Change your Lifestyle to prevent Epidemic of Non Communicable Diseases Principles of Nutrition and Physical Activity in Cancer Control

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1 Change for the better Dr. Arun Kurkure Change your Lifestyle to prevent Epidemic of Non Communicable Diseases Principles of Nutrition and Physical Activity in Cancer Control Scientific evidence suggests that dietary factors are estimated to account for approximately 30% of cancers in industrialized countries, making diet second only to tobacco as preventable cause of cancer. The majority of the variation in cancer risk among populations and among individuals is due to factors that are not inherited; behavioral factors such as a cigarette smoking, certain dietary patterns, and physical activity can substantially affect one s risk of developing cancer. These factors modify the risk of cancer at all stages of its development. The introduction of a healthy diet and regular physical activity at any time from childhood to old age can promote health and impact cancer risk. Healthy lifestyle and link to Cancer Breast Cancer Being overweight- and gaining excess weight throughout the lifecycle increase the risk of breast cancer. Physical activity reduces the risk of breast cancer. Some studies suggest that diets high in vegetables and fruits decrease the risk for breast cancer, although this evidence is much weaker than for other cancer sites. Consuming alcohol increases risk to some extent. The best advice to reduce the risk of breast cancer is to: Reduce lifetime weight gain through the combination of limiting your calories and exercising regularly Engage in vigorous physical activity at least 4 hours a week Avoid or limit your intake of alcohol to no more than one drink per day. Colorectal Cancer - The risk of colorectal cancer is higher for those with a family history of colorectal cancer. In addition to diet and physical activity, several other factors are linked to this cancer. Risk is increased by tobacco use and may be decreased by use of aspirin or other nonsteroid anti-inflammatory drugs and, possibly, by hormone replacement therapy. The best advice to reduce the risk of colon cancer is to: Increase your physical activity Avoid obesity Eat more vegetables and fruit Limit intake of red meats Avoid excess alcohol

2 Endometrial Cancer Studies of endometrial cancer (cancer of the lining of the uterus) show that obesity and use of hormonal replacement therapy after menopause increase risk. Lung Cancer More than 85% of lung cancers result from tobacco smoking. Many studies have shown that the risk of lung cancer is lower among both smokers and nonsmokers who consume at least five servings of vegetables and fruits a day. Oral and Esophageal Cancers Tobacco (including cigarettes, chewing tobacco, and snuff) and alcohol, alone and especially when used together, increase the risk for cancers of the mouth and esophagus. Obesity increases the risk for cancer occurring in the lower esophagus and at the junction of the esophagus and stomach; this is likely due to the increased acid reflux, in which stomach acid flows up into the esophagus. Eating recommended amounts of vegetables and fruit probably reduces the risk of oral and esophageal cancers. The best advice to reduce the risk of oral and esophageal cancers is to: Avoid all forms of tobacco Restrict alcohol consumption Avoid obesity Eat at least five servings of vegetables and fruits each day PREVENTION RECOMMENDATIONS FOR INDIVIDUALS Eat a variety of healthful foods, with an emphasis on plant sources. Adopt a physically active lifestyle. Maintain a healthful weight throughout life. If you drink alcoholic beverages, limit consumption. Eat a Variety of Healthful Foods, With an Emphasis on Plat Sources There is strong scientific evidence that healthful dietary patterns, in combination with regular physical activity, are needed to maintain a healthful body weight and to reduce cancer risk. Consider these guidelines: Eat five or more servings of a variety of vegetables and fruits each day. Include vegetables and fruits at every meal and for snacks. Eat a variety of vegetables and fruits. Limit snack chips, crisps and other fried vegetable products. Choose 100% juice if you drink fruit or vegetable juices. Choose whole grains in preference to processed (refined) grains and sugars.

3 Choose whole grain rice, bread, pasta, and cereals. Limit consumption of refined carbohydrates, including pastries, sweetened cereals, soft drinks, and sugars. Limit consumption of red meats, especially those high in fat and processed. Choose fish, poultry, or beans as an alternative to beef, pork and lamb When you eat meat, select lean cuts and smaller portions. Prepare meat by baking, broiling, or poaching, rather than by frying or charbroiling. From The Complete Guide Nutrition and Physical Activity 3 2X Diet and Activity Factors That Affect Risks.asp Adopt a Physically Active Lifestyle Scientific evidence indicates that physical activity may reduce the risk of certain cancers as well as provide other important health benefits. Adults should engage in at least moderate activity for 30 minutes or more on 5 or more days of the week; 45 minutes or more of moderate to vigorous activity on 5 or more days per week may further enhance reductions in the risk of breast and colon cancer. Children and adolescents should engage in at least 60 minutes per day of moderate to vigorous physical activity at least 5 days per week. Prevent Type II diabetes, which is associated with increased risk of cancers of the colon, pancreas, and possibly other sites. The benefits of physical activity go far beyond reducing the risk of cancer. They include prevention of heart disease, high blood pressure, diabetes, falls, osteoporosis, stress, and depression. Helpful Ways to Be More Active Use stairs rather than an elevator. If you can, walk or bike to your destination. Exercise at lunch with your workmates, family or friends. Take a 10-minute exercise break at work to stretch or take a quick walk. Walk to visit co-workers instead of sending a . Go dancing with your spouse or friends. Plan active vacations rather than only driving trips. Wear pedometer every day and watch your daily steps increase.

4 Join a sports team. Use a stationary bicycle while watching TV. Plan your exercise routine to gradually increase the days per week and minutes per session. Maintain a Healthful Weight Throughout Life Overweight and obesity are associated with increased risk of cancers, including breast (among postmenopausal women, and especially those who gain weight through adulthood), colon, endometrium, adenocarcinoma of the esophagus, and kidney. If You Drink Alcoholic Beverages, Limit Consumption People who drink alcohol should limit their intake to no more than 2 drinks per day for men and 1 drink a day for women. Alcohol consumption is an established cause of cancers of the mouth, pharynx, larynx esophagus, liver and breast. For each of these cancers, risk increases substantially with intake of more than 2 drinks per day. Alcohol consumption combined with tobacco increases the risk of cancers of the mouth, larynx, and esophagus far more than the independent effect of either drinking or smoking. Regular consumption of even a few drinks per week has been associated with an increased risk of breast cancer in women. The mechanism for the effect of alcohol on breast cancer is not known with certainty, but may be due to alcohol-induced increases in circulating estrogens or other hormones in the blood, reduction of folic acid levels, or the direct effect of alcohol or its metabolites on breast tissue. Consider these risk and protective factors: Alcohol o Alcohol increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, and breast. o People who drink alcohol should limit their intake to no more than two drinks per day for men and one drink per day for women. o The combination of alcohol and tobacco increases the risk of cancer far more than the independent effects of either drinking or smoking. Saturated Fat o Diets high in saturated fat are associated with increased risk of colon and prostrate cancers. Overweight and obesity o Overweight and obesity are associated with increased risk for cancers of the breast, colon, endometrium, gallbladder, esophagus, pancreas, kidney, carcinoma, and possibly other sites.

5 Salt o Studies link diets containing large amounts of foods preserved by salting and pickling with an increased risk of stomach, nasopharyngeal, and throat cancer. Physical Activity o People who engage in moderate-to-vigorous levels of physical activity are at lower risk of developing colon and breast cancer. This risk reduction is independent of the impact of activity on weight. Because physical activity also helps with weight control, being active may reduce the risk of those cancers associated with being overweight. Vegetables and Fruit o Greater consumption of vegetables, fruits, or both together has been associated with a lower risk of lung, oral, esophageal, stomach, and colon cancer. RECOMMENDATION 1) BODY FATNESS Be as lean as possible within the normal range of body weight. To maintain median body mass index between 21 and 23. 2) PHYSICAL ACTIVITY Be physically active as part of everyday life. 3) FOODS AND DRINKS THAT PROMOTE WEIGHT GAIN Limit consumption of energy-dense foods. Avoid sugary drinks. 4) PLANT FOODS Eat mostly foods of plant origin. 5) ANIMAL FOODS Limit intake of red meat and avoid processed meat. 6) ALCOHOLIC DRINKS Limit alcoholic drinks 7) PRESERVATION, PROCESSING, PREPARATION Limit consumption of salt. Avoid mouldy cereals (grains) or pulses (legumes). 8) DIETARY SUPPLEMENTS Aim to meet nutritional needs through diet alone.

6 9) BREAST FEEDING Mothers to breastfeed; children to be breastfed. 10) CANCER SURVIVORS Follow the recommendations for cancer prevention...source: - World Cancer Research Fund Global Network COMMON CANCERS IN WOMEN Cancer of the Cervix The India Cancer Society s most recent estimates for cancer of the cervix in India are for new cases of invasive cervical cancer (cancer that has spread beyond the cervix) deaths from cervical cancer Common Signs & Symptoms of Gynecological Cancers Women Should Know 1. Abnormal Vaginal Bleeding Bleeding between periods and bleeding during and after sex, Heavy periods. 2. Vulva or Vaginal Abnormalities - Look for any sores, blister, changes in skin color and discharge 3. Changes in the Breast Look for lumps, soreness, nipple discharge, dimpling, redness or swelling (quick reference chart can be downloaded from IARC website) 4. Pelvic pain Pelvic pain which is persistent an unrelated to menstrual syndrome. 5. Abdominal swelling and Bloating Persistent unexplained urogenital and abdominal symptoms in women more than 40 could be due to ovarian cancers. 6. Persistent Lower Back Pain 7. Persistent Stomach Upset or Bowel Changes 8. Unintentional weight loss 9. Fatigue What Causes Cancer of the Cervix? More than 99% of cancers of the cervix are due to persistent human papilloma virus (HPV). There are more than hundred HPV viruses and are known by the number. More than 60 HPV viruses infect cells on the surface of the skin and cause genital warts. The other 40 HPV viruses infect mucosal lining of the ano-genital area. Some of them will cause cauliflower shape warts on or around genitals and are called as low risk HPV type (HPV 6 or 11). HPV viruses like 16 and 18 are high risk type and they are responsible for low and high grade cervical changes (precancerous stage) and cancer of the cervix. How do you get genital HPV? Genital HPV is spread mainly by direct genital contact during vaginal, oral or anal sex. HPV is passed from one person to another during skin-to-skin contact. Infection is very

7 common soon after a woman becomes sexually active. Oral-genital and hand-genital transmission of some genital HPV types is possible and has been reported. How common is HPV? Who gets it? Genital HPV is a very common virus. What are the symptoms of HPV? Most people will never know they have HPV because they have no symptoms and the body s immune system causes the virus to become inactive. In about 90% of cases, the body s immune system clears the HPV infection within 2 years. A smoall number of people with HPV will have the virus for a longer time. How is HPV related to cervical cancer? Almost all cervical cancers are related to HPV. Of these, about 70% are caused by HPV types 16 or 18. Nearly all cervical cancers are related to HPV, but most genital HPV infections do not cause cervical cancer. In research studies, most people who test positive for genital HPV DNA test negative later on, often within 6 to 12 months. If cells stay infected with HPV, the virus may cause the cells of the cervix to change and become precancer cells. True pre-cancer cell changes are called high-grade SIL (squamous intraepithelial lesions), sometimes abbreviated as HSIL. Another term for HSIL is CIN 2 and CIN 3 is an abbreviation for cervical intraepithelial neoplasia. What about other cancers and HPV? About 8 out of 10 squamous cell anal cancers are caused by either HPV 16 or 18 the same types of genital HPV that cause cervical cancer. Can HPV be treated? No. Treatments cannot cure HPV. But most genital HPV infections go away with the help of the body s immune system. About 70% of HPV infections appear to go away within a year and 90% within 2 years. Can HPV be prevented? The only sure way to prevent HPV is to abstain from all sexual activity. What are the risk factors for genital HPV? People with the following risk factors are more likely to have genital HPV: Having many sex partners Being younger than 25 years of age Starting to have sex at age 16 or younger Having a partner who has had many different sex partners. How to avoid HPV? Delay sex Use condoms Don t smoke Get the HPV vaccine

8 There are now vaccines that can protect people against certain types of HPV. These vaccines are only used to prevent, not treat, an HPV infection. The vaccines now in use are given as series of 3 shots over 6 months. Side effects of the vaccine are mild. To work best, the HPV vaccine should be given before a person starts having sex. Vaccination is not an alternative to PAP test or similar diagnostic test as HPV vaccine does not protect against all cancers. Exposure Transient infection Persistent infection HPV Results from continued expression of HPV oncoproteins Genetic instability Development of Aneuploidy LOH at various loci Progression Normal cervix Productive infection Precursor lesion Invasive lesion Clearance Regression Normal CIN 1* CIN 2# CIN 3 Cancer Cancer of the Ovary Cancer of the ovary The India Cancer Society s most recent estimates for cancer of the ovary in India are for new cases of ovarian cancer deaths from ovarian cancer Screening for Ovarian cancer: There is no revival screening test to diagnose ovarian cancer in general population. The transvaginal ultrasound and blood test Ca 125 are used for early diagnosis. Cancer of the Uterus Cancer of the uterus The India Cancer Society s most recent estimates for cancer of the uterus in India are for new cases of uterine cancer. deaths from uterus cancer