Cancer, Weight and 'The Blame Game'

Breast cancer links to weight, diet and exercise are all over the news, but remember this: You are not to blame.
PUBLISHED July 09, 2019
Martha lives in Illinois and was diagnosed with metastatic breast cancer in January 2015. She has a husband and three children, ranging in age from 12 to 18, a dog and a lizard.

When I was diagnosed with metastatic breast cancer four and a half years ago, one of the items I came across while trying to learn more was a piece of preliminary research in mice that seemed to show exercise increased the effectiveness of chemotherapy drugs. I’m pretty sure I was on the treadmill in my house the very day I read those words.
           
Although it was difficult, I walked upwards of three miles several days a week during six months of weekly Taxol treatments. Since then, I’ve continued on the treadmill but have added elliptical workouts and weight machines to my routine. I’m the first to say I’m lucky to be able to do this since I don’t have complications or metastatic sites that seriously affect my ability to move without pain or risk of injury.
           
My personal experience with exercise and diet (heavy on the vegetables and fruit) informs how I think and feel about the relationship between diet, exercise and cancer. In short, I feel better and seem to experience fewer side effects soon after treatment (most notably diarrhea but also fatigue) when I’ve been exercising and eating a healthier diet.
           
But that is a long, long way from saying that diet/exercise/weight reduction prevents cancer. At the recent American Society of Clinical Oncology (ASCO) meeting in Chicago, Dr. Jennifer Ligibel from Dana-Farber Institute, who spoke about diet/exercise interventions and reducing breast cancer recurrence, pointed out that so far, studies such as the Women’s Health Initiative show a non-significant reduction in death from breast cancer.
           
That “so-far” sticks in my mind. We want to believe that something within our control can prevent cancer altogether or at least mean we won’t die from it. I’m not going to lie — I’d be super-happy to be in absolute control. But I know there’s a vast difference between risk reduction and prevention.
           
For instance, smoking is linked to lung cancer but many of us know someone who has developed lung cancer despite never smoking nor living with a smoker. Smoking is a risk factor but while not smoking dramatically reduces risk of lung cancer, it does not prevent it.
           
The association of smoking to lung cancer is so strong that public support for patients with lung cancer can be hard to find. I know from experience that the very first question asked about someone with lung cancer is whether or not they smoked. And if they did, well, you can forget about sympathy.
           
Right now, it seems to me we are very close to falling into the same trap with weight and breast cancer. There is a lot of talk about the links between diet/exercise/weight and breast cancer. Preliminary evidence that risk can be reduced does not mean you can prevent breast cancer. More importantly, patients should never feel like because they live with one or more risk factors — including those considered within their control — they are to blame for their cancer.
           
I know this is much easier said than done. I know it because I live it every day. Despite eating reasonably well and exercising, my BMI is still in the borderline obese range. You probably wouldn’t know it to look at me.
           
But because of where I fall on this scale, I hear the rumblings of patient-blaming in a lot of research I read or presentations I attend. Everyone wants an answer that means they won’t hear the words, “You have cancer.” So it’s no wonder I sat up straight at the ASCO presentation when the full picture of exercise and diet interventions was stated.
           
Those words reinforced what I want to keep in mind when I start to shoulder responsibility: I am not to blame, and neither are you.

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