Reducing Your Risk of Cancer
Deljeet Singh, MD, is a gynecologic oncologist for Banner MD Anderson Cancer Center.
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Banner Health: Reducing Your Risk of Cancer - Full Transcription
Audio: Music over opening titles and introduction.
Text: Banner MD Anderson Cancer Center presents
Text: Reducing Your Risk of Cancer
Diljeet Singh M.D.
Banner MD Anderson Cancer Center
Text: Andrew Schorr
Founder and Host, Patient Power
Author, The Web-Savvy Patient
Image: Andrew Schorr on camera
Audio: “Hello. I’m Andrew Schorr for Banner MD Anderson Cancer Center. Any of us who think about cancer want to prevent it if we can. What can we do? What can we do with our doctors so that it does not happen to us? We’re going to talk about that with someone who’s really in the know, and that’s Dr. Diljeet Singh. She’s a Gynecologic Oncologist. She’s also the Director for Cancer Prevention and Integrative Medicine at Banner MD Anderson Cancer Center in Gilbert, Arizona. Thank you so much for being with us, Dr. Singh.”
Image: Dr. Singh on camera
Audio: “Happy to be here.”
Image: Andrew Schorr on camera
Audio: “Dr Singh, so all of us want to do everything we can so it doesn’t happen to us. So let’s start with our life style. Tell us some of the things that we can do just every day that can lower our risks—that have been proven to lower our risk.”
Text: Diljeet Singh, M.D.
Cancer Prevention and Integrative Medicine
Images: Dr. Singh and Andrew Schorr on camera as each speak.
Dr. Singh Audio: “I think there are a lot of important things. Diet is very, very important and we know that making sure we’re getting enough fruits and vegetables is important. Trying to get your protein from healthy protein sources, so some plants sources like beans and lentils and tofu and things like that. And then fish. Having fish as a source of protein in your diet, also. And then getting your fats from healthy places, too. We know there are certain fats that are more healthy, what we call the Omega 3 fats, that come in olive oil and nuts and fish, and that those are better for us and may reduce our risk of cancer. So, diet.
And then the second thing I think of is physical activity. There’s lots and lots of evidence that, sort of, even a small amount of physical activity, like 20 to 30 minutes, three to four times a week, can decrease your risk of cancer and your risk of heart disease.
And then the third thing I think of is the big category of stress management, social support. There’s lots of evidence that people who manage their stress have decreased risk of cancer. Stress is a funny thing. Lots of people I’ve talked to say, “I don’t have any stress.” But as we think about it, like, driving is stressful. Driving turns on our stress nerve system and turns off our healing nervous system. So, really small things, like taking deep breaths, like laughter, like praying, like meditation—all of those things I think of as stress management. And, for a lot of people, working out is kind of a ‘two-for.’ They get physical activity and they get stress management out of it.”
Andrew Schorr Audio: “I know that when people are stressed, they also can sometimes eat for comfort. So where does obesity come in? Is obesity a bad guy when it comes to cancer?”
Dr. Singh Audio: “Absolutely. Obesity is a really bad guy in three major ways. So one is, there’s probably some things about obesity itself that increases the risk of a lot of cancers: uterine cancer, post-menopausal breast cancer, colon cancer, gall bladder cancer, liver cancer. And we keep adding to the list the more and more we study this. The other thing we know is that once people get cancer, if they’re obese or even overweight, that their chances of getting through surgery and chemo and radiation, and all the other things that enable us to help people survive cancer, is harder. All of those things are harder if you’re overweight or obese. And then the third thing is being obese increases your risk of a cancer coming back, even if you successfully beat it the first time around. So in all three places, obesity and being overweight are bad guys.”
Andrew Schorr Audio: “I want to go back to diet. So is someone who eats a steak or some beef like that with animal fast all of the time, more at risk than someone who’s a strict vegetarian? Or do we want to be in the middle somewhere? What’s your thought about that?”
Dr. Singh Audio: “I think that we want to be in the middle somewhere. You know, animal fat and animal products are a complicated thing. For the longest time, the way we’ve raised our cattle, or didn’t raise it when cattle were grass fed, they were that healthy fat I was talking about, the Omega 3s? They were Omega 3 dominate. And as we change the way we raised our cattle, that’s the thing that started making red meat bad for us, right? As the healthy fats, the Omega 3s, got to be less and less a part of animal fat and Omega 6, the not healthy ones, increased, suddenly they became less healthy. I think that, on the other hand, it’s very, very hard to get all the protein you need being a strict vegetarian. There’s lots of evidence that protein is an important part of normal metabolism and cell repair and all of those things. So I do think somewhere in between is good.”
Andrew Schorr Audio: “What about the way we cook our food? So, for instance, in Arizona, people might, many months of the year, want to grill out a steak. And I’ve read reports sometimes that the charcoal, and things like that, might be carcinogenic. What about that? Or even if we fry or use different oils? Does that make a difference?”
Dr. Singh Audio: “That’s all about fat content, to some extent, the frying and using different oils. So we can get around that by thinking of different ways to prepare it. Now the grilling meats and that blackened thing that we see, really does seem like there’s solid evidence to say that is some kind of carcinogen. Other really interesting data, though, is that if your marinade your meats and vegetables and whatever you’re grilling, in red wine vinegar or vinegar solutions, that it seems to decrease the negative effects we see. So it gets kind of complicated because we don’t know the exact details of why, but I do say, if possible, marinade whatever you’re going to grill before hand. And then if you can have things not get so blackened and try to avoid that blackened effect, you’re going to do better. And then keep your eye out as we learn more and more about this. I think we are going to figure out exactly what part of that process makes the risk of cancer higher and where those carcinogens come from and figure out ways to avoid them.”
Andrew Schorr Audio: “What about alcohol use?”
Dr. Singh Audio: “Alcohol use is complicated. And alcohol use is different for men and women. The bulk of the data shows that probably, in men, a glass of red wine a day or so was good when it comes to cardiac protection. The tricky part is, breast cancer risks go up with alcohol use. And so, especially in women, I sort of stick to saying a couple glasses of red wine a week are probably the healthiest thing to do. But, again, just like we were talking about meat, it’s all about moderation, right? Anybody who’s drinking a lot every day, there’s a lot of things that that is not good for their health. So I think that, for now, you sort of take the moderation message and then, in women, realize that there are risks that are different than in men.”
Andrew Schorr Audio: “I want to ask you about one area where I’m willing to bet you’ll say moderation does not apply, and that’s tobacco use.”
Dr. Singh Audio: “I knew you were going to say that. Yes. Absolutely. No tobacco is the answer on that one. But I will say for people who are smokers, like, don’t give up. The less you smoke the better and, if you can quit, over time, you can get yourself back to close to the same level of risk of someone who never smoked. So, absolutely, tobacco is one of those ‘none is the best, but less is better than more.’”
Andrew Schorr Audio: “Okay, so ‘less is better,’ and exercise…you don’t have to feel like you have to run a marathon or maybe even walk all 18 holes of the golf course. Whatever you do is to the good, for exercise.
Dr. Singh Audio: “Absolutely. Although, one of the tricky parts is, for some people when they exercise, they’re not actually getting the cardio part of the exercise. Right? So lots of us say, ‘Okay, if I walk for 20-minutes…, right Doc?’ and they’ll walk for 20-minutes. But if you’re chatting on the phone and strolling, you’re not going to get the same benefit. So I tell people, ‘If you’re going to do your 20 to 30-minutes of walking or running or whatever it is, you should be a little out of breath enough that you can’t be talking on the phone.’ And for people who are just starting up an exercise plan, I usually say, ‘Do, what we call, intervals where you walk faster for five minutes and then more of a normal pace, and go back and forth. And even if maintaining five minutes of fast is hard, do it a minute at a time and work your way up until you get to that, where you can do the whole 20-minutes at that higher pace.’”
Andrew Schorr Audio: “All right. Another big area of lowering your risks of developing cancer is screening. I’ve been through it a few times. Many viewers have. And that is, for example, colonoscopy, where I know the doctor’s looking for precancerous polyps. You’d endorse that, of course.”
Dr. Singh Audio: “Absolutely. I think the two cancers that we’re really good at preventing are cervical cancer and colon cancer. With colon cancer, you’re exactly right. We pick up precancerous changes and remove them before they even become cancer. Or, occasionally, we pick up early cancers. So following your health care provider’s recommendations on colonoscopy is really important.
Cervical cancer—it’s amazing. Now we have a vaccine that, if you get it at the right ages, you substantially decrease your risk of even getting a precancer. But then Pap smears and HPV tests are very good at picking up precancers and then we treat those before people even develop cancer.
Some of the other screening that we do is more targeted on trying to pick up early cancers. Mammography, specifically, and then breast awareness—both of those are targeted on trying to pick things up early when they’re curable.”
Andrew Schorr Audio: “So anyone’s who’s developed cancer, and we have about 12 million cancer survivors in the U.S., does not want a recurrence or develop another cancer—all these things we’ve talked about: healthy diet, exercise. That all applies to someone who’s had cancer previously, to try to lower their risks again. Am I right?”
Dr. Singh Audio: “Absolutely. It’s one of the things that’s harder to study but it makes sense that diet, and we’ve seen evidence that the combination of diet and exercise, clearly decreases the chance of breast cancer coming back, decreases the chance of colon cancer coming back. But probably for all cancers, again, it’s one of those things where you need to talk to your health care provider to figure out what you’re individual risks are. There’s lots of things for cancer survivors that we can do that decrease the risks of the cancer coming back or getting a new different cancer.
We know people who have lung cancer are at risk for getting a new lung cancer or at risk for getting head/neck cancers. So there are different things we would do, depending on what somebody’s cancer was to make them at less risk for having it come back or getting a new one.”
Andrew Schorr Audio: “Dr. Singh, I know this last area I’m going to ask you about it complicated but many people take supplements. They go to the health supplement store and there are all sorts of claims: this will reduce your risk of cancer, this will reduce that risk. What’s your overall feeling about that and how can people get information that’s specific to their situation?”
Dr. Singh Audio: “Ultimately, a one-on-one consultation with a health care provider who has a really good understanding of this is the individualized answer to that. The general answer is—think about whole foods. If you can get your antioxidants from the fruits and vegetables you eat, if you can get your Omega 3 fats from the things you eat: from the fish, from the nuts, from olive oil. All of those things are better than supplements. Supplements are really complicated and some of the research shows that there’s, actually, an increased risk of cancer associated with, for example, high doses of synthetic beta-carotene. Even regular multivitamins, over the counter multivitamins, have definitely not been shown to decrease the risk of cancer and they’re some cancers that they may increase the risk of, like lung cancer. So I really push people to, at least in general, stay away from supplements.
On the other hand, if there are things you’re missing from your diet and if you talk with your provider and, together, you guys figure out that there are specific vitamins or other things you need, then supplementation makes sense.
One of the tough ones is Vitamin D. Most of where we get our Vitamin D, some of it’s from diet but a lot of it is from sun exposure and, in general, I really encourage people to use sunscreens because of the risk of skin cancer. So Vitamin D is one of those things that lots of people do need to supplement but, again, talk to your provider. Get a Vitamin D blood level. And then, based on that, people should figure out what kind of supplements you should be taking.”
Andrew Schorr Audio: “As an Integrated Medicine Specialist, you study all this and so that would be a discussion that someone could have, for example, with you.”
Dr. Singh Audio: “Absolutely, absolutely.”
Andrew Schorr Audio: “Thank you for helping us understand what we can do to lower our risks and then have a dialogue with our doctor. Dr. Diljeet Singh, Banner MD Anderson Cancer Center and the Director of the Cancer Prevention Integrated Medicine Program, thank you so much for being with us.”
Dr. Singh Audio: “Thank you.”
Image: Andrew Schorr addresses camera
Audio: Closing music over conclusion and titles.
Andrew Schorr Audio: “And thank you, our audience, for joining us on Patient Power. Remember, knowledge can be the best medicine of all.”
Text: Banner MD Anderson Cancer Center presents
Text: Banner MD Anderson Cancer Center
Making Cancer History
© 2012 Banner Health