ecancer
Lifestyle-based prevention strategies to decrease cancer risk
Dr Jennifer A. Ligibel speaks to ecancer at the WIN 2019 Symposium in Paris about the use of weight management, physical activity and nutritional interventions to reduce the risk of malignancy.
She provides an overview of the epidemiological association between these factors, especially the connection between obesity and the risk of developing cancer.
Dr Ligibel explains some of the lifestyle interventions that exist and mentions several trials that examine the impact of weight-loss and different diet regimes on cancer risk.
She also discusses how these strategies can be implemented and how these must become more personalised to the patient in the future.
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my talk is about lifestyle based cancer prevention strategy so thinking about using weight management physical activity and nutritional interventions to reduce the risk of malignancy the talk started out really reviewing what we know from the epidemiological literature about the connections especially between body weight in the risk of developing cancer we know that obesity and being overweight are becoming more and more prevalent not just in the United States but really around the world and even in countries where obesity has been relatively uncommon over time we see really high rates of childhood obesity in places like China and South Korea so suggesting that body weight really is rising around the world and along with that inactivity and poor dietary quality there's more and more evidence that suggests that these factors contribute to cancer risk there was a large analysis that was done by the International Agency for research in cancer a few years ago that evaluated more than a thousand epidemiologic reports looking at body weight in cancer and found that there was consistent evidence for thirteen different cancers that excess adiposity in overweight being obese increase the risk of developing the malignancy there's also growing evidence that inactivity is related to the risk of developing cancer and dietary quality although really difficult to study has increasingly been linked to aerodigestive cancers colon cancer esophageal cancer as well as things like alcohol intake being like – head and neck cancer and breast cancer so there's a lot of evidence that lifestyle is linked to the risk of developing cancer what we have less of our studies looking at the impact of lifestyle interventions on cancer risk but there have now been a number of randomised trials looking at different types of lifestyle based cancer prevention strategies so weight is really the strongest risk factor for cancer that has been that showed today and there are there's evidence from bariatric surgery cohort studies there's not randomized trials of bariatric surgery unfortunately but large cohorts have shown that individuals who go through bariatric surgery have about a 50% lower risk of subsequently developing cancer compared to individuals of the same weight gender age that don't go through the procedure some of the more recent data have suggested lowering specific cancer rates especially things like endometrial cancer postmenopausal breast cancer and this has been seen really consistently there's less information from lifestyle based weight loss programs but a secondary analysis of a large trial done in the u.s. called the look-ahead trial which was a study that enrolled diabetics and looked at the impact of a weight loss intervention on cardiovascular disease a secondary outcome of cancer risk recently was reported and suggested about a 20% reduction in the risk of developing cancer as a result of the weight loss intervention so this is one of the first studies that's really suggested that losing weight may actually reduce the risk of developing cancer there have also been studies looking at things like low-fat diets to reduce the risk of cancer a large study called the Women's Health Initiative looked at this in the 1990s and 2000's and although the risk of developing cancer overall was not reduced by this intervention there's recently been an updated report that suggested that there may be a reduction in breast cancer related mortality as a result of the low-fat dietary intervention there's also been some really interesting provocative secondary analyses from studies of the Mediterranean diet suggesting a lowering of the risk of breast cancer so I think there's a lot that we still have to learn but there's emerging evidence that you can lower your risk of developing malignancy through lifestyle change I think one of the topics of meeting is really prevention medicine and this is an area that these types of lifestyle prevention studies need to move toward in the future most of these large prevention studies have just enrolled people who are at risk of developing malignancy based on their gender and age and they really haven't enrolled a particularly high risk group of individuals and so I think moving forward we need to recognize the fact that cancer treatment is not one-size-fits-all and cancer prevention also likely will not be one-size-fits-all so we need to figure out how to do lifestyle based prevention studies that enroll higher risk groups of people and people who may be at particular risk of developing disease based on their body weight their physical activity patterns or their diets and so far that has not necessarily been the way these trials have been conducted so I think that's a really good question and there is a lot of information both within cancer and without about how you implement like large-scale lifestyle change I think there are really large studies that have been done in diabetes and heart disease that show us that we can successfully get people to change their diets and to lose weight but the real trick at this point is connecting the interventions to the patients who need them the most and I think we haven't identified those biomarkers yet to help us predict who may be at most risk of developing cancer based on things like metabolic factors inflammatory mediators the status of their immune system which are all things we know can be impacted by body weight dietary patterns I think those are really interesting strategies and they have different feasibility of implementation in different countries around the world my own country is not one that has very fond of that type of governmental intervention but there have been very successful initiatives especially in the UK and in Europe doing things like putting taxes on foods that are less healthy or moving them away from cash registers so I think that these are things that can really work and there's a lot of efforts to try to figure out how do we improve population health there's going to not need to be a lot of work that's done because what we see is that despite these efforts the rates of obesity inactivity poor dietary quality are increasing around the world and to counteract that I think we really need coordinated strategies and it's important that we do this there have been some analyses that suggest that in the United States alone over the next 20 thousand over the next 20 years there are likely to be 500,000 cases of cancer directly attributable to obesity so we really need to do something now and I think you're right this needs to not only be on an individual level but also a population level I think that we need to be aware that things like diet exercise and weight influence cancer and that these are areas where we have the ability to intervene we need over the next years to figure out ways to do this more intelligently and more based on that personal risk of cancer and I think that this really needs to move hand-in-hand with the research that's going on about precision ways of treating cancer
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