Letter to the Editor

I read with great interest the article in the November/December ACS Bulletin, “Clinicians Struggle to Understand Dramatic Rise in Early Onset Colorectal Cancer.” As a surgical breast oncologist who is certified in lifestyle medicine, I am a strong advocate for lifestyle improvements as primary prevention in my practice.

I applaud the article highlighting the importance of colonoscopy and emerging serum screening tools. These secondary prevention modalities are important parts of the puzzle to decrease cancer incidence, but surgeons are also well-positioned to be advocates of primary prevention using our influence to spread the word about the effects of lifestyle factors in cancer development. 

As in colorectal cancer, lifestyle factors such as a sedentary lifestyle, alcohol intake, low diet quality, and increased adiposity increase one’s risk of at least postmenopausal breast cancer. Additionally, optimizing these lifestyle factors after a breast cancer diagnosis can markedly decrease recurrence.

In my practice, a lifestyle discussion takes this form:

1. A 2- to 3-minute discussion with nearly every patient highlighting that lifestyle factors are very important in cancer care and assessing readiness for change.
2. If the patient is amenable to discussing the topic, I start with basic points such as trying to limit processed foods and beverages, increasing fiber intake, limiting alcohol intake, and increasing daily activity. To make the discussion more actionable, I use behavior change techniques such as SMART goals (specific, measurable, achievable, relevant, and time-bound).
3. If I find myself having more time during a visit, I usually extend the conversation to take a short, informal dietary history (e.g., “Can you share with me what a typical breakfast/lunch/dinner for you is?”), discuss barriers to implementing healthy behaviors (e.g., work, family commitments, sometimes lack of access to fresh foods), and strategize about solutions to making small changes.
4. Lastly, I have equipped myself with a list of local referral sources such as dieticians, health coaches, local food banks, and preferred websites (e.g. Noom, American Institute for Cancer Research, MyPlate) to give to the patient. There are many resources, many of which are online, that patients can consider. 

Much can be accomplished with a few basic scripts (and some practice) and even a short discussion such as this underscores that we, as a cancer center, see lifestyle as integral to our patients' care and optimal health.

Lora Hebert, MD, MPH, FACS, DipABLM
Dignity Health Cancer Institute at St. Joseph's Hospital and Medical Center in Phoenix, AZ

Bibliography

Armenta-Guirado BI, Gonzalez-Rocha A, Merida-Ortega A, et al. Lifestyle quality indices and female breast cancer risk: A systematic review and meta-analysis. Adv Nutr. 2023;14(4):685–709. doi: 10.1016/j.advnut.2023.04.007.

Kohler LN, Garcia DO, Harris RB, et al. Adherence to diet and physical activity cancer prevention guidelines and cancer outcomes: A systematic review. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1018–1028. doi: 10.1158/1055-9965.EPI-16-0121.