Wellness for Cancer Initiative

2022 Trends

The intention of these trends is to increase our collective health literacy about preventable cancers. Health education for 40+-year-old women is globally trending and is a primary strategy for health promotion.

Making healthy lifestyle choices, the best time to prevent cancer is NOW.

Making healthy lifestyle choices is very important for women in their 40s and beyond. This is especially true because this is when cancer prevention becomes more important. In addition, women usually make most of the decisions for their families, so it is important to inform them about how to stay healthy. Post-menopause is the age when women are most likely to develop breast cancer, the number one risk of death in women behind heart disease. Obesity-related cancers: meningioma, multiple myeloma, adenocarcinoma of the esophagus cancers of the thyroid, postmenopausal breast, gallbladder, stomach, liver, pancreas, kidney, ovaries, uterus, colon, and rectum.

What determines health? ¹

• Medical Care 10%
• Genes/Heredity 16%
• Environment 21% – Environment includes surrounding yourself with others who make good lifestyle choices as well.
• Lifestyle 53% -Lifestyle includes choices made about all aspects of living.

The Big FIVE unhealthy habits include: Smoking, Alcohol Abuse, Unhealthy Eating, Sedentary Behavior, and Ineffective Stress Management.² Wellness has the broad capacity to include all aspects of physical, psychological, and social wellbeing including health- health promotion- and disease prevention.³ Post-Menopausal Breast Cancer Risks are Modifiable

Up to 80% of postmenopausal breast cancers are associated with increased estrogen levels.

Most women are unaware endogenous estrogen exposure can lead to an increased risk of breast cancer, the early onset of menstruation (<12 years) or late menopause (>55 years), using hormone replacement therapy, and having a body mass index (BMI) greater than 30.4 Up to 80% of postmenopausal breast cancers are fueled by endogenous estrogens.⁵ It takes years for cancer to develop but lower estrogen levels have been observed to reduce the risk of both new diagnosis and recurrent Breast Cancer (BC).

While there are numerous mechanisms and pathways that trigger the opportunity for cancer to grow, our trends highlight endogenous estrogens and their association with overall BC risk, particularly for postmenopausal women. Reducing these estrogens by diet and exercise maintaining a BMI <30 has served as a primary means to decrease overall risk.

Where does the estrogen come from since the ovaries no longer produce it? It is adipose tissue that contributes to most of the circulating estrogen in postmenopausal women which is associated with increased risk of BC. Menopausal weight gain means more adipose tissue and more estrogen. Overweight postmenopausal women increase their BC risk by 20-40%, and have a 20-60% BC greater risk than leaner postmenopausal women.⁴ That extra belly fat acquired during menopause becomes the body’s main source of estrogen in later years further increasing the risk of BC. Fortunately, being overweight is a reversible condition. Reducing these estrogens through healthy lifestyle behaviors serves as a primary means to decrease this risk of postmenopausal BC.

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TREND 1: Dietary options can lower postmenopausal breast cancer risk up to 40%

The Mediterranean diet is one of the more researched diets and has been observed to decrease endogenous estrogens in postmenopausal women⁷ Cancer-oriented diets are often plant-centered — vegetables are viewed more as the entrée than a side dish. El Camino Hospital’s Cancer Healthy plate recommends ½ vegetables and fruit, ¼ lean protein and ¼ whole grains.⁸

Healthy Breast Cancer Diet Guidelines⁹ (UCSF Cancer Center)

• Eat 8 to 10 colorful fruit and vegetable servings daily
• Consume 30 to 45 grams of fiber daily
• Avoid processed and refined grains/fours/sugar
• Lean protein with every meal, plant protein daily
• Limit fatty and processed meats and dairy
• Include healthy fats like cold-water fish, chia seeds, flaxseeds, walnuts, soybeans, avocados, olive oil
• Consume 1-2 Tablespoons chia or ground flax daily
• Herbs and spices daily
• Limit alcohol consumption
• Drink 1-4 cups of green tea daily
• Drink plenty of fluids
• Daily activity to achieve and/or maintain healthy weight

A Swedish study reported 1-2 daily servings a day of cruciferous vegetables reduced the risk of postmenopausal BC by as much as 20-40%.¹⁰ A vegetable-fruit-soy diet reported lowered BC risk by 30% in Singaporean Chinese postmenopausal women, increasing to 43% when diet was followed 5 or more years.¹¹

Studies associate flaxseed with production of less active forms of estrogen. A high fiber diet is associated with reduced hormones linked to BC, increased estrogen in stool, and reduced obesity.⁴ An NIH/AARP Dietary fiber study concluded a reduced risk of 13% when comparing postmenopausal women in the high quintile of fiber intake to the lowest quintile.¹²

Dietary Lifestyle in Action Changing dietary lifestyle behaviors may start with a cooking class.  Evidence supports cooking classes have favorable results on BMI and increased consumption of grains, seeds, legumes, berries, and vegetables.¹³ Psychologically speaking, women may view attending the class as a more approachable action step than immediately trying to adhere to a controlled diet.

TREND 2: Physical Activity is trending…It’s not too late to influence BC risks

Studies associate Physical Activity (PA) with a reduction in BC risk through hormonal and non-hormonal pathways.¹⁴ Postmenopausal women who exercised the equivalent to running 3 hours weekly and those active in doing moderate household work to the equivalent of 24 hours weekly reduced BC risk by 40%⁴.

Evidence also suggests that prolonged time spent sitting may lead to higher levels of estrogen in postmenopausal women.¹⁴ And women who engaged in low activity levels at menopause transition and who later increased their activity levels were at a reduced BC risk compared to those that remained sedentary.¹⁵

Body weight is especially important in postmenopausal BC prevention, physical activity helps to reduce total body weight and abdominal fat. In a large study with 20 years of follow up, higher levels of both recent and long-term moderate/vigorous physical activity, including brisk walking, were associated with lower BC risk among postmenopausal women.¹⁵ This finding of lower risk associated with recent activity suggests that it is not too late to modify physical activity levels to influence BC risk.¹⁵

Physical Activity in Action (Marketing): Evidence suggests the general public has limited knowledge that cancer can be prevented by the same options as reducing heart disease.

Physically active women tend to be more responsive to existing PA health messages compared to women who do not exercise. Health promotion needs to envision new ways to communicate with women who are not interested in physical activity. Messaging could be tailored by the stage of change/readiness (pre-contemplation, contemplation, planning, action, maintenance), self-efficacy, and social support needs.

Some studies report that using forceful or fear-based language appears to be ineffective and may negatively affect motivations and outcomes. Recent messaging “Do what you can” appear to have broader acceptance. A social marketing approach could be more effective – where techniques are used to influence people’s behavior for social good or to improve individual health outcomes. An appealing message would focus more on the immediate social and mental benefits of increasing energy, having fun, and spending time with others. These messages in contrast to longer-term benefits like reduced risks of breast cancer.

Physical Activity in Community Design: According to the CDC, creating or modifying environments to make it easier for people to walk and bike to everyday destinations (e.g., library, grocery store) helps increase PA and can make communities a better place to live. Making a healthy community is good for everyone.

Global evidence is accumulating: the sum is greater than the parts. While individual lifestyle factors have been associated with postmenopausal BC prevention (e.g, diet, physical activity, smoking, alcohol, and body fatness), studies are accumulating evidence on the benefits of clustering factors to reduce cancer risks. Behavioral risk factors are often correlated as individuals follow common lifestyle patterns influenced by intrapersonal, social, and cultural characteristics.¹⁶ Globally, studies have created versions of a Healthy Lifestyle Index (HLIS) to assess the effect of these combined factors on the risk of BC.

One of the first HLIS studies was conducted in Mexico and observed an 80% lowered risk of postmenopausal BC comparing the highest to the lowest quintiles of the index.¹⁷ A 2014 European Prospective Investigation into Cancer (EPIC) study was undertaken with 242,918 postmenopausal women and created a BC-specific HLIS. Results showed a lowered risk of BC in women with healthier lifestyles, a 3% reduced risk of BC per point increase in HLIS. ¹⁶ An HLIS study conducted on Indigenous Maori women in New Zealand reported that among postmenopausal Māori those in the top HLIS tertile had significantly lower odds of breast cancer.¹⁸

Integrated Lifestyle in Action: Lifestyle behavioral improvement is a holistic concept. People are not isolated –they are part of bigger systems involving family, workplace, and community. Their lifestyle behaviors tend to cluster around perceptions, feelings, beliefs, self-confidence, and self-efficacy. The Travis Iceberg model³ depicts this point beautifully. What contributes to the state of health (what is observable above the surface), is built on what lies below the surface. Remembering always that our clients are naturally creative, resourceful, and whole.  Our role is not to fix or to treat, it is to meet people where they are. Health coaches can support how to eat healthily and add more PA into one’s day, effectively manage stress, develop supportive relationships, and identify community resources to sustain change.

Resources:

1. Jordan, M. “How to be a Health Coach: An Integrative Wellness Approach,” 2013.
2. Prochaska, J.O. and Prochaska, J.M., Changing to thrive: the stages of change to overcome the top threats to your health and happiness,” 2016.
3. Travis, John W., 3^rd Edition: “The Wellness Workbook: How to Achieve Enduring Health and Vitality,” 2004.
4. Wiggs, Alleigh, “The Effects of Diet and Exercise on Endogenous Estrogens and Subsequent Breast Cancer risk.” Frontiers of Endocrinology, 2021.
5. Majumder et al. “Post-menopausal Breast Cancer: from Estrogen to Androgen Receptor.” Oncotarget, 2017.
6. Cohen, Lorenzo PHD and Jeffries Alison, Med, “Anticancer Living: Transform Your Life and Health with the Mix of Six” 2018.
7. Carruba G, Granata OM, et al. “Traditional Mediterranean diet decreases endogenous estrogens in healthy postmenopausal women.” Nutr Cancer. 2006.
8. https://www.elcaminohealth.org/
9. Ledsmo, Natalie MS, RD, CSO “Women’s Health Matters: Nutrition and Breast Cancer, UCSF Medical Center.
10. Terry P, et al. “Brassica vegetables and breast cancer risk.” Jama. 2001.
11. ButlerLM, WUAH, “A vegetable-fruit-soy dietary pattern protects against breast cancer among post-menopausal Singapore Chinese women.” AM J Clin Nutr 2010.
12. Park, Yikyung, “Dietary fiber intake and risk of breast cancer in postmenopausal women: the National Institutes of Health-AARP Diet and Health Study.” AM J Clin Nutr 2009.
13. Berrino F, et al. “Reducing Bioavailable Sex Hormones Through a Comprehensive Change Diet: The Diet and Androgens (DIANA) Randomized Trial. Cancer Epidemiol Biomarkers Prev. 2001.
14. Slojewska, Kinga, “The effect of Physical Activity on Sex hormone levels in women. Implications for Breast Cancer risk.” Via Medica, 2021.
15. Eliassen, A. Heather, SCD et al “Physical Activity and Risk of Breast Cancer among postmenopausal women.” AMA, 2010.
16. MeKenizie, et al “Health Lifestyle and risk of Breast Cancer among post-menopausal women in the European Prospective Investigation into Cancer and Nutrition Study.” Intl Jrnl of Cancer, 2014.
17. Sánchez-Zamorano LM, et al.: “Healthy lifestyle on the risk of breast cancer.” Cancer Epidemiol Biomarkers Prev. 2011.
18. McKenzie, F.,et al. “Healthy lifestyle and risk of breast cancer for indigenous and non-indigenous women in New Zealand: a case control study.” BMC Cancer 2014.