MiCMRC Educational Webinar

Power of Prevention: Helping Your Patients Reduce Their Cancer Risk

August 23rd, 2017

MiCMRC Care Management Educational Webinar:Power of Prevention: Helping Your Patients reduce Their Cancer Risk

Expert Presenter:

Danielle Karsies, MS, RD, CSOSymptom Management and Supportive Care ProgramMichigan Medicine Comprehensive Cancer Center

Danielle Karsies, MS, RD, CSO

The Power of Prevention: Helping your patients reduce their cancer risk

Danielle Karsies, MS, RD, CSO

∗ Identify the current cancer rates and the trend in survivorship.∗ List the 10 evidence-based cancer prevention recommendations.∗ Identify the significant role obesity plays in cancer risk and

simple ways to address this issues. ∗ Identify the two types of physical activity that play in disease

prevention ∗ Provide simple tips to patients when resistance due to cost is

identified in relation to increasing fruits or vegetables ∗ Provide simple weight loss strategies to patients by what to

include (not what to exclude).

Objectives

Estimated and projected number of cancer survivors in the United States from 1977 to 2022 by years since diagnosis.

de Moor J S et al. Cancer Epidemiol Biomarkers Prev 2013;22:561-570

©2013 by American Association for Cancer Research

World Cancer Research Fund International/American Institute for Cancer Research. Continuous Update Project: Diet, Nutrition, Physical Activity and the Prevention of Cancer. Summary of Strong Evidence. Available at: wcrf.org/cupmatrix accessed on 08/09/2017.

Cancer Prevention Diet

∗ Maintaining a healthy weight brings an array of health benefits besides cancer prevention. ∗ Feel better∗ Less likely to develop other chronic diseases such as type 2

diabetes and heart disease.∗ Location, location, location

∗ Excess abdominal fatness acts like a ‘hormone pump’ releasing estrogen into the bloodstream as well as raising levels of other hormones in the body.

∗ Abdominal fatness is strongly linked to colon cancer and probably to cancers of the pancreas and endometrium (lining of the uterus), as well as breast cancer (in postmenopausal women).

Be as lean as possible without becoming underweight.

Proposed Relationship Between Obesity and Cancer

∗ Estradiol

Obesity

insulininflammatory factors

Sex Hormone Binding Globulin

∗ Physical activity in any form helps to lower cancer risk. ∗ Help to keep hormone levels within a healthy range (increased hormones = increased

cancer risk)∗ Strengthen the immune system∗ Aids digestion∗ Enables us to consume more cancer-protective nutrients/healthy foods without gaining

weight.∗ For maximum health benefits, scientists recommend that we aim for 60 minutes or more of

moderate activity every day, or 30 minutes or more of vigorous activity.∗ Moderate activity is anything that gets your heart beating a bit faster and makes you

breathe more deeply – like brisk walking.∗ Vigorous activity means raising your heart rate so that you warm up, start to sweat and

feel out of breath.

Be physically active for at least 30 minutes every day.

∗ To help avoid overweight and obesity and thereby reduce our cancer risk.∗ Avoid processed foods high in added sugar, low in fiber,

or high in fat.∗ Avoid sugary beverages that are energy dense but

provide minimal satiety and nutrients

Avoid sugary drinks and snacks.

∗ By choosing a diet based on low-energy-dense foods, you can actually eat more food but consume fewer calories.

Limit consumption of energy-dense foods.

Does Sugar Feed Cancer?

∗ Simply: No!∗ Insulin more likely the real issue.

∗ Cancer cells contain plenty of insulin receptors, the more insulin the more these cells can grow

∗ Insulin:∗ Stimulates growth directly and through IGF-1∗ Increases inflammatory hormones∗ Suppresses immune function∗ Limits apoptosis

∗ Increased Relative Risk of cancer with insulin resistance∗ When receptors work poorly, more insulin is released to cope

Eat Strategically to Avoid Spikes in Insulin

∗ Watch the total carbohydrate intake (only 1/4 of the plate)

∗ Mix higher GI foods with lower GI foods∗ Eat sweets less often∗ Eat it raw and eat it whole

∗ Eat strategically∗ Avoid “naked carbs” on an empty stomach ∗ Combine any carb with protein, fiber and/or fat to slow

stomach emptying and release a slower trickle of insulin

Eat more of a variety of vegetables, fruits.

Diets High in: Convincingly lower risk of the following cancers:

Foods containing vitamin C Esophagus

Foods containing beta-carotene Esophagus

Foods containing carotenoids Mouth, pharynx and larynx, lung

Non-starchy vegetables Mouth, pharynx and larynx, esophagus, stomach

Fruits Mouth, pharynx and larynx, esophagus, stomach, lung

1 1/2 -2 ½ cups of non starchy vegetables and 1-2 cups fruit per day

Color Matters!

Make ½ your plate fruits and/or vegetables!

No convincing evidence that shows a difference between organic and conventionally grown foods related to cancer risk.

Pesticide residues on conventionally grown produce are almost always within safe tolerance levels.

The benefits of including more fruits and vegetables in your diet strongly outweigh potential risks from pesticides.

If you are interested in eating organically, do so as long as you can afford them without decreasing your intake of fruits and vegetables.

Hot Topics: Organic vs. Non-Organic

Practical guide from the Environmental Working Group

Saving on Fruits & Vegetables

Buy fruits and vegetables that are in season. Don’t pass up on canned and frozen section Choose fruit that is packed in its own juice vs. syrup Look for vegetables that have "no salt added" or that are low

in sodium. Avoid buying costly pre-cut or ready-to-eat fruits and vegetables. Try to get the most out of your food! Use an overripe fruit for a

smoothie or less desirable parts of vegetables for homemade stock!

Low-cost fruits: apples, bananas Low-cost vegetables: carrots, greens, potatoes

Make sure to consume whole grains daily and legumes (beans/peas) at least a

few times per week.

Diets High in: Convincingly lower risk of the following cancers:

Foods containing dietary fiber Colorectal

∗ Eat no more than 18 oz. (cooked weight) per week of red meats, like beef, pork and lamb. ∗ Heme iron has been shown to damage the lining of the

colon.∗ Avoid processed meat such as ham, bacon, salami,

hot dogs and sausages.∗ Smoking, curing or salting can form carcinogens that

can damage cells in the body.∗ Cancer risk starts to increase with any portion

Limit consumption of red meats and avoid processed meats.

∗ Alcohol can directly damage our DNA. It is particularly harmful when combined with smoking.∗ There is convincing evidence that alcohol increases the

risk of cancer of the mouth, pharynx, larynx, esophagus and breast, as well as colorectal cancer in men.

∗ Alcoholic drinks also probably increase the risk of colorectal cancer in women as well as liver cancer.

∗ For cancer prevention, do not drink alcohol.

If consumed at all, limit alcoholic drinks to 2 for men and 1 for women

a day.

∗ Studies have shown that high salt intake can damage the lining of the stomach. ∗ Limit processed foods and foods eaten outside of the

home (accounts for ~77% of American’s sodium intake)

Limit consumption of salty foods and foods processed with salt

(sodium).

∗ Defined: Vitamins and minerals, herbs, amino acids and other compounds in pill, capsule, tablet or liquid form∗ No benefit of multivitamin-mineral treatment on the risk of

mortality from all causes. Am J Clin Nutr. 2013 Feb;97(2):437-44

∗ Increased cancer risk with supplement intake:∗ High dose beta-carotene (20 mg) and retinol (25,000 IU) supplements

in tobacco smokers (lung)∗ Limited but suggestive risk with selenium (200 µg) supplements (skin)

∗ Balanced diet of whole foods is recommended∗ Proposed mechanism: Synergistic effect between all the nutrients in

the food that you can not get from a single nutrient in supplement form

Don't use supplements to protect against cancer.

∗ Convincing evidence that breastfeeding protects mothers against breast cancer. ∗ Lowers the levels of some cancer-related hormones in

the mother’s body∗ At the end of breastfeeding, the body gets rid of any

cells in the breast that may have DNA damage.

∗ Having been breastfed probably protects children against overweight and obesity.

It is best for mothers to breastfeed exclusively for up to 6 month.

Cancer survivor is defined as an individual from cancer diagnosis, through treatment and survivorship. ∗ There is growing evidence that physical activity and other

measures that help us to maintain a healthy weight, such as a balanced diet, may help to prevent cancer recurrence, particularly for breast cancer.

∗ However, the evidence is not yet clear enough to be able to make any specific recommendations for cancer survivors in general, or for those who are survivors of any specific form of cancer.

After treatment, cancer survivors should follow the recommendations

for cancer prevention.

Case Study: Mrs. A.G.

1 fried chicken breast + 1 fried chicken leg with 1 ½ cups Macaroni and Cheese = 1114 calories

Focus: Adding Healthy Foods

1 fried chicken breast and ½ cup macaroni and cheese with salad and corn = 613 calories

Just making ½ her plate vegetables saved 501 calories without any other changes!

Daily∗ Make ½ your plates fruits and/or vegetables∗ Include 3 or more servings of whole grain foods∗ Drink at least 64-80 ounces per day (caffeine and

calorie free liquids)Weekly∗ At least one meal a week substitute beans, peas, soy

or nuts for animal products

A.G. was Ready for More Additions

Start making better choices (lean protein, whole grains) & save even

more calories

1 skinless chicken breast, grilled¾ cup brown rice¾ cup each cooked carrots and broccoli = 423 calories

∗ Red meat (Beef, pork, lamb, venison)∗ Animal fats (saturated fat)∗ Processed foods∗ Dessert after meals not “later”

Instead of Removal, Focus on Moderation

∗ American Institute of Cancer Research at http://www.aicr.org/∗ Food that fight cancer ∗ Risk reduction recommendations

∗ National Cancer Institute https://www.cancer.gov/∗ Diet and Nutrition fact sheets∗ PDQ (Physician Data Query) contains summaries on a wide range of cancer topics

∗ American Cancer Society at www.cancer.org∗ Stay healthy topics∗ Tools and calculators (BMI, calorie counter)∗ Screening guidelines

∗ Oncology Dietetic Practice Group at https://www.oncologynutrition.org/erfc/healthy-nutrition-now/foods/∗ Fact sheets and articles on common patient questions

Resources for Cancer Information

∗ de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, Forsythe L, Scoppa S, Hachey M, Rowland JH. Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):561-70.

∗ Dunstan, D.W. et al. 2010. Television viewing time and mortality: the Australian diabetes, obesity and lifestyle study (AusDiab). Circulation 121: 384-391

∗ Healy, G.N., et. al. 2011. Sedentary time and cardiometabolic biomarkers in US adults: NHANES 2003-06. European Heart

∗ Arjamandi, et al. J clin Endocrinol Metab. 2003;88:1048-1054

References

∗ World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Report. Accessed August 9, 2017. Available at http://www.dietandcancerreport.org.

∗ American Institute of Cancer Research. AICR’s Foods that Fight Cancer. Accessed August 8, 2017 at http://www.aicr.org/foods-that-fight-cancer/

∗ Cancer Statistics 2017: a presentation from the American Cancer Society. Accessed at https://surveillance.cancer.gov/survival/ on August 9, 2017.

References and Resources

Questions?