Watch for an empowering conversation on how everyday choices can make a big difference in cancer prevention and outcomes. MSK’s Jessica Scott (Director of MSK’s Exercise Oncology Program and Associate Attending) talks:
- How regular screenings, balanced nutrition, and physical activity work together to lower cancer risk and support better recovery.
- Practical steps you can take to protect your health, catch cancer early, and build lasting habits that help you feel your best.
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Today we are talking about how activity, nutrition and lifestyle impacts cancer outcomes, but also on the preventative side as well.
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So joining us today, we have Jessica Scott and we'll learn a little bit more about her later webinar.
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Everyone of you on this call is an MSK Direct partner via your employer.
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It's a cancer benefit that gives you access to the expertise and resources of Memorial Stone Kettering Cancer Center.
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So if there's any suspicion or diagnosis for you, your friends, your family, we'll, we'll help you get the connection to care, the connection to care more specifically from housekeeping to this webinar, we're going to answer all the questions at the end.
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So please use the Q&A box at the top of your screen and we'll keep track of those as we go through and answer them at the end.
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Recording of the session will also be emailed out to each of you after after.
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So you can be able to replay at your at your leisure, but the slides themselves won't be shared.
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Just no, due to doctor Jessica Scott.
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She previously worked at NASA for seven years doing research over there and then decided to share her expertise with our cancer patients and the Cancer Research community here at Memorial Sun Cuttery.
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So I'll hand it over to you, Jessica.
1:38
Hey, Jessica, Great.
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Well, thanks so much, Lily.
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I'm very excited to share some of the, the work that we're doing looking at exercise training in, in patients with cancer.
1:51
And I know it might sound a little disconnect between what astronauts experience when they're individuals with cancer experience, but there's actually a lot of similarities between patients and and astronauts in terms of the deconditioning that happens in space.
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Not all astronauts are extraordinarily healthy individuals.
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The average astronaut is a 52 year old male with some cardio, some cardiovascular deconditioning and exercise training is mandatory before flight, after flight and, and post flight.
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And so a lot of the work that we're doing is trying to apply some of those tools and techniques that NASA used in the cancer space to prevent cancer and prevent deconditioning, prevent deconditioning that happens during cancer and in that that post treatment setting.
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Lily, I'm not able to click next on the slide.
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Would you mind clicking next?
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Next.
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So today we're going to go over some of the evidence that looks at how healthy living and exercise and nutrition can help prevent cancer.
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Look at some of the risk reduction benefits, some screening and some proactive health tools that you prevent or reduce the side effects of cancer treatment.
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Next.
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Yes, there is a a really big problem in the United States.
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Last year there were an estimated over 2 million new cancer cases and over 600,000 new cancer deaths.
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Just to put that into perspective, every day that's over 5000 new cases and over 1500 new deaths.
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So that's why we're why we're so interested in what are different ways that we could prevent cancer from occurring and prevent those deaths.
3:44
Once you have been diagnosed with cancer, next there is not only a high risk of developing cancer and some of the side effects, but there's also the other issue of a high financial burden.
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This craft shows the change in financial burden from 2015 in light blue to 2022 in dark blue.
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And in 2022 there were over $200 billion costs associated with cancer care.
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And some of those costs have to do with on this graph, the different cancer types have to do with the number of individuals that are diagnosed with different cancer types.
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Like breast cancer is a high financial burden, financial burden, but there are a lot of individuals that are diagnosed with breast cancer and some of those costs are also driven by the treatment types, for example, in lung and some of the blood cancers that are the very high treatment related costs as well as some of the the side effects associated with this treatment and with this treatment next.
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But the good news is that a lot of the the cancers are are can be reduced by a healthy living.
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So they can not only prevent cancer from occurring in the 1st place, but it can also improve cancer outcomes.
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So all that has looked at how cancer prevents modifiable risk factors are are helpful in preventing some of those cancer related outcomes.
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Next, there is a large body of evidence showing that exercise is associated with a reduced risk of at least eight different types of cancer.
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This was a study in over 1,000,000 participants and they asked these individuals how much precise do you do in a typical week and compared to individuals that reported high levels of exercise about 5 hours a week.
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These individuals had a reduced risk of esophageal cancer, lung cancer, kidney cancer, gastric cancer, all these different types of cancer.
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But that was based on was based on doing the high levels of exercise versus the lower levels of exercise next.
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But a healthy diet can decrease the risk of cancer occurrence.
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This was a study in over 85,000 individuals with a self reported diet and they asked individuals what do you what do you eat in a typical week?
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And they categorized it into a healthy diet, which consisted consisted mainly of healthy fruits and vegetables compared to an unhealthy diet that consisted more of processed foods and higher alcohol intake.
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And an individual that reported a healthcare diet, they had a 10 to 20% reduced risk in cancer incidence or cancer from cancer from occurring over the course of the study.
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Next.
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Now there's also a newer line of evidence that is looking at if a healthy lifestyle can be different once you've been diagnosed with cancer.
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And one of the the big revelations in in recent years was that even before you go in for hospitalization, if you exercised and looked at their rates of hospitalization.
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So in individuals who had diagnosis of cancer, if they were reported to make exercise, they had an 8% reduced risk in being hospitalized at all.
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And if they did need hospitalized, need hospitalization, they had a lower length of hospital stay, so 1.44 days in hospital compared to individuals that reported doing low levels of exercise.
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And this is really important when we think of hospitalization costs and time in hospital and time away from in hospital and time away from family.
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This is a really important metric that we always try and encourage patients to exercise to not only help them feel better, but also prevent some of the lengthier hospital stays or hospital stays or hospitalization in the first place.
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No, unfortunately the cost of cancer care don't end when someone finishes active treatment.
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And we often think of receiving cancer and undergoing chemotherapy or the end after that active treatment setting.
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Many survivors are on maintenance treatment.
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So for breast cancer for example or prostate cancer there is a requirement to take hormone therapy for five or more years.
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The other major concern is the acute side effect effects of that active cancer treatments and over 50% of survivors experience side effects and this can be everything from anxiety, depression, low function and that is really happens in that first acute phase after they finish active, finish active treatment, also long term effects.
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So these are years after finishing active treatment.
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And one of the major concerns is cardiovascular disease.
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And we know now that our treatments are getting so good that patients are living longer, but we're finding out that this increases, increases the risk of factors like cardiovascular disease and cardiovascular disease is over 2 fold higher in cancer survivors compared to individuals that have not been treated with for cancer.
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And then finally, there is the monitoring.
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So once you've been diagnosed with cancer, there are regular follow up visits.
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There might be a scan to yearly scan to evaluate make sure that the cancer has not recurred and laboratory work.
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So there are a lot of repeated visits that an individual without cancer will have to endure and and go through for many years through for many years after that active treatment next.
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So what are the what's the evidence showing that exercise could be beneficial at preventing some of those acute effects?
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This is some of the work by by our group where we found that I mentioned cute effects and in one of our studies we found that 12 week course of chemotherapy for breast cancer was the equivalent to 10 years of healthy aging.
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So we often hear from patients, I feel like I've aged 10 years and physiologically this is the case where the the physiological side effects of receiving chemotherapy is very, very intense.
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Next, unfortunately in a series of studies, we looked at what is the best modality of exercise to offset that accelerated aging that we see with chemotherapy.
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So one of our studies we looked at is it better to train like an astronaut or like an athlete compared to a standard program.
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What this consists of is doing a high intensity exercise session as well as lower intensity.
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It's that mix of high intensity and low intensity that is really beneficial, beneficial to offset that decline that we see during chemotherapy.
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Another question that we often get asked is what is the best modality?
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So I'm receiving chemotherapy or radiation treatment.
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Should I do resistance exercise?
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Should I do aerobic?
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Should I do both?
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And we did a study where we compared aerobic alone or resistance alone or a combined aerobic and resistance training program.
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We were a little bit surprised.
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We thought that the combined program would be the best.
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But we actually found that a walking alone program was the fast mode was the fast modality to improve fitness or that functional capacity in individuals that had been diagnosed with cancer.
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Next and then in a final study, we looked at when is the best to start an exercise training program.
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In all of these trials, these trials, these individuals were not exercisers.
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They were doing less than 90 minutes a week of exercise.
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And we wanted to know, is it better just to rest and take it easy during chemotherapy, which was really standard and kind of the best practice at the time?
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Is it better to start immediately during start immediately during chemotherapy or is it better to start early and go long?
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And that's what we found with this study in breast cancer, is that starting as soon as you initiate chemotherapy and continuing into that post treatment setting, that's the best way to begin an exercise program.
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We also know that exercise not only is helpful for some cardiovascular disease endpoints, but we're also seeing that it can reduce the Reza, a really major concern for individuals who've diagnosed with cancer.
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In this study, we've looked at over 10,000 individuals with breast cancer and they reported their levels of exercise at diagnosis.
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And then these individuals were followed for up to 8 years.
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And we found that individuals that were individuals that were reported doing at least an hour of exercise per week.
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So these were the high exercise levels had an 18% reduced risk of breast cancer recurrence compared to individuals that reported doing less than an hour a week of exercise exercise.
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So again, really encouraging that exercise may have some tumor specific effects next, and not only we're looking at cancer recurrence, but also how can we reduce the risk of death from cancer.
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So in a similar study at of individuals with cancer, this time with lung, prostate, colorectal or ovarian, individuals that reported doing at least three hours of exercise per week had a 21% reduced risk of death from cancer compared to individuals reporting low levels.
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So hopefully there's a trend that you're starting to see where are they going to see where are these higher levels of exercise.
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Even just an hour a week of exercise can be beneficial for preventing some of these outcomes.
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We can also see there evidence in with diet.
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So there are smaller numbers, but looking at over 2000 individuals that healthy diet, which is mostly fruit central based at a 26% reduced risk in death from cancer compared compared to individuals that reported higher alcohol intake or a higher processed foods.
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Next.
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And one of the studies that I think was that one of my highlights was showing a study that showed it was never too late to start exercising.
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All of the studies I've looked at exercise at a single time point, but there wasn't a study that looked at if you changed your exercise levels, did that help with outcomes.
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So in this study, we've looked at over 5000 adult survivors of childhood cancer and we categorized individuals who had repeated measures of an exercise questionnaire, guys questionnaire into those that reported maintaining low levels of exercise, so less than 20 minutes per week.
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Those that increased exercise levels at least 40 minutes per week, or those that maintained higher levels of exercise, which was at least 100 minutes per week of exercise.
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And in those individuals that those individuals that had the highest that increased exercise levels or maintained high levels had a 40% reduced risk and death from any cause.
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So this is really highlighting the importance of exercise can have a really dramatic effect and there are there are no pharmacological interventions that can have those same benefits as exercising or diet.
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Next.
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So when looking at how can we help promote the health and Wellness in daily lives, there are a couple of different aspects could be beneficial.
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So 1 is just the recognition and advice that health and Wellness is important and encouraging those different types of behavior.
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Improving access to healthy nutrition is a really important component.
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So at conferences, it's really easy to have the the brownie, the the brownies and the cookies that are out.
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But having including a fruit plate or some other healthy nutrition vegetables is just makes it easier for access instead of going towards the the more processed foods.
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Promoting physical activity is another great way.
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So if they so in our team, we do walk and talks.
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If we don't need to be sitting here leading a presentation or giving a presentation, we will, each of us, even though we're remote, we all take our phones and go for a walk and then we talk while we're trying to get our steps.
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And I think a lot, I think a lot of the awareness comes from the seminars and different approaches where it's just increasing the, the knowledge about how much of a difference healthy activity levels and healthy nutrition are important for overall lifestyle.
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The the other components that had has been importance in in our group is how we can leverage technology and data.
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And whether you know it or not, your your phone for example, is tracking your step counts.
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So even if you don't have a Fitbit or one of those other activity monitors, most individuals always have a smartphone.
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And you can look up the health app and you can get a really great idea of what your daily step count has been over the past month, over the past week, over the past year.
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And that's a really great way to get a baseline level of what your activity is and try to increase those activity levels from activity levels from there.
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And for individuals who have been diagnosed with cancer, integrating a disease management support team, whether those are peer individuals or having a support group for individuals diagnosed with cancer is a really important component of social awareness and just acceptance that there is a disease and, and how you can incorporate that into your daily lives.
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And we try and encourage the the health and Wellness next.
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There are a lot of sources of information particularly so there are programs specific to individuals who have been diagnosed with cancer.
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That is the LIVESTRONG at the YMCA.
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So at most YMCA centers, there is a program with trainers who have been specifically have knowledge regarding some of the side effects associated with cancer treatments and how to navigate exercise training while you're either going for treatment or are in that post treatment setting.
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The American College of Sports Medicine has a specialized certification training course.
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So if you are looking for an individual or a personal trainer and personal trainer and you have been diagnosed with cancer.
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Looking for an A trainer with that specific certification will help with understanding some of those side effects that individuals who've not been treated, who've not been treated for cancer don't have.
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And there are different ways that you can train or start to train if you've been diagnosed and there are are links to those specific guidelines in that the cancer phase next.
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So moving now into cancer risk reduction.
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We've talked about healthy exercise and healthy diet, but there are some other factors that are are really important for reducing the risk of cancer as well.
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Next at the cancer.
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The causes of cancer are are numerous, and I've had a professor say many times that it's just luck or bad luck what causes cancer.
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But there are certain lifestyle factors that can increase the likelihood of developing cancer in the first place.
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The, the, the major one that a lot of people know about is, is tobacco, but there's also obesity and diet.
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We're finding more and more about the risk related to alcohol.
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So we'll delve a little bit more into each of these elements and how they could reducing some of those could help reduce the cancer risk.
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Next, starting with tobacco.
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And I think there is a common conception that smoking or tobacco can cause lung cancer, but it's really not just lung cancer that tobacco can increase the risk of there, it increases the risk of mouth and throat cancer, but other cancers that you might not think there's that you might not think about like bladder cancer and colorectal cancer and stomach cancer, pancreatic cancer.
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So there are a lot of carcinogens and tobacco that can drive some of those mutations that increase the the rest of developing cancer.
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Next in in MSK has a wonderful smoking cessation program and it includes a lot of clinical support and behavioral strategies and other tobacco cessation medications that can help with tobacco cessation.
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It's really challenging without without additional support to stop with tobacco once you've got started.
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And this is where the smoking cessation program program is is so beneficial and helpful.
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We know that there are one in five adults who who use VACCO and it causes 30% of all cancer related deaths.
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So this program is a is amazing resource and they're the clinicians are licensed in over 42 states.
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So there are a lot of different, even if you're not in the New York area, this program is available next.
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Next.
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The other really big risk is from the sun.
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So skin cancer is the most common form of cancer, but there are a lot of different ways how you can reduce the risk of developing cancer.
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One of the ways is to limit exposure to the sun.
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That is a really big deal, especially during the day from 10:00 AM to 2:00 PM, when the sun is the highest and the strongest.
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We know that tanning machines can increase the risk of skin cancer.
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So avoid those indoor, indoor tanning machines and increases the risk of developing skin cancer, particularly in the early stage.
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So before 40 they can increase it by up to 70%.
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So we know that there is a rest with those indoor Tanner Tanners.
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Sunscreen is a really importantly important barrier.
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So at least 20 minutes before you go outside, apply sunscreen with an SPF of at least 30.
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And even in the cloudy days, even during the winter and reapply that every two hours, especially after swimming or if you're exercising, exercising.
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And I think it's really important to note that even in winter and especially now in New York City, there's a lot of snow on the ground.
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There is an increased risk with the reflection of the snow.
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And so to add sunscreen, even in the winter, it's a really important part of part of your daily routine.
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There's other aspects if you're sensitive to sunscreen.
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So wear protective clothing.
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There is really great shirts now with SPF rating, so you can wear those and hats.
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And if you're out there for a really long period of time, just try and get some rest, get some rest in between and and find some shade.
25:14
Talk a little bit about nutrition in terms of the evidence, but what can you do really to make healthy nutrition choices?
25:23
And those are are really important and nutri food in your in your daily routine.
25:29
It's really easy to grab some processed foods because they're quick and easy, but you can start to lower your cancer risk because we know that obesity is related to an increased risk.
25:41
So trying to look at different ways to stay at or reach a healthy weight, healthy weight for you is it is an important component.
25:50
Again, I mentioned the obesity.
25:52
So reducing that the excess body fat is really important to lower some of the drivers of certain obesity related cancers.
26:03
Healthy microbiome is really important and that and that comes with eating a lot of fruits and vegetables.
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So the microbiome is the good bacteria living in your digestive tract act and you're having a good microbiome or a healthy microbiome that helps with your immune system to work better and can help your your body carry out the essential functions and limit some of those driver with mutations that could lead to to cancer.
26:38
Next, this is a a newer 1 is to limit or avoid alcohol.
26:45
But we're finding out more and more about the risk of excess alcohol.
26:50
So I think the biggest shift over the past two years or so, large observational studies that showed that even small amounts of alcohol can increase the risk of cancer.
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And it doesn't matter what type of alcohol that is.
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I think for for many years, the thought was that was that red wine in particular could be beneficial in terms of preventing and it would be a healthy choice.
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But we're we're seeing now that it doesn't matter and and any type of alcohol could increase the the risk of developing certain types of cancer.
27:28
And it goes with the higher, the higher the intake, I think the higher the risk again with the exercise and physical activity.
27:43
I think this is a really important one as the lead in the exercise oncology program.
27:49
But exercise is with nutrition and it's helpful for getting into the healthy weights, body weight for your body.
27:58
It can help reduce inflammation, it balance its hormones like insulin and estrogen.
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It help it helps with gut motility in terms of moving through your digestion through your body.
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And it is also really helpful for reducing stress.
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So it's really a multi system intervention that not only helps your mind, but it also helps your body.
28:26
So any movement that you can get throughout the day is is helpful.
28:32
Next, moving into cancer screenings and what are the recommendations on how to get screened and what are those screenings look like next?
28:47
So, but the cancer screening guidelines are are updated and these are the the most recent guidelines looking at the straightforward or the main cancers that we know have a screening with prevention.
29:02
So I'll go into a little bit more depth on each of these cancer screenings.
29:06
But with skin cancer, it includes a monthly self self exam.
29:11
Colorectal cancer is a colonoscopy starting about age 45.
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Lung cancer involves low dose CT scanning.
29:21
Cervical cancer is a Pap test every three years and breast is self exam and then a mammogram, A mammogram starting at age 40.
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So I'll go in a little bit more detail into each of these.
29:38
Looking at breast cancer, the the mammograms are the current recommendations are every year or two years in women that are 50 to 70.
29:49
And there are are recommendations that say between women between the ages of 40 to 49 should get a mammogram every year.
29:59
This is a little bit controversial.
30:01
There are more positive tests in individuals that are under the age of 40.
30:06
And this is where conversations with your clinician or your clinician or your provider can really help guide your personalized approach to how often you get your your mammogram screaming screening.
30:19
And then in women that are over at the age of 70, you can continue mammograms if you are in good health.
30:27
But a big component is that the self exam, breast exams by doctors.
30:34
And the other screening method is using an MRI machine for women with dense breasts.
30:40
And those are women with high risk.
30:42
So if you risk, so if you've had a mammogram and you've been told that you have dense breasts and that is where you might get referred to have an MRI for screening for lung cancer.
30:57
This includes an annual low dose CT scan.
31:01
And this is really targeted to our smokers or former smokers.
31:06
And what this consists of is if you have smoked at least one pack per day for 20 years and you are 55 to 80 years old and you smoke now or used to smoke, that is what would trigger an annual, an annual low dose CT scan.
31:25
And these are low dose.
31:26
It doesn't increase the risk of developing other types of cancers, but they are very effective at identifying any cancers at an early stage.
31:34
And that's what screening is really for.
31:37
You want to identify the cancer as early as possible before it gets too big or it's gets too big or it starts to metastasize or move to other parts of the body.
31:48
That's the goal of screening is to catch it early.
31:52
Next, for cervical cancer, it is again very age-related.
31:58
So under the age of 21 there's not a need for screening on.
32:02
From from 21 to 29, you get a Pap smear every three-year years and then from 30 to 65 it's again a Pap smear every three years or HPV testing every five years.
32:16
Over the age of 65, there's no screening unless there is a prior history of cancer or there has been no screening.
32:25
And again, this is where it's important to, it's important to talk to your healthcare provider and if you have any symptoms or at higher risk, then you are able to get screened more often.
32:38
Next, for prostate cancer screening, there are a little bit of a variety depending on which guy, but in general the recommendations are a baseline test at the age of 45 and based on the results of that blood test, the prostate antigen.
33:01
If it's less than one or PSA, there is no need to repeat it for several years.
33:06
If it's a little bit elevated or between 1:00 and 3:00, then the guidelines recommend repeat testing everyone or every two years.
33:15
And then if it's above 3, the guidelines are to repeat that test in six weeks.
33:22
And if higher than 3, then refer refer to urology.
33:27
There are certain groups that are at high risk of developing prostate cancer.
33:32
Again, this is very individualized and personalized based on your background, your race, your age.
33:40
And it is really important to talk to your healthcare provider if you have have you have familial history or any other increased risk, there is the option to begin testing a little bit earlier or increase the frequency of those tests.
33:57
Next, for colorectal cancer screening, the guidelines right now recommends beginning at the age of 45 to 50.
34:07
And I think this is a really important consideration and there are discussions on whether to start the screening a little bit earlier because there is an increase in an early onset cancers that we've seen particularly in the colorectal cancer setting.
34:23
These guidelines can, can or the screening tools or there's a variety of different tools that can be used.
34:30
A colonoscopy has been the standard of care for many, many years and it is diagnostic, but it can also remove any polyps that are found at the same time.
34:41
There are stool based tests that are are very, very easy.
34:46
They'll ship a kit to your home, you collect your sample and then ship it back.
34:51
And with those assessments of the stool kits, they can identify whether you need to go in for additional screening based on those results.
35:00
And again, if you have any symptoms, it's really important to bring those up and advocate up and advocate for testing, even if you are at an early age or a younger age, because we are seeing an increased risk and or increased prevalence of colorectal cancer in individuals who are under the age of 50.
35:21
Next proactive health space and, and what can you do to to look at or use your own tools at home?
35:34
So one of the for skin cancer, it is skin self exam.
35:39
So just being aware of what is your standard state or your baseline state.
35:44
So exam.
35:45
So examine your skin regularly or have a partner help examine your skin.
35:50
One of the factors that are important for skin cancer is looking for if there are any growing or darkening moles or if you have a mole with an irregular border.
36:04
The important part is to look to look for change in any of these markers.
36:09
And you can do this by looking in places you may not think to look in.
36:14
And cancer, skin cancer, it's not just on the typical places you may think of.
36:19
So you need to look at your legs.
36:21
You're in the mirror, the backs of your legs, look at your elbow legs, look at your elbows and the palms.
36:28
I think your feet are a really important place in your hands to look for some different changes in either your moles or any irregular borders.
36:40
Next, a breast self exam.
36:43
So this is really easy and helpful to do either in the shower or once you get out of the shower is it's looking for changes.
36:52
So know what a standards the form and feel of breasts are, and if you'll notice any changes in the density or shape or form shape or form or dimpling of the breast, that's when it's important to go to your provider.
37:08
And then they can go through additional testing if needed or do an exam at the healthcare provider's office.
37:17
Next, we have item SK screening and prevention tool.
37:23
It takes 5 minutes and you can answer a few questions about yourself and we can provide personalized screening recommendations and advice on how to reduce your your risk of cancer.
37:36
All of this is anonymized and will and will not be saved or shared with your employer.
37:41
It is simply to to give you personalized recommendations looking at your age and any familial history on do to reduce your risk of developing cancer.
37:56
So that was a very quick overview of some screening and tools that we can use to help it from occurring and what we can do if you develop cancer in the 1st place.
38:09
So now I am happy to answer any questions that have come up during the talk.
38:17
Thanks so much.
38:19
That was great.
38:19
You covered so, so much.
38:22
I know we have a lot of questions.
38:24
All right, let's get started.
38:28
I see people running outdoor when wind chills are -15 is it healthy to exercise at these really cool temperatures?
38:37
That's a, that's a great question.
38:38
And I'm Canadian, so I am very used to -30 temperatures.
38:43
And the exercising question in those really cool temperatures is related to making sure that you are layered up and safe.
38:54
So there is no physiological harm to exercising in really, really cool temperatures as long as you have adequate liquid coverage.
39:04
So there's not a risk of frostbite.
39:07
There's no issue with lung.
39:08
It may feel like when you go outside that you're damaging your lungs, but that is just heating up the air.
39:15
And as long as once you warm up, you maybe wear a neck warmer and you can cover your mouth and your nose a little bit when it's when you're exercising, there is no physiological risk to exercising an extreme cold.
39:29
Thank you for the very specific expertise as well.
39:35
Another question came in about fasting.
39:39
Can you talk a little bit about how that plays a role or information you have about how that helps with prevent preventative efforts as well?
39:48
Yeah, that's a great question.
39:49
And there is a lot of research coming out now showing the benefits of intermittent fasting and by intermittent fasting that typically consists of.
40:00
Of not consuming anything other than anything other than water for a period of at least 8 hours.
40:06
There are different approaches to intermittent fasting.
40:10
There are some more extreme fastings where you go for 24 hours without eating.
40:17
But what most of the literature shows is that at least going for a period of 12 period of 12 hours, and that can be from an overnight.
40:28
So stopping eating at 5:00 PM and then 12 hours later, that's when you can start eating.
40:33
That has been shown to reduce the risk of developing cancer.
40:38
And even in individuals that have cancer and are receiving chemo chemotherapy, there's evidence showing that intermittent fasting during chemotherapy can help reduce the risk of cancer recurrence as well.
40:52
So this is a really growing area of research and there needs to be more, but it looks like instrument fasting is beneficial for renting cancer.
41:03
Renting cancer.
41:06
Thank you so much.
41:10
This is a popular question.
41:11
What about coffee and caffeine?
41:14
Is there any risk or contributing factor there that you're aware of?
41:21
Coffee is in observational data.
41:24
So that's again where they ask individuals what, how much coffee do you consume in a day?
41:30
So it's self reported caffeine levels.
41:33
And again, there's different levels of caffeine.
41:36
So tea has some caffeine, some cola drinks have caffeine and, and coffee has caffeine.
41:42
And, and what the evidence shows, particularly for coffee is it helps with gut motility and that's beneficial for preventing colorectal cancer because it improves gut motility.
41:55
So we're seeing some of the mechanisms on why coffee can be beneficial and it depends on the, the dose of coffee, on the, the dose of coffee.
42:04
So again, too much is not ideal, but there there might be some benefit to a certain level of coffee, maybe 1 cup or two cups a day that can be beneficial for the the gut motility and some of those GI cancers that we see cancer treatment or life prevents you from doing really intense or aerobic exercises.
42:34
Is it still helpful to do stretching or or walking?
42:39
That's a really important point to, to raise eyes.
42:43
We don't mean that everyone has to go out and be a marathon runner or an Ironman triathletes.
42:51
A lot of the exercise is movement based and starting where you're at and any exercise is better than than no exercise.
43:01
And it can be as simple as walking up a flight of stairs.
43:05
That is helpful.
43:07
It can be walking around the block and the goal is to gradually increase and try and get to about 30 minutes of walking exercise per day.
43:18
If you have not exercised for months or years or years, that will be starting at a 5 minutes walk and then gradually increasing up to a 10 minute walk and then the next week it'll be a 15 minute walk.
43:35
So you don't, if you haven't exercised, you do not want to just try and go for a 60 minute walk right away.
43:42
We want right away.
43:44
We want to gradually build up to that level.
43:48
And if you're receiving treatment it, it also looks a little bit different.
43:51
It's a 10 minute walk is helpful and you want to stay at that 10 minute walk for for many weeks until you feel like you can do a little bit more.
44:01
So typically what we recommend, what we recommend is, is starting slow and building from there.
44:08
The once you've built an aerobic base, again this can be walking or cycling depending on on what equipment you have available you.
44:18
If you're already doing 150 minutes a week of aerobic exercise exercise, that's when we can start to layer in some resistance training or strength training.
44:28
And it's starting at the point where you are comfortable with.
44:33
If you have not done any strength training, we typically recommend starting with body weight exercises.
44:39
So this can include doing stand, doing standing up and sitting down in a chair 8 times per day.
44:48
It can include doing push ups on a wall and then gradually building up to a full form push up on the floor.
44:55
But it's really about starting where you are and gradually building up along this small thinking.
45:05
You mentioned taking like walking meetings.
45:08
Do you have any other tips for sneaking and some exercise at work, maybe like this?
45:12
Sitting up and down in the chair is another one.
45:14
Yeah, I think those are those are great ones.
45:17
So I like to do between calls, I'll get up and I'll do 1010 squats if I don't have time to go out for a walk and talk.
45:27
And I think some of my colleagues look at me like I'm a little funny, but then they start to see it and there's a couple other people that start doing squats spots as well.
45:36
So I think any way that that you can get out, sometimes I will instead of will instead of, you know, going to the bathroom on my floor, I'll take the stairs up five flights and use the bathroom on a on a different floor.
45:52
So I think it's about finding different ways in your everyday life or you can sneak in a little bit of, of activity and even those short little bursts are, are are helpful for increasing your heart rate.
46:05
Increasing your heart rate is what helps get your blood moving.
46:08
And that's those are some of the drivers that help reduce inflammation and and help with the mental and and physical health.
46:18
Thanks.
46:19
Switching to the more like nutrition side of things, do you know any research or data about organic versus inorganic and and what we're eating there?
46:30
Yeah, but these are great questions.
46:33
I think the organic versus inorganic question is really the data shows it's important for certain types of veg fruits.
46:44
So for leafy vegetables I the with the pesticides, some of that is beneficial if you go or get organic because they have lower pesticides.
46:57
For certain fruits it is not and as important to go organic.
47:01
So fruits that have peels like bananas, that have peels like bananas and oranges, those have not been shown to have a higher levels of pesticides or those higher risks.
47:11
So if you are concerned about pesticides for leafy vegetables and fruits that don't have peels, you can look too organic, but if you're you're not then the levels of pesticides have been a lot lower for the the non leafy and the fruits with peels.
47:33
Great thanks.
47:36
Staying on the nutrition track, what about artificial sweeteners?
47:42
This is a newer, especially in the the cola space or the soda space is some of you may call it.
47:52
And there's a lot of evidence in the preclinical setting.
47:56
So this is studies in animals.
47:59
And I think some of the, the big news stories that you hear or some of the headlines, they're, they're often reporting on those animal studies.
48:09
And while it's might be easy to try and translate that into human models, it's, it's not the same.
48:17
So I think there's not great evidence on whether it's bad or whether it's OK because so far a lot of evidence is from those animal models where they're given these really high doses of sweeteners and things like aspartame.
48:34
And it's hard to know how that translates into to human models in, in humans, there are there are some observational studies showing there might be an increased risk with the sweeteners.
48:49
Again, there's a debate in the nutrition world right now on whether sure, we know sugar is bad and it can increase the the risk of a lot of different cancers, but that those preclinical clinical studies showing that aspartame and some of those other sweeteners are bad as well.
49:08
So I think the recommendations would be to, if possible, stay away from the sodas and those other sweeteners and try and use alternatives like carbonated water, then carbonated water that maybe doesn't have a lot of those other additives.
49:26
Great.
49:29
Thanks.
49:30
This is shifting gears a little bit.
49:32
I'm interested if you have any viewpoint, but a question came up around blood tests for cancer.
49:39
So I think like those early detection tests, which I think are still in very early testing periods to see how beneficial and and and which ways we can use them.
49:51
But do you have any guidance there or or thoughts on those sorts of tests?
49:59
Yeah, I, I think we'll, we will see more and more in the coming years.
50:03
Beneficial.
50:04
And this actually goes back to PSA testing for prostate cancer.
50:08
That is a blood based test that we now know is standard of care.
50:12
It's in the guidelines because it is so helpful with screening.
50:15
And right now a lot of the other blood based tests, they're still in the research phase.
50:21
And typically the research phase, research phase takes many, many years to work through the the process.
50:27
So I mentioned the animal studies.
50:30
So typically that's where research starts.
50:32
And then it moves through smaller studies in humans to larger studies.
50:38
And then finally you need studies in, in thousands and 10s of thousands of individuals of individuals.
50:44
And that's where a lot of the the blood based screening is.
50:47
It's at the stage where they're testing it in 10s of thousands of individuals.
50:52
And I think in the next couple of years we'll start to see those results.
50:55
And once we have those results, it will be included in guidelines.
51:01
So it may seem frustrating, it may seem frustrating that this research takes such a long time when there is some benefits to either a test or an intervention, but there is a very rigorous process before it is incorporated into guidelines and that's for a lot of the blood based tests are right now.
51:21
Thank you so much.
51:25
OK, switching gears again back to fasting.
51:28
Can you include time while you're asleep fasting or does it have to be awake time?
51:35
Sleep time is a great time to to log your fasting hours.
51:40
Surprisingly, there is a lot of individuals who will will wake up at night and they will go get a a midnight snack.
51:50
So I think if you are are sleeping that definitely counts as as fasting hours.
51:56
And because you're asleep, it's a great way to like to get those extra hours.
52:00
And if you are interested in in intermittent fasting, in intermittent fasting and supplementation, so like vitamins, that sort of thing.
52:12
Any general guidance there?
52:15
I think it depends on what you're using the supplements or the vitamins for.
52:22
And this is working with your healthcare provider is really important.
52:26
At MSK, we have a team that deals specifically with herbal and supplements and they are really knowledgeable about how certain medications may interact with either herbs or different supplements and supplements.
52:44
And it is really important to talk with your your healthcare provider about some of the why you're interested in a specific supplements and whether there is evidence to show that it's helpful, whether it's needed because of some blood tests that you had, you had showing maybe there's anemia or some other components.
53:08
But at the end of the day, it's really important to have a conversation with your healthcare provider.
53:15
I think also the if you do go supplements or vitamins to make sure that you're disclosing that to your provider that you're working with.
53:24
I think sometimes there's the thought that it's a vitamin.
53:28
So it's not a medicine that I have to write down on these forms, but some of some of these supplements, vitamins can alter like lab results or have interactions with other drugs.
53:37
So definitely make sure you're disclosing any, any supplements you are taking 100 100% all information is, is great information and it helps, it helps with your care.
53:51
And that's the the goal of any healthcare provider is, is to make your care better.
53:58
And having that information is really useful on what's you know, why you're interested in taking that specific supplement or herb.
54:06
And having those conversations are are important.
54:13
Have a take on this as well.
54:14
I know you shifted your your focus towards more cancer specific research.
54:20
The question here was, has cancer always been a more of a modern day issue due to environmental factors?
54:26
And I feel like maybe you're you're shifting gears.
54:30
The cancer might have some insight there.
54:34
Yeah, we know that cancer has been around for a very, very long time.
54:39
And part of the the shift in the recognition is, is that people earlier on, there were other causes of death.
54:48
So there were other animals that would attack us.
54:52
And so often humans would die at a younger age.
54:56
The average age of death was was 30 and even in the industrial age it crept up to 6060.
55:03
But now the average age is 80.
55:06
And cancer is primarily an age-related disease.
55:09
So the longer we live, the the more likelihood that some of the the mutations can arise in tissues or blood cells.
55:19
And that's what really drives cancer.
55:21
So it's not a new, it's not a new phenomenon.
55:24
It's that we've been living longer, which is great.
55:29
We're just experiencing some of these age-related changes that happen as a result of UV exposure or different exposures to to chemicals and some of it is genetic or some genetic or some genetic drivers of cancers.
55:45
And that is driving some of the the higher cancer related deaths that we're starting to see now.
55:55
Yeah, the circle back on the coffee talk a little bit ago, someone wanted to specific Sir that helps with the motility or is it caffeine in general?
56:08
It's the it's the caffeine.
56:09
So the the gut motility is a little bit of different things.
56:13
It's whether it's a hot coffee.
56:17
There are some studies that show drinking a hot beverage can help with gut motility.
56:22
Some some of it is caffeine related because it it causes the changes in the intestine and some contractions.
56:29
So it's both caffeine related and some mechanics related in terms of the whether it's hot or whether it's cold.
56:39
I think that's where exercise is also helpful, particularly helpful, particularly walking that impact and gravitational forces can help with emptying the gastric with your your gastric and that's what helps with your starting your stomach and that's what helps with the gut motility.
57:04
Another nutrition one, are eggs and milk still healthy?
57:09
I've seen lots of mixed messages lately.
57:11
So any insight you can add in there?
57:15
Yeah, yeah, we, we know that eggs and and milk are, are really important component of diet, though there are really no studies that I'm aware of showing that normal levels or not excessive levels of egg or milk intake are associated with an increased risk of, of any cancer type.
57:38
So it's again mostly about moderation.
57:40
You don't want to go too much, you don't want it, you don't want to go too little.
57:45
It's a balance of what is available and what you consume that is important.
57:51
And to my knowledge, there's been no evidence suggesting there's increased risk with moderate intake of milk or eggs.
57:59
Thanks.
58:00
We have two minutes left.
58:02
So I want to wrap up with kind of a question slash closing thoughts.
58:07
The question was about some cancer vaccines have been completing pre clinical trials and that's exciting.
58:16
But along that they kind of thought what are you excited about and in the cancer space or what's on the horizon, horizon for, for prevention or cancer outcomes?
58:27
Yeah, I think there are so many different exciting avenues that the one that you mentioned on cancer vaccines, I think that's our really exciting Ave.
58:37
and there's amazing data showing that it's helpful for cancer prevention.
58:42
And and that's our main goal is we we don't want to develop cancer in the 1st place.
58:49
There's also particularly for pancreatic cancer, and that's one that is really, really hard to treat.
58:55
And so preventing some of those hard to treat cancers is is really important.
59:00
The MSK Direct team is available to help you and your family make smart decisions about the best cancer care options. Call the dedicated MSK Direct phone number at 646-449-1515 or visit msk.org/mskdirectforyou to learn more.
