t put as much attention on preventing heart disease, diabetes, or cancer...The bigger problem, says Hyman, is that most doctors aren’t well equipped to treat chronic disease. “We have an acute-disease system for a chronic-disease population,” he told me. “The whole approach is to suppress and inhibit the manifestations of disease.” 

The question is how integrative doctors try to restore balance—and the answer varies. Many of them focus on diet to a degree that goes far beyond the usual guidelines about avoiding salt or trans fat. They’ll look for undiagnosed food sensitivities or hormonal imbalances, with the idea that these problems account for many chronic health complaints and cause even more serious breakdowns over time. There’s a lot of emphasis on intestinal bacteria. “We now know that so many separate things are linked to what’s going on in the gut,” Hyman told me, alluding to a growing body of literature linking the microbiome to everything from cancer to mood disorders. Guarneri, the cardiologist who founded the integrative center at Scripps, told me integrative health is highly personalized

Integrative doctors tend to favor treatments that are—as Briggs, the NCCIH director, put it—“amenable to scientific investigation.” Several of the doctors I interviewed told me they don’t prescribe homeopathic remedies, for instance, because there’s no evidence to support them....When integrative doctors do employ alternative-seeming treatments, it’s usually to manage pain or reduce stress. 

Aside from these variations, there’s another reason it’s hard to define integrative health: It doesn’t exist in a vacuum. Its practitioners are part of the same medical establishment as other doctors, going to the same conferences and publishing in the same journals. They’ve influenced and been influenced by major trends in medicine—for instance, the movement toward patient-centered medicine, or the backlash against the overuse of drugs and surgery that the New Yorker writer Atul Gawande calls “the epidemic of unnecessary care.”

Data: CDC Report on Multiple Chronic Conditions Among Adults; Chart: Lauren Giordano / The Atlantic

When Blackwelder teaches family medicine at East Tennessee University, he says he reminds his students to stay open to treatments that once seemed esoteric, as long as they show some promise. “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half,” he says. “We find things out by remaining inquisitive, being open to exploring new ideas when a question is asked. We should never just say we’ve got it all figured out, because we rarely do.”At a time when one in two American adults has at least one chronic disease, it’s safe to say there are a lot of things medicine still hasn’t figured out. 

This is Part 2 on how lifestyle influences aging. Many recent research reports tell of a link between our lifestyle and how we'll age - whether we'll be active and healthy well into our 80s or in terrible shape and dying young. Mind you, these are not "definites" because nothing can give you a guarantee, but they are ways we can improve our odds in living the long and healthy life that we want. From February 2014 Medscape:

Cancers Caused by Lifestyle Behaviors: Experts Urge Action

In launching the World Cancer Report 2014 earlier this week, the editors emphasized the need for prevention and highlighted lifestyle behaviors that lead to cancer, including smoking tobacco, drinking alcohol, overweight/obesity, and lack of exerciseThe report, issued by the International Agency for Research on Cancer (IACR), contains contributions from more than 250 scientists worldwide, many of them leading experts in their fields. 

In the United States, 1 in 3 cancer deaths is related to obesity, poor nutrition, or physical inactivity, and the problem will only increase as more countries and regions adopt the diet and lifestyles of more economically developed economies."

Tobacco, both smoked and smokeless, remains the world's leading cause of cancer morbidity and mortality, the report notes. The IACR and also the US Surgeon General have concluded that the relationship with smoking is causal for cancers of the nasal and oral cavities, hypopharynx, larynx, trachea, esophagus, lung, bronchus, bone marrow (leukemia), stomach, kidney, pancreas, ureter, uterus, bladder, and cervix. The IACR expands this list to also include paranasal sinuses, liver, colon, rectum, and ovary (mucinous), but says it is unclear if there is a link with breast cancer.

Still under-recognized, and not acted on, is the association between drinking alcohol and cancer. The agency says cancers caused by drinking alcoholic beverages include those of the oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast.

Excess body fat increases the risk for cancers of the esophagus, colon, pancreas, endometrium, and kidney, as well as postmenopausal breast cancer. The evidence for obesity increasing the risk for these cancers is "convincing," the agency comments, and there is a dose–response relationship, so being overweight is less risky than being obese.

Regular physical activity reduces the risk for multiple cancers by contributing to weight control, and also reduces the risk for colorectal and breast cancer by additional mechanisms. The general consensus among researchers is that exercise should be of moderate intensity and average at least an hour each day.

High consumption of red meat, especially processed meat, is associated with a risk for colorectal cancer. "A diet high in fruit and vegetables and whole grains does not appear to be as strongly protective against cancer as initially believed," the report notes. "However, this dietary pattern is still advisable because of the benefits for diabetes and cardiovascular diseases, and some possible reductions in cancer incidence."

From Science Daily:

Watching too much TV may increase risk of early death: Three hours a day linked to premature death from any cause

Adults who watch TV three hours or more a day may double their risk of premature death from any cause. Researchers suggest adults should consider getting regular exercise, avoiding long sedentary periods and reducing TV viewing to one to two hours a day.

Results of a large study published in the Mayo Clinic Proceedings. From Science Daily:

Large waist linked to poor health, even among those in healthy body mass index ranges

Having a big belly has consequences beyond trouble squeezing into your pants. It’s detrimental to your health, even if you have a healthy body mass index (BMI), a new international collaborative study has found. Men and women with large waist circumferences were more likely to die younger, and were more likely to die from illnesses such as heart disease, respiratory problems, and cancer after accounting for body mass index, smoking, alcohol use and physical activity.

Some good news for those who have to sit for long periods every day at work - being physically fit may help. From Science Daily:

Physical fitness associated with less pronounced effect of sedentary behavior

Physical fitness may buffer some of the adverse health effects of too much sitting, according to a new study. Sedentary behavior has been linked to an increase risk of obesity, metabolic syndrome, type 2 diabetes mellitus, cardiovascular disease, some cancers, and premature death. But previous studies of the association have not taken into account the protective impact of fitness, a strong predictor of cardiovascular disease incidence and mortality.

I've been seeing research report after report looking at how our lifestyle determines how we'll age - whether we'll be active and healthy well into our 80s or in terrible shape and dying young. Mind you, these are not "definites" because nothing can give you a guarantee, but they are ways we can improve our odds in living the long and healthy life that we want. From Medical Xpress:

A healthy lifestyle adds years to life

Live longer thanks to fruit, an active lifestyle, limited alcohol and no cigarettes. This is the conclusion of a study by public health physicians at the University of Zurich who documented for the first time the impact of behavioural factors on life expectancy in numbers. 

...Brian Martin and his colleagues from the Institute of Social and Preventive Medicine (ISPM) at the University of Zurich have examined the effects of these four factors – both individual and combined – on life expectancy. An individual who smokes, drinks a lot, is physically inactive and has an unhealthy diet has 2.5 fold higher mortality risk in epidemiological terms than an individual who looks after his health. Or to put it positively: "A healthy lifestyle can help you stay ten years' younger", comments the lead author Eva Martin-Diener.

"The effect of each individual factor on life expectancy is relatively high", states Eva Martin-Diener. But smoking seems to be the most harmful. Compared with a group of non-smokers, smokers have a 57 percent higher risk of dying prematurely. The impact of an unhealthy diet, not enough sport and alcohol abuse results in an elevated mortality risk of around 15 percent for each factor.

According to Martin an unhealthy lifestyle has above all a long-lasting impact. Whereas high wine consumption, cigarettes, an unhealthy diet and physical inactivity scarcely had any effect on mortality amongst the 45 to 55-year-olds, it does have a visible effect on 65 to 75-year-olds. The probability of a 75-year-old man with none of the four risk factors surviving the next ten years is 67 percent, exactly the same as the risk for a smoker who is ten years younger, doesn't exercise, eats unhealthily and drinks a lot.

From Medical Xpress:

Picking up healthy habits in your 30s and 40s can slash heart disease risk

The heart is more forgiving than you may think—especially to adults who try to take charge of their health, a new Northwestern Medicine study has found. When adults in their 30s and 40s decide to drop unhealthy habits that are harmful to their heart and embrace healthy lifestyle changes, they can control and potentially even reverse the natural progression of , scientists found. On the flip side, scientists also found that if people drop  or pick up more bad habits as they age, there is measurable, detrimental impact on their coronary arteries.

For this paper, scientists examined healthy lifestyle behaviors and coronary artery calcification and thickening among the more than 5,000 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study who were assessed at baseline (when participants were ages 18 to 30) and 20 years later.The healthy  assessed were: not being overweight/obese, being a nonsmoker and physically active and having low alcohol intake and a healthy diet. 

By young adulthood (at the beginning of the study), less than 10 percent of the CARDIA participants reported all five healthy lifestyle behaviors. At the 20-year mark, about 25 percent of the study participants had added at least one healthy lifestyle behavior. Each increase in healthy lifestyle factors was associated with reduced odds of detectable  and lower intima-media thickness—two major markers of cardiovascular disease that can predict future cardiovascular events. Adulthood is not too late for healthy behavior changes to help the heart."

"That loss of healthy habits had a measurable negative impact on their coronary arteries," Spring said. "Each decrease in healthy lifestyle factors led to greater odds of detectable  calcification and higher intima-media thickness.

Spring said the healthy changes people in the study made are attainable and sustainable. She offers some tips for those who want to embrace a  at any age:Keep a healthy body weight; Don't smoke; Engage in at least 30 minutes of moderate to vigorous activity five times a week; No more than one alcoholic drink a day for women, no more than two for men; Eat a healthy diet, high in fiber, low in sodium with lots of fruit and vegetables.

From Science Daily:

Adults who lose weight at any age could enjoy improved cardiovascular health

Weight loss at any age in adulthood is worthwhile because it could yield long-term heart and vascular benefits, suggests new research. For the first time, the findings indicate that adults who drop a BMI category -- from obese to overweight, or from overweight to normal -- at any time during adult life, even if they regain weight, can reduce these cardiovascular manifestations. The findings are from a study examining the impact of lifelong patterns of weight change on cardiovascular risk factors in a group of British men and women followed since birth in March 1946.