**October – BREAST CANCER AWARENESS MONTH**

Let’s talk about lifestyle and breast cancer…

How common is breast cancer?

Breast cancer is the most common cancer in women across the world and it is the most common cancer in the UK. Almost 1.7 million new cases were diagnosed in 2012 worldwide, representing ~12% of all new cancer cases and 25% of all cancers in women (World Cancer Research Fund, WCRF). In the UK, 1 in 8 women will develop the disease at some stage in their life. It can also happen in men, but this is very rare.

What causes breast cancer?

Due to the increased awareness of breast cancer and its genetic link, thanks to well-known celebrities like Angelina Jolie, a lot of people think that their risk of getting breast cancer is mostly down to their genes. However, only ~3% of breast cancer cases in women are due to their genes (WCRF). There are many reasons why breast cancer can develop and hormones, particularly oestrogen, can influence the development and growth of some breast cancers. Therefore, life events that affect your hormone levels, such as pregnancy or the menopause, can alter your cancer risk.

Lifestyle factors have a BIG impact on your risk of developing breast cancer. Scientists estimate that lifestyle factors including maintaining a healthy weight, being physically active and not drinking alcohol could prevent around 2 in 5 breast cancer cases in the UK. That is ~20,000 cases per year!

The WCRF analyses worldwide research on how lifestyle factors including diet, nutrition, physical activity and weight affect the risk of developing cancer. They produced an up to date report in May 2017 on how lifestyle factors affect the risk of breast cancer which can be seen in the link below. There are some different factors affecting the risk of breast cancer before and after the menopause, such as being overweight and obese.

http://www.wcrf.org/int/research-we-fund/continuous-update-project-findings-reports/breast-cancer

Summary of lifestyle risk factors:

-        Being overweight or obese (for post-menopausal breast cancer only)

-        Adult weight gain

-        Drinking alcohol

-        Not doing enough exercise

-        Not breastfeeding after having a baby

So how can you reduce your risk of breast cancer?

1.       Cut down on your alcohol intake, or even better don’t drink at all

There is strong evidence that drinking alcohol increases your risk of breast cancer where 1 in 5 breast cancers could be prevented if we didn't drink any alcohol. Scientists are still researching how alcohol can cause cancer. One theory is that when alcohol is broken down in our bodies, harmful compounds are formed that might directly damage the DNA in our cells, which can then lead to cancer. Alcohol is even more harmful when combined with smoking and it provides empty calories so contributes to weight gain. To protect yourself against cancer it is best not to drink at all. However, if you do, then try to stay within the recommended UK guidelines of drinking < 14 units a week, spread over at least 3 days (~ seven drinks a week). This factsheet explains more benefits of cutting down on your alcohol intake and useful tips to do so:

https://www.wcrf-uk.org/sites/default/files/closer-look-alcohol-factsheet.pdf

2.       Be a healthy weight

Surprisingly, there is evidence that being overweight or obese in adulthood before the menopause can reduce the risk of breast cancer before the menopause. However, being a healthy weight and avoiding weight gain throughout adulthood are important in decreasing your risk of breast cancer after menopause. As post-menopausal breast cancer is the most common type of breast cancer (~80% of cases) and we know that being a healthy weight helps to prevent 10 other common cancers in addition to type 2 diabetes and heart disease, we should therefore try to be a healthy weight. Being overweight or obese can increase your risk of cancer by encouraging the body to produce growth hormones or other hormones, like oestrogen, which can promote the growth of cancer cells. This booklet gives you useful tips and practical ways you can lose weight:

https://www.wcrf-uk.org/sites/default/files/Be-A-Healthy-Weight.pdf

3.       Be more active

Vigorous physical activity lowers the risk of premenopausal breast cancer and every type of physical activity (moderate and vigorous) reduces the risk of postmenopausal breast cancer. Physical activity is important to reduce our cancer risk, but it also has so many other health benefits including lowering our risk of heart disease, stroke and diabetes. Regular exercise is also a great stress reliever and helps to boost your mood. Being active for 30 minutes a day at least 5 times per week could prevent 1 in 8 cases of colon and breast cancer. Regular exercise can help to lower our insulin resistance, regulate our hormone levels and help us to maintain a healthy weight. This booklet produced by the WCRF gives you lots more ideas, includes plans to help you track your progress, and tells you how much calories you burn per 30 minutes of different types of activities:

file:///C:/Users/user/AppData/Local/Microsoft/Windows/INetCache/IE/BWSCPHBT/move-more-booklet.pdf

4.       Breastfeed your baby if you can

Breastfeeding is a personal choice but it is good for your baby’s health and it can also help protect you against breast cancer. It can help you to lose any excess baby weight more quickly, lower the levels of some cancer-related hormones in your body and get rid of any cells in your breasts that may have DNA damage. If you are able to, it is advised that you breastfeed your baby exclusively for 6 months and then continue to breastfeed alongside introducing other foods.

What about after breast cancer?

Breast cancer survivors should also try to eat a healthy diet, maintain a healthy weight and do regular physical activity to reduce the risk of getting cancer again. In the latest update on diet and breast cancer survivors in 2018, there are indications of links between better survival after breast cancer and:

-        Eating foods containing FIBRE

-        Eating foods containing SOY

-        A LOWER INTAKE OF FAT, in particular SATURATED FAT

-        A healthy BODY WEIGHT

-        Being PHYSICALLY ACTIVE

A lot more research is needed in this area yet, but you can read more detail on latest evidence behind these links here.

 https://www.wcrf.org/dietandcancer/breast-cancer-survivors

This leaflet includes everything you need to know about reducing your risk of breast cancer based on the most up to date research across the world.

https://www.wcrf-uk.org/sites/default/files/RYR-Breast-Cancer.pdf

Please share this information with friends and family to continue to raise awareness of breast cancer and empower others to make positive changes to their lifestyle so we can beat cancer together!

How does being overweight or obese affect our cancer risk?

Research shows a direct link between being overweight and obese and 11 different types of cancer including bowel, breast (in postmenopausal women), gallbladder, kidney, liver, oesophagus (adenocarcinoma), ovary, pancreas, advanced prostate, stomach (cardia) and womb cancer. In England in 2015-2016, 62% of adults were overweight or obese. Even scarier, 28% of children from 2-15 years of age were overweight or obese. This alone is increasing their risk of developing cancer later in life before we even start talking about their dietary habits or physical activity levels.

How?

There are a number of ways being overweight or obese can increase your risk of these cancers including:

  • Fat cells encourages the body to produce growth hormones which can promote the growth of cancer cells

  • The more overweight we are, the more fat cells our body stores. These fat cells produce hormones like oestrogen also which research shows increases the risk and promotes the growth of breast and womb cancer.

  • Fat cells can also stimulate the body to have an inflammatory response which may also increase the risk of several cancers.

So what should we do to reduce our cancer risk?

The World Cancer Research Fund International (WCRF) is the world's leading authority on the link between diet, weight, physical activity and cancer. The Continuous Update Project is an ongoing programme that the WCRF runs to continually analyse global research on these links and provide us with the most up-to-date guidance on what we can do on a daily basis within our normal lives to minimise the risk of cancer from lifestyle factors.  This is outlined in their 10 Cancer Prevention Recommendations. Their first recommendation is:

'Be as lean as possible without becoming underweight'

What is a healthy weight?

To determine if you are a healthy weight, we measure your weight and height to work out your Body Mass Index (BMI). You can do this using the BMI calculator below:

https://www.wcrf-uk.org/uk/here-help/health-tools/bmi-calculator

If your BMI is between 18.5-24.9kg/m² you are a healthy weight for your height. If it is less than this you are underweight and would benefit from gaining some weight to achieve a BMI in the healthy range. If your BMI is >25kg/m², you are carrying too much weight and can lower your cancer risk by losing weight. Checking your BMI is only an estimate and is not very accurate in older people, pregnant women, those with a high muscle mass like athletes, some ethnic groups and those less than 5 foot tall.

It is also important to understand the distribution of extra weight around your body as too much weight or fat around your stomach is associated with an increased risk of cancer, but also diabetes and heart disease. A healthy waist measurement for men is <94cm/37 inches and for women is <80cm/31.5 inches.

What can you do to be a healthy weight?

You can maintain your weight by balancing the amount of energy you take in through your diet and the amount of energy you expend through your body’s daily requirements and your daily physical activity. Think of it like a see-saw; if you consume more than you expend you will gain weight and vice versa. A typical man needs around 2500 calories per day and a woman needs around 2000 calories per day. If you take in more than this, you need to do more exercise to balance it out.

  • Losing just 5-10% of your weight has huge health benefits.

  • Small changes make a big difference in the long term

  • A weight loss of 0.5 to 2 lbs per week is a realistic goal

The following resources from the British Dietetic Association will provide you with practical ideas on how to be more active and eat more healthily to lose weight. However, you must first decide why you want to lose weight and change your lifestyle habits because it is important for success to choose a time that is right for you.

https://www.bda.uk.com/foodfacts/Want2LoseWeight.pdf

http://bdaweightwise.com/index.html

If you find it easier to stick to a structured meal plan to lose weight, most men will lose weight on a 1800 calorie per day meal plan most women will lose weight on 1500 calories per day. Ideally, you need to eat 500-600 calories fewer than your daily calorie needs in order to lose a healthy 0.5kg/1lb per week - you may lose more if you're more active too. A structured meal plan can be found below:

http://bdaweightwise.com/eating/eating_plan.html

It is also important to track the changes to your diet and activity levels to help keep you motivated and to identify where you might be able to improve further.

Weight diary: https://www.wcrf-uk.org/sites/default/files/weight-diary.pdf

12 week planner: https://www.wcrf-uk.org/sites/default/files/healthy-new-you-planner.pdf

Exercise is an extremely important part of the weight loss process so don’t forget it! It not only helps you to burn more calories, but also helps to increase your muscle mass (especially resistance exercise) and improves your mood. When you incorporate it into your lifestyle regularly, it helps to keep the weight off which is the part that people often struggle with the most. Build up the amount of exercise you do slowly so that it is realistic for you to keep it up and choose something you enjoy. It is also good to incorporate more exercise into your usual daily routine such as getting off the bus earlier to walk or cycling instead of getting the train.

Everyone will slip up now and again and it is okay to have a little treat now again. Remember to reward yourself when you do reach your target and then make another one. If you do slip up, accept it and get back on track again. No one is perfect all of the time!

What is a Dietitian?

What is a Dietitian?

Dietitians are qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. They translate the most up-to-date scientific research on food, health and disease into practical advice that people can use to change their everyday lifestyle and dietary habits to improve their health. Dietitians are experts in food and nutrition and can use their knowledge to help prevent and treat various health conditions including cancer.

Dietitians can work in a wide variety of areas including hospitals, community health sectors, as health educators in public health, in the NHS or private practice, food service and industry, sport, education, media or research.

Registered Dietitians are qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level
— British Dietetic Association

Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard. All Registered Dietitians are registered with the Health & Care Professions Council (HCPC) which is an independent, UK-wide health regulator that sets standards of professional training, performance and conduct for 14 professions including dietitians. They ensure dietitians stay up to date through continuing professional development and ensure we meet the highest standards to protect the public.

Dietitians are statutorily regulated, with a protected title and governed by an ethical code to ensure that they always work to the highest standard.
— British Dietetic Association

What is a Nutritionist?

Nutritionists are qualified to provide information about food and healthy eating, but not about special diets for medical conditions. Nutritionists are not required to be registered in order to work in the UK. Their title is not protected by law so anyone can call themselves a nutritionist. Therefore, it is advisable to check they are registered with the UK Voluntary Register of Nutritionists (UKVRN) run by the Association for Nutrition. However, it is not a legal requirement for a nutritionist to be registered with the UKVRN.

What is a Nutritional Therapist?

Nutritional therapists encompass the use of recommendations for diet and lifestyle in order to alleviate or prevent ailments, often based on complementary ‘medicine’ recommendations not recognised as valid treatment in conventional medicine. Nutritional therapists use treatments such as high dose vitamins, detox, and food avoidance for which there is little robust scientific evidence. They are not independently regulated and there title is not protected by law so anyone can call themselves a nutritional therapist or diet expert.

Who should I choose to provide me with reliable dietary advice?

Choosing the right person to seek help and advice from can sometimes be a confusing task. Many people claim to be experts in nutrition yet have very limited knowledge and offer no protection to the public. This leaflet from the British Dietetic Association is very useful as it explains the differences between dietitians, nutritionists and nutritional therapists so you can choose an appropriate person to provide you with reliable dietary advice.

https://www.bda.uk.com/publications/dietitian_nutritionist.pdf

Lifestyle and cancer risk - Is there really a link?

We see information in the media nearly every day telling us about what we should be eating to stay healthy and recommending the next ‘superfood’ that will prevent us from getting cancer. But how much truth is behind these claims? What is a healthy diet and can it really reduce our risk of getting cancer?

Firstly, let’s look at what the risk factors for cancer are. Cancer is caused by damage to the DNA or genetic make up of our cells. Cells are the building blocks of our body which are controlled by this DNA. If it is damaged, the cells can start to multiply uncontrollably to produce a cluster of cells which is often called a tumour. This tumour is not always cancerous, but if it is, it can grow bigger and invade surrounding healthy organs and tissues and can spread to other parts of the body also. We don’t know exactly what causes many cancers but there are certain things that can increase your cancer risk.

  • Inherited genes - Research shows that these genes only cause about 5-10% of cancers and scientists have linked genes to certain cancers such as bowel and breast cancer.

  • Infectious diseases – some infectious diseases can increase the risk of cancer such as Helicobacter pylori bacteria which can increase the risk of stomach cancer, HPV (human papilloma virus) which is linked to cervical cancer and Hepatitis B and C which is linked to liver cancer.

  • Occupational and environmental factors – Certain harmful substances found in the workplace or environment have been found to cause cancer including asbestos which is a natural mineral that can cause damage to the lungs which is now banned in the UK. The main environmental factor that can cause cancer is exposure to the sun or ultraviolet light (UV) which is linked to skin cancer.

  • Lifestyle factors – Smoking alone is responsible for 90% of lung cancers so avoiding smoking or quitting it is the most important action you can take to reduce your risk of cancer. After that, ABOUT ONE THIRD of the most common cancers in the UK could be prevented by EATING A HEALTHY DIET, being PHYSICALLY ACTIVE and maintaining a HEALTHY WEIGHT. That is about 80,000 cases in the UK every year so yes there is definitely a link between your lifestyle and risk of developing cancer! 

Over the next few blogs, I am going to explain how diet, physical activity and weight can either reduce or increase your cancer risk based on the most up to date scientific research currently available. Stay tuned!