Cheryl Martin (Host): You can lower your risk of getting many common kinds of cancer by making healthy choices. Here to tell us about key cancer prevention strategies is Dr. Sandeep Malik, a hematologist and medical-oncologist at the Medical Group at Montefiore St. Luke's Cornwall.

This is Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Cheryl Martin. Dr. Malik, thanks for coming on.

Sandeep Malik, MD: Thank you, Cheryl. And greetings, everyone.

Host: First, what are the most impactful lifestyle changes we can make today to meaningfully reduce our cancer risk?

Sandeep Malik, MD: There are a lot of meaningful ways we can reduce cancer, and this is very important. Prevention is the best strategy we can have when we're talking about cancer. And there are several things we can address. The biggest one is staying away from tobacco. Maintaining a healthy weight is important. Having a regular physical activity also is very important. Eating healthy, which includes plenty of fruits and vegetables, whole grains, limiting red meat and processed food is paramount. For us, protecting our skin also comes into play. We should know ourself, our family, and our risks. Having regular checkups and screening for cancer is important. And last but not least, taking vaccination. The human papillomavirus also is very important when it comes to cancer prevention.

Host: What about sugar, eating sweets?

Sandeep Malik, MD: Having a healthy diet is extremely important when we're talking about cancers. We are seeing more of colorectal cancer arising in younger age groups. And one of the big factors, I think, is what we have been eating or putting inside our stomach. So, any processed food, and sugar could be included in that is somewhat a risk factor. It also leads on to obesity, which has been linked with a variety of cancers. If you look at the number of cancers which can be linked, as well as the mortality associated with the body weight, overweight and obesity is a very big factor. It could be 50% or so of the uterine cancer, 37% of gallbladder cancer. We have about 35% of esophageal cancer, which can be linked to excess weight. Liver cancer, kidney cancer, pancreas, stomach, thyroid, myeloma, breast, and even colon cancers. So, having less weight is important. Eating healthy is important. When we say eating healthy, then we need to limit or not include the red and processed meats, the sugar-sweetened beverages, where your sugar comes into play, as well as the highly processed foods and refined grain products.

What we should be doing is having more fruits and vegetables. And vegetables are the dark green, red and oranges, the fiber-rich legumes, the beans and peas, they're all good. Fruits are all very good, and whole grains also are very good. So, the right choices of food is what is going to lead us into healthy lives as well as prevent cancer from occurring.

Host: Now, screening and early detection are often called the second line of defense. So, which screenings do you think are most underutilized and who should be getting them?

Sandeep Malik, MD: So, American Cancer Society recommends screening for some cancers which are very important. Just by sheer numbers, in a woman it's breast cancer screening, and then just because of the fact that what's happening with the colorectal cancer screening, cancer of cervix screening, lung cancer screening for people who are at risk, which means the smokers, and last but not least, the prostate cancer screening sometimes. You know, all these are important screening modalities. And early screening or screening or early detection of cancer does save lives. The earlier we find a problem, the better we are in getting rid of it.

And so much so in colorectal cancer, actually, there is a polyp to carcinoma sequence that can be as long as ten years. So when a person goes for the colonoscopy, which is recommended at age forty-five these days, then the polyp can be found when it is not even cancer. The doctor removes the polyp, and even the chances of getting cancer are completely negated.

Host: Now, environmental and occupational exposures are a less talked about piece of the puzzle. So, how significant a role do factors like air quality, household chemicals, or workplace hazards play in cancer risk?

Sandeep Malik, MD: There have been some cancers which have been linked with the environmental influences or exposures. If you take population all across the world in high density or polluted cities or mega cities, more incidence of respiratory diseases as well as cancers arising from the airways or aerodigestive tract have been attributed to the pollutants which are in the air.

Sometimes we do have occupational exposure to chemicals which can lead on to problems later on. Years ago, we found that benzene and benzene-related products, which are also found in petroleum industry, have been linked with leukemia or blood cancers. So, there are some unique situations where environmental or occupational exposure are important. And if we can limit our exposure to these agents, then that's much more desirable.

Host: A lot of people may not know that some vaccines can actually help prevent certain cancers. Which vaccines are they? And then, please break this down for us in simple terms.

Sandeep Malik, MD: So, vaccination and cancer prevention is very, very important. And the most talked about in that situation is the human papillomavirus or HPV vaccination. HPV vaccination should be given to the children. The best age to give this is to children between 9 to twelve years. Two doses are given six to twelve months apart, and almost all of the cancers, which are linked with the HPV, can be completely prevented. That could include cancer of cervix, for example, the anal cancers, penile cancers, and so on.

The American Cancer Society says that the HPV vaccination, if it is not completed by age twelve, you can go on until about nine to 14 years. If the child still has not been vaccinated, then we can continue to vaccinate them between the ages of 15 to 24 years, but then three doses are needed. The second one being given one to two months after the first dose, and the third one given six months apart. After twenty-six years, American Cancer Society does not recommend vaccination, but there is a commercially available product which can still be used until into 40s.

The next vaccine, which is very important or which we should consider using is the hepatitis B vaccine. Liver cancer has been a problem since many decades. It used to be viral hepatitis, which was the big problem, or alcohol. Now, it's been moving on into what we call the fatty liver. But we can easily prevent viral hepatitis by giving the series of hepatitis B vaccination at an early age. So, childhood, before the children get sexually active or are exposed to body fluids is the right time. So, both HPV as well as the hepatitis B vaccine are important when it comes to cancer prevention.

Host: Doctor, we hear so much about super foods and things to avoid. What are some simple, realistic eating habits that can actually make a difference when it comes to cancer risk? And this is in addition to what you shared earlier about healthy fruits and vegetables and so forth. Any other tips?

Sandeep Malik, MD: Anything which nature provides to us, you could say is good for us. So, anything which nature is providing primarily comes into the category of fruits, vegetables, beans, peas, legumes, and so on. Anything which the man makes or turns them into is not so good. So, all those super foods that we talk about are not really the best ones when it comes to what they do to us. They always come into play. There are food fads, sometimes the protein-rich supplements come into play, and sometimes there are other commercially available products. But so much so, if we have a balanced diet and a balanced diet consisting of the natural foods, then we are much better off. And it's very easy to accomplish that.

About two and a half cups per day of fruits and vegetables is all we need. We can supplement that with some whole grains and fruits and limit the intake of the processed foods and so-called super foods as much as we can. The food pyramid keeps on changing. What we knew as the food pyramid is completely reversed now. But so much so, anything when it comes to food, anything which is a natural product, I think, is better for us in terms of what it does to our health.

Host: Now, for someone who feels overwhelmed by all the cancer-causing headlines and advice, what is your single most important message about prevention that you wish more people understood?

Sandeep Malik, MD: So, the single most important points or the most important points to keep in mind are maintaining a healthy weight, which is in our hands, being physically active, which is again in our hands, following a healthy eating pattern, which again is in our hands, and trying our best not to drink alcohol or consume as little as we can, and supplement this with staying away from tobacco.

So if we pay attention to all these, then I think we will have a much healthier body and many of the cancers which are linked to these products or food choices will be less in numbers or we'll face less of those issues.

Host: Dr. Sandeep Malik, thank you so much for sharing these cancer prevention strategies. Practical and very helpful. Thank you.

Sandeep Malik, MD: Thank you. You're welcome.

Host: To learn more about Dr. Malik's services, just visit slcmedgroup.com. Please remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts. Thanks for listening to Doc Talk, presented by Montefiore St. Luke's Cornwall. For more information, visit montefioreslc.org. That's montefioreslc.org.