Graham lecturer explains diet’s role in cancer risk

Elisa Bandera, the 17th annual Saxon Graham lecturer, has had her eye on the history of cancer-prevention recommendations pretty much since her arrival in Buffalo — and the United States — in the early 1990s.

After completing medical school in her native Spain, Bandera earned a PhD in epidemiology and community health from UB in 1995.

It was then that she began working with the renowned epidemiologist Saxon Graham, former chair of UB’s Department of Epidemiology and Environmental Health, on cutting-edge research into chronic diseases. That work set her on a path helping build multiple versions of healthy living recommendations — not just for Americans, but for the global population as well.

Her work earned her a place with the World Cancer Research Fund and the American Institute for Cancer Research, which tasked her and other experts with developing recommendations for reducing the risk of developing different cancers.

Successful, she joined the American Cancer Society in its attempt to pare down recommendations that had been in place since 1984. At the time, those recommendations included such things as avoiding obesity, lowering fat intake, increasing intake of fibrous foods and cruciferous vegetables, and decreasing alcohol consumption.

Eventually, that lengthy list was paired down to four recommendations: achieve and maintain a healthy body weight, increase physical activity, follow a healthy dietary pattern and reduce the consumption of alcohol.

“We know that people ... that follow the guidelines do better,” Bandera told a UB audience on April 5. “For breast cancer survival, there’s a lot of literature.”

No magic diet exists, she said, nor a magic pill — despite some seemingly marketable products that provide results only when they’re taken — to reduce the risk of cancer. It takes hard work and following a mostly plant-based diet where alcohol isn’t even considered, especially in the case of breast cancer, on which the American Cancer Society’s recommendations focus.

For instance, alcohol, she said, is like a magic bullet going in the wrong direction. It’s not a question of how much.

“For (breast) cancer, there’s (no dose) that is safe,” she said. “Even a small amount can increase risk.”

Meanwhile, obesity is another noteworthy risk factor. For both women and men, obesity is the second-leading risk factor behind smoking, she said, citing a 2018 study in A Cancer Journal for Clinicians.

The issue is measuring obesity. Researchers and clinicians argue over what methods should be followed and what’s effective. Bandera is a proponent of taking body-mass index measurements and pairing them with waist circumference — even if BMI’s uses are criticized in some circles.

Whether BMI is used — and she acknowledges the issues concerning what constitutes “overweight” using the simple calculation — waist circumference has proven to be a strong indicator of risk, she said.

“In our own research, we found waist circumference was a great marker of increased risk in survivors,” Bandera said. “This study was of Black women with breast cancer. It was much more than BMI. It’s a measure ... about central (body) obesity, so people who have greater waist circumference ... are more likely to have metabolic syndrome. And that’s going to increase risk of cardiovascular disease and many other (chronic diseases).”

Bandera noted that some research gaps need to be addressed in the future. Most notably, the question of underrepresented populations regarding the effectiveness of these guidelines and whether they’re accurate for all deserves more attention.

More research is needed, she said.

The annual Saxon Graham Lecture is presented by the Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, in honor of the late Saxon Graham, a pioneering epidemiologist and former chair of the department.