Thursday, July 3, 2014

Alcohol and Health: Three New Studies and What They Mean for Youth and Young Adults

Photo: Flickr/Tim RT
It's been a big week in the news for alcohol and health. Three separate studies were released that helped shed light on a key issue we often discuss here at Cancer News in Context: the important impact that drinking has on cancer risk - particularly when started early in life.

The first report, which appeared in the online journal Preventing Chronic Disease, details the impact that drinking has on both disease risk and lifespan.  In the overall population, excessive drinking was found to cause over 87,000 deaths each year, resulting in 2.5 million years of life lost.  Acute causes - like car crashes, suicide/homicide, and falls - accounted for a little over half of these deaths, while chronic diseases - like stroke, cancer, and liver diseases - accounted for the rest.  Among working age adults (20 - 64 years), 10 percent of all deaths each year could be attributed to alcohol.

In those under age 21, alcohol accounted for about 4,300 deaths each year and a total of 249,727 years of life lost.  Not surprisingly, the most important contributors to these deaths were more immediate causes - car crashes and suicides/homicides -  rather than chronic diseases.  

Yet, just because the full chronic disease effect of excessive drinking doesn't show itself until later in life, this doesn't mean that drinking in youth doesn't have an important impact on later risk.  This seems especially so for breast cancer, where there is now good evidence that drinking in youth and young adulthood has a pronounced influence on later-life breast cancer risk.  Unlike most other organs in the body, the breasts continue to develop until a woman has her first child, and up until then, breast tissue appears more susceptible to harmful risk factors, like alcohol.  

This makes the results of another study released this week particularly concerning.  This study, released in the Journal of the American Medical Association - Psychiatry, found that younger generations of Australian women now drink much more excessively than did their mothers when they were the same age.  One primary reason for this is, simply, that women today are more likely to delay childbirth, deciding to have children later in life than their mothers did.  Without obligations of children and family there is greater opportunity for, and fewer drawbacks to, drinking.  

This new pattern  - which is likely mimicked across multiple nations - can have important implications for breast cancer for the reasons discussed above related to breast development.  Not only are women drinking more, they're doing so during the key period in breast development between first having a period and having a first child.   

Finding effective ways to help adolescents and college-aged women understand these risks and avoid alcohol - or at a minimum avoid excessive amounts of alcohol - will be a challenge for health professionals moving forward.  

Another paper released in the journal Nature this week could eventually help with this (related NPR story).  Researchers looked at various characteristics of 700 European 14 year olds - from family history, to personality traits, to brain anatomy - to see if any patterns emerged that predicted drinking at age 16.  They found that life experiences, personality, and certain aspects of brain anatomy could predict with decent accuracy who would go on to become problem drinkers.  While using such an algorithm is a long way off from practical application, it does show that it may be possible in the future to identify in the health care setting which youth may be more likely to put their health at risk with early life drinking.  Interventions could then be better targeted and would hopefully be more effective at curbing youth drinking.

Despite the depictions in magazine, TV, and website ads, drinking is a major minefield for adolescents and young adults.  There's the very immediate dangers of car crashes, injuries, and unsafe sex, and the longer-term dangers of alcoholism, cancer, and other chronic diseases.  Forming effective channels to reach out to youth with such messages needs to be a continued priority for public health.

Friday, June 27, 2014

Time on the Side: New Analysis Finds That to Eat Less - Eat Slower

Photo: Flickr/thomashawk

It probably comes as no surprise, but mom was right: We really shouldn't eat so fast.

Apart from the noise and the mess and the ill-effects on dinner table conversation, wolfing down food may have ill-effects on health as well.

A detailed new analysis in the American Journal of Clinical Nutrition shows that taking your time when you eat can substantially cut down on how much you eat.  And in today's world, where at least two thirds of the nation struggles with weight, this can have important implications.

The researchers performing the analysis combined the results from 22 separate studies looking at speed of eating and the amount of food eaten.  What they found was that those who ate their food slower ate less overall than those who ate their food faster, and apparently without feeling deprived.  Eating speed - fast or slow - had no effect on feelings of hunger, either right after a meal or three and half hours later.

We live in a society that often works against us when it comes to choosing healthy food and getting physical activity.  This can make it tough to lose weight, or even stay at the same weight. Yet, there are some simple steps we've promoted for a long time that can help with cutting back on calories and burning more calories through exercise.  Eating more slowly is one of these.  It may take some re-training of eating habits but in the end, its a pretty simple step  - just sit back, enjoy your food, and let time do the hard work.  In the end, we're likely to have eaten less - and to feel just as satisfied.

Try this and other tips to help keep weight in check: 

Choose smaller portions, and eat more slowly.  At the most basic level, eating slowly gives our stomachs time to tell our brain when we’ve had enough food.  As competitors at the Nathan’s Hot Dog eating contest will tell you, it takes about 8 minutes or so for the brain to register when the stomach’s full.  If you eat too quickly, you can down a plate of food, grab more, and then down that before your brain knows what hit it.  By then, you may have had twice as much food as you needed or even really wanted.  So why not slow down and enjoy your food.  You won’t even miss the extra food you’re not eating and that you didn’t even really want.

Fit physical activity and movement into your life each day.  Regular activity is one of the best ways to keep weight in check.  Choose things you enjoy that get you moving and shoot for at least 30 minutes a day.  And studies show that 60 minutes or more is even better for weight loss. 

Limit time in front of the TV and computer.  Screen time – the phrase given to time spent with our TVs, computers, phones, and tablets – is a double whammy when it comes to weight and health. Not only does it up the amount of time we spend each day in complete inactivity, but it also makes it more likely that we’ll overeat (especially unhealthy foods) while we’re sitting in front of those screens.  Shoot for under two hours of non-work screen time each day.  Less is even better.  Zero is ideal.  

Eat a diet rich in fruits, vegetables, and whole grains.  Eating a lot of plant-based foods can help keep appetite and weight in check.  Not only are they very filling but they also keep at bay wild swings in blood sugar that make you want to eat – even if you’ve just had a big meal.  Shoot for at least 3 servings of whole grains a day, 5 serving of fruits and vegetables, and keep red meat to a minimum.

Wednesday, June 25, 2014

New Study: Tanning Bed Use Brings Skin Cancer Risks - and Brings Them Early

Photo: Flickr/whatshername
A new study out this week further confirms the dangers of indoor tanning, finding that use of tanning beds and other UV tanning devices is strongly linked to developing skin cancer early in life. Published early online in the medical journal Pediatrics, the study compared the history of indoor tanning in a group of 25 - 50 years old participants, 657 who'd been diagnosed with a type of skin cancer called basal cell carcinoma and 452 who did not have cancer.

The researchers found that any indoor tanning was linked to a 60 percent increased risk of early-onset basal cell carcinoma, and all types of tanning devices carried risks, from tanning lamps to tanning booths to tanning beds, which carried the most harm - doubling the risk of cancer. Beginning tanning before age 20 was linked to greater risk than tanning starting later in life. And cancer risk increased 10 percent for each year under the age of 24 that participants first indoor tanned.

These results are part of a disturbing trend in the United States - both in the popularity of indoor tanning by youth and in growing rates of skin cancer. And although basal cell carcinoma is not as serious a skin cancer as the much more deadly melanoma, it is not to be taken lightly. If not treated early, basal cell carcinoma can result in significant scars and other cosmetic damage. If it returns after initial treatment, it can be more complicated to treat.

Melanoma skin cancer is the most deadly type of the disease, and is also tightly linked with indoor tanning. A 2012 analysis of over 25 studies found that having ever used a tanning bed raised the risk of melanoma by 20 percent compared to those who had never used a tanning bed. Use in early life boosted risk even more. Using a tanning bed before age 35 raised the risk of melanoma nearly 90 percent.

Rates of melanoma have been rising steadily over the past 30 years. And a recent analysis found that indoor tanning use has also been increasing and is responsible for over 400,000 cases of skin cancer each year in the United States.

Despite such troubling numbers, full scale regulation of the tanning industry is slow to catch on. While there have been positive moves by state governments in recent years, it still still too easy for minors to access indoor tanning facilities. A 2014 analysis of 2012 data found that numerous states had no regulations in place at all that restricted youth access and many others had lax enforcement of regulations.

The dangers of indoor tanning, though, is a subject that is finally beginning to gain traction, moving states that once had no regulations to finally get some in the books. In June, for example, Missouri put into place legislation requiring minors to have parental consent to indoor tan. Though such a move is short of the outright ban on minors tanning supported by the American Academy of Dermatology, it is a move in the right direction and, along with similar legislation in other states, should help garner further support for indoor tanning protections across the nation.

More and more evidence is showing that youth and young adulthood are key times in determining cancer risk in later adulthood. We need to do everything we can to help our children, grandchildren, nieces, and nephews be as healthy as they can throughout life. This means helping them to eat well, to be active, to not smoke, to protect themselves from the sun, and to avoid indoor tanning.

Monday, June 23, 2014

Data Show More Support Warranted for Worksite Wellness Programs

Photo: Flickr/abraj
This week I had the privilege of addressing the American Cancer Society CEOs Against Cancer at their annual meeting that this year was held at Washington University in St. Louis. As a member of the panel addressing worksite wellness, I was able to briefly summarize the strong evidence that worksite wellness programs can generate substantial savings. For example, in a critical meta-analysis of the literature on costs and savings associated with workplace disease prevention and wellness programs, Baicker, Cutler and Song (2009), show that medical costs fall by about $3.27 for every dollar spent on wellness programs. In addition, absenteeism costs fall by about $2.73 for every dollar spent.

Others have summarized the evidence on worksite physical activity and nutrition programs. A systematic review and meta-analysis of 18 programs shows that physical activity and nutrition programs are effective in reducing body weight when compared to usual care (van Dongen et al., 2012).

Even more impressive are the benefits of smoking cessation. Halpern and colleagues (2007) show savings in terms of reduced healthcare costs. The savings per smoker range from $350-$582 at 10 years, with internal rate of return ranging from 39% to 60% at 10 years. In addition, as noted in the 50th anniversary Surgeon General’s Report on Smoking and Health (2014) after stopping smoking, former smokers experience an increase in their quality of life. Never smokers have the lowest health care costs in the age range of 45 to 64. Smokers have a loss of productivity in the workplace through absenteeism and also incur more hospitalization and medical charges as a result of outpatient visits. It is the sum of these benefits of quitting smoking, over several years, that drives the benefits of worksite wellness.

A rigorous evaluation by investigators at RAND evaluating a worksite wellness program that included prevention services as well as navigation and support for those with chronic conditions also shows substantial savings (Liu et al 2013). Disease management interventions reduce costs per employee per month significantly. The prevention interventions also substantially reduced costs. While such a program has expenses in the first year, savings are visible in 3 to 5 years after implementing a worksite wellness program.

In sum, worksite wellness programs save employers in terms of health care costs and increase productivity of the workforce. It is hard to see why we don’t have even more support for these programs across all workplaces.

References
Baicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff. 2010;29:304-311.

DeVol R, Bedroussian A. An Unhealthy America: The Economic Burden of Chronic Disease. Santa Monica, CA: Milken Institute. 2007. 

Halpern, MT, Dirani, R, and Schmier, JK. Impacts of a Smoking Cessation Benefit Among Employed Populations. J Occup Environ Med. 2007;49:11–21. 

Liu, H, et al. Effect of an Employer-Sponsored Health and Wellness Program on Medical Cost and Utilization. Population Health Management. 2013;16:1–6.

U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014. 

van Dongen, JM, et al. A systematic review of the cost-effectiveness of worksite physical activity and/or nutrition programs. Scand J Work Environ Health, 2012. 38:393-408.

Wednesday, June 18, 2014

The Ongoing Challenge to Secure Resources for Cancer Prevention

The ongoing challenge of garnering appropriate resources and recognition for cancer prevention was highlighted yet again by a recently released paper in the Journal of Cancer Policy titled Cancer economics, policy and politics: What informs the debate? Perspectives from the EU, Canada and US.

The overall goal of this paper was to assess the factors that are informing and influencing the political debate on cancer economics in the United States, Canada, and Europe.  That the analysis focuses on cancer diagnosis and treatment isn't surprising.  What is surprising, however, is that a paper on the economics of the burden of cancer and cancer care almost completely ignores prevention.

If there is one thing that has become clear over the past decade it is that cancer is a problem we will not be able to treat our way out of.  With the aging population, prevalence of the disease is increasing so much, and the disease itself is simply so diverse, that therapies are very unlikely to have a major impact on cancer burden population-wide in the foreseeable future.

We know enough today, however, to prevent at least half of all cancer cases.  Yet, the word "prevention" appears exactly once in this paper, and the concept of prevention appears only in passing in a handful of places throughout.

Of course, this single paper isn't responsible for cancer prevention not receiving its due attention.  It is, however, an example of many cancer-related policy papers that don't fully acknowledge the potential of prevention in reducing population-wide cancer burden.

As CNiC's Graham Colditz stated in his recent paper: Carpe Diem: Time to Seize the Opportunity for Cancer Prevention:
"What is currently lacking is the political will to allocate resources, prioritize incentives and rewards, and implement regulations that reinforce behaviors that will prevent cancer. Given that we know today that 50% or more of cancer is preventable, gathering political support for prevention should be our highest priority. One likely reason for its current limited support is simply the nature of prevention. Its success is marked by silent victories. Those who do not get cancer do not have compelling stories of survival that often accompany cancer treatment. And the understated approach of prevention—putting into practice the knowledge we already have—does not garner the same political and research excitement associated with newer technologies and the hunt for undiscovered and unproven cancer risk factors. 
Of course, research across the full spectrum of cancer is essential and needs to continue. Cancer prevention, however, must be funded in proportion to its potential effect. If we do not act, with the aging United States population, the number of new cancer cases diagnosed annually will double within 35 years."
To make true headway against the burden of cancer - especially in the face of economic realities - it's time for such a vision for prevention to become reality. 

Tuesday, June 17, 2014

Sitting, Cancer Risk, and Developing Strategies to do Something About It

Photo: Flickr/DanielGo
This post seems a bit cruel, coming out as it does during the current TV season's finale week and the beginning of the World Cup.  But, science doesn't rest - not even for Game of Thrones or the Brazilian national soccer team. So, neither do we.

Just released on the Journal of the National Cancer Institute's website is a new analysis by two German researchers that combined the results from numerous studies on sedentary behavior and found that the simple act of sitting can significantly increase the risk of multiple cancers, including colon cancer, endometrial cancer, and lung cancer.  Even in those who exercised regularly, being sedentary increased cancer risk.

The large analysis looked at data from 43 observational studies that included nearly 70,000 cancer cases.  The researchers found that, compared to those who sat the least, those who sat the most had a 24 percent higher risk of colon cancer, a 32 percent higher risk of endometrial cancer, and a 21 percent higher risk of lung cancer.  When looking only at TV viewing, the risks jumped considerably, with the risk of colon cancer increased by 54 percent and endometrial cancer by 66 percent.

Researchers hypothesized that time spent watching television was linked to greater risk than say, time spent sitting at work, because people who are watching TV are more likely to spend that time eating unhealthy foods, drinking alcohol, and smoking.

Although regular physical activity is a great boon to health, this new report also helped confirm that exercise is not enough on its own to protect against the health risks of an overall sedentary lifestyle.  Even after taking activity level into account, high levels of sedentary behaviors still increased the risk of colon cancer by 20 percent and endometrial cancer by 32 percent (see figure).

In an accompanying editorial, Washington University School of Medicine researchers, Lin Yang and CNiC's Graham Colditz, discuss how the continuing modernization of society sets the stage for increasingly sedentary lifestyles and the negative health effects that go with it.  To successfully combat sedentary lifestyles it will take approaches similar to those that helped rein in tobacco use and that have just started to show some success against obesity. The key is targeting multiple layers of society, and with appropriate resources.  These include worksite policies that can help reduce sitting time (such as, standing desks, regular standing/walking breaks, and active (vs. passive) commuting benefits) and programs focussed on youth that promote physical activities as an attractive choice to sedentary screen time.  

With recent high profile studies, sitting is quickly being recognized as the health risk that it is.  For many years, it was seen simply as the direct opposite of exercise and physical activity.  And while there are clearly close links between the two, it's now clear that it is an important cancer risk factor even in those who exercise regularly.

Because this relationship has taken a while to be broadly recognized, we're behind in developing strategies to effectively address the issue.  As Yang and Colditz state:  "strategies remain poorly defined to meet this goal [of reductions in sedentary behavior]."

Now that we have the results of this latest analysis to further show the impact that sedentary lifestyles are having on our health, it's time to develop an approach to address the issue with the energy and resources that are equal to its impact.

Sunday, June 1, 2014

ASCO Awards Lecture: Seizing the Opportunity for Cancer Prevention


Cancer News in Context's own Graham Colditz received the American Society of Clinical Oncology (ASCO)–American Cancer Society Award today at the ASCO Annual Meeting in Chicago (more info).  The award honors contributions to cancer prevention and control.

In his associated lecture, Colditz will focus on the need to place a higher priority on prevention if we are to make real strides in the fight against cancer.  A synopsis of his key points:
The United States and other high-income nations have long developed a “cancer culture” – one marked by lifestyle profiles that together greatly increase cancer risk. There is immense potential to reduce the cancer burden by focusing prevention resources in a relatively small number of key areas. At least half of the roughly 1.6 million new cases of cancer diagnosed each year in the United States could be prevented using knowledge that we already have. Available strategies for cancer prevention include vaccination and safe sexual practices, smoking cessation, physical activity, healthy body weight, healthy diet and moderate or no alcohol intake, sun protection and avoidance of indoor tanning, and screening. Yet, budget realities remain focused on areas other than prevention. To address the burden of cancer as effectively and efficiently as possible, prevention and control must become a true resource priority, with funding on par with other key areas. We need the political will to allocate resources, prioritize incentives and rewards, and implement regulations that reinforce behaviors that will prevent cancer. Link to full article in annual meeting education book.  
To see lecture slides, background papers, and related online patient prevention materials, visit: http://tinyurl.com/l4a4g2j