I was fortunate enough to be selected for my residency training at Thomas Jefferson University in the Department of Radiation Oncology. The department – one of the oldest in the country – was founded by Simon Kramer in 1956. Dr. Kramer, a legend in the field, later founded the Radiation Therapy Oncology Group (RTOG). The RTOG still remains the major clinical trial group for radiation oncology trials decades later. Oddly enough, I always think of Dr. Kramer during Breast Cancer Awareness month, when we often find ourselves celebrating breast cancer and sugar.
Many of those who worked with Dr. Kramer during his time at Jefferson told stories of how he would leave the department in the basement to head upstairs to see an inpatient consult with cigarette in hand. When he was entering the room to see the patient, he would place his lit cigarette in a holder near the door. It’s shocking to think that one of the founding fathers of an entire field of cancer treatment would smoke in-between patients. Fast-forwarding 60 years, it seems almost as irrational to think that we fill our hospitals and cancer centers with sugar cookies with pink frosting every October to support breast cancer.
You are probably thinking, “is he really comparing cigarettes with sugar cookies?” Back in Kramer’s time, they did not yet know about the harms of smoking. Around 1965, the dangers of smoking were becoming well known, and Dr. Kramer even received a personal copy of The Health Consequences of Smoking: A Public Health Service Review in 1967. This was sent out by the U.S. Department of Health, Education, and Welfare as a public health service. Kramer’s time smoking in the hospital and elsewhere was over.
Breast Cancer and Sugar – Time to End the Connection in our Hospitals
I had previously written about my dismay with promoting Breast Cancer Awareness Month with sugar cookies and other horrendous foods that may actually increase a woman’s risk of getting breast cancer (and others).1–5 We also know that foods high in sugar cause inflammation, lead to obesity and overeating, and increase serum insulin; all are associated with an increased risk of breast cancer and an increased risk of dying from breast cancer in those women already diagnosed.1,2,6–9 Women with breast cancer who are undergoing treatment – i.e. those who are frequenting the same hospitals filled with pink sugar cookies – do significantly worse when they gain weight after treatment, something intimately linked with sugar consumption.2
While it is tough to see events like “Cupcakes versus Cancer” (and yes, this was an American Cancer Society event), this is still more permissible than bringing similar events into our hospital, where we are supposed to act as role models for our patients. My hospital has an event called “The Race to No Place” where teams compete on stationary bicycles to raise money for the American Heart Association. It takes place in the lobby of the hospital, where patients can see that we not only promote exercise, we do it ourselves. Why should eating habits be any different?
Breast Cancer and Sugar and…Terrorism
I had tweeted my dismay with all the poor food choices promoted during Breast Cancer Awareness Month, only to be targeted by several individuals and groups (some apparently breast cancer survivors). I was called a terrorist. I was told there is nothing wrong with an occasional treat. Apparently we have a different definition of “occasional” or these women have not been to the hospital in October. Also, they seem to be missing the point that hospitals and their staff should serve as role models, not enablers of poor health choices. This is exactly why, while Dr. Kramer smoked in the hospital 60 years ago, it is now banned on hospital grounds. As I had written about in the past, while we know many patients smoke at home, we do not allow it in the hospital partially to send a responsible message and to avoid promoting it at our supposed epicenters of health. Why is sugar any different?
Luckily, most agree with me, as there was an outpouring of support within minutes of the tweet.
But it is not all bad news. Many healthy activities are making a difference by supporting breast cancer awareness and by making the fundraising event one that may in itself fight breast cancer. For instance:
- Trek bicycles had their 10th annual Breast Cancer Awareness Ride
- The Breast Cancer Fund has their 21st annual “Peak Hike for Prevention” where contributors hike Mt. Tamalpais in Marin County, California.
- Barbells for Boobs members lift weights to raise awareness and money for younger women with breast cancer
- Or my favorite, DeAngelo Williams of the Pittsburgh Steelers wears pink strands of hair and ribbons on his eye black while running over countless defenders, even though he gets fined thousands of dollars. The man is committed and it’s admirable.
Instead of promoting poor food choices, let’s follow the lead of these groups that promote healthy activities that will actually reduce a woman’s risk of getting breast cancer.
Breast Cancer and Sugar at our Hospitals – Let’s Be Proactive
So what can we do to help? Let your local hospitals, grocery stores, you name it, know about the mixed message they are promoting. Some organizations are just following societal patterns and are not pausing to question their own decisions or actions. Remind them about the connections with dietary sugar and cancer. If enough people voice issues, something tells me this will stop.
Let’s push healthy activities to help fight breast cancer to fund raise and to, well, help fight breast cancer. We would not promote lung cancer awareness month with cigarettes, so let’s help women turn away from unhealthy activities next October to help fight breast cancer.
Let’s not support unhealthy habits and promote them within our hospitals, especially in the name of fighting cancer. And for those woman who are fighting cancer or are survivors, let’s give them the support and motivation to help make healthy decisions instead of dangling a sugar-laden carrot in front of them.
- Lajous, M., Boutron-Ruault, M.-C., Fabre, A., Clavel-Chapelon, F. & Romieu, I. Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women. Am J Clin Nutr 87, 1384–1391 (2008).
- Champ, C. E., Volek, J. S., Siglin, J., Jin, L. & Simone, N. L. Weight Gain, Metabolic Syndrome, and Breast Cancer Recurrence: Are Dietary Recommendations Supported by the Data? Int. J. Breast Cancer 2012, 9 (2012).
- Clemons, M. & Goss, P. Estrogen and the Risk of Breast Cancer. N. Engl. J. Med. 344, 276–285 (2001).
- Emond, J. A. et al. Risk of Breast Cancer Recurrence Associated with Carbohydrate Intake and Tissue Expression of IGF-1 Receptor. Cancer Epidemiol. Prev. Biomarkers (2014).
- Romieu, I., Lazcano-Ponce, E., Sanchez-Zamorano, L. M., Willett, W. & Hernandez-Avila, M. Carbohydrates and the Risk of Breast Cancer among Mexican Women. Cancer Epidemiol. Biomarkers Prev. 13, 1283–1289 (2004).
- Champ, C. E. et al. Nutrient Restriction and Radiation Therapy for Cancer Treatment: When Less Is More. Oncologist 18, 97–103 (2013).
- Calle, E. E., Rodriguez, C., Walker-Thurmond, K. & Thun, M. J. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348, 1625–1638 (2003).
- Arcidiacono, B. et al. Insulin resistance and cancer risk: an overview of the pathogenetic mechanisms. Exp. Diabetes Res. 2012, 789174 (2012).
- Pierce, B. L. et al. Elevated Biomarkers of Inflammation Are Associated With Reduced Survival Among Breast Cancer Patients. J. Clin. Oncol. 27, 3437–3444 (2009).
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