Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Improving the Impact of Your Cancer Prevention Message

Introduction

The English language is so broad that you can find an idiom to voice your point of view – and another one to express the opposing view. For example, I grew up hearing, “The squeaky wheel gets the grease.” Some friends were nurtured on the opposite notion, “The nail that sticks out gets the hammer.”

Practitioners of integrative and alternative medicine have long been the “squeaky wheel” for cancer prevention. Their unrelenting voices have saved lives and changed public health. Yet many times they have received the “hammer,” especially when the message points to inconvenient truths for industry. This column offers practitioners three tips for drawing favorable attention to their cancer prevention and treatment messages.

Epidemiology Essentials

Alternative and integrative practitioners tend to roll up their sleeves and study human pathophysiology and the molecular origins of cancer. In contrast, the medical establishment directs large resources towards naming, describing, classifying, monitoring, and counting cancer.

I encourage practitioners to be savvy about cancer statistics. For one, it helps safeguard their important message. Also, the statistics emphasized by the medical establishment can often be wielded to highlight the underlying molecular pathophysiology which integrative medicines address.

The following three epidemiology essentials can help navigate the nuances of cancer statistics:

1. Cancer rates.

   More people die from lung cancer in the US than any other cancer. Lung cancer has the highest mortality of any cancer. That doesn’t mean that lung cancer is the most common cancer, but that it is more often lethal.

Colon cancer is the second leading cause of cancer mortality for US men and women. But prostate and breast cancers are more common, right? However, only half of the population is at risk for prostate cancer, and women are at much greater risk of developing breast cancer than are men. So if prostate cancer among men and breast cancer among women are combined, then colon cancer becomes the third leading cause of cancer mortality.

3. Life expectancy data.

   Population screening and life expectancy change the statistical risk of developing a cancer even when someone’s personal risk is unchanged. Consider the statistic that 1 in 8 women will develop breast cancer. When more women in the population have mammograms, the more cancers are identified. Public opinion about screening changes the rates of cancer in the short term, even though an individual’s risk is unchanged. Similarly, as life expectancy increases, so does the number of women who develop breast cancer in their lifetime. But the statistic doesn’t change how long a person lives.

4. The cohort effect.

   Consider the cohort effect, especially for cancers which have taken decades to form on the molecular level. Sometimes cancer rates seem to decrease with age. When age is plotted on a graph, cancer incidence forms a bell-shaped curve. This doesn’t necessarily mean that rates of cancer incidence decrease in older age. What more likely is happening is an interaction between age and time called the cohort effect. For example people who are now in their 70s were exposed to little carcinogen. People in their 80s and 90s had less exposure to the relevant carcinogens. That doesn’t mean that people who are now in their 30s and 40s will have less of the cancer in their older years. These younger cohorts can expect higher rates as they age if the cohort effect is occurring.

Emphasizing That Which We Know That We Don’t Know

There’s medical science that we know, there’s what we don’t know, and there’s a great expanse of medical science that we have no idea that we don’t know. Cancer prevention and treatment messages can effectively emphasize what we know we don’t know and what we have no idea about. It beckons us to apply the Precautionary Principle.

The medical establishment and media focus public messages around what we know. However, credible government agencies provide excellent resources and even continuing education credits on what we don’t know about toxicology and cancer. Especially relevant are the following:

1. National Institute for Occupational Safety and Health (occupational carcinogens)

2. Agency for Toxic Substances Disease Registry (ATSDR.CDC.GOV)

3. US Environmental Protection Agency

To learn more about what our tax dollars are revealing about what we don’t know, I attended a lecture from David Dix, PhD, director, Office of Science Coordination and Policy, Office of Chemical Safety and Pollution Prevention, US Environmental Protection Agency. Dix spoke to the Johns Hopkins Environmental Health Sciences Department, Center for Alternative to animal Testing, about the EPA’s Endocrine Disruptor Screening Program. Until the recent past, the EPA used rabbits to study potential endocrine disrupting carcinogens. Now it is using molecular studies which greatly increases the number of pesticide chemicals being tested.

What stood out to me from Dix’s lecture is how few chemicals identified as potential endocrine disruptors have actually been tested. Dix referred to the tested chemicals as “two drops in a bucket.” Chemical safety, especially around pesticides, has been and remains an illusion rather than the established nontoxicity for which public health is calling.

Another striking challenge with Dix’s effective work is information sharing. Barriers that one wouldn’t anticipate are springing up around sharing the toxin databases and the analytic software to analyze potential endocrine disruptors.

Spotlighting Cause and Effect

Because the associations between toxicology and cancers usually fall into that category coined by Al Gore “inconvenient truths,” cause and effect are often left uncoupled.

Unfortunately, I have a hometown example. A longtime mentor of mine, Robert Lawrence, MD, MPH, wrote a January 23, 2015, blog in his capacity as director emeritus of the John Hopkins Center for a Livable Future:

Bad news in Maryland

. New Maryland Governor Larry Hogan has wasted no time rolling back environmental protections in this state. On his first day, he killed new farm regulations aimed at helping clean up the Chesapeake Bay. The restrictions were aimed at reducing how much poultry manure farmers are allowed to apply to their fields; the manure is rich in phosphorus, which runs off the fields into Bay tributaries, where it becomes pollution and creates dead zones. …

The new administration continued its start in regards to environmental laxity.

Then in June 2015, Governor Hogan publically announced that he was diagnosed with late stage III non-Hodgkin’s lymphoma. In November of last year, he announced that his cancer was in remission, thankfully. I have great empathy for cancer survivors, and I admire the courage it takes to make a harrowing medical journey a public one.

However, what has not taken place since the governor’s remission is an effort to publically link the scientifically robust causal association between environmental toxins introduced through agriculture and non-Hodgkin’s lymphoma.

Summary

Integrative health practitioners can further strengthen their cancer prevention and treatment messages with these three strategies:

1. Epidemiology can help link toxins and cancer. One important and often overlooked epidemiologic concept is the cohort effect. For example, cancer rates that go down with age are probably due to fewer exposures among the elderly rather than a protective effect of old age.

2. Official government websites provide credible information around the toxicology that medical science does not yet know.

3. Real-life situations receiving media coverage provide examples of the causal link between toxin exposures and cancer.

• Ingrid Kohlstadt, MD, MPH, FACPM, FACN

  Faculty Associate, Johns Hopkins Bloomberg School of Public Health

  Executive Director, NutriBee National Nutrition Competition Inc.

  Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)