Everyone knows of an ‘Auntie Jean’. She is the older woman, who liked a good drink, hearty meals, and big puddings and specialises in spectator sport (with feet up in front of the telly). She scores 0 for lifestyle actions for reducing cancer risk. Not a second thought to worrying about health (“the doctor never said I was doing anything wrong“), lived well over the three score years and ten, and dropped dead one day without bothering a soul.
Then there is ‘Auntie Norma’ – the model of health. She is slim and trim, walks everywhere, eats more salads than a rabbit and may have a wee drink at a very special occasion (“just to join in“). She scores top marks for lifestyle actions for reducing cancer risk. One day, she went to the doctor and, within six months, she was dead from a cancer that did not respond to the treatment that made her hair fall out and made her feel as sick as a dog.
Every public audience I have ever addressed about raising awareness of cancer, talks about these aunts usually as evidence that cancer cannot be prevented. In our qualitative work to develop a lifestyle programme for women attending routine breast screening clinics, participants frequently drew on personal anecdotes to explain why they were somewhat cynical of cancer prevention.
“There’s a lot of people overweight, have a drink and smoke but live to their 90 odds”
“There are some that will never, ever get [cancer], smoke till they are 90, they will drink all the time and they never get any cancer of any kind”
One way to try and make sense of the importance of lifestyle and cancer risk is illustrated by Hastert et al, who studied a cohort of 30,797 women and examined compliance to lifestyle recommendation and the later development of breast cancer. Interestingly, only 1.9% of women could be classified as an ‘Auntie Jean‘ and 6% classified as an ‘Auntie Norma‘ in that they were following 5 or 6 recommendations for a healthy lifestyle for cancer risk reduction. When the two groups of women were compared, the Auntie Norma’s were 60% less likely to develop breast cancer. True that some women who did all the right things did develop the disease, but it was clear the risk was significantly less.
These data are a timely reminder that what we are talking about is finding a way to stack the odds against cancer occurrence (and recurrence). No promises, but it is clear that – not smoking; taking action to be a healthy weight and being physically active; with a healthy dietary intake low in alcohol, meat and salt, and high in fruits, vegetables and dietary fibre – goes a long way to diminish cancer (and diabetes and heart disease) risk. We cannot change our genes, but action on lifestyle offers so many opportunities for maintaining and improving the quality of our years.
– Professor Annie S. Anderson