Cancer prevention guideline emphasizes more physical activity, less meat and alcohol
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An updated American Cancer Society guideline increases the amount of weekly physical activity recommended to reduce cancer risk.
The guideline — published in CA: A Cancer Journal for Clinicians — also suggests individuals reduce consumption of red and processed meat, sugar-sweetened beverages, processed foods and alcohol, and includes evidence-based strategies to reduce barriers to healthy eating and active living.
“We update our guidelines as new scientific evidence becomes available. This update has been in the works for some time now and is finally available for release,” Laura Makaroff, DO, senior vice president of prevention and early detection for American Cancer Society, told Healio. “The updated recommendations reflect the totality of the evidence on diet and physical activity on cancer risk since the last guideline update in 2012.”
The updated American Cancer Society Guideline for Diet and Physical Activity for Cancer Prevention — published this morning —recommends 150 to 300 minutes of moderate-intensity physical activity per week, or 75 to 150 minutes of vigorous-intensity physical activity per week. The previous guideline recommended at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity weekly.
“The guideline continues to emphasize and help people achieve and maintain a healthy body weight throughout life, as well as continue to be physically active,” Makaroff said. “Moderate activity includes brisk walking and rigorous activity may consist of a light jog to get the heart pumping. The update also includes a recommendation for children to be moderately or vigorously active for at least 1 hour per day, including reducing the time spent being sedentary, such as with screen time,” Makaroff said.
Regarding healthy eating, the updated guideline recommends all age groups consume high-nutrient foods in amounts that help achieve and maintain a healthy body weight. It specifically recommends a variety of vegetables, fruits and whole grains.
Conversely, the guideline specifies that a healthy eating pattern limits or does not include red or processed meats, sugar-sweetened beverages, highly processed foods or refined grain products.
The guideline states that it is best to not consume alcohol, strengthening the recommendation from a previous guideline that recommended individuals limit consumption. For those who choose to drink alcohol, the updated guideline recommends maximum daily consumption of one drink for women and two for men.
The updated guideline also includes a recommendation for community action.
“Public, private and community organizations should work collaboratively at national, state and local levels to develop, advocate for and implement policy and environmental changes that increase access to affordable, nutritious foods; provide safe, enjoyable and accessible opportunities for physical activity; and limit alcohol for all individuals,” it states.
Clinicians should remember that helping individuals reduce their cancer risk and make healthy choices can have a significant impact on the nation’s overall cancer burden, Makaroff said.
“We must remember that up to 20% of all cancer cases in the U.S. have some compilation of excess body weight, physical activity and alcohol intake and that these individual risk factors are modifiable,” Makaroff said. “Helping to educate patients and empower them can make a big difference in reducing their risk for cancer.”
It also is important to recognize that, for many individuals, making healthy choices can be challenging.
“Helping the community develop strategies to break down barriers to help all people have access to healthy choices, including eating well and living a physically active lifestyle, is important,” Makaroff said. “The guideline has more specific recommendations around community action for public, private and community organizations to work collaboratively to implement policy and environmental changes to help individuals make healthy choices.”
For more information:
Laura Makaroff, DO, can be reached at American Cancer Society, 250 Williams St., Atlanta, GA 30303.
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Perspective
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Steven K. Clinton, MD, PhD
The American Cancer Society touches many people — including patients and their families, health care providers and the government — and it plays a critical role in conveying timely, accurate information to the public. The society has done a great job developing these guidelines and putting them in a form that is very convincing and worthy of action.
Over the 8 years since the last report, we have seen much more data from large, human studies, plus outstanding reviews from HHS/NIH, and updated guidelines from American Institute for Cancer Research and World Cancer Research Fund. All of these organizations have more precise data, so we know more than we did the last time American Cancer Society did its review. Instead of simply saying, “We need to exercise more,” they are starting to put numbers to these recommendations. When you give numbers, you give people a clear and reasonable target they should work toward, based on good science.
With regard to nutrition, this work emphasizes the importance of people composing a pattern to their diets. This healthy eating pattern starts with foods that are rich in nutrients, fruits, vegetables and whole grains, while limiting red meat and processed meat. You can eat a healthy diet with meat, but if you’re following the recommended pattern, there is a little less room for it. It’s the difference between eating several servings a week or several servings a day, which was a historical approach to our eating patterns. It also is very important for people to be cognizant of the amount of sugar in their diet because, if we’re eating a diet full of refined sugar, we’re not getting the healthy phytochemicals and fiber we need from fruits, vegetables and whole grains.
There is an accumulation of evidence from many studies about the effects of alcohol. Some large cohort studies and pooled studies suggest that even as much as a drink per day may have a measurable impact on breast cancer risk among women. I think the American Cancer Society recommendation on alcohol is consistent with that of other cancer organizations and is a fair assessment for a public health recommendation.
The community action component is probably the best part of this document because it addresses what we need to do to use this information. We hear people criticizing organizations that make guidelines by saying, “They’re not having an impact. Obesity continues to rise. Cancer, heart disease and diabetes are still major problems.” Well, they’re not helping because we’re not implementing them. It’s like saying we’re going to fight a war but we don’t have an army or a navy to do it.
We need to work at a government level — whether it is national, state or community — to make sure these recommendations are achievable by all people. This is particularly important for those who suffer from social or economic disparities, which contribute greatly to public health. Many people have a hard time meeting these guidelines because their world is challenging. They are working two or three jobs for minimum wage. As they are rushing around to feed their children, they can only find food at the convenient market at the gas station, and they’ll pass 25 fast food restaurants before they can find a grocery store.
We need to take action to ensure our communities have parks and other spaces where people can get the physical activity they need, and we need to improve access to good food — with more farmers markets, community gardens and similar initiatives — to reinforce these recommended health patterns. We can have all the guidelines we want, but the most important step is creating ways to implement those guidelines and making sure everyone can benefit from them.
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