Cancer- Should Money Be Spent on Prevention or Therapy?

[haha]

Maybe we should call a truce in the War on Cancer and concentrate on prevention. Besides smoking, the most preventable cause of cancer seems to be obesity. It is generally thought that obesity may account for about a third of many cancer types, particularly breast, colon, uterus, kidney and esophagus. Obesity is a risk factor for type II diabetes and these patients are not only more likely to get cancer, but to have poor outcomes. Other speakers will explore the relationship of obesity and cancer, the epidemiology and the science, and see if this lends support to any practical prevention measures.""-Gary Abrass, MD

The War on Cancer « The Eating Academy | Peter Attia, M.D. The Eating Academy | Peter Attia, M.D.

This article says that obesity is becoming second only to smoking as a cause of cancer. I think smoking and obesity should be fairly amenable to modification, and likely very worthwhile to do that for the individual and the society.

Thinking about the thread about low carb, one thing jumps out-it is easy to find embarrassing pictures of low carb gurus looking fat. However, when studies are done, it seems like low carb diets are more effective and helping people lose weight, and keep a fair amount of it off.

IMO, there is absolutely no doubt that almost any diet that reduces amount eaten will cause weight loss. Opening your eyes in any third world country that is still poor will demonstrate that. But will that work for people in advanced countries who will always be able to get plenty calories unless something very large happens to mess up our food system? I strongly doubt it, becasie it will take too much will power for most people day to day.

Ha

 

[jerome len]

I think we have to continue our war on cancer and continue to warn on smoking and obesity. I've know thin friends that have developed prostate, brain and breast cancer that were neither obese nor smokers.

Within the past month a distant family member passed from brain cancer, 48 years of age and never smoked. Why? that's what his kids are asking today. All of us that have health are lucky.......some lose health through no fault of their own. Yes, I hate to see people clogging their veins with fat or smoking away and then we have to pay their medical bills........I wouldn't want to live in a country, however, that controlled our actions more than we are controlled today......and, we have to continue to look for cures so we can "almost eliminate cancer the way we have eliminated polio.

Again, I am very thankful for my health and the health of my family.

 

[samclem]

IMO, there is absolutely no doubt that almost any diet that reduces amount eaten will cause weight loss. Opening your eyes in any third world country that is still poor will demonstrate that. But will that work for people in advanced countries who will always be able to get plenty calories unless something very large happens to mess up our food system? I strongly doubt it, becasie it will take too much will power for most people day to day.

Maybe gastric bypass surgery will come to be seen as a far more normal response to this very unnatural cheap, abundant food environment. People are struggling against the "wiring" (psychological and metabolic) of millions of years of evolution that tell us to eat high calorie foods when we can get them, and bodies that use this energy efficiently and which are programmed to store excess immediately and let it go only reluctantly. A pharmaceutical answer would be cheaper and probably reversible, but for now there's a permanent surgical approach to a chronic, permanent problem.

Cancer: I guess we should keep applying efforts to the most "do-able" problems (even if the data comes from epidemiology and we have only a foggy idea of the "why it works") while we work to understand the genesis and mechanics of the disease(s) to get better prevention and treatments.

 

[M Paquette]

Prevention is certainly important, and cheaper than treatment. One tube of Efudex costs as much as a decades worth of sunblock. One Mohs surgery costs much more than a lifetime supply of sunblock.

That said, the cellular anomalies that lead to cancer are not 100% preventable. Even the normal internal biological processes, screened from all external influences, have a small error rate that includes flaws leading to cancer. Cancer is an inevitable byproduct of living long enough and not being done in by something else.

So, I'm a big fan of prevention where we know how, and research for cures or other corrective technology for the inevitable cellular errors that lead to cancer.

 

[ShortInSeattle]

Prevention is key, but it might require a personality transplant for most Americans. It's hard to get people to give up (or greatly reduce) their fast food & sodas. It's easier to float along and assume medicine will save you if needed.

We don't know enough about cancers to prevent them all, but perhaps some better health & nutrition classes in school? Should we reinvent and bring back home ec?

These days I see little difference between soda/candy advertising and cigarette advertising. And the latter is prevalent in schools. Plus you have the machines right there. (shudder)

 

[Amethyst]

As I think we are all aware, overeating has a much better PR lobby than smoking could ever hope for - because, while nobody has to start smoking if they don't want to, we all must eat!

Somewhere recently, I read that a significant percentage of obese people have perfectly normal blood-analysis numbers, including normal blood sugar. This link is not to the cited study, but says something similar:

Obese and Healthy?

There is, moreover, a significant "fat acceptance" propaganda movement, which started out as a justifiable backlash against judging fat people (especially women) by their looks and has grown into something much more comprehensive:

Fat acceptance movement - Wikipedia, the free encyclopedia

So, between the uncertainty of the fat-disease link, and the dynamism of the pro-fat lobby, I'm not looking for society to generate the "will" to reduce (let alone eliminate) overeating and overweight, even though the last two generations have, I think, achieved wonders in reducing smoking in the developed world.

Amethyst

 

[Bestwifeever]

If the rate of obesity is way up but cancer has still dropped by 5 percent, then maybe the War on Cancer has not been completely ineffective.

 

[haha]

If the rate of obesity is way up but cancer has still dropped by 5 percent, then maybe the War on Cancer has not been completely ineffective.

Are you certain that the incidence of cancer ex lung cancer is down? Or perhaps just the death rates are down.

Ha

 

[ohyes]

I found this thread so timely--and always do when i have a story to share- but this blew my mind.

A former co-worker posted on FB Thursday that her DH was having lapband to "control his diabetes". I sent her a message, that i would pray, let me know if there was anything I can do and "Hey, I did not know K had diabetes! Since when?"

Her answer: It was diagnosed seven years ago but he pretended he did not have it.

Lapband seems so much more difficult than changing eating habits. Perhaps not...I have not been there. Still, it rendered me speechless. My maternal grandmother lived to 86 with Type 1 diabetes. She was oh, so very careful with her diet and exercise.

 

[Bestwifeever]

Are you certain that the incidence of cancer ex lung cancer is down? Or perhaps just the death rates are down. Ha

It is from your link, that the death rate from cancer is down 5 percent. So I am thinking the war on cancer can't be totally ineffective (if obesity is a risk factor for cancer and is way up).

 

[haha]

It is from your link, that the death rate from cancer is down 5 percent. So I am thinking the war on cancer can't be totally ineffective (if obesity is a risk factor for cancer and is way up).

I thought you were saying that the incidence of cancer was down. The death rate is s different animal, and I agree that it at least in part reflects treatment. But we are spending a very large amount of money to get a fairly small effect.

What you may not know, however, is that we have made virtually no progress in extending survival for patients with metastatic solid organ tumors since the “War on Cancer” was declared over 40 years ago. In other words, when a solid organ tumor (e.g., breast, colon, pancreatic) spreads to distant sites, the likelihood of surviving today is about what it was 40 years ago with rare exceptions. We may extend survival by a few months, but not long-term (i.e., overall) survival.
We screen better today for sure, but subtracting lead-time bias, it’s not clear this extends overall survival. We’ve had success in treating and even curing hematologic cancers (e.g., some forms of leukemia and lymphoma). Certainly testicular cancer patients (especially seminomas) are better off today and those with GI stromal tumors (GIST), too. Surgical control of cancer is much better today and some local treatments (e.g., specific radiation), too. But for the most part, when a patient has metastatic cancer today, the likelihood of living 10 more years is virtually unchanged from 40 years ago.

Ha

 

[donheff]

I am not holding my breath waiting to see an effective war on obesity. It certainly feels to me like we have had a increasing frenzy of attention on weight loss over the last 30 years. If you graphed the attention it would probably show a slope matching the rise in obesity.

 

[H2ODude]

The obesity issue is one that I have strong opinions on. However, the backlash that can come from expressing those opinions makes me just keep it to myself in most cases. I understand that it's difficult to control (had an admin assistant who suffered from it and while she tried every diet aid around, didn't exercise and seemed plain miserable) but have to believe that the vast majority who have the problem could achieve results.

Just came back from two weeks in London. Admittedly was in an upper class area (Hampstead) but the incidence of obesity appeared minimal. But, that's because you WALK EVERYWHERE. Whereas we walked two grandchildren to school daily (2 mile round trip twice daily) with crowded sidewalks, I couldn't help think of the school near us here where at 3:00 pm there are four abreast about 30 deep SUV's and vans waiting each school day to collect kids. And of course there must be ~12 fast food places within a mile and a half of here, and few sidewalks. Wouldn't be used if there were. Point is our lifestyle is just incredibly conducive to the problem. Real estate/builder interests promote sprawl, food interests obviously push their products, and the whole planning/transportation design facilitates it (although there are attempts to mitigate that). In the end, we've been conditioned to want to live in big spread out houses that don't promote walkability and to want to eat tasty cheap fatty sweet foods. So if you want to buck all that it takes concerted effort. Unfortunately, we Americans don't care much for that; exercise? no thanks, I'll just have that lap band surgery and put it on my insurance tab.

 

[rgarling]

Concentrating on prevention rather than a cure is absolutely the right approach; however, since there is no money to be made preventing disease but there are massive profits to be made treating symptoms, we will not see a change given our current systems. This probably is going to take a grass-roots effort to overcome the entrenched dogma that has resulted in bad health for the (now) majority of the US population.

If you are interested in preventing cancer using a nutritional approach, here is the best rationale that I have found. It is a synopsis of the (very technical) book "Cancer as a metabolic disease ..." by Thomas Seyfried: Cancer as a Metabolic Disease: Thomas Seyfried

 

[M Paquette]

You guys might be shocked to learn that:

1) Cancer can be caused by things other than diet. No, really!
2) People who are not obese, or even overweight can get cancer.

I weigh about 151 pounds, and am 5' 8". I do 300 minutes of exercise a week holding my heart rate at 80% of maximum for my age, including a 5 mile daily run. I've never smoked. I eat a diet with almost no processed foods, almost vegetarian, with no 'high fructose' anything, very little breads or baked goods, no beef, and sodium restricted to less than 1500 mg/day.

I have cancer.

 

[haha]

The obesity issue is one that I have strong opinions on. However, the backlash that can come from expressing those opinions makes me just keep it to myself in most cases. I understand that it's difficult to control (had an admin assistant who suffered from it and while she tried every diet aid around, didn't exercise and seemed plain miserable) but have to believe that the vast majority who have the problem could achieve results.

Just came back from two weeks in London. Admittedly was in an upper class area (Hampstead) but the incidence of obesity appeared minimal. But, that's because you WALK EVERYWHERE. Whereas we walked two grandchildren to school daily (2 mile round trip twice daily) with crowded sidewalks, I couldn't help think of the school near us here where at 3:00 pm there are four abreast about 30 deep SUV's and vans waiting each school day to collect kids. And of course there must be ~12 fast food places within a mile and a half of here, and few sidewalks. Wouldn't be used if there were. Point is our lifestyle is just incredibly conducive to the problem. Real estate/builder interests promote sprawl, food interests obviously push their products, and the whole planning/transportation design facilitates it (although there are attempts to mitigate that). In the end, we've been conditioned to want to live in big spread out houses that don't promote walkability and to want to eat tasty cheap fatty sweet foods. So if you want to buck all that it takes concerted effort. Unfortunately, we Americans don't care much for that; exercise? no thanks, I'll just have that lap band surgery and put it on my insurance tab.

I live in an urban district less fancy than Hampstead, but similarly with almost all educated people. People walk everywhere, all day long, for getting to work, stores, university. Morning and evening there is a steady stream of people walking to and then home from work. Overweight is very unusual. If people walk enough, it is very hard to get fat no matter what they eat. How many fat people do I see in the International Distract/Chinatown? Few to none, in spite of them eating a very high carb diet. Nevertheless, I believe for the average westerner it is easier to match eating to our typically reduced daily movement on a low carb diet.

I follow a low carb diet to try to control metabolic derangments. I also exercise. Since September 15 2011, I have burned 336,065 kilocalories in measured exercise activities, a respectable but not particularly unusual amount About 3/5 are rowing on my Concept2, 2/5 walking around using measured distance and a pedometer, sometimes with a fairly heavy pack. I believe my walking kc expended are figured conservatively, as my neighborhood is quite hilly, and also for ~the last year I have been using shorty crutches. Anyone who has gotten around on crutches knows that it is walking+, a bit like poling with xc-skis.

Still, I am only about 5# lighter than I was before I started moving this much 2 years ago. Most of us living a fairly natural life will have our intake pretty well match our output, with zero need to measure things, which IMO is basically impossible to do effectively since small mismatches will cause considerable weight change over time.

Several posters have mentioned that they know plenty people who are neither smokers nor fat who nevertheless got cancer. Of course; an effect of smoking or weight is meaningful, but only as one thing in the mix. Other factors will always dominate. Obesity or smoking is not like the tubercle bacillus- without this organism you cannot get tuberculosis. Not so with diseases like cancer.

Smoking was successfully attacked by a campaign to make it look like a low class loser thing to do rather then a glamorous thing to do. The same could be done with obesity, but I doubt that it is possible in our current political environment where slogans like "Fat is beautiful" are widely praised. I notice though on TV, the morning show guest my be fat and full of fat is beautiful, but the very well paid woman who is interviewing her is slim.
Ha

 

[Dawg52]

You guys might be shocked to learn that:

1) Cancer can be caused by things other than diet. No, really!
2) People who are not obese, or even overweight can get cancer.

I weigh about 151 pounds, and am 5' 8". I do 300 minutes of exercise a week holding my heart rate at 80% of maximum for my age, including a 5 mile daily run. I've never smoked. I eat a diet with almost no processed foods, almost vegetarian, with no 'high fructose' anything, very little breads or baked goods, no beef, and sodium restricted to less than 1500 mg/day.

I have cancer.

I'm sorry. Just curious, does your family have a history of cancer?

 

[CoolChange]

The obesity issue is one that I have strong opinions on. However, the backlash that can come from expressing those opinions makes me just keep it to myself in most cases. I understand that it's difficult to control....

+1

My hope is that eventually popular opinion turns on this as it finally seems to have on smoking in most of the USA.

I still remember a similar backlash when I would express similar opinions about smoking/smokers not all that many years ago; thankfully, this no longer seems to be the norm.

 

[haha]

You guys might be shocked to learn that:

1) Cancer can be caused by things other than diet. No, really!
2) People who are not obese, or even overweight can get cancer.

I weigh about 151 pounds, and am 5' 8". I do 300 minutes of exercise a week holding my heart rate at 80% of maximum for my age, including a 5 mile daily run. I've never smoked. I eat a diet with almost no processed foods, almost vegetarian, with no 'high fructose' anything, very little breads or baked goods, no beef, and sodium restricted to less than 1500 mg/day.

I have cancer.

I am very sorry to hear about this. Best of luck for a successful treatment.

Ha

 

[M Paquette]

I am very sorry to hear about this. Best of luck for a successful treatment. Ha

It's totally not a big deal. It's under control, very slow growing, and very unlikely to kill or inconvenience me. I'm almost certain to die from something else first.

My point is simply that avoiding sloth, obesity, or other things viewed on this thread as being bad doesn't mean someone won't get cancer. The the various dietary fan clubs can all follow their favorite diets religiously, and a similar percentage of each group will still come down with various forms of cancer. Prevention is good, and can reduce the incidence of some cancers, but not eliminate them. That's why working on cures is also a good idea.

I mentioned skin cancers earlier. Sunblock. It works. It can greatly reduce the incidence of skin cancer, along with wearing hats and UV-blocking clothing. Alas, pale and covered in fabric ain't fashionable. I suppose some folks feel that a little cancer is a small price to pay for being stylish, and showing off their svelte, well maintained bods.

And, for the 'ketogenic diet' fans out there, I am well aware of the effects and causes of internal cellular metabolic errors, the processes of glycolysis and the good old Krebs cycle. Altering nutrients alone with the intent of modifying intracellular osmotic pressures to the point where cancer cells will cease reproducing is a wonderful idea, and works well for a cell culture in a nutrient bath. It has unfortunate side effects in vivo. Reduced oxygen transport across cellular membranes with changes in osmotic pressure is one item you may not have considered. The cancer cells die. So do certain other cells that are very sensitive to oxygen partial pressures, like those in the central nervous system. Living in a hyperbaric chamber might help, I suppose. That's one hell of an expense, and a poor lifestyle.

At a macro level (what one shoves down their food hole) a 'ketogenic diet' is a high-fat, low carbohydrate diet, plus magical thinking (these carbs Good, those Bad, and never mind what digestive enzymes turn them all into). I like my science fact-based, reproducible, and not linked to fat book and media contracts

 

[Bestwifeever]

I.... Smoking was successfully attacked by a campaign to make it look like a low class loser thing to do rather then a glamorous thing to do. The same could be done with obesity, but I doubt that it is possible in our current political environment where slogans like "Fat is beautiful" are widely praised. I notice though on TV, the morning show guest my be fat and full of fat is beautiful, but the very well paid woman who is interviewing her is slim. Ha

But eating disorders and skewed self-images continue to be the curse of young women and increasingly young men. There are no fat girls (save the lovable no-boyfriend fat girl, or Megan McCarthy and Rebel Wilson whose weight is part of their shtick, and no average weight young woman is likely to pack on pounds to emulate them) in magazines, movies, etc. Jennifer Lawrence in the Hunger Games was raked over the coals for not being thin enough in the first movie. I think obesity has already been indirectly attacked for more than 20 years. Today there are plenty of grassroots efforts in grade schools to reform school lunches and to incorporate more activity in the school day. Many recent news stories about taking candy and refreshments out of Halloween, for example.

People I know who have had lung cancer the past several years were not heavy--one a long-time ex-smoker thirty years since her last cigarette, a current smoker, and two who never smoked. Several others who had other forms of cancer (brain, myeloma, primary bone, leukemia) were not at all heavy and would have fit right on those Seattle streets, to continue anecdotal instances. My own mother exactly fit M Paquette's profile of healthy behavior and was gone at 50 of her third relapse. So I guess I am just saying I am firmly on the side of funding therapy and letting the education and prevention efforts continue on their own, and I will let this go now as I think I am a little too emotionally invested in it (and I have the holidays to depress me instead ).

 

[M Paquette]

I'm sorry. Just curious, does your family have a history of cancer?

Now, what would THAT have to do with anything? The consensus here seems to be that sloth, obesity, and improper nutrition causes cancer.

(And yes, there is a history of certain cancers. P53 dysfunction strikes again.)

 

[bld999]

"My point is simply that avoiding sloth, obesity, or other things viewed on this thread as being bad doesn't mean someone won't get cancer."

That same claim is also true if you replace "cancer" with "type 2 diabetes".
No one yet knows all the risk factors for either condition.

 

[M Paquette]

"My point is simply that avoiding sloth, obesity, or other things viewed on this thread as being bad doesn't mean someone won't get cancer." That same claim is also true if you replace "cancer" with "type 2 diabetes". No one yet knows all the risk factors for either condition.

Yup. Thin fit people get Type 2 diabetes, too. They may find it easier to control, but the loss of insulin sensitivity seems to bite a lot of folks as they age. Diet may be one risk factor, but simply living a long time appears to be another.

 

[jowi]

My husband was diagnosed with Type 2 diabetes when he was about 43. Not overweight and he works out daily, does martial arts and even MMA (he's too old to *be* an MMA fighter but he's really into it and fights with young guys for practice/fun - it's a very intense workout). His brother, on the other hand, is 4 years older and morbidly obese (by the charts - he's active but he's a HUGE guy) and his blood sugar is A-OK. It's frustrating!!!