Cancer- Should Money Be Spent on Prevention or Therapy?

[NW-Bound]

Quote:

Originally Posted by haha ... But (according to Dr. Abrass) not much progress has been made in the treatment of metastatic cancer in a very long time. It might be that this is saying that another pathway might be worth trying.

This is very true! People should also read the book that I reference in another thread as described in my earlier post, which describes how cancer cells can mutate very quickly to get around new drugs.

However, researchers will keep on trying, out of professional prestige and financial rewards. If it is from private funding, they can do whatever they like. They may make some breakthroughs, and we cannot rule that out.

Quote:

... Dr Abrass' final statement: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.

Yes, but why call a truce on treatment? And every bit in prevention helps. It is not about blaming. It's about an individual doing what he/she can to help him/herself. A lot of time, they just do not know.

And if they know, but ignore the risks like smokers do, what is left to do?

[NW-Bound]

About cancer prevention, the common wisdom that a diet high in fruits and veggies can prevent some cancer types has been retracted. It made no difference in several studies.

[Bestwifeever]

I read all of the article that you linked to before I posted, ha.

[haha]

Quote:

Originally Posted by NW-Bound Yes, but why call a truce on treatment? And every bit in prevention helps. It is not about blaming. It's about an individual doing what he/she can to help him/herself. A lot of time, they just do not know. And if they know, but ignore the risks like smokers do, what is left to do?

Again, write him and ask him why he choose those words. Anyone will know that treatment is never going to be slighted, because that is where the real $$$ are, and also that is where the political pressure is. I used a variation of Dr Abrass' title to introduce he thread, only because the management insists on a title and a description.

I would appreciate knowing from where the blame thread comes.
I guess I never could have guessed the problems members have found here.

[Katsmeow]

As someone who has struggled with weight, bouncing up and down between normal weight, overweight, and obese during most of my adult life, I am very interested in the issue of obesity. (And, no, I'm not obese because I drink sugary drinks. I haven't those types of drinks in over 30 years).

Quote:

I think smoking and obesity should be fairly amenable to modification, and likely very worthwhile to do that for the individual and the society.

Let me first say that I think the treating obesity is something that is worthwhile to do for many reasons.

That said, I think the above statement is fundamentally not true at this time. That is, obesity is in fact extremely difficult to successfully treat, if you consider successful treatment to be persistence of lost weight. In fact, it is so difficult that many experts feel that it is basically a waste of time to try to treat obesity and that virtually all efforts should be directed to obesity prevention.


Of course, there are people who are obese who successfully lose weight and keep it off. However, they are outliers and aren't the norm. Over 95% of people who successfully lose weight regain within 5 years (I am one of them).


On another board, an obesity researcher posted about this issue awhile back:

http://boards.fool.com/to-preface-my...-27721294.aspx

Basically one of the major problems with obesity is that a once obese person who reduces weight to a normal weight will have a lower metabolism and burn fewer calories than a never obese person.

See this article:

MMS: Error

Basically it is showing that formerly overweight people burn about 15% less calories than expected.

That may not sound like much but the thing most people don't understand is that the difference between staying weight stable and gaining weight is a very small one.

In order to be overweight it doesn't require eating a lot of fast food (I don't, some but not a lot), or sugary drinks (I don't), or lots of sugary sweets (I don't). If you eat an extra 100 calories a day, you would gain about 10 pounds in a year.

Now imagine that a never obese person at a certain weight and activity level would be weight stable at 2000 calories a day. Let's imagine she has a friend of the same weight and activity level, who was once obese. That person also eats 2000 calories a day. But, in her case, she isn't weight stable at 2000 calories. She is eating 300 calories too much and at the end of year, she has gained 30 pounds even though she ate the same amount as her weight stable friend. She would be weight stable at 1700 calories a day, but that is very, very difficult to maintain on a permanent basis. And, if she instead says she will eat 1900 calories a day, then she is back to gaining 10 pounds every year.

By and large most of the people (not saying all) who are able to maintain weight loss after being obese either restrict calories to a point well beyond that of other never obese people or exercises a great deal - far more than the average person who was never obese.

Anyway - the main point I am making is that for whatever reason, obesity is very, very difficult to treat. It is not just that obese people don't want to lose weight. I know many people who are highly motivated to lose weight, try very hard and still don't permanently succeed. (Yes, there are exceptions. Some people don't try hard and some people lose weight easily and keep it off easily. But when 95% of people who actually did lose weight, can't keep it off there is more going on than lack of willpower or people just being lazy. The best explanation I've seen that makes sense is the change in metabolism.

[kyounge1956]

Quote:

Originally Posted by haha I have a question-did any of you rather outspoken critics read any of the article? It isn't at all clear that you did. It's not my thesis, I have no clear opinion, BECAUSE I DON'T KNOW ENOUGH ABOUT THE ISSUES. It is not the thesis of Peter Attia, who just wonders if perhaps our LIMITED resources might go further if a larger % were spent on basic research. As he clearly points out, operative therapies tend to work very well. But (according to Dr. Abrass) not much progress has been made in the treatment of metastatic cancer in a very long time. It might be that this is saying that another pathway might be worth trying.

The first time I saw this thread I mistakenly thought the link was to a TED talk, which had been linked on an earlier thread and which I had already listened to when it was originally posted. I have now read the article linked on this thread, but it doesn't change my reaction. It is one thing to suggest that another pathway--prevention--might be worth trying, and another thing to suggest "calling a truce". A truce is an agreement between adversaries to stop fighting each other, either temporarily or permanently. A disease isn't capable of making such an agreement.

I do not see any call for more "basic research" in the article. Basic research is what revealed the complexities of cancer described in the first and largest part of the article, but the author doesn't call for more of such research, but for a greater concentration on prevention, and specifically prevention focused on obesity.

I have stage IV cancer, and it is no news to me that not much progress has been made in treatment of metastatic disease over the last several decades. That does not strike me as a good reason to divert resources away from development of more effective treatments for the aspect of the disease which actually kills people.

Quote:

Hey, but feel free to ignore what this expert says, just don't blame me, since I only posted what I mistakenly thought might interest the group. I should have known better. (snip)

Yes, you should have known better than to suppose that leading off your thread with a quote advocating a "truce" with cancer would not raise hackles. What were you expecting?

[Amethyst]

Yes, I read the article, and a number of the following comments, until they inevitably degenerated into the familiar religious war over "carbs."

Amethyst

[NW-Bound]

Quote:

Originally Posted by haha Again, write him and ask him why he choose those words. Anyone will know that treatment is never going to be slighted, because that is where the real $$$ are, and also that is where the political pressure is. I used a variation of Dr Abrass' title to introduce he thread, only because the management insists on a title and a description. I would appreciate knowing from where the blame thread comes. I guess I never could have guessed the problems members have found here.

What I meant about "blaming" was that if a researcher found that any lifestyle or obesity was linked to a disease and reported it, he would risk offending people. However, the fact has to be told, else we cannot reduce the rate of cancer. Obesity is a risk factor, and some obese people may still die of old age, but being thin gives you an edge. It's just like non-smokers who can still get lung cancer, but smoking increases your risk.

The book that I referenced talks about a study in Europe called EPIC (European Prospective Investigation into Cancer and Nutrition) that found a strong link between obesity and cancer. This is a study of 520,000 people over more than a decade. It is also the study that finds a diet high in veggie and fruits does not offer protection as previously thought. What they have found is that obesity itself is the problem. How you get there with different diets do not matter that much. Here's an excerpt.

"Moving beyond culinary issues, EPIC has strengthened the case against obesity. One study found that older women who had gained 15 to 20 kilograms, or roughly 40 pounds, since they were twenty had an increased breast cancer risk of 50 percent. As in the old animal experiments, fatness itself, whatever its cause, appeared to be the driving force. Along with lack of exercise, it may account for as much as 25 percent of cancer, with dietary specifics falling to as little as 5 percent."

The above means that 1 out of 4 cancer cases is due to obesity and can be avoided, and 3 out of 4 cases have unknown other causes.

So what if obesity itself is a medical problem? Let's try to understand it. People were not obese in the old days. What changed? Was it carb, meat, processed food or whatever? In Europe, the per capita consumption of sugar has increased from 2 to 3 kilos per year in the 1800s to 50 to 60 kilos today. EPIC researchers think that is a contributing factor.

PS. By the way, I searched the Web and found that the US per capita consumption of sugar is 77 lbs per year. That is a lot less than European consumption, and I find that very surprising. Europeans are thinner than US citizens by far.

[Katsmeow]

Quote:

Originally Posted by NW-Bound PS. By the way, I searched the Web and found that the US per capita consumption of sugar is 77 lbs per year. That is a lot less than European consumption, and I find that very surprising. Europeans are thinner than US citizens by far.

You have to be sure what you are comparing. According to the below in 2008, American per capita consumptiom of refined sugar was 65.4 lbs per year, but there was also consumption of 68.3 lbs of corn-derived sweeteners per person.

Sugar - Wikipedia, the free encyclopedia

Here is a nice graph which shows intake by country but is apparently just the actual amount, and not per capita so hard to use to compare. The notable thing is that high fructose corn syrup on this is about half of all sweeteners in the US and it is apparently only a significant (but well under half) contributor in Japan, Canada, Mexico and Argentina (with what looks like a tiny amount in Australia).

CONVERSABLE ECONOMIST: The Global Sugar Market and US Sugar Consumption

The biggest source of sweeteners in the US is from soft drinks. Basically about 43% of added sugar in the US comes from soft drinks or fruit drinks (fruitades and punch).

As an aside looking down the list of added sugar I rarely have any of it. No sweetened drinks at all, rare candy (maybe once or twice a year), occasional cakes and cookies (maybe once or twice a month and even then a small serving), occasional ice cream, no sweetened cereals. I track my nutrition online and I am routinely very low on sugar. So getting rid of sugar is undoubtedly important to preventing obesity but it hardly explains all of it.

[NW-Bound]

Thanks. The number you cited makes more sense.

The number I quoted was from the USDA, which does not include fructose. When all sweeterners are added together, the US per capita consumption is about the same as that of Europeans. I still find that surprising, becase we all know Americans are soda guzzlers, while Europeans rarely drink that. So, in what form do Europeans consume their sugar? It's a mystery, and I will need longer trips to Europe to learn more about their culinary habits for myself.

But, another statistic worth mentioning is that the US does not lead the world in cancer rate, and in fact ties in #6 with France, despite having a higher obesity rate.

Nation	Cases per 100,000
Denmark	326
Ireland	317
Australia	314
New Zealand	309
Belgium	307
France	300
US	300
Norway	299
Canada	297
Czech Rep.	295

If we look at continental aggregates, then Australia is highest, followed by Western Europe, then North America. Poor countries have the lowest cancer rates which are 1/10 or less of the above numbers.

The Web sources were never clear, or perhaps I miss something, but I think the above numbers are newly diagnosed cases each year. As many cancer patients survive more than 1 year, then the number of cumulative patients will be higher.

Regarding cancer prevention, I found the fact that fruit and vegetable consumption not helping ward off cancer disheartening. I am an omnivore and will continue to consume a lot of fruit and vegetable as I love them, and they still help with diabetes, cholesterol, high blood pressure, and weight control.

[M Paquette]

Quote:

Originally Posted by NW-Bound If we look at continental aggregates, then Australia is highest, followed by Western Europe, then North America. Poor countries have the lowest cancer rates which are 1/10 or less of the above numbers.

Skin cancer.

Which is why I suggested way back there that the best preventive measures one can take against that most common of cancers is sunblock, UV blocking clothing, and a hat. One tube of Efudex (skin cancer chemo) costs roughly as much as a decade's worth of sunblock. One Mohs surgery costs as much as a lifetime supply of sunblock. As a bonus for cosmetics users, many moisturizers now include a sunblock, and tests have shown that the UV damage is a big cause of 'skin aging'.

Regarding cancer rates in poor countries:
http://www.inctr.org/about-inctr/can...ing-countries/

The death rate from infectious disease is higher than that from cancer, but that is changing. The incidence rate is lower, but a higher percentage die.

Quote:

Originally Posted by NW-Bound Regarding cancer prevention, I found the fact that fruit and vegetable consumption not helping ward off cancer disheartening. I am an omnivore and will continue to consume a lot of fruit and vegetable as I love them, and they still help with diabetes, low cholesterol, and high blood pressure, and weight control.

Sounds like an excellent, rational, and reasonable plan to me.

[ziggy29]

Quote:

Originally Posted by Amethyst Yes, I read the article, and a number of the following comments, until they inevitably degenerated into the familiar religious war over "carbs."

We live in an era where we are encouraged to make everything "us versus them". We're no longer allowed to listen to, and actually consider, alternative viewpoints to our own. The result is that just about everything is fair game for full-contact, belligerent "discourse" that used to be reserved to politics and religion.

As for the question in the title, isn't that a false dichotomy? It's not like going "all in" with prevention or going "all in" with treatment are the only options. That said, sure, prevention is better than cure, but even the best "lifestyle choices" are far from a guarantee of a cancer-free future.

[marko]

Quote:

Originally Posted by 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.

Doesn't that statistic sort of negate the obesity/cancer connection?

BTW, my Doctor had a chart on his wall that said my 6 foot tall, 210lb frame was 'near obese'. I pointed it out to him and he laughed.

[ziggy29]

Quote:

Originally Posted by marko BTW, my Doctor had a chart on his wall that said my 6 foot tall, 210lb frame was 'near obese'. I pointed it out to him and he laughed.

Former NFL star running back LaDainian Tomlinson was listed at 5'10" and 220. That makes him "obese" according to the charts. Obese people don't run a 4.4 40 or rush for nearly 14,000 yards.

We do have an obesity "problem" in society (I dislike the term "epidemic"), but sometimes it does feel like these BMI charts are being revised in a way that makes people more obese without gaining a single pound.

[haha]

Quote:

Originally Posted by ziggy29 As for the question in the title, isn't that a false dichotomy? It's not like going "all in" with prevention or going "all in" with treatment are the only options. That said, sure, prevention is better than cure, but even the best "lifestyle choices" are far from a guarantee of a cancer-free future.

Well, for my part I just made the erroneous assumption that no one was likely to think that the oncology centers of America were likely to be shut down, that pharmacology departments in universities and drug companies were at all likely to close one of their most profitable, and patentable revenue centers. Given this, I would have thought that going "all in" on prevention was easy to recognize as a red herring. Obviously, it would have been better if I had ignored the push of the article (in itself not easy to do) and titled my post, "Perhaps we should debate adding more research into mitigating known risk factors in our war on cancer."

I would also like to point out, that the theme of focusing on weight equals blaming the victim is a rather narrow way of looking at it. These people are doctors, they are used to looking for solutions that can be delivered by doctors or somewhat less, by social interventions. Like pills, or even weight loss surgery. If something is social problem, it may be that social solutions are needed. But my guess is that it might be hard to even consider anything about the topic, if many people will immediately get defensive. How would cigarette smoking ever have been greatly lessened if we hesitated to mention that while some people smoke, some don't, and some former smokers no longer do?

On other threads I have myself stated that the "calories in calories out" idea misses some things. Like for example Katsmeow's statement that once one has been obese, they must forever under eat just to stay in place. Doesn't that kind of challenge calories in-calories out as the complete explanation for overweight? Also, unless I missed something, the association mentioned was not with being plump, but with considerable obesity.

Ha

[ziggy29]

Quote:

Originally Posted by haha Well, for my part I just made the erroneous assumption that no one was likely to think that the oncology centers of America were likely to be shut down, that pharmacology departments in universities and drug companies were at all likely to close one of their most profitable, and patentable revenue centers. Given this, I would have thought that going "all in" on prevention was easy to recognize as a red herring. Obviously, it would have been better if I had ignored the push of the article (in itself not easy to do) and titled my post, "Perhaps we should debate adding more research into mitigating known risk factors in our war on cancer."

I was referring more to the "push of the article", actually, as that was where it seemed to be guiding the reader.

[NW-Bound]

Quote:

Originally Posted by M Paquette Skin cancer. Which is why I suggested way back there that the best preventive measures one can take against that most common of cancers is sunblock, UV blocking clothing, and a hat. One tube of Efudex (skin cancer chemo) costs roughly as much as a decade's worth of sunblock. One Mohs surgery costs as much as a lifetime supply of sunblock. As a bonus for cosmetics users, many moisturizers now include a sunblock, and tests have shown that the UV damage is a big cause of 'skin aging'.

Yes. Skin cancer accounts for 80% of all newly diagnosed cancer each year in Australia. And 2 in 3 Australians will get skin cancer by the time they are 70.

See: Skin cancer - Cancer Council Australia.

Quote:

Regarding cancer rates in poor countries: Cancer in Developing Countries *-*INCTR

Cancer is a disease of the old, and when a country has a life expectancy of 48 as in Sierra Leone, most people do not live long enough to get cancer.

The article says that "approximately 50% of cancer in developing countries occurs in individuals less than 65 years of age", which of course has to be true when most of the population do not make it to 65.

Quote:

Originally Posted by marko Doesn't that statistic sort of negate the obesity/cancer connection?

Not necessarily. The EPIC study in Europe thinks otherwise.

And in the US, lung cancer rate has been going down dramatically due to fewer smokers. The lung cancer newly diagnosed rate in men peaked at 68/100,000 in 1982, and dropped down to 41/100,000 in 2008. As lung cancer is the most common cancer among men, that drop due to fewer lung cancer might be taken up by other forms of cancer and the total number still dropped.

See: GLOBOCAN Cancer Fact Sheets: Lung Cancer

PS. Another form of cancer that has been going down in the US is stomach cancer. Yet, that cancer is rising in Japan and Korea. In the US, it is thought that people eating less cured meat contributes to the decline, while Japan's consumption of salted fish is the reason they lead the world in stomach cancer.

Come to think of it, could it be that European consumption of cure meats are detrimental to their health too? They have the best jambon and Jamón and prosciutto. They still smoke more than the US, but their lung cancer rate is not higher!

[Katsmeow]

Quote:

Originally Posted by haha On other threads I have myself stated that the "calories in calories out" idea misses some things. Like for example Katsmeow's statement that once one has been obese, they must forever under eat just to stay in place. Doesn't that kind of challenge calories in-calories out as the complete explanation for overweight? Also, unless I missed something, the association mentioned was not with being plump, but with considerable obesity.

The reduced metabolism is seen with people who lost 10% of body weight, so not necessarily obesity. You can be in the overweight category and lose 10% of body weight to get to normal and still get the reduced metabolism.

Also I don't think this does challenge calories in/calories out. What is challenges is that idea that calories out is the same for 2 similar people of similar activity. That is, the one person who weighs 140 pounds and has X amount of activity a day may find that the formulas for total energy expenditure would burn 2000 calories a day. However, if that person had gotten to the 140 pounds by losing 10% of her body weight she might actually instead be burning 1700 calories a day. Now, if she was for eating 2000 calories a day - which would be normal for her weight and activity and would not make her hungry - she would gain 30 pounds in a year.

So calories in/calories out work. However, simplistic notions as to how many calories out each person has does not work.

[NW-Bound]

Though I have been on the skinny side all my life, I tend to believe that overweight people do burn fewer calories. Life is not fair and they have to cut down the calorie intake even more.

Over the years, my BP has been creeping up from around 125/82 to 135/87. My doctor recommended that I reduced my weight from 25 BMI. It's tough to do as I love to eat, but once I got down to 23 BMI, I saw that he was right!

I also reduced my sodium intake, and that is tough. Some of my relatives, my wife included, eat the same if not more salty food, and their BP is on the hypotension side! Life is never fair.

[haha]

Quote:

Originally Posted by Katsmeow Also I don't think this does challenge calories in/calories out. What is challenges is that idea that calories out is the same for 2 similar people of similar activity. That is, the one person who weighs 140 pounds and has X amount of activity a day may find that the formulas for total energy expenditure would burn 2000 calories a day. However, if that person had gotten to the 140 pounds by losing 10% of her body weight she might actually instead be burning 1700 calories a day. Now, if she was for eating 2000 calories a day - which would be normal for her weight and activity and would not make her hungry - she would gain 30 pounds in a year. So calories in/calories out work. However, simplistic notions as to how many calories out each person has does not work.

Does this mean that the formerly overweight woman does not need as much fuel to produce a given amount of muscle work, when compared to her never overweight sister? If so, are any mechanisms for this known?

Ha