Obesity rivals smoking on cancer
Tobacco trends down, while lack of activity grows as a health threat
Obesity and inactivity could someday account for more cancer deaths than smoking if current trends continue, a leading cancer expert says.
As the rate of smoking decreases, other unhealthy habits threaten to offset the progress in reducing cancer deaths, says Richard Wender, a physician and chief cancer control officer at the American Cancer Society ( ACS). A study in the New England Journal of Medicine last fall found 13 types of cancer were linked to excess body weight.
There’s no guarantee that obesity and inactivity will surpass smoking as a cancer cause, Wender says, but the possibility is startling.
“Who would’ve thought we’d ever see the day where what you eat ( and) exercise could account for more cancer deaths than smoking?” he asks.
The connections between smoking and too much exposure to the sun and cancer are well known, but the connections between nutrition and exercise and cancer are less known and harder to determine.
Calculating cancer’s link to obesity is difficult in part because of an overlap in cancer risk factors, ACS’ Rebecca Siegel says. While 20% of cancers are caused by poor diet, alcohol consumption, a lack of physical activity and/ or excess weight, that can’t be combined with the 30% of cancer deaths caused by cigarette smoking. That’s because poor people are more likely to be obese and to smoke than more affluent people, says Siegel, strategic director of ACS’ surveillance information services. A HEALTHY LIFESTYLE A striking 50% of all cancer deaths could be prevented by following the basics of a healthy lifestyle, Wender says.
That includes diet and exercise, having regular cancer screenings and getting the HPV vaccine that helps prevent cervical cancer and likely oral cancer and for Hepatitis B, which can lead to liver cancer.
Wender was speaking at a recent meeting of the Council of Accountable Care Physicians, which represents the doctors who work at integrated health care systems such as Kaiser Permanente and Geisinger Health, which treat and insure patients. These groups says they are better positioned to address social determinants of health that can lead to cancer — like access to healthy food — than other health systems.
After all, they don’t have to worry about whether federal programs such as Medicare or Medicaid or independent commercial insurers will reimburse them, say, for connecting patients to diet and fitness professionals. They are motivated to screen patients more often for cancer since they have to pay to treat cancer that is caught too late.
The effect of the decline in smoking on cancer “has been somewhat counterbalanced by this steady rise in obesity trends beginning in the ’ 70s,” Wender says. The obesity rate has tripled since the early 1970s to about 36% of adults.
Geisinger Health in Pennsylvania has expanded a program that gives some of their least- healthy, low- income patients free healthy groceries through Fresh Food Pharmacy. There are now about 65 patients in the program and the results “have been spectacular,” Geisinger spokesman Michael Ferlazzo says. Patients have lost weight, reduced their medications and reduced their hemoglobin A1c blood sugar rate by at least three points. One patient cut the level in half — from 16.4 to 8.4— in four months.
Each decline of one point in A1c results in about $ 8,000 in annual health care cost savings, research shows.
WHERE YOU LIVE
People’s ZIP codes are also important indicators of their cancer risk due to the close link between where people live and social factors that contribute to health.
ZIP code often defines one’s educational opportunities, income, diet options and access to health care resources. There is a strong correlation between region and the percentage of Americans who have access to cancer screenings and make unhealthy lifestyle choices, Wender says.
“We do not have a knowing problem, we have a doing problem,” says surgeon Robert Pearl, who is CEO of the Permanente Medical Group, which represents Kaiser doctors.
TRANSPORTATION KEY
Much of the “doing gap” results from issues of transportation. If people do not live close to a specialist that they are supposed to see, then they are less likely to seek the treatment that they need. This disproportionately affects those living at or near the poverty line.
Hunter Jones, a cancer survivor and Geisinger patient, noted how difficult it was for her to travel almost two hours to the hospital to meet with her specialists and receive treatments.
Many times doctors may blame the patient because they didn’t come to an appointment, says John Bulger, a physician and chief medical officer for Geisinger Health Plan. But it’s not their fault, he says, if they didn’t have the transportation to get there.
“Who would’ve thought we’d ever see the day where what you eat ( and) exercise could account for more cancer deaths than smoking?” Richard-Wender, a physician and chief cancer control officer at the American Cancer Society