Oncologists on simple, doable, everyday things they do to try to prevent cancer | Hacker News Reader

Oncologists on simple, doable, everyday things they do to try to prevent cancer

theguardian.com

65 pointsrobaato71 comments

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1. Don’t smoke

2. Try to maintain a healthy weight

3. Reduce your meat intake

4. Avoid ultra-processed foods

5. Drink less alcohol

6. If you notice anything you are worried about, see a doctor

7. Keep up to date with screenings

8. Get physical

9. Wear sunscreen

10. Manage stress

11. Look into genetic risk

12. When faced with a diagnosis, knowledge is power

13. Don’t fear treatment

14. Talk about it

15. Live life to the full

Is this an ordered list?

On some measurement function F.

If so, 15 is a really funny lowest priority.

And most of the steps above are how to live a full enjoyable life.

A guy goes to his doctor and when the doctor asks if he has any questions he asks the doctor, "Doc, what do I have to do to live to 100?"

"Well," the doctor says "you have to quit smoking."

"No problem, I don't smoke" the guys says.

"And no drugs."

"OK, no problem, what else?" the guys says

"You have to exercise five times a week."

The guy pauses for a moment and says, "Anything else?"

"No processed foods or fast food. And no alcohol. Stay out of the sun and always get a good night's sleep."

Looking irritated the guy says, "And if I do all that I'll definitely live to be 100?"

"Well, no" says the doc, "But it'll feel like it."

In context of the article was clearly put last to be the most important take away and what the reader is most likely to remember.

Does not seem to be the case.

from tangible to abstract maybe

Yes, it’s ordered by occurrence in the article.

Young-ish cancer survivor here. I would add "9a. Don't ever go to a tanning salon" to this list, per my oncologist. There are genetic factors that caused my cancer, so naturally I was worried about recurrence. Her comments to me? "Do you smoke? No? Good. Don't start. Do you visit tanning salons? No? Good. Don't start." The rest falls into "trying to live a moderately healthy lifestyle". Oh, and definitely #6. If something doesn't seem/look/feel right then have a doctor check it out.

Did you get skin cancer?

I’ve often wondered if the higher vitamin D we get from the sun or even tanning beds outweighs the risks from melanoma. Low vitamin D is a big risk factor in the modern world.

https://ajcn.nutrition.org/article/S0002-9165(22)03753-4/

https://ar.iiarjournals.org/content/38/2/1111

> Therefore, we rebut these conclusions by addressing the incomplete analysis of the adverse health effects of UV and sunbed exposure (what is ‘safe’?) and the censored representation of beneficial effects, not only but especially from vitamin D production. The stance taken by both agencies is not sufficiently supported by the data and in particular, current scientific knowledge does not support the conclusion sunbed use increases melanoma risk.

To get enough vitamin D you need ~10 minutes a day[1] in direct sunlight with 25% skin exposed.

> In spring and summer, 25 percent of the body (the hands, face, neck and arms) is exposed to the sun, and in these seasons, about 8 to 10 minutes of sun exposure at noon produces the recommended amount of vitamin D.

[1] https://www.uclahealth.org/news/article/ask-the-doctors-roun...

At noon, in summer, in Spain. And probably 25% of your skin needs to be hit by direct perpendicular sunlight, and not just be exposed. In any case, don’t assume, go measure your Vitamin D levels.

So 20 minutes then, just to be sure.

Sunlight intensity varies greatly. Depending on where you live, season and cloudiness, you may only get a small fraction of the amount implied above. Again, there is no substitute for measuring your levels. Speaking from experience.

Or take your shirt off to increase exposed area...

Anecdata-point: In the summer I regularly run for hours at a time (marathon training), without a shirt and without sunscreen. (I've got a good tan which seems to keep me from getting sunburned.) And yet I regularly test as low Vitamin D. A daily Vitamin D supplement suffices to keep the numbers in range.

I assume that this is a personal thing, something about my specific metabolism or skin or whatever that doesn't produce vitamin D particularly well. I have no idea if the supplement actually improves my health outcome -- I was generally healthy both before and after adding supplements.

My advice, such as it is: don't take any supplement without a doctor telling you it's needed. But if a doctor says it's necessary, yeah, do that.

You can significantly lower risk of dying from melanoma by taking H1 antihistamines, especially desloratadine and to some extent diphenhydramine.

At least provide a source for this information please.

Desloratadine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868613/

Diphenhydramine: https://pubmed.ncbi.nlm.nih.gov/27779705/

The first article merely shows that the use of tanning beds is one way to raise vitamin D levels. The second tries to make vitamin D an issue, but to show that there is a case for raising vitamin D levels in a nontrivial part of the population, it relies on studies which show that supplementation via pills is beneficial! It is one thing to say that there is no good evidence for tanning beds increasing melanoma risk (a claim that I am in no position to either endorse or dispute), but I regard it as tendentious for the authors to raise the vitamin D issue when no evidence is presented to show that tanning beds are any better at doing this than simple supplementation - it is like saying that one of the benefits of chemically treating the water supply is that dehydration is bad for you.

It is known that vitamin D is best obtained from sunlight. I was once at a dinner and sitting with the head of the office for supplements for the United States and asked him how much vitamin D someone should get. His answer was quite simple, get it from sunlight. The skin autoregulates vitamin D dosage that way.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897598/

>Thus when the skin is exposed to sunlight it can only convert approximately 15% of 7-dehydrocholesterol to previtamin D3 (Fig. 18).32 Any further exposure will result in a photoequilibrium whereby previtamin D3 is converted into lumisterol3 and tachysterol3 as well as revert back to 7-dehydrocholesterol (Fig. 17). In addition when vitamin D3 is made from previtamin D3 in the skin if it is exposed to solar UVB radiation it will absorb UVB radiation and be converted into several suprasterols and 5,6-trans-vitamin D3 (Figs. 17 and and19).19). In addition previtamin D3 can also be converted to several toxisterols (Fig. 20).33-36 Therefore no matter how much sun a human is exposed to vitamin D intoxication will not occur because any excess previtamin D3 and vitamin D3 is photodegraded into products that have no calcemic activity.31,32

No doubt, but it is an empirical fact that this is not working too well for a nontrivial number of people - and if it were working well, there would still be no reason to bring up the issue in the article about sunbeds, especially as no evidence for vitamin D intoxication being a difficult-to-avoid problem in practice was presented either in that article or above. If sunlight is the optimal solution, then outdoor activity is better for you than lolling on a sunbed.

I am a case in point: I am frequently outdoors in all seasons, well beyond the point where I have to be careful to avoid sunburn, yet I have a significant all-seasons vitamin D deficiency. The conclusion of the abstract to the article you link to says "a three-part strategy of increasing food fortification programs with vitamin D, sensible sun exposure recommendations and encouraging ingestion of a vitamin D supplement when needed should be implemented to prevent global vitamin D deficiency and its negative health consequences" [my emphasis.]

No, my cancer was a sarcoma in my left shoulder.

Arguably, I think exercise should be #1. EDIT: Assuming they are ordered, otherwise ignore me.

Cancer is about 20% of your chance of death. Intuitively exercise helps with many things on this list. The other (roughly) 25% is cardiovascular/cerebrovascular events. For that, the best thing you can do is exercise. https://news.ycombinator.com/item?id=18264323

Then there's COVID (12), alzheimer + diabetes (6) and a smattering of "other causes" https://www.cdc.gov/nchs/data/databriefs/db492-tables.pdf#4

For a less trite list with really solid scientific backing, try the book Outlive.

I would have thought #8 was exactly that, right?

Yes I suppose - edited to limit to ordered lists only. I'll leave it up for the links.

Also, several types of preventable cancer are caused by the Human Papilloma Virus (HPV). Get vaccinated for it. Although this virus is primarily associated with cervical cancer, men should be vaccinated for it as well since it can cause penile, oral, anal, and other cancers.

And you can give it to your cervix-owning partners.

And something about sleep

I'm not an oncologist. But I'm married to one. So she tells me these rules on an almost daily basis. Also, many of her cancer patients don't make it - and then she tells me - this person didn't make it because he/she broke this rule #xyz in that list.

I mean, ok, I get it. I work in ML in an enterprise. So everyday we have our usual litany of complaints. This item is not ranked correctly. Boosting isn't working on that item. Human overrode the item recommendation and now the faceting is broken. Search is running out of memory. P2 alert!!! program crashed and we are losing $10000 per hour wake up the programmers in the middle of the night...

So I can also play this rule game.

1. Don't use computer.

2. If you must use computer, don't program.

3. If you must program, please let it not be in Java.

4. If it is Java, please don't call Python ML code from it.

5. Better yet, don't use ML at all if you have humans overriding recs.

6. Don't cache everything to reduce latency. You'll run out of memory.

7. If you run out of memory don't wake up the fucking programmer in the middle of the night when he's trying to get some action.

and so on...I mean, what purpose does it serve ? You can't get programmers in 2024 to stop using hadoop and sprintboot and whatever ancient enterprisecrap. You expect to get Americans to eat less meat, drink less, maintain healthy weight ? With an official obesity rate of 39%, the non-cookedup version hovering in the 70s ? Fat chance.

> Fat chance.

I see what you did there.

TIL that 40% of cancers are preventable.

Not opposing or anything but how do you even measure that? Really asking to see if anyone knows / has an idea.

I don't know off-hand, but probably a longitudinal survey of cases and pretty rough estimates. It is probably made a bit easier by there being some big chunks which are (likely) more clearly attributable to behavioral choices: smoking-related, sun exposure, and probably some occupational (chemical exposure, etc.).

It’s pretty straight forward— you compare the average risk for individuals to the rates for those exposed to carcinogens. For instance, if a population of people develops lung cancer at a rate of 2% by age 70, and a population of smokers has a rate of 10% by age 70– the difference between the base line and the exposed populations becomes the “preventable” count.

Which reduces your risk from roughly .5% down to .3% by age 49.

https://www.cancer.gov/about-cancer/causes-prevention/risk/a...

Why is the advice "Try to maintain a healthy weight?" Just maintain it. Sure, some people are genetically predisposed to obesity, but we should stop coddling the rest. Obesity puts you at 300% risk for cancer and several other lethal diseases. A great place to start is by not spending money on drinks that contain sugar and carbs - drink water. The recipe for healthy weight is 85% diet (less carbs) and 15% exercise (elevated heart rate).

Check out the books: Cancer Code, Obesity Code, Diabetes Code

Your point is what, that behavioral disorders aren't disorders? Do you give the same advice to addiction patients or anxiety or OCD sufferers? Some people have an easier time controlling some behaviors that some other people, and that fact is important where it intersects with health and worthy of consideration as a "medical" condition worthy of treatment, and not knee-jerk judgement on HN.

Surely you personally are a skinny guy whose never had trouble with weight. Equally surely there's some behavioral quirk you have that you'd like to change but have struggled with. So... maybe hold off on the "just do it" framing?

Notice that everything else is phrased as "Don't smoke." It's tiptoeing around obesity

Why do you think anyone is coddling when saying "Try to maintain a healthy weight". Its also not about carbs but calories.

Everything else is phrased affirmatively, but it tiptoes around obesity with "try"

Not all calories are created equal: https://www.hsph.harvard.edu/news/hsph-in-the-news/carbs-cal....

That is just noise for undisciplined people. If you track calories you will not be overweight.

“The solution to this problem is just don’t have this problem”

Be an adult, take care of yourself.

Depressed? Just stop being sad.

>but we should stop coddling the rest

While it is comforting to fall back on reductive and overly simplistic answers that simply blame the individual for not having the willpower to "just maintain" a healthy weight, the reality is a bit more complicated. The intersection of education, food availability, economics, genetics, mental health, etc. all play a factor.

Notice that everything else is phrased as "Don't smoke." It's tiptoeing around obesity

Smoking cigarettes is distinct act you can choose not to engage in at all. Obesity is a result of how much food you eat, the types of food, how active you are, etc. and each of those are influenced by many factors like eating habits learned growing up, local economics, how able bodied or disabled you are, etc.

Smoking isn’t an outcome of a variety of actions, obesity is. Saying “motorcycles are dangerous, don’t ride motorcycles” is very different than saying “don’t drive dangerously”. You can simply choose not to buy or ride a motorcycle to reduce your risk of injury. But “not driving dangerously” is not so simple. Do you need glasses and don’t realize it? Did you learn bad driving habits? Are there too many distractions in your car? It isn’t a simple answer. It is the same with obesity. It isn’t tiptoeing around it.

Also stop being poor. Just earn more and spend less. Then spend the money you earned and saved to improve living conditions so you have less risks. It is very simple and no one should have any trouble with it. /s

woah woah woah. can you please phrase that as "try to earn more and try to spend less" we don't want to offend anyone here

> If you notice anything you are worried about, see a doctor.

Yeah, good luck with that. I've had several relatives who all eventually died of cancer who tried to get their symptoms checked for years only to get bullshit answers like "it's only stress" or false, or incomplete diagnostics.

Personally I have a quite severe back pain issue and I have not managed to find a doctor to send me for an MRI for over 12 years now.

In the UK at least, the main difficulty in getting referrals for MRIs is that the evidence for their efficacy at improving outcomes is low enough that unless there are other indicators you're usually referred for physiotherapy first.

But at the same time for those willing to go private you can get a same day MRI for down to a few hundred pounds many places.

In the US I tore my hamstring very badly. Insurance did not approve an MRI under the reasoning “We know it’s torn, an MRI does not provide actionable information”. Therefore the decision to do surgery or not, and all of my treatment options were barely informed at all.

In Austria a lot of doctors (most?) don't understand that MRIs do not use ionizing radiation (unlike CT scans) and will refuse to schedule a MRI for you, even if you are willing to pay and go private.

If you think this is crazy I will also pont out that homeopathy was invented in Austria and many doctors currently prescribe homeopathic "treatments". You have to specifically state that you don't want homeopathic "medicine" every time you visit a doctor or go to the pharmacy.

Are the doctors prescribing homeopathic medicine real (M.D. equivalent) doctors? It seems wild to me the equivalent of a board certified physician would prescribe treatments that don't work (in theory or practice); but if they have the equivalent of e.g. our Chiropractors there, would make more sense.

Yes, they are real MDs. I would say that the majority of doctor's offices you will visit will proudly showcase homeopathy diplomas and certifications.

I don't know if they do it because of the money or because they actually believe in it, but the effect is the same. Waste of time, money, and erosion of trust in the medical industry.

Search Google for "site:reddit.com Austria OR Germany what is up with homeopathy" for a lot of crazy stories.

I know they are trying to be practical with "reduce meat intake" and "drink less", but meat and alcohol is on par with smoking and they say "don't smoke". I hope we get to a point where we can say "don't eat meat or drink alcohol" just like we say "don't smoke". If the point is to stop cancer from happening, not doing any of those things is huge.

He says that the reporting of nutritional data about cancer can be very confusing, and references the work of the statistician David Spiegelhalter from the University of Cambridge, who has shown that even if everyone ate an extra 50g of bacon every day, that would only increase the incidence of colon cancer from 6% to 7%. “I think it is about having a healthy, balanced diet,” says Sivakumar, “and occasionally having a sweet treat or a steak.”

Def not on par with smoking.

Processed red meat is a class one carcinogen and red meat is a class two. Smoking is a class one. What this means is there is a direct, provable correlation to consuming these products to cancer. Sure, a cigarette may not cause the same level of harm as one steak, but they both cause cancer. So, if you goal is to reduce as far and wide as possible your chances of cancer, meat should be off the plate. The "balance" approach is only to be practical, so I find it odd we never say to have a balanced approach with smoking, but we will with red meat.

Just because they are both class one doesn't mean they are on the same level quantitatively.

Also red meat doesn't cause addiction. I don't feel like I crave red meat if I've just been eating chicken and fish for the whole week.

Fresh unprocessed red meat is not directly known to cause cancer but it's implicated by the association to smoked/processed red meat that is a strong carcinogen. IARC says that maybe it can increase the risk of certain cancers but there is no direct evidence like with processed red meat.

Indeed -- though reducing seems to have other benefits.

Though as far as is practicable [0], one should not drink alcohol. No amount is safe or good enough for you to offset the other risks.

[0] life is short and not all social offers of a drink should necessarily be turned down, unless you're willing to figuratively or literally show the trappings of "one who must not" (pregnant, alcoholic, religion, training for sports, on medication, etc.)

At least the information is out there for anyone to read: no level of alcohol consumption is safe for your health.

- https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...

- https://www.who.int/azerbaijan/news/item/04-01-2023-no-level...

There are of course also counter-programming, like "Surprising Ways Alcohol May Be Good for You" (https://www.webmd.com/diet/ss/slideshow-alcohol-health-benef...).

The Recommended Glasses of Wine per Week index could be a RNG source.

Opposing information from mayoclinic with a link to a webmd post (i refuse to even call it an article), with zero actual scientific information in it, reduces the value of your comment. Which, otherwise, I fully agree with. There is no "although" here. Alcohol is bad for your health. That doesn't mean you should or should not drink X amount, that is anyone's free choice. But we don't live in the Dark Ages where it was suposedly good for you (...only compared to the alternative being bacteria ridden waste water).

Totally agree with you. The reason I included the webmd example and labeled it “counter-programming” was merely to highlight that the average person is faced with conflicting information (I bet even MDs don’t uniformly say any amount of alcohol is bad for you).

The webmd article is especially pernicious because the “positives” probably resonate with many (most?) people and gives people an “out” to optimize for the moment rather than their health. Webmd should do better.

Now I understand your reasoning for using that example, it fits the purpose quite well.

Cancer isn't the only disease you're trying to prevent. Your approach that single-mindedly reduces your risk of cancer may very well increase your risk of cardiovascular disease and type 2 diabetes - both diseases which are far more prevalent in the general population.

A diet rich in proteins provided by grilled chicken breast and salmon, and low in simple carbs such as sugar, pasta, and rice, will dramatically reduce your risks for the most prevalent diseases and not increase your risk of cancer.

You need to take a moderate and wholistic view of health.

Once you get hit by an autoimmune disease your stance will turn into "eat only meat" quickly.

Meat isn't on par with alcohol and tobacco.

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