Karen Collins
How can health professionals most effectively help people adopt lifestyle choices that reduce their risk of cancer? The 2018 AICR Third Expert Report provides updated evidence-based recommendations for eating habits, physical activity, and healthy body weight. A new scoring system has been published that reflects these recommendations, giving researchers a tool to consistently assess habits of study participants.
For health professionals, a scoring system can potentially identify and prioritize an individual patient’s lifestyle choices that could be addressed to reduce cancer risk. The new cancer prevention scoring system may not be practical for most health professionals’ work with patients, but it can be a useful guide to shape patient conversations.
When cancer prevention recommendations seem out-of-reach, it’s important to let patients know that moving closer to the recommended goal is better than not changing at all. The new scoring system exemplifies this by awarding partial points for getting part-way to identified target habits.
For health professionals, the new scoring system may be more useful to guide conversations with patients than the score itself.
The Scoring System as a Conversation Guide
The new scoring system uses data scientists get from research tools like detailed surveys with more than 100 questions about eating habits. Most health professionals don’t have such detailed data for discussions with their patients. Still, the elements of the score identify priority areas for attention, and scoring details can be modified to guide patient conversations.
Weight: Excess body fat increases risk of at least 12 different cancers, likely acting through effects on hormones, chronic inflammation and cell signaling. The new score considers body mass index (BMI) and waist size and reflects the AICR report findings that risk begins with elevated waist sizes below those tied to obesity. The message is to avoid and troubleshoot adult weight gain, rather than ignoring it until health problems develop.
Physical activity: The primary target is to get at least 150 minutes of moderate activity like brisk walking (or its equivalent in vigorous activity) each week. If that seems out of reach, a regular habit of even smaller amounts seems to provide some risk reduction. The new scoring system doesn’t include two other findings from the AICR report: more activity than this target seems to reduce cancer risk even further, and a target of reduced time being sedentary.
Plant-focused eating: For research studies, the new score awards points based on grams of vegetables and fruits and grams of dietary fiber consumed daily. A more practical way to talk to patients about this is to see if vegetables and fruits total at least five servings daily. (Count each half-cup of raw or cooked vegetables or fruit as one serving, but count one cup of lettuce and other raw leafy greens as a serving.) Also check whether whole grains and/or pulses (like dried beans and lentils) are included in most meals.
Ultra-processed foods: Despite all the buzz – and confusion – about “processed foods”, this recommendation specifically targets choices that are high in added sugars or unhealthy added fats. Frequently including foods like donuts, ice cream, bakery, French fries, chips and sweets tends to promote weight gain. For research studies, the new score awards points based on how the percent of daily calorie consumption that comes from these foods compares to other people in a study. In talking with patients, health professionals can discuss how frequently these foods are consumed. Although some research suggests that a broader range of highly-processed foods may promote over-eating and weight gain if they’re a significant part of eating habits, some processed foods (for example, plain frozen vegetables) are not a problem.
Red and processed meats: Red meat includes beef, lamb and pork. Patients may be used to hearing about choosing lean cuts, but limiting red meat to no more than 12 to 18 ounces a week is recommended to reduce colorectal cancer risk. (That would be comparable to four to six portions the size of a deck of cards. If people eat big portions, target less frequent use.) Processed meats, such as bacon, sausage, and hot dogs, are an even greater concern. The goal is to minimize consumption. For people who eat these choices often and want more concrete language, the new scoring system provides perspective. It doesn’t penalize for small amounts (less than one ounce/week) that might be used as a flavoring in cooking, and allows partial points if amounts add up to less than about a deck of cards each week.
Sugar-sweetened drinks: These include not only soda and sports drinks, but also highly sweetened ice tea, specialty coffee drinks sweetened with sugar-laden syrups, and sweetened “juice beverages”. Cancer prevention recommendations encourage minimizing consumption because these drinks can promote weight gain and excess body fat that raise cancer risk. For people who aren’t willing to completely avoid them, a middle ground might include working toward no more than eight ounces/day, which earns partial points in the new scoring system.
Alcohol: Keeping alcohol consumption within the definition of moderation earns only partial points in the new scoring system, since cancer-focused recommendations call for avoiding it. Since large portion sizes and higher-alcohol beverages are becoming common, health professionals help by providing specifics, instead of simply referring to a number of “drinks” per day. Check this information about alcohol in common drink sizes.
A Beginning, Not an End
A score, like the recently published score that assesses how closely eating and activity habits and weight come to AICR’s Cancer Prevention Recommendations, is only the beginning — not an end in itself — when it comes to supporting health.
For health professionals, the conversation needs to move on to an open, two-way discussion of which habits someone might be ready to adjust, and an exploration of achievable goals and specific new habits that could be implemented. Cancer Health Check is a free online tool can be a valuable asset, using practical language to check current habits, and then providing feedback with a positive tone and tips for moving forward.
Regardless of the tool used, the key message for health professionals to share is to aim for progress, not perfection.
