6:29AM EDT October 27. 2012 – When USA TODAY’s Nashville music critic Brian Mansfield was diagnosed with colon cancer at age 48, he figured that a lifetime of Southern-fried foods, extra-large sodas and stress eating on deadline had brought it on. Turned out he had a genetic syndrome that gave him an 80% chance of developing colon cancer. He’ll chronicle his life with the disease — and with only a small part of his colon — in a series of weekly installments.
The chili-pepper boxers hadn’t come out in ages.
I bought them in Austin a good 20 years and about that many pounds ago. They never were practical for everyday use because, well, they don’t open in the front. I think I keep them only because they remind me of a dear friend who died too young.
Maybe that, and the fact that they don’t open in front, is why they seemed the perfect choice to wear at last weekend’s Undy 500 in Nashville. The run, which raises funds for the Colon Cancer Alliance, encourages participants to run in boxer shorts.
I look ridiculous in them, of course. Not even my black Johnny Cash T-shirt — another article of clothing I couldn’t fit into four months ago — made me look less silly, especially once I added the black knee-high compression socks I bought to help keep me from tearing any more calf muscles. But after posting detailed accounts of my bodily functions here and on Facebook for the past four months, I don’t embarrass easily.
Fortunately, friends from nearly every part of my life — from high school, from work, from my neighborhood — were willing to not only be seen with me, but to wear their own boxers and run.
One in particular, my pal Cindy, has never been more than a phone call away since the very start. If I remember correctly, I had to cancel lunch with her the day I got my diagnosis. We were part of a weekly lunch group, but I had no idea then that she’d be one of the first people to visit me in the hospital and to bring food to my family when I got home. As a runner who’d recently completed a half-marathon, she even agreed to pace me on the 5K.
Having not had a good run in three weeks because I kept getting hurt, the run concerned me, especially when I realized the course’s first mile went uphill. We started in front of the Country Music Hall of Fame and went straight up Demonbreun Street to Musica, a giant statue of dancing naked people you may have noticed recently on ABC’s Nashville during a video shoot for Hayden Panettiere’s character. The next mile cut through the Music Row area, going down 17th Avenue South to Edgehill Avenue — which, I didn’t realize until I had to run it, is so named because it’s on the edge of a hill — up to 16th Avenue South, then to Musica again. From there, it was all downhill, which was good, because by the time I got back to Musica, I felt like I was ready to throw up.
Cindy might have let me throw up, but she wasn’t about to let me stop. We started too fast because we didn’t want to run in a crowd. When she realized we were on track to make my dream pace — a goal I’d all but given up when injuries prevented me from training — she kept encouraging me, giving me our times at each mile marker, moving in front of me on the inclines so I could watch her feet instead of staring at the top of the hill, reminding me in the last stretch that “You can do anything for four minutes.”
Friends like Cindy have helped me all through my journey with cancer. From simple, reassuring Facebook posts to offers of substantial amounts of money, support has come from all over — from people I loved, from people I admired, from people I hardly knew. Most often, it came from places I wouldn’t have expected. I used to think I had a hard time making friends; now I realize I just had a hard time recognizing them.
According to Cindy’s running app, we crossed the finish line nine seconds under my dream goal: 29 minutes, 51 seconds. The official time had me just over, 30:20 — a reminder to never, ever slow down when the finish line’s in sight, no matter how well you think you’re doing. Either way, I couldn’t possibly have done that before my diagnosis. I guess that means I’m healthier now than I was before I had cancer.
My cancer story’s not over, though. I’ve only finished this chapter. Because of my genetic disorder, a new cancer is always a possibility; the scar across my bellybutton and the changes to my digestive process are daily reminders that my life will never be the same as before this summer and could suddenly change again. I can do things to minimize the likelihood that new tumors will grow. With my doctors, I can keep a vigilant watch to catch future problems early. But even if I never receive a troubling test result, in my mind cancer will never be farther away than just around the corner. There’s always a better-than-average chance that it’ll be what eventually takes me out.
I don’t think about beating cancer, though. We’re not in a competition. I absolutely understand why some people approach treating cancer like waging war, but, to me, it’s not a battle; it’s more of a workaround situation. Besides, right now, I don’t have cancer. I have Lynch syndrome.
Cancer is just a complication.
Music that makes me want to live
Cancer has changed the way I hear music, more than any other life event except marriage. Songs I once appreciated only on a surface level now strike deep at the core of my soul. Some inspire me; some terrify me. Others that I might have liked before I’ve got no use for now. I’ve also got more time to listen, whether it’s during my morning exercise time or while lying in a hospital bed. This week’s soundtrack to my cancer story comes from some of the musicians the world has lost to cancer. I admired all of them, and I knew far too many of them.
Physical activity and exercise protect against bowel cancer
Amidst the usual flurry of scare stories, it makes for a pleasant change of pace when we have a positive and scientifically strong study to report in the area of cancer prevention.
One such story appeared last week. A new study published in the British Journal of Cancer showed that keeping physically active – walking, running, taking part in sport, or manual work – can reduce the risk of bowel cancer.
By (quite literally) taking simple steps, both men and women could reduce their risk of colon cancer – the most common type of bowel cancer – by a quarter.
We’ve talked about this message elsewhere, but it’s worth restating here, especially because bowel cancer is the third most common cancer in the UK. It’s important for people to know what they can do to reduce their risk of developing it.
This new work was a comprehensive review of the existing scientific evidence, taking the results of 52 previous studies into account.
The researchers found that several different types of physical activity, from occupational activity like manual labour, to more traditional leisure-time activity such as running or going to the gym, can all reduce the risk of bowel cancer.
Cancer Research UK recommends that you try to take half an hour’s “moderate” physical activity a day, five days a week.
“Moderate” activity should be enough to leave you feeling warm and slightly out of breath. It doesn’t have to be strenuous, time-consuming or expensive – it can even include housework, gardening or walking briskly. In fact, a couple of studies included in the review even suggested that brisk walking is enough to reduce the risk of bowel cancer.
Why does being active reduce the risk of bowel cancer?
There are a few possible explanations and it could be one or a combination of these.
One or more of these theories could be correct. Perhaps all of them are. Either way, the benefits of physical activity are clear, and they have been established through a significant amount of research in large numbers of people.
The benefits of keeping active aren’t limited to bowel cancer either. We also know that breast cancer, and possibly womb cancer, are less common among physically active women.
So if you want some tips for becoming more active, have a look at our Exercise and activity pages. Alternatively, why not sign up for one of Cancer Research UK’s many running events, such as Race for Life or Run for Moore. You’ll be helping us to raise funds for vital research, while making a start at reducing your risk.
K Y Wolin, Y Yan, G A Colditz, I-M Lee (2009). Physical activity and colon cancer prevention: a meta-analysis British Journal of Cancer, 100 (4), 611-616 DOI: 10.1038/sj.bjc.6604917
Risk factors other than family history can play a more important role in the development of bowel cancer. The main risk factor for bowel cancer is increasing age. Only 7% of bowel cancer occurs before the age of 50 years. However, even if you have a family history or other genetic risk of bowel cancer, this risk can be reduced by leading a healthy lifestyle. This kind of healthy lifestyle can also reduce your risk of heart disease, stroke and other cancers. It has been recently estimated that approximately 70% of colorectal cancer could be avoided by changes in lifestyle in Western countries.
A good further source of information about dietary and other lifestyle related risk factors is available from Cancer Research UK at http://www.cancerresearchuk.org/cancer-info/cancerstats/types/bowel/riskfactors/bowel-cancer-risk-factors
Summary: A diet high in red meat and animal fat and low in fruit and vegetables increases your risk of bowel cancer. So if you want to reduce your risk of bowel cancer, whether or not you have a genetic risk, eat 5 pieces of fruit or vegetables daily, plenty of fibre, and don’t eat too much processed or red meat.
Putative anti-carcinogenic mechanisms of dietary fibre within the bowel include: the formation of short-chain fatty acids from fermentation by colonic bacteria; the reduction of secondary bile acid production; the reduction in intestinal transit time and increase of faecal bulk; and a reduction in insulin resistance. In the European Prospective Investigation into Cancer and Nutrition (EPIC) study after an average 6.2 years of follow-up, and 1,721 colorectal cancer cases, a 21% reduced risk amongst participants in the highest intake quintile was observed when compared against the lowest intake group. These results support our previous conclusion, of the potential of reducing colorectal cancer incidence by increasing fibre intake from cereal, fruit, and vegetable food sources.
In the EPIC study high intake of red or processed meat may increase risk by 71%. The mechanisms underlying the association between colorectal cancer risk and high intake of red and processed meat are uncertain. Controlled human intervention studies have raised the possibility that the endogenous nitrosation that arises from ingestion of heme iron but not of inorganic iron or protein may account for the increased risk associated with red and processed meat consumption. Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAH) in diet may pose a potential risk of cancer to humans, depending on the extent to which the compounds are activated in vivo by metabolic enzymes. HCAs are formed as a byproduct of reactions during the cooking of meat, poultry, and fish at high temperatures, such as pan-frying or grilling with charcoal or on a gas grill; PAHs are formed in grilled and barbecued meat and in cured, processed foods. It has been suggested that processed meat intake has a stronger association with colorectal cancer than red meat intake.
Folate (a water-soluble B vitamin) appears to protect against bowel cancer, but it remains unclear whether the same level of benefit is derived from dietary folate (from food, particularly fruit and vegetables) and synthetic folate (folic acid supplements). Selenium can be obtained in food (particularly brazil nuts) and supplements; evidence for its effect on bowel cancer risk is mixed. The WCRF/AICR 2010 Report concluded that “Evidence for foods containing folate… and selenium… is less consistent and no conclusion could be drawn”.
Some experts have proposed that folate plays a dual role in bowel cancer in which moderate dietary intake before development of pre-cancerous adenomas reduces risk of adenoma development, but increased folate intake once adenomas have developed increases risk of cancer. Data from interventional studies indicate that folate supplementation decreases colonic mucosal cell proliferation . A large prospective study showing a 31% reduction in bowel cancer risk for people with the highest overall folate intake 12-16 years before diagnosis, but no effect of intakes in the more recent past.
The US Government was sufficiently convinced of the health benefits (and absence of risk) from folic acid that it introduced mandatory folic acid fortification of grain products in 1997, and a recent large cohort study found that 8.5 years on, higher total folate intake (including intake specifically from supplements) was associated with a decreased bowel cancer risk. There is some evidence that it is better to take folic acid in its natural form rather than as supplements i.e. tablets.
A 2011 meta analysis found men with the highest concentrations of selenium in the blood had 32% lower bowel cancer risk compared with men with the lowest concentrations, but found no association between selenium level and bowel cancer risk in women.3A 2004 pooled analysis found a similar level of risk reduction for both sexes combined.
Obesity is associated with an increased risk of colon cancer, particularly for men. Meta analyses show the risk of colon cancer increases by an estimated 24-30% per 5kg/m2 increase in body mass index (BMI) for men. In comparison to healthy-weight men (BMI less than 25 kg/m2), overweight men (BMI 25-29.9kg/m2) have a 23% higher risk of colon cancer, and obese men (BMI 30kg/m2 or more) have a 53% higher risk. The association is weaker in women, with colon cancer risk increasing by 9-12% per 5kg/m2 BMI increase, and the association proving non-significant in one meta analysis.
Larger waist size has been associated with increases in colon cancer risk in men (33% risk increase per 10cm waist circumference increase) and women (16% risk increase per 10cm waist circumference increase), as has increasing waist-to-hip ratio in both men (43% risk increase per 0.1-unit increase in ratio) and women (20% risk increase per 0.1 unit increase in ratio).
Higher BMI is linked less strongly to higher rectal cancer risk: a 5kg/m2 BMI increase is associated with a 9-12% higher rectal cancer risk for men (obese men have a 27% higher rectal cancer risk than healthy-weight men), but with no effect on rectal cancer risk in women
Regular physical activity can reduce your risk of bowel cancer, this is clearly shown in many studies. We would recommend 2-3 30 minute sessions per week of dedicated exercise (rather than more ‘passive’ exercise such as being busy at work!).
The relationship between physical activity and a reduced risk is one of the most consistent findings in epidemiologic literature.
Not smoking and drinking less than the upper recommended limit of normal (less than 21 units for men and less than 14 units for women) may also be helpful.