This is a four part series-
- Why exercise helps
- A framework for why this matters
- How much is enough and practical guidelines
- Putting prevention in a new light
Putting prevention in a new light
As the cost of sequencing genomes has come down, we’ve started to face an ethical and personal dilemma. Should we do it? Should we tell people their results?
Anytime someone says they don’t want to know if they say, have the BRCA gene, or they don’t want to get their genome sequenced, the rationale seems to be, “Why bother? They can’t do anything about it, right? So what’s the point?” Nearly half of people wouldn’t want to know if they were likely to develop cancer or Alzheimer’s.
It’s true the medical establishment, beyond extreme measures, like double mastectomy, often can’t do much. Early screening, like mammograms, is becoming more and more controversial. We’re learning how often we over treat people from these and other screening, like MRIs. The only thing that’s been unequivocal from all this is healthcare workers have made more money.
But these aren’t the only things that can be done. The mindset needs to be flipped to some degree. Not what can the healthcare system do for you, but what can you do for yourself? Once again, exercise IS a genetic treatment. One of the biggest risk factors for breast cancer is lack of physical activity.
My family has a metric ton of breast cancer in our history. The BRCA gene hasn’t been found anywhere, but the history is there. My sister is 20. Why aren’t doctors talking to people like her and saying “Look, I don’t think you need a genetic test to tell you what your family history is. We can do one, but regardless, with your history, you should really be making sure you’re physically active. It’s highly recommended you get at least three and a half hours a week in, at an intensity of at least jogging. This is the minimum.”
That’s a hell of lot more empowering than “Be sure to start coming for mammograms once you hit 35.”
Alcohol is another risk factor for breast cancer. The more you drink the higher the increase in risk. Why, at 15 years old, was nobody talking to her saying hey, be careful about drinking? Not because of drunk driving, but because of our family’s cancer history? “If you decide to drink, know having X amount per week increases the odds Y amount. We recommend people stay below Z.”
If you’re a family with a history of breast cancer, you should be even more on your kids from the get go about being physically active.
When we consider these lifestyle interventions, then it’s silly to hear you don’t want to scare someone so young. Or there is no point worrying so young. These types of changes we’re talking are habits. The sooner they begin, the better. Fear can be quite the motivator to begin a new habit. It’s not always a bad thing. We have it for a reason. Plus, with everybody living longer, most of us are becoming more and more acutely aware of what our genetic profile likely is anyways. You tend to know if a cancer runs in the family, or diabetes, etc.
A lot of the research finds correlations between occupational physical activity and cancer risk. Say you have a lot of lung cancer in the family, but you’re a truck driver. Maybe you can start getting a note from your doctor saying look, I need to take a break every X amount of hours, and walk around.
Or if you get genetically tested and found positive for a certain gene tied to a cancer, maybe that guides you down or around certain career paths. A person with a BRCA gene probably shouldn’t sit in a cubicle all day.
A recent example of this is Alzheimer’s. We know there is a certain allele of a certain gene, APOE, associated with Alzheimer’s risk. We also know physical activity helps mitigate the risk of cognitive decline.
But what we found out in this study was those who had the risk allele got more out of physical activity. Compared to being sedentary, being physically active helps mitigate Alzheimer’s. But if you have the Alzheimer’s gene, you might get an even greater benefit. Those at the most risk may very well be those who need activity the most.
“We usually recommend X amount of exercise as being sufficient. However, for someone with your genetic profile, it’s best to achieve X+Y amount.”
If you have a risk of Alzheimer’s and you’re trying to decide between being a physical therapist or a stock broker, but you’re ambivalent, maybe that makes your decision for you- the more active job. But you need the information first.
Just like we know certain personalities, various traits, how tall a person is, certain DNA, are suited for certain jobs / behaviors better than others, we are starting to find more and more suggesting certain DNA respond to certain jobs / behaviors better than others. As was mentioned, when in doubt, do more and do it more intensely. But the majority of people are not on any physical activity program. Perhaps knowing what type of DNA they have can provide a kick in the ass.
There is a misnomer out there prevention is about guaranteeing something won’t happen. With biology, like cancer and other diseases, guarantees aren’t what we’re working with. You might not smoke, but you can’t guarantee your apartment building won’t have some toxin in the air ducts causing you lung cancer anyways. The name of the game is putting the odds as much as possible in your favor.