Cancer. The scariest thing about it to me is just how random it seems to be. Yes, there is definitely a genetic component – for some types of cancers more than others – but equally sometimes it just hits. Out of all of my family, we would likely all agree that I’m the one that has lived as close to the ‘healthy’ lifestyle out of everyone. There was once a time where five of the seven of us smoked. Dad and I excluded (I took it up when I was 11y old, then had to quit a week later as Kylie Wirepa, the friend that had also decided to start smoking with me, said she had a heart murmur. Thank god!) While my family have begun to be more interested in their diet over the last 10 years or so (for various health/weight reasons) and intermittently jump on the exercise bandwagon, consistently only Dad and I would be the ones that – all things equal – would be the least likely to be diagnosed. All things being equal. But that’s not how it works. A close friend of mine has just found out that her sister has aggressive breast cancer that has spread to her lymph nodes. She described her as the ‘healthiest’ out of all of them* – the ‘alternative’ soy-drinking, non-smoking, moderate drinking, exercising sister when compared to the rest of her family.
Cancer is the uncontrolled growth of abnormal cells in the body. Instead of growing old, dying, and being replaced by new cells, cancer cells are cells that become damaged replicate, and then the mutation is replicated yet the cell doesn’t die – they continue to accumulate and form a tumour. When we studied the pathophysiology of disease in nutrition I remember Murray Skeaff teaching us that those predisposed to cancer can stay cancer free their entire life – there can be a long a latent period, if you like. However if they are exposed to risk factors, then this can start the process of cancer developing. Lifestyle can play a large part in determining risk of developing chronic conditions, as you know. Looking at the epidemiological evidence, a high intake of fruit and vegetables, maintaining a healthy weight, regularly exercising, a low alcohol intake, oral contraceptive pill use and hormone replacement therapy are all linked to an individual’s risk of breast cancer. This doesn’t determine cause and effect, but gives an idea of the types of lifestyle factors associated with the risk of developing it.
We discussed the fact that her sister avoided dairy and drank soy milk in the interests of health. Interestingly, there is a lot of controversy around the consumption of soy and breast cancer risk. Soy and soy products contain isoflavones a particular class of phytoestrogen that interacts with endogenous estrogen signaling pathways. Isoflavones can either block our endogenous oestrogen from being taken up in the body, or can increase the oestrogen receptor activity. This impacts our risk as increased exposure to oestrogen can drive hormone-related cancer. Asian populations have long consumed soy in its unprocessed or fermented form, in foods such as tofu or tempeh, whereas Westerners more commonly eat it either as dietary supplement or as a source of an industrial seed oil and protein substitutes. Nowadays, proteins or oil of soy origin also appear in numerous food products – such as infant soy-based formula, bakery items, (biscuits, doughnuts and cakes), fast foods (hamburgers, chicken nuggets, takeaway hot chips and pizza dough), cereal bars, protein bars and salad dressings. However the isoflavone content of these processed foods is far less than the traditional Asian diet – the typical Western diet consuming less than 1g/day, compared to intakes of up to 30g/day in Korea or Japan.
For women who are of Asian ethnicity, who have consumed whole soy products (such as soy beans) and fermented soy products (Natto and tempeh two such examples) their entire lives, in small doses, have a reduced risk of developing risk cancer. The relationship with European women is not the same. It is thought the processed nature of soy products, that they aren’t in their whole form, and they are consumed in the context of the Westernised lifestyle, changes the relationship. Indeed Asian migrant women have a higher risk of developing breast cancer when moving from Asia to the US. Women in Asian eat less processed food and have less of a caloric dietary load overall – these two factors undoubtedly contribute. Statisticians can adjust away a lot of factors to find significant relationships within epidemiological evidence – but many argue that, in real life, you can’t account for the differences in lifestyles that contribute to higher or lower risk regardless of the p value.
As we sat around on Friday night it’s fair to say that the rest of us were reeling a bit from the news too. Obviously it’s not the first time any of us have had someone close to them be diagnosed with cancer, but its sobering that, where once it seemed to affect those in the older age group more than anyone else, increasing numbers of younger, fitter, healthier people are being diagnosed with cancer – of all types. Yes, mortality rates are decreasing – increased awareness, earlier diagnosis and better treatment will all contribute to this. But more and more people are living with chronic illness and reduced quality of life – affecting them and those around them. Anyway, in my normal Women’s Weekly approach to this blog, this isn’t to educate you on the metabolic pathways and how these interact with diet and lifestyle to impact on your risk of cancer. Indeed I didn’t even mention sugar – I could write a book on that (likely don’t need to, I’m sure it’s been written). It’s more a reflection based on recent events. That’s fairly obvious actually, if you just look at the title of this. I couldn’t put a title on this that gave you an idea of the content – this is just a collection of thoughts based on recent events. One thing that my friend did say was that her sister is someone who tends to stress more than most people. This has a massive bearing on our overall health and wellbeing and may, down the line, be found to be THE most important contributor to ill health. Diet, lifestyle, physical activity and sleep patterns all contribute to this. As we start to reflect more on how we live our lives and the concessions we make to keep up with what modern life demands of us, I think more people may look to take a step back and try to do things differently.
*– though she is no slouch when it comes to the health front, especially over the last couple of years as she’s switched from a higher sugar diet that included processed food to a paleo-approach to diet.