Some of the world's leading experts in nutrition epidemiology have cast a
resounding vote in the decades-long debate between treating or preventing
cancer: Prevention wins.
Their report, being released today, argues strenuously for diet and exercise as
the keys to fighting cancer. It calls research and spending on the treatment of
cancer "necessary but not sufficient," and contends that a far better strategy
for reducing the world's annual tally of 11 million cancer cases would be to
develop a public-health policy aimed at preventing people from getting the
disease in the first place.
The report, issued by the World Cancer Research Fund/American Institute for
Cancer Research, is based on an exhaustive review of nearly 7,000 scientific
studies into whether cancer rates are influenced by diet, obesity and exercise.
Based on this review, it concludes that cancer "is mostly preventable,"
estimating that about one-third of all cases in advanced countries like Canada
could be eliminated by diets that aren't loaded with fatty, sugary foods, by
people exercising regularly and, if they are obese, by slimming down to an
appropriate weight. Among the cancers with links to these factors are those of
the breast, prostate, mouth and colon.
Another third of cancers are due to smoking, indicating that well over half the
cases of the disease could easily be prevented.
"It's a very compelling case" that cancer incidence could be cut dramatically
through prevention, said Shiriki Kumanyika, an epidemiologist at the University
of Pennsylvania in Philadelphia and a member of an expert panel that oversaw the
writing of the report. Also on the panel were such nutrition luminaries as the
Harvard School of Public Health's Walter Willett.
Dr. Kumanyika said scientific evidence strongly supports the estimate that poor
diet, obesity and lack of exercise cause one out of three cancers. "I definitely
feel confident that it's at least that much," she said.
Much of the medical research into the causes of cancer has looked at factors
such as genetic susceptibility. But Dr. Kumanyika said studies tracking
immigrants and their children who move from areas of low cancer incidence, such
as Asia, to countries with high rates, such as the United States, suggest the
genetic factor may be overrated. Over time, cancer rates among migrants and
their children rise toward the levels prevalent in their adopted countries,
suggesting that something common to everyone in the new environment is the
cause.
Although individuals can make decisions to get more exercise or eat better food,
thereby reducing their chances of developing cancer, the report says that
entities ranging from governments to schools need to develop public-health
strategies to reduce the incidence of the disease.
Among the steps it recommends are banning advertising of sugary drinks and
unhealthy foods directed at children, a step Quebec has already taken. The
report says the Quebec action has led to a decrease in the amount of sugary
cereals purchased, particularly among francophones.
It also calls for vending machines that dispense high-fat, sugary sweets or
drinks to be moved out of schools and workplace cafeterias.
Another approach that should be considered is having processed meals, snacks and
food reformulated to contain less sugar, refined starches, fat and salt, the
report says.
To encourage more physical activity, it says society should place less emphasis
on elite professional sports that lead people to be sedentary spectators, and
instead develop entertainment that inspires everyone to be physically active.
It says cities should be designed for walking and cycling, rather than the
current practice of promoting automobile use through road expansion.
The Canadian Cancer Society supports the report's approach, saying Canada needs
a two-pronged strategy for dealing with cancer that involves both individual
action and public-policy interventions that help people reduce their cancer
risk.
"There are things that individuals can do, among them not smoking, having a
healthy body weight, eating a healthy diet," said Heather Logan, a spokesperson
for the society. "But it's insufficient merely to tell Canadians to do that. We
need to make those healthy choices easy choices."
Prevention: the best cure
U.S. estimates of cancers that can be prevented with appropriate nutrition and
physical activity:
Endometrium: 70%
Esophagus: 69%
Mouth, pharynx, larynx: 63%
Stomach: 47%
Colorectum: 45%
Pancreas: 39%
Breast: 38%
Lung: 36%
Kidney: 24%
Gallbladder: 21%
Liver: 15%
Prostate: 11%
Total for these cancers: 34%
Total for all cancers: 24%
TRISH McALASTER / THE GLOBE AND MAIL / SOURCE: WORLD CANCER RESEARCH FUND