Cancer Care Connections
Cancer Care Connections
Reducing Cancer Risk Through Healthy Lifestyle Choices
Ever wondered how simple lifestyle changes can drastically reduce your cancer risk? On this episode of Cancer Care Connections, Cheryl sits down with Dr. Ligeng Tian from Virginia Oncology Associates to uncover the powerful role of healthy habits in cancer prevention. Dr. Tian shares practical advice on embracing a plant-based diet, incorporating whole grains, and steering clear of processed and red meats to lower cancer risk. We explore the benefits of high fiber intake, the importance of a colorful plate filled with fruits and vegetables, and the surprising power of foods in reducing cancer risk. Additionally, the conversation touches on how maintaining a healthy weight and tackling obesity can be key factors in reducing your cancer risk.
Dr. Tian explains the complex relationship between supplements, medications, and cancer prevention. We explore why no supplement should be taken for cancer prevention unless there's a genuine nutritional deficiency and examine the nuanced roles of Vitamin D, calcium, aspirin, NSAIDs, and Metformin. Understand the potential risks and benefits and discover the importance of consulting healthcare professionals before self-prescribing.
Gain practical health tips for cancer prevention, from avoiding tobacco and limiting alcohol to seeking trustworthy medical advice. We encourage you to prioritize your health with actionable steps.
Finally, get a sneak peek into our next episode where Dr. Michael Miller will delve into the latest innovations in radiation oncology. This episode is packed with actionable insights and expert advice you won't want to miss!
Dr. Tian is board-certified in Internal Medicine. She received her medical degree from Beijing Medical University, China, and her Doctor of Philosophy in Molecular Biology & Genetics from Weill Graduate School of Cornell University, New York. Tian completed her Internal Medicine Residency at Long Island Jewish Medical Center of Albert Einstein College of Medicine, New York, and her Medical Oncology/Hematology Fellowship at Yale Medical School, Connecticut.
During her time at Yale, Dr. Tian participated in several clinical research studies. Her studies showed that bone marrow findings correlate poorly with the disease activity in hemophagocytic lymphohistiocytosis (HLH). She also participated in phase I clinical trials in hematologic malignancies, as well as teaching at Yale Medical School. She is the author of numerous publications, abstracts, and book chapters on topics in Hematology and Oncology.
Dr. Tian is a member of several professional organizations, including the American Society of Clinical Oncology and the American Society of Hematology. Dr. Tian's particular clinical interests include providing personalized cancer care to patients with lung cancer and hematology.
In her free time, Dr. Tian enjoys spending time with her family, traveling, and cooking.
Resources mentioned in this podcast
The American Cancer Society Prevention and Early Detection:
Thank you for listening! If you're interested in hearing more from Virginia Oncology Associates, make sure to subscribe to Cancer Care Connections on Apple Podcasts, Spotify, or anywhere podcasts are available, or listen online at cancercareconnections.buzzsprout.com.
Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at VirginiaCancer.com. or find us on Facebook or Instagram at Virginia Oncology Associates.
Intro
00:04
Welcome to Cancer Care Connections. On this episode, Cheryl spoke with Dr. Ligeng Tian, a medical oncologist and hematologist with Virginia Oncology Associates. In this episode, Dr. Tian emphasizes how a healthy lifestyle can significantly reduce your cancer risk, and explains why long-term, healthy habits are far more beneficial than temporary fixes. While there is no magic pill that will stop you from getting cancer, there are many things you can do to reduce your risk.
Cheryl
00:38
Dr Ligeng Tian has been with Virginia Oncology Associates since 2013. She loves serving the Peninsula community and is passionate about educating patients about their health. She has a special interest in treating lung cancer, breast cancer, and hematologic conditions. In her free time, Dr. Tian enjoys spending time with her family, traveling, and cooking. Dr Tian, thank you so much for sitting down with us today.
Dr. Tian
My pleasure.
Cheryl
We enjoy learning about our doctors at Virginia Oncology Associates and hearing what they're passionate about. What brought you into medicine?
Dr. Tian
01:17
Yeah, that's a very interesting question. For me, there are no big glorious stories I can share. It's actually pure, pure interest. I've always been interested in how the body works, interested in health, interested in correcting and fixing things, and when comes to medicine, all of the rewarding moments. Our patients and family appreciate how they're being helped and that keeps me going. So, it's just pure love and interest in health and medicine.
Cheryl
01:48
I love that, and I love your interest in fixing things. And I know your patients certainly appreciate that. We wanted to talk with you today about prevention, specifically preventing cancer. And I know that there's no sure way to prevent cancer but you can reduce your risk by making some healthy choices. So let's get started. What can someone do if they're interested in prevention? We're kind of thinking that this episode is, of course, for patients of Virginia Oncology Associates but for loved ones, family, and friends of those people who are going through a tough time right now. This talk about food, nutrition, and prevention kind of works for everybody.
Dr. Tian
02:39
That's true, indeed. I think this is a very important topic because you kind of get one step ahead rather than just having a cancer diagnosis and getting treated. What if you don't even need to come to the VOA office, right? That's even better. Not just for the patient, but for everybody, as you pointed out. It's such a big topic. When you talk about cancer prevention, it's easy to think of, say, quitting smoking helps prevent lung cancer. Not taking estrogen products, helps prevent breast cancer. Everybody should go through each appropriate cancer screening. A colonoscopy and the removal of a colon polyp helps prevent colon cancer. I can go on and go on and on: During the summer, wear sunscreen to reduce chances of skin cancer, the HPV vaccination helps prevent cervical cancer. Those are really known to the public, but one mystery we should really address is what can one do day in and day out to try to prevent cancer. It really comes down to a healthy lifestyle, diet, exercise, and physical activity, and that's becoming a very hot topic right now.
Cheryl
03:50
Yeah, definitely, it's one of those things that in many cases, people know and I'm saying know in quotes, but what you're saying is it really does matter. It works in some cases.
Dr. Tian
04:05
Yes, it works. So it's actually very interesting to think that for many, many years when we talked about nutrition and diet, and we've tried to find one product, one supplement, one vitamin. I can't say take this magic pill for cancer prevention. Actually, we're shifting from that nutrient-centric supplement idea to a more holistic approach. More and more now shows it's more about the pattern of the diet. That's actually reflected in the American Cancer Society's published guidelines. You really start to notice it's not about one thing, it's about a pattern, and it's not just a good pattern, but also easy to carry out and you can continue. So, in other words, it has to be something good and long-lasting.
Cheryl
05:01
I really want to hear more about that. When you're thinking about food and nutrition, your diet...again, diet is another one of those words where it feels very restrictive. But when you're saying, pattern, to me we're talking consistency and something constant.
Dr. Tian
That's right. Yeah.
Cheryl
So, pattern, tell me more about that.
Dr. Tian
05:21
Yeah, so it really comes down to what you should be eating, what you should not be eating, and how you eat. For example, the basic concept is you should eat food that helps achieve and maintain a healthy weight. We know now that obesity contributes to a lot of cancers. You should eat vegetables and fruits; a more plant-based diet. You really need to focus on the variety. You should eat different kinds and different colors. Eat fruits as a whole fruit rather than blended juice. You should eat whole grains rather than highly processed ones. We do see that people who have a higher intake of fruit and vegetables seem to lower the risk of lung cancer, gastric cancer, and even breast cancer. We all know that high fiber intake decreases the risk of colorectal cancer. And maybe it's interesting to you that tomato helps lower the risk of prostate cancer. So that's all very important. It's about what not to eat or drink; again a pattern.
06:29
It's actually pretty well known now that processed meat and red meat contribute to colon cancer. So that's something we constantly talk to people about avoiding processed meat, decreasing their intake of red meat to help cancer prevention, and a low-fat diet. Everybody knows we really should not eat anything with trans fat. That's a known fact. But saturated fat versus unsaturated fat, and low-fat versus high-fat all make a difference. We also see that low-fat dairy products decrease the risk of breast cancer in premenopausal women. So that is a lot of things to talk about. To a different extent, sweetened sugary drinks with additive sugar content are not good for you. They are not good for your health and they increase weight. From every health perspective, they're no good. Highly processed foods, such as cookies and cake are not good compared to whole grains. You should eat whole-grain bread versus white bread. All that makes a difference. If one really sticks to a healthy diet and focuses on whole foods rather than highly processed food and watches calories, that ultimately leads to cancer prevention.
Cheryl
07:59
I want to ask, sticking with the food and nutrition, where does alcohol fall into this?
Dr. Tian
08:05
Oh, that's a great question. Who can say no to a drink at a graduation party? Or when finishing chemo and being cured of cancer? Who can say no? But if I have to say one thing, it's to try to eliminate or at least minimize alcohol. When it comes to cancer prevention, alcohol does increase the risk of oral cavity cancer, pharyngeal cancer, esophageal cancer, liver cancer, and even breast cancer for females. So we really counsel people about reducing alcohol for cancer prevention in terms of breast and colorectal.
08:51
So how much alcohol then? Well, I would never say no to a social drink, but when you look at the relationship between how much alcohol you consume and the risk of cancer, that relationship starts from even a drink every other day or say three to six drinks a week. If you ask me, "Just tell me how much, I can't just cut it?" We say in general, limit one drink a day for females and less than two for males. What I say to patients is, if you don't crave it, (say, "Well, you know today I don't have to have a drink for dinner") then skip it. If you say you know "I've had one drink, I'm happy," don't have two. So just little things to work on.
Cheryl
09:34
Some people might be hearing this and think, oh my goodness, this pattern is not attractive, but I want to hear more about the results. So you might have people who are listening here today who are patients and might be thinking well, I've already been diagnosed, this won't make a difference. I'm going to have a drink, I'm going to have some potato chips, I'm going to have some French fries. And they might think, well...
Dr. Tian
What's the big deal right? What's the difference?
Cheryl
10:09
We're all good...or not. So what do you say, in your experience here, what have you seen as the benefits of changing to a more positive diet? How does that have an effect on their health?
Dr. Tian
10:20
Yeah, so there are actually many prospects to that question. It's a wonderful question. We do notice a lot of things. I'm going to deviate a tiny bit here to smoking. It's very interesting to say that, especially for patients diagnosed with lung cancer, even stage four, that's no longer curable (with exceptions). Those people who are diagnosed with cancer and smoke still live shorter lifespans, meaning have a worse prognosis compared to people who quit smoking. So indeed, a lot of modifications help. Alcohol, among other things out there, actually supposedly affects the liver metabolism, so that can interfere with the efficacy of the treatment and affect the outcome.
11:14
If a person says, well, my goal is to prolong my overall survival and that is your goal, you're not giving up on things, then these are things worth looking into and understanding. It's hard, of course, it's hard. It's easy for us to sit here and say quit, but it takes a lot of effort for the patient and the family members. Regarding food, it's still important. First of all, a healthy diet, even though we're not going to say any supplement helps; there isn't any specific product that's going to help with cancer prevention or treatment per se, but a healthy diet will lead a person to a healthier state. It is another perspective of quality of life. If you can, I don't want to say cleanse your body, because it's very misleading, but in a certain way, it gives you a healthy body, a healthy metabolism, and helps you achieve a better, muscle fat ratio of your body. It does improve the quality of life. So I think for a person, even with a cancer diagnosis, they still need to pay attention even for quality of life, in addition to survival benefit. And not to mention we have a lot of patients even with a cancer diagnosis, who will be cured at Virginia Oncology Associates. Here we see miracles.
12:07
It's because of cancer research and advances in cancer treatment development that I see people who have breast cancer and have been with me for 10 years. They deserve a good quality of life rather than just saying I'm going to have a drink, I'm going to binge on my French fries and chips and end up dying from a heart attack five years after diagnosis instead of living their full potential of 10 years. That's important. Also, because of immunotherapy, I have patients, say, with brain metastases of lung cancer. In the old days, they would have a prognosis of six months and these people are now alive, living a good life. They come to see me every few months and live a wonderful life.
I think a cancer diagnosis should not shorten a person's expectation for a lifespan just by sacrificing their health. I always say to my patients, "Look, you're cancer-free, or look your cancer is under control. You should go on with your normal life as much as you can." From that perspective, I think a healthy lifestyle helps them to achieve that. Don't shorten your lifespan because of a poor lifestyle. That's important.
Cheryl
14:03
I love what you said. And cancer, it seems is, like an uncontrollable thing that has happened to you. But your food and nutrition, what you put in your mouth, how you exercise, is something you can control.
Dr. Tian
14:15
So well said, yes. Take your life under your own control.
Cheryl
14:20
A little piece of it, right? So I have a couple more questions that I want to ask you about supplements. Can those help prevent cancer?
Dr. Tian
14:29
That's actually a very good question. That's exactly how we used to think about cancer prevention; nutrient-centric. However, as I mentioned, we're really shifting to a more holistic pattern approach with all that we learn with all the data out there. The answer is, unfortunately, really not much. I would start by stating the conclusion, which is no supplement is recommended for cancer prevention unless a person truly has a nutritional deficiency. So we look at a lot of things. The only real thing that may be beneficial out there is if a person is vitamin D deficient, then repleting vitamin D levels seems to help reduce the risk of colorectal cancer, breast cancer, etc. However, if a person is not deficient in vitamin D, taking vitamin D does not help. I have to note that vitamin D supplements have other benefits. Purely focusing on cancer prevention, the answer is no. Another interesting thing is, that some can be harmful.
15:37
Calcium, for example. We take calcium all the time and certain calcium levels help to reduce colorectal cancer, but too much calcium may increase the risk of prostate cancer. See, it's a subtle difference. Should a person take calcium just on their own? Should they take the vitamin D on their own? It's a tricky question. It's important to talk to your primary care physician, talk to your oncologist if you have one, and ask how much should you take. That's why we actually generally recommend calcium to be like 1,200mg a day. I'm not saying take as much as you want.
16:13
Now another interesting thing is for lung cancer. We don't know so much about antioxidant cancer prevention, but at least in two, maybe three trials we have some incidental findings. We aim to figure out about vitamin supplements for lung cancer prevention. We found out that vitamin A and beta-carotene supplements potentially increase the risk of lung cancer and prostate cancer. That's another really very, very important remark here that people need to remember, not all supplements are good. We don't have all the data out there, we haven't tested every supplement, but we do know from these examples that a person should not just take supplements and you shouldn't over-supplement. A lot of people take vitamins. How much that vitamin serves your health is a different question when you're talking about them outside of the cancer world. But for the cancer field, don't just do it on your own.
Cheryl
17:20
It's such good advice to think about. When you're at the store and you see all these shelves and shelves of supplements, you're like this is going to help me feel better, am I going to lose weight? And so it really is kind of buyer beware, especially with those little bottles. Which kind of leads to my next question about medication. Is there a perfect medicine?
Dr. Tian
17:43
That's another field. We don't have many findings, not because of a lack of trying. The only thing so far we truly know is probably aspirin and NSAIDs. NSAIDs means Motrin, ibuprofen, Aleve, and those kinds of medication. Those seem to reduce the incidence of colorectal cancer and also reduce the incidence of adenoma, which is a kind of colon polyp. That seems to be helpful to take those before age 70. Taking it ongoing seems to reduce the risk of cancer. But, there's always a but. These are not just benign medications. They all put the patient at risk of bleeding and may give the patient ulcers in the stomach. And those NSAIDs, ibuprofen, Motrin, can, if a person takes it long-term, damage the kidney and damage the liver. So there are consequences of those medications. So are you really a candidate for this medication for cancer prevention? Talk to your doctor, don't just take it on your own. If you're taking it for, say, a history of stroke, heart attack, and other things, then sure, you're killing two birds, but don't try to kill one bird and come to the hospital with GI bleed and all that.
18:59
Another thing that's very hot out there...you may hear about is Metformin. That's a medication people use to treat diabetes and there are a lot of publications out there that say, metformin is a magic drug. Can we take metformin for all those benefits, including cancer prevention? And that's tricky. What we find is, that it seems to reduce the risk of cancer in diabetes patients, meaning again, if you don't have an indication for metformin, you don't have diabetes, taking metformin has its own risk, such as metabolic acidosis and renal insufficiency. Those medications out there will have certain data, but it's not strong first of all, and not for everybody. They have consequences.
Cheryl
19:46
Beware what is on the packaging that makes you think that it's a cure-all. We were talking earlier about physical activity and exercise, as we were talking about nutrition. So what kind of physical activity are we talking about?
Dr. Tian
20:04
I know, right? We always say go exercise, but how much? What does that mean? That's actually another recent hot topic. It's actually interesting to speak to cardiologists and primary care physicians. It all comes down to a healthy diet and physical activity. So the WHO went ahead and gave some true, solid recommendations. Fortunately, we can borrow those not just for cancer prevention, but for overall health. It's really for everybody, even if you're not interested in cancer prevention. We recommend that not only you do some fat-burning activities, aerobic activity like running, but also some resistance activities such as squatting, and dumbbells. Of course, with instruction.
20:55
Don't try this on your own. Be careful, you may hurt yourself. When we talk about these activities, the most beneficial pattern is if you do moderate activity for about 150 minutes to 300 minutes a week. This comes down to roughly 30 minutes a day for five days and above. Or if you do one hour a day, up to three days a week. What is moderate intensity? Moderate means you can talk but cannot sing. If you walk, you can sing, but that's not moderate enough. If you're running and you're panting, you can't talk. That is not moderate. So if you're jogging with your friends and chatting along the way, that's a perfect moderate activity.
21:01
If you don't have time, you want to do more intensive activity. What's intensive? Intensive means you can't even talk. So jumping jack or burpees. That's a perfect example of that. If you can talk when you do burpees, you're probably not doing them right. Truth, yeah. But when you're getting intensive, it's 75 to 150 minutes a week. On a side note, it's important to balance train for seniors. It's important to maintain good bone health and muscle strength so you don't fall and break your femur, fall and need surgery, or fall and end up bedridden for years which affects your quality of life. Exercise, resistance, and muscle strength for seniors are important too.
Cheryl
22:27
Well, we're talking about the quality of life as you get older and taking those things that you mentioned, the strength training, the aerobic activity- that's really important to keep into your golden years, as you get older.
Dr. Tian
22:41
Yes, yes, we are really living longer and longer. In the office, we see 80 and 90-year-old patients. Routinely when we see somebody 60 years old, we say "At your young age". People laugh, but it's truly a young age. And let's talk about golden years. You want to keep it golden. You want to keep the activity going. That's a very important note: keep the activity going. One should really start exercising at a younger age. Maintain your bone density, maintain your muscle strength into your senior years so you can travel, have fun, and enjoy life. If you can't start at 60, start at 70. It's still a good thing. You can start at 30, start at 50, it's still good. The goal is to have the idea, to work on your pattern of life, both for health and physical activity, because it really benefits you long term.
Cheryl
23:32
It's not too late to start. I want to talk about obesity because it is a problem in our country and people might think well, I'm not going to do all that exercise, I'm not doing five days a week. Like Dr Tian said, I can't eat vegetables all day, every day, and so, as it relates to cancer prevention or cancer in general, how does obesity contribute to that?
Dr. Tian
23:58
Yeah, it's a very, very important question. It's not just for the heart health and other health conditions that your primary care physicians are actively managing. It's indeed very, very important in the cancer world as well. It's actually shocking numbers. We actually think about 40% of cancer can be attributed to being overweight and obesity. These were old numbers from 10 years ago but I'm sure it's remained the same. It's a very shocking number, and in fact, we can easily list 13 types of cancer out there with publications like breast, colon, endometrial, kidney, ovarian, blood cancers, and pancreatic. You can name so many. That's why, to some extent, gastric bypass and bariatric surgery are really helpful in cancer reduction.
24:59
So it's not just for heart and diabetes, it's also for cancer. As I mentioned, we do observe a decrease in cancer incidence by reducing weight. Of course, one should not rely on surgery to reduce weight. Diet and exercise contribute to weight loss. We count both physical activity and ideal body weight as two points. So if a person cannot lose weight, but they do have a very healthy lifestyle in terms of physical activity, they are protected. If you are very physically active and try to work on your weight by other measures, you are also contributing to cancer prevention. If you can do both, wonderful, but don't give up because you can only do one, and not both at the same time.
Cheryl
25:51
I have one last question about prevention, and you might have someone who is related to someone else who already has a cancer diagnosis. So should that person pay more attention because there is a cancer diagnosis in their family?
Dr. Tian
26:07
I would say the simple answer is yes because cancer in the family can come from two different perspectives. One is truly a genetic component. Those are typically seen in breast cancer, ovarian, pancreatic, prostate, GI, and, colon; a lot of those. So what one wants to pay attention to is if they suspect it runs in the family. Because genetic components are: what's the age? Is it a young diagnosis? How many members of the family have it? And what kind of cancer do they have? If it's, let's say, lung cancer, then we know it's not genetic. When you're in doubt, when you truly have concerns, always talk to your primary care physician. Ask should I be worried about a genetic component. They can always refer you to a genetic counselor. We do have a genetic counseling service at VOA. Ask, should I be tested? And that is an evolving field. You didn't need genetic testing five years ago, but you may need it this year. Always come back, reassess, and ask questions.
27:18
Environmental behavior. Just like we mentioned, smoking. If everybody in the house smokes and you are always exposed to secondhand smoke, then you should watch out. Modify your behavior, ask people around you to please not smoke in your house, and don't pick up the habit of smoking. For example, if there is a family history of colon cancer, it may be because the person drinks and eats sausage every day and has a not-so-healthy lifestyle. You can help modify and remind yourself, especially after listening to this podcast, that you can adopt a better lifestyle. But it's certainly, for a layperson, hard to understand which one is genetic and which one is not, especially in this evolving field. I would say, yes, be concerned and always reach out and find out what you should be concerned about and what you should be doing. Is it just purely lifestyle modification versus needing genetic counseling?
Cheryl
28:14
This has been such a helpful conversation to really hear that these small changes to diet, to your movement, can really have an impact on not only how you feel but how you will feel in the future. So what are some resources that you can share, that people who are listening can go to, that you trust?
Dr. Tian
28:37
Yeah, a very good website, of course, is the American Cancer Society website. There are a lot of very reliable and very good guidelines. There are many, other very good websites out there, like the Mayo Clinic website and the Medscape website. I would not go to forums or other sites not sponsored by major medical societies or major medical institutions because hearsay can be very misleading. Again, when you're in doubt, consult your primary care physician, and ask for help.
Cheryl
29:12
Do you have any last words or takeaways that people can hear at the end of our episode to remember as the key points?
Dr. Tian
29:24
Yep, I would say the most important things would be to avoid tobacco, quit smoking, limit or even eliminate your alcohol, be physically active, maintain a healthy weight, eat a healthy diet, and everything your primary care physician or a VOA physician tells you.
Cheryl
29:49
Yeah, and you're happy to talk with them about how they can achieve these health goals. Dr. Tian, thank you so much for your time, your expertise, and your energy about this subject.
Dr. Tian
29:58
Thank you. Thanks for having me.
Exit
30:04
That’s all for this episode of Cancer Care Connections. Stay tuned for our next episode where Cheryl will sit down with Dr. Michael Miller, a radiation oncologist with Virginia Oncology Associates. Dr. Miller discusses recent advances in Radiation Oncology and attributes these advances to the technology and precision of the machines used today to treat patients.
Don't forget to subscribe to our podcast via Apple Podcast, Spotify or anywhere podcasts are available, or listen online at cancercareconnections.buzzsprout.com. Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at virginiacancer.com or find us on Facebook or Instagram at Virginia Oncology Associates.