COMMENTARY

Lifestyle Alone Cannot Shield Us From Cancer

Mark A. Lewis, MD

Disclosures

March 15, 2021

This transcript has been edited for clarity.

Hello. This is Dr Mark Lewis. March is Colorectal Cancer Awareness Month, so I'm wearing blue today to stay on theme with that campaign. We know that when October comes around, everything turns pink in recognition of breast cancer awareness. We owe a huge debt of gratitude to our women's health advocates for showing us how to raise the profile of a disease in the public consciousness and how to promote screening.

When screening a large population, it is incumbent upon us as the physicians and organizations recommending the screening intervention that we not inflict more harm than good and that we properly convey the likely individual benefit of a given screening intervention. I would argue that colonoscopy is very powerful in the sense that it can interrupt the adenoma-to-carcinoma sequence through which a polyp degenerates into a malignancy. I want to talk about that in particular because of Chadwick Boseman, who was just given a posthumous award for his acting at the Golden Globes.

Boseman has become the face of early-onset colorectal cancer. I will never forget sitting with my son and watching Black Panther. My phone started to ring as all my friends, many of them nonmedical, asked me, a GI oncologist, if I knew that Chadwick Boseman had just died of colon cancer. Chadwick Boseman is proof positive that lifestyle alone cannot reverse the risk of a malignancy. I don't know all the details of his case, nor do I want to intrude posthumously, but working backwards, we can surmise that he was diagnosed at age 39 with already locally advanced colon cancer and ultimately succumbed to metastases 4 years later. In the interim, he was the picture of health, literally portraying a superhero. He had a phenomenal fitness regimen. Presumably he had access to wonderful nutrition and probably even formal support there.

One thing that really bothers me is this notion that lifestyle alone is enough. Back in January, the CEO of Whole Foods said that Americans would need less or no healthcare if they just ate right. I was preparing to record a commentary about that, but then January 6 happened and understandably, America's attention was diverted to the government and hopes for a peaceful transition of power. But now, 2 months later, I'd like to revisit those remarks.

I'll be honest: I have been privileged in the past to be among the people who can afford to shop at Whole Foods. However, you cannot extricate the place in society that allows you to shop comfortably at Whole Foods from all the accompanying variables that affect your environment and access to the quality of food that the Whole Foods CEO was invoking. Socioeconomic status also affects other ways that people can influence their risk factors for disease. This is not meant to abdicate responsibility for healthy living. Where I see the disconnect is the passionate individualism by which people rightly assert control over their own bodies to the extent that they have autonomy. Some people are justly proud of their exercise regimens and of their commitment to a healthy diet. But that should not negate collective compassion. You should still be able to see that is not a foolproof shield against the "slings and arrows of outrageous fortune."

When you look at people with cancer, you should realize that there but by the grace of God go I. That is where I have a problem. Whole factions and hashtags on Twitter are designed to promote healthy lifestyles. I'm all for it. But it is not a perfect antidote against cancer. I see that all the time in my clinic.

Recently, a 40-something-year-old professional triathlete in my clinic died of metastatic esophageal cancer. You could hardly have faulted this person for his commitment to fitness. I mentioned this on Twitter as an almost rhetorical question: How can you explain such a physically fit person's death? Someone responded that it's because the exercise suppressed their immune system ergo they got cancer. I believe that's a bit of a stretch. I came back with a counterargument, which is, how do you explain the 4-year-old with medulloblastoma? What did that child do to incur cancer? And I got absolutely no response, which is exactly what I expected.

There are limits to our ability to explain any one person's oncogenesis. Thus, screening is extremely important. It is incumbent upon us to protect ourselves when and where we can; however, we should not fault other people for getting cancer. It is not entirely preventable. I actually see some patients push back on the word "prevention" and describe it more as risk mitigation. I believe that's exactly right; risk mitigation is the name of the game. The formula, and I quote Dr Siddhartha Mukherjee, the poet laureate of oncology, is this: Cancer equals heredity plus environment plus triggers plus chance. I would advise us all to be both compassionate and careful before we pass judgment on others who have succumbed so tragically to this awful, awful disease.

Mark A. Lewis, MD, is director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He has an interest in neuroendocrine tumors, hereditary cancer syndromes, and patient-physician communication.

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