Dr. Penny Stern is the Director of Preventive Medicine at Northwell Health and an Assistant Professor at the Hofstra Northwell School of Medicine, New York. We talked to her about the conversations she has with her patients on how to reduce cancer risk by managing lifestyle factors.
Do you talk about cancer prevention with your patients during their routine examination? If so, what do you tell them?
In terms of specific cancer prevention, patients like to talk about it when a friend or a family member is diagnosed with cancer, or when a patient hears something about cancer in the media. People want to know what their own risks are and whether there are any concrete steps they can take to reduce those risks. I tell patients and non-patients alike that it makes sense to do what we believe will help ensure a healthy life for as long as possible. That is, engaging in physical activity on a regular basis (not being a weekend warrior!), eating a diet rich in fruits and vegetable while limiting consumption of saturated fat, reducing alcohol consumption, managing stress and not smoking. There is obviously a need for such conversations. It always amazes me that more than 50 years after the first Surgeon General’s report on the dangers of smoking, we still have upwards of 15% of the population routinely smoking tobacco.
Are patients open to talking about the connections between modifiable lifestyle factors and cancer risk? How do you see them react to it, when you bring up the topic?
In my experience, people are very willing to talk about modifiable lifestyle factors, particularly in regard to cancer. Acting on this information, however, may be an entirely different matter! I do believe that people want to do the right thing, the best thing, for their long-term health. But it is often not easy to put these good intentions into practice. Everyone is familiar with the person who makes wonderful health-related resolutions each January 1st and within several weeks, has resumed his/her less-than-healthy behaviors. People vow to stop smoking and shortly thereafter, are back to square one. Very few individuals can claim with a straight face that smoking is a health-promoting behavior, for example. Many smokers really do want to quit. But do they know that the average smoker needs something like 8 - 10 attempts before succeeding in breaking this most difficult habit? Nicotine is addictive and so smoking many be an extreme example. But the point is simply that modifying behaviors is not easy and needs resolve.
Do you think that there is enough awareness about how alcohol increases the risk for cancer?
That is an excellent question. Awareness on alcohol and cancer risk, in general, varies among different populations and age groups. People enjoy alcohol in our culture, as well as in many others. It is often the hub around which social events pivot. One need only watch television or movies to see just how much alcohol is touted as a wonderful beverage for almost all occasions. In addition, the concept of moderation in alcohol consumption is variously understood. Anything more than a drink (for women) or two (for men) takes a drinker out of the realm of moderation. I once had a patient who admitted to drinking a six-pack of beer nearly every day. It seemed incredible to me but perfectly okay to him! What we do know is that a number of cancers are linked to alcohol consumption. And that risk increases with the amount of alcohol consumed.
We have seen a spike in the number of people suffering from obesity and we know that obesity increases risk to many cancers. Do you talk about this link and how do you convince people to understand that they can take control of their health and reduce their risk for cancer?
More than one-third of US adults fall within the benchmark for obesity. That’s an astounding percentage. The problem also extends to children unfortunately, with an estimated 17% of young people ages 2 – 19 being obese. And, obese children frequently grow into obese adults. Although the mechanism of this relationship is not well understood, the data so far seems pretty compelling. It has been suggested that obesity is associated with chronic low-level inflammation. This inflammation may result in damage to cellular DNA which can cause cancer to develop. Obesity may possibly impact negatively on immune function, as well as on certain hormones that influence cell growth. All of these factors may contribute to cancer. At present, overweight and obesity has been linked to a number of specific cancers including kidney, pancreatic, endometrial, esophageal, breast, and colon cancers. For those of us involved in prevention and lifestyle medicine, we can encourage patients to eat a nutritious diet, pursue a program of regular physical activity, avoid smoking, limit alcohol consumption and maintain an appropriate weight. Making the right lifestyle choices can help us and our children live longer, healthier lives.
Published on February 6, 2018