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Interviewer: Diet and exercise can help reduce cancer risk. Talk about that next on The Scope.

Announcer: Health tips, medical views, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Cancer can be caused by many different factors, but some of them like diet and exercise is actually something a lot of us can control. Dr. John Sweetenham is a medical oncologist from Huntsman Cancer Institute. And how much of cancer risk is related to diet?

Dr. Sweetenham: Well, overall in the U.S., the current estimates are that about 20% to 30% of all cancers are related in some way to either excess body weight, to poor nutrition, or to inactivity and lack of exercise.

Interviewer: So to round up, maybe around a third. That's pretty substantial. Give me an idea of how that fits in context with maybe some of the other risk factors that are out there like genetics or smoking or stuff like that.

Dr. Sweetenham: Sure. I mean, if you look overall at risk factors for kind of cancers globally, we know for example, that tobacco and smoking is a very significant cause for lung cancers. And we can kind of rest the blame for certain types of cancer on certain types of lifestyle changes and behaviors.

For excess weight and for inactivity, it seems like it affects a whole breadth of different types of cancers. So there are many cancers which are more common in folks who are maybe overweight and folks who are inactive and who have deficiencies of whatever type in the diet or excesses of diet in the diet like high fat and so on.

Interviewer: Yeah. I'd like to delve into some of those details here. But before we kind of get into the how's and why's of some of those details, let's just lay out what a good diet and exercise plan for cancer prevention would look like, and then we'll go from there.

Dr. Sweetenham: Sure. So we don't know the absolute details of that, but some general rules are to eat plant based foods as much as you can, plenty of vegetables, beans, any other plant-based foods, they're helpful in that regard. They seem to reduce cancer risk. And stay away particularly from cured and processed meats and red meats. They seem to be particularly risky. And then finally, the other components of the diet that's well known about is high fat foods. So it's difficult to eliminate those from diet, but if you can reduce the amount of high fat food that you have, that can be a big help.

Interviewer: So this might be a bit of a technicality, but is it plant-based foods are good just because they're not the bad foods? Or are there actually some positive health benefits to those?

Dr. Sweetenham: Yeah. That's a great question. There are very definite health benefits from those. For example, the fiber content of your diet, we know that that can reduce your risk of certain cancers like colon cancer. So it isn't just about not eating bad foods, there are positive benefits from a lot of vegetables and fruits and so on.

Interviewer: Yeah. So the bad foods, what's going on there? How are they causing damage?

Dr. Sweetenham: So we don't really know in detail. We know for sure that if you are for example, overweight, that can affect the way that your body reacts to levels of insulin, and that is thought to be one reason why some folks develop cancer as a result of the way the body handles insulin.

Some of the hormone levels are affected by excess weight. Estrogen levels are thought to be affected by how heavy somebody is, and that may be responsible for certain types of cancer such as breast cancer. But exactly why it is that excess weight causes cancer is still something that a lot of people are researching.

Interviewer: Yeah. So we have pretty good research to show that the diet that you laid out, plant-based diet, avoiding a lot of red meats and processed foods, we just don't know the why's kind of that.

Dr. Sweetenham: Absolutely, yeah. The evidence for that is very good. The cause is still a little unclear.

Interviewer: Got you. So what about a lack of activity? We started out by talking about food and exercise. So you're talking about how people that have excess body fat could be at more risk of cancer. Is the activity just about keeping a lean physique so that doesn't happen, or are there actually benefits to activity?

Dr. Sweetenham: There are clear benefits to activity, and we see that at several levels. Partly in cancer prevention it seems to reduce the risk. But also there's increasing information around how someone who already has cancer, how they may respond to their treatments and what their likely outcome is going to be, if they're able to exercise during the treatment after the diagnosis. So now, some really interesting evidence that exercising during and after your treatment can reduce your risk of a cancer coming back.

Interviewer: Yeah. So is it generally thought that it's chemical reasons? Again, for the exercise and for the food it's the chemical changes that are going on in the body that might be affecting the cell division?

Dr. Sweetenham: Yes, it probably is. Again, a number of large research programs addressing that and we have some big research programs at Huntsman Cancer Institute which are specifically looking at why that is and how it is that exercise can reduce your cancer risk, and improve your cancer outcome if you do develop the condition.

Interviewer: Yeah. Here's what I think I know. I want you to tell me if this is right, and then fit it into the context of this conversation. So cancer is an uncontrolled division of cells which is caused by genetic mutation. So every time your cell divides there's a chance of a genetic mutation happening. Some are . . . it doesn't matter, some could be bad, some could be good.

Dr. Sweetenham: Correct.

Interviewer: Over time, you get enough of these genetic mutations, then the cancer or the cell loses its ability to control its division speed.

Dr. Sweetenham: Yeah. The brakes come off.

Interviewer: Okay, the brakes come off, and that's when you start to get cancer.

Dr. Sweetenham: Exactly.

Interviewer: So eating red meats, we don't know why that's causing that genetic breakdown.

Dr. Sweetenham: There are clues. It may be that there are substances within the red meats, or within the processed meats that actually kind of accelerate that mutation, that genetic change within the cells. But again, we don't know in great detail why that is.

Interviewer: Got it. Are some people more susceptible to one trigger than others? Meaning, for one person it might be the foods they eat or don't eat, but for them smoking isn't quite as much of a risk. I guess what I'm trying to ask here, is there a cumulative protection in all of it? Like the more right things I do, the better chance I'm going to have of not developing cancer.

Dr. Sweetenham: At the moment, all the evidence would suggest that's the case. Yeah. The more healthy behaviors that you're able to follow, the lower your risk of cancer. So that as you eliminate one of these risk factors from your life, your risk of cancer goes down in proportion. So if you stop smoking, you reduce your risk of certain types of cancer. If you lose weight, you're reducing your risk of additional types of cancer. So absolutely. It all adds up.

Interviewer: Yeah. And all 30% of it you can control.

Dr. Sweetenham: Absolutely.

Interviewer: With just diet and nutrition.

Dr. Sweetenham: That seems to be the case. Yeah. Absolutely.

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Interviewer: You've been diagnosed with cancer. Now what? We'll examine that next on The Scope.

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Interviewer: You've been diagnosed with cancer, and I'm sure there are a million questions going through your mind at that point and we're going to try to figure out some of the answers to those questions. We're with Dr. John Sweetenham, with Huntsman Cancer Institute.
First of all, what is in your experience the general reaction when somebody gets a cancer diagnosis?

Dr. Sweetenham: I think it's a combination of fear, anxiety, anger, and bewilderment.

Interviewer: Yeah, that's generally what you see.

Dr. Sweetenham: Yes, generally that's what you see; mostly fear. And I would say the second thing that most people experience is this kind of lack of direction and bewilderment about what they need to do next.

Interviewer: Yeah. Well, I hope to cover a few of those things right now, because is it the case when you tell somebody they have cancer that they don't hear a lot of what you say after that?

Dr. Sweetenham: That's exactly right. And when we start thinking about now what, one of the first things that I would say to anyone who has actually been given this diagnosis is that in any other encounter you have with a healthcare professional have somebody with you, because you are absolutely right. I think when many people hear the word cancer, they stop at that point and they hear nothing else that they're told. So a second or a third pair of ears is going to be so important to get you the information you need to make good decisions about what to do next.

Interviewer: Yeah, that's good advice. I would imagine a lot of the now what depends on what kind of cancer it is.

Dr. Sweetenham: Absolutely. Probably the most important thing that you can do very early on in this journey is to get as much information as you possibly can about your cancer. Find out the name of your cancer. Find out where it is in your body. Find out where it started if you can, and if it has spread, find out where it has spread to.
And then ask a few questions about whether your care provider thinks that this is a fast-growing tumor, or a slow-growing tumor. So in other words, as early on in the process as you possibly can, just get as much information as you can, because it's having information in an understandable form for you which is going to be your best and strongest tool in figuring out how to get through this journey.

Interviewer: And not only that, but feeling comfortable, right? You've kind of answered some of the unknown questions. So cancers aren't necessarily a death sentence. I think a lot of people hear cancer and immediately we go, bad.

Dr. Sweetenham: Right, and that's absolutely right. And of course, remember that in our lifetimes one half of all men and one third of all women are going to get a cancer diagnosis. And as you say, it's not for everybody by any means a kind of life sentence. There are at the moment in this country 70 million cancer survivors, and that number is going to steadily increase. So this is not a death sentence by any means.
So once you get past that initial kind of panic and anxiety and fear, just remember that fact. That the outcome for many people with cancer is actually extremely good, and it's improving every week.

Interviewer: What are some other thoughts you have when somebody receives, that I have cancer, now what?

Dr. Sweetenham: One of the most important aspects is going to be in choosing your team. In other words, who do you want to take care of you? And I think immediately when you think about that the tendency is to think that everybody needs to see an oncologist. Well, they may not, and I think right up front, for example if you have a skin cancer many dermatologists treat skin cancer and treat it very, very effectively.
If you have a thyroid cancer, it is likely that a thyroid specialist would treat that, and again, would treat it very effectively. So it's very important, and right up front, not to assume that you necessarily need to see an oncologist, although most people will need to see some kind of oncologist, And just to be clear, an oncologist is a cancer specialist.
There are three types, major kind of groups of oncologists. There is the surgical oncologist, who uses surgery. There are radiation oncologists who treat it with x-rays and other radiation-type treatments. And there are the medical oncologists who predominantly use drug and hormonal therapies to cancer. And you may need to see one, two, or all three of those kinds of specialists, just depending upon what type of cancer you have.

Interviewer: So you generally get that diagnosis, and the next step is to determine who you're going to talk to next, it sounds like?

Dr. Sweetenham: Exactly right. And usually the person who gives you the diagnosis is going to be able to direct you for where to go and maybe set up a referral so that you get to the appropriate oncologist.

Interviewer: And I would imagine a lot of that research that the patient would do at that point would give them more direction as to how long this treatment is going to last, the side effects of the treatment. Is it generally very different for all different types of cancers, or is there kind of a common thread?

Dr. Sweetenham: There really isn't a common thread. It's very different depending on the type of cancer, and it might range from surgery only, no surgery at all, radiation only, chemotherapy only, or even none of the above. There are some cancers where at least when they are initially diagnosed they grow so slowly that we actually recommend no treatment at all to begin with.

Interviewer: That must be kind of shocking when people hear that.

Dr. Sweetenham: It is, and many people take quite a long time to come to terms with that. But they can be reassured that when we do that, it's because the evidence is that folks can live with some of these very slow-growing cancers for many years and in excellent health. And, "If it ain't broke, then don't fix it."

Interviewer: It sounds like to me like you should get a lot of information. Ask your physician a lot of questions, even if you feel they might be stupid questions. Do whatever it takes to kind of mitigate that uncertainty that you have. Do you have any other advice?

Dr. Sweetenham: Yes, first of all, there are no stupid questions. And I think it's really important that everybody understands that. Secondly, choose your cancer care team very carefully. A couple of things that I think are really important; number one, ask your team how many of your type of cancer they treat every year, because that's going to give you some comfort level with their level of expertise.
Ask your cancer care team how they feel about you getting a second opinion. You know, not everybody needs a second opinion; if fact, most people don't. But if your team doesn't want you to get a second opinion, then that's probably a good occasion in which you might want to think about getting one.

Interviewer: Sure.

Dr. Sweetenham: And then finally, for many patients who have a diagnosis of cancer they're going to be interacting with the healthcare team for the next five years. So just make sure that you're comfortable with the team, that they listen to you, that they understand you, that they can explain things to you in a way that you can understand; and that you like them. That's very important.

Interviewer: Yeah. So somebody has been diagnosed with cancer, now what? What's your final thought on that? What would be the one message you'd want that person to hear from you?

Dr. Sweetenham: The information and knowledge about your cancer is the most powerful thing that you can have, so get as much information as you can. And have your friends and family as your support network to actually fill in the gaps of information that you may not necessarily be able to hold onto.

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