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Decade Round-Up
Top experts in the field of diet, nutrition, weight and cancer weigh in on the top accomplishments over the past decade and where to go from here.
In terms of cancer research, it’s been a busy decade. To celebrate the New Year, CRU has asked a handful of top experts in a variety of fields related to cancer prevention what they think are the biggest findings of the last few years when it comes to diet, nutrition, physical activity, and cancer.
Susan Higginbotham, PhD, RD, MPH
AICR’s Director of Research, an epidemiologist and a registered dietitian.
“Researchers are examining the totality of evidence in ways that were not possible before.”
During the past few years, there have been improvements in the methods scientists use to evaluate research, such as in systematic literature reviews, meta-analyses, and pooled analyses. Computer technologies and the statistical software available to researchers are much more advanced today then they were even ten years ago.
Results from extremely large population studies, such as EPIC [The European Prospective Investigation into Cancer and Nutrition], are regularly being published. Researchers are examining the totality of evidence in ways that were not possible before. The AICR/WCRF expert report and the continuing updating project are examples of this comprehensive approach to synthesizing results from many different studies.
From these research reviews, patterns are emerging that suggest it's the whole diet and ways of life, rather than single exposures, that are important for the prevention of cancer and other chronic diseases.
Elisa V. Bandera, MD, PhD
An Associate Professor of Epidemiology at The Cancer Institute of New Jersey
UMDNJ-Robert Wood Johnson Medical School, Dr. Bandera focuses on the prevention of cancer by dietary means.
One clear finding that has emerged over the past ten years is the importance of obesity in cancer prevention. Maintaining a healthy weight is now the first recommendation for cancer prevention by both the WCRF/AICR and ACS. This is particularly important as obesity rates have been increasing exponentially at a state, national, and global levels.
“Up until recently, we thought that only older adults needed to start thinking about cancer prevention. Now we know that early life events…can have an impact in the risk of developing breast cancer later in life.”
In the US the obesity epidemic is particularly alarming in some minority groups, such as African Americans. We have learned more about the mechanisms involved, including hormonal and inflammatory pathways. There is also growing evidence that obesity affects cancer survival.
Another important discovery over the past decade is the relevance of early life events in modulating cancer risk. Up until recently, we thought that only older adults needed to start thinking about cancer prevention. Now we know that early life events, even in-utero and early childhood exposures can have an impact in the risk of developing breast cancer later in life. These findings have widened the target population for our cancer prevention/education efforts to all ages, and to families, not just individuals.
Wendy Demark-Wahnefried, PhD, RD
Professor of Behavioral Science at University of Texas M. D. Anderson Cancer Center, her research involves nutrition-related concerns of cancer patients, as well as determining effective lifestyle interventions that improve the overall health of cancer survivors and their families.
“Survivorship is starting to become a huge issue: There’s an increasing awareness that this is important for us to address.”
At last, survivorship is starting to become a huge issue: There’s an increasing awareness that this is important for us to address. I think governmental agencies are starting to realize it's not only just a population at increased risk [for secondary cancers and other poor health outcomes], but it’s a population that can really have a big budget impact because cancer survivors are such intense users of health services.
We’ve learned there’s a whole energy balance issue and now we’re really trying to ferret out how body weight status plays a huge role in how people successfully get through their treatment, have long-term survivorship and overall health afterwards. We have to figure out what seems to be the most important role for various outcomes: could it be energy restriction or is it increased physical activity? Those basic issues aren’t solved yet. It could also be different: physical activity could help improve physical function and quality of life, whereas energy restriction could be important to hinder progressive disease.
It is exciting. For the next 10 years it would be so great if we could start to make strides on interventions, how to best deliver them and how we can get the message to cancer survivors, and their family. If cancer survivors have high-risk family members, wouldn’t it be great to prevent cancer from happening in their family? And if we can really make strides as to what’s the best way to deliver interventions, how often do you need to deliver it? There are a lot of issues that need to be addressed.
Jed Fahey, MS, ScD
A nutritional biochemist and Faculty Research Associate at Johns Hopkins School of Medicine who now focuses on nutritional strategies for cancer chemoprotection in humans.
"For me, the pleasant surprise of the past decade has been the dramatic increase in public awareness of these interrelationships, and the increase in people practicing–or at least talking–about healthy lifestyles.”
A decade ago, the associations between diet/nutrition, physical activity, and cancer had become familiar to most scientists, and there was both good supportive evidence and a range of mechanistic explanations available for many of these associations. Over the past decade, we, and many others, have been excited by our contributions to better understanding the basic science of these associations, and the epidemiologic evidence has continued to grow.
For me, however, the most pleasant surprise of the past decade has been the dramatic increase in public awareness of these interrelationships, and the increase in people practicing–or at least talking about–healthy lifestyles.
Unfortunately, even when people know what’s good or bad for them, many still either do not, or cannot act on that information in what we believe is their own best interest. That educational/motivational hurdle is the challenge for the coming decade.
June Stevens, PhD
Nutritional epidemiologist and the Chair of the Department of Nutrition at The University of North Carolina at Chapel Hill, Dr. Stevens focuses on the causes, consequences, and prevention of obesity in different populations.
The most exciting finding I think is we now know the importance of obesity and physical activity to both the incidence and reoccurrence of cancer. This was highlighted in the AICR evidence report and in my mind was one of the most important contributions of the report.
I see this giving cancer survivors something that they can do for themselves to help them live a longer, healthier, cancer-free life.
Karen Collins, MS, RD
Nutrition Advisor to AICR and a nationally-syndicated columnist in the field of diet and nutrition since 1991.
Research now shows that healthy eating means much more than getting enough of a few specific nutrients like vitamin C and beta-carotene. Vegetables, fruits, whole grains, beans, nuts and seeds contain thousands of phytochemicals, many of which influence one or more stages of cancer development.
“Supplements can help fill specific nutrient gaps, but they can't provide the same protection we get from an abundance of plant foods and their many natural phytochemicals all acting synergistically.”
Some of these compounds can "turn on" genes that protect us from cancer and "turn off" genes that can promote cancer development. This is a key message because it makes variety in the plant foods we eat more important than ever. It also explains why studies using supplements often don't show the cancer protection that might have been expected. Supplements can help fill specific nutrient gaps, but they can't provide the same protection we get from an abundance of plant foods and their many natural phytochemicals all acting synergistically.
We've also learned much more about the ways that body fat (especially the fat deep within our abdomen) is metabolically active in ways that influence cancer development. And we know that physical activity is much more than just a way to help control weight; it seems to affect hormones and other influences on cancer development regardless of weight. This is important because it means that eating healthful food is not enough.
The Continuous Update Project is a systematic and ongoing review of all of the science related to food, nutrition, physical activity and body fat to cancer. A panel of experts will continuously evaluate new research and combine the data with studies already in the database to update the findings of the AICR/WCRF 2007 report. In 2009, AICR/WCRF released an updated review of the evidence on breast cancer. The CUP is currently reviewing data on colorectal cancer and prostate cancer; results are expected this year.
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