Obesity, inactivity could outpace smoking in cancer death risk

Jayne O'Donnell, Erin Barry and Kate Covington | USA TODAY

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Obesity and inactivity could someday account for more cancer deaths than smoking if current trends continue, a leading cancer expert says.

As the rate of smoking decreases, other unhealthy habits threaten to offset the progress in reducing cancer deaths, says Richard Wender, a physician and chief cancer control officer at the American Cancer Society (ACS). A study in the New England Journal of Medicine last fall found 13 types of cancer were linked to excess body weight.

There's no guarantee that obesity and inactivity will surpass smoking as a cancer cause, Wender says, but the possibility is startling.

"Who would’ve thought we’d ever see the day where what you eat (and) exercise, could account for more cancer deaths than smoking?” he asks.

The connections between smoking and too much exposure to the sun and cancer are well known, but the connections between nutrition and exercise and cancer are less known and harder to determine.

Calculating cancer's link to obesity is difficult in part because of an overlap in cancer risk factors, says ACS' Rebecca Siegel, While 20% of cancers are caused by poor diet, alcohol consumption, a lack of physical activity and/or excess weight, that can't be combined with the 30% of cancer deaths caused by cigarette smoking. That' s because poor people are more likely to be obese and to smoke than more affluent people, says Siegel, strategic director of ACS' surveillance information services.

A striking 50% of all cancer deaths could be prevented by following the basics of a healthy lifestyle, says Wender. That includes diet and exercise and having regular cancer screenings and getting the HPV vaccine that helps prevent cervical cancer and likely oral cancer and for Hepatitis B, which can lead to liver cancer.

Wender was speaking at a recent meeting of the Council of Accountable Physician Practices, which represents the doctors who work at integrated health care systems like Kaiser Permanente and Geisinger Health, which treat and insure patients. These groups says they are better positioned to address social determinants of health that can lead to cancer — like access to healthy food — than other health systems.

After all, they don't have to worry about whether federal programs like Medicare or Medicaid or independent commercial insurers will reimburse them, say, for connecting patients to diet and fitness professionals. They are motivated to screen patients more often for cancer, since they have to pay to treat cancer that is caught too late.

The effect of the decline in smoking on cancer "has been somewhat counterbalanced by this steady rise in obesity trends beginning in the '70s," says Wender. The obesity rate has tripled since the early 1970s to now comprise about 36% of adults.

Geisinger Health in Pennsylvania has expanded a program that gives some of their least-healthy, low income patients free healthy groceries through a program known as Fresh Food Pharmacy. There are now about 65 patients in the program now and the results "have been spectacular," says Geisinger spokesman Michael Ferlazzo.

Patients have lost weight, reduced their medications and reduced their hemoglobin A1c blood sugar rate by at least three points. One patient cut the level in half — from 16.4 to 8.4 — in four months.

Each decline of one point in A1c results in an average of about $8,000 in annual health care cost savings, research shows.

Another patient's A1c dropped from 13.8 to 6.9 in four months, marking the first time the woman had a level lower than 7.0 since becoming a Geisinger patient in 2001. She has also lost 14 pounds and reduced her bad cholesterol significantly, Ferlazzo says.

People's Zip codes are also important indicators of their cancer risk factors due to the close link between where people live and social factors that contribute to their health.

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Zip code often defines one’s educational opportunities, income, diet options, and access to health care resources. There is a strong correlation between region and the percentage of Americans who have access to cancer screenings, use tobacco products, and make unhealthy lifestyle choices, says Wender.

"We do not have a knowing problem, we have a doing problem," says surgeon Robert Pearl, who is the former CEO of the Permanente Medical Group, which represents Kaiser doctors. He is also author of the new book Mistreated, which examines the high cost, low quality and poor access to health care in the United States.

Transportation key to treatment

Much of the “doing gap” results from issues of transportation. If people do not live close to a specialist that they are supposed to see, then they are less likely to seek the treatment that they need. This disproportionately affects those living at or near the poverty line.

For those who rely on carpools or public transportation to get to work, attending a doctor’s appointment could cause them to miss work. Transportation also plays into the disparities between urban and rural populations.

Hunter Jones, a cancer survivor and Geisinger patient, noted how difficult it was for her to travel almost two hours to the hospital to meet with her specialists and receive treatments.

Many times doctors may blame the patient because they didn’t come to an appointment, says John Bulger, a physician and chief medical officer for Geisinger Health Plan. But it’s not their fault, he says, if they didn’t have the transportation to get there.

A possible solution is finding new ways to bring providers to patients, which can be helped by using electronic health records, Bulger says.

Electronic records, telemedicine and video conference can reach patients with transportation problems, Bulger says, adding that ride-sharing services can help, too.

Blue Cross and Blue Shield and Lyft announced last month that they were joining forces to improve access to health care in what they called "transportation deserts."



