[grandiego]

> Be your own advocate and research the things your doctor tells you

I share your concern but I think there is no definitive advise about how to prevent these horrible outcomes (besides the usual "do regular exercise", "lower sugar consumption", "avoid stress", etc.) Did you find anything more concrete?

[zamadatix]

Generally it's about catching issues early as possible not necessarily preventing the issue from occurring. If you wait until you're experiencing impacting systems before getting things like this checked your likelihood of having the same quantity of quality adjusted years of life is much lower.

[abawany]

Sometimes it means asking for tests that the doctor ignores or is reluctant to order. I go to a university-run clinic and often deal with trainee doctors with my regular GP present and I have had to get into arguments with them on whether I need a given test for this year's checkup even with the test showing deviated results the prior year. I was stunned at the audacity of the trainee in question as I often go to the annual checkup not in a combative frame of mind but this dismissal of my concerns rubbed me the wrong way. I was able to prevail but I shudder to think of the damage this budding physician will wreak on their future patients with this off-handed arrogance - I hope they will get better with time and age.

[Gatsky]

There are not really any lifestyle interventions with good quality evidence for preventing cancer. This is my list:

Definitely worth doing:

- Don't smoke anything that burns or chew tobacco.

- Depending on your age and sexual experience, get the HPV vaccine.

- Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor.

- If you have certain ethnicity, just get a genetic test, pay for it if you have to (Mainly for Ashkenazim)

- Avoid consuming herbs/plants which contain aristocholic acid.

Probably worth doing:

- Reduce red meat consumption (observational data and plausible mechanism)

- Reduce or eliminate alcohol (observational data and plausible mechanism)

- Eat highly processed meats rarely (charcuterie etc)

- Make sure to get sufficient fruit and vegetables and fibre. This may offset the risk of red meat consumption.

- Take vitamin D, particularly if your levels are low or you live far from the equator. Don't take intermittent megadoses, take some every day. This seems less useful if you are overweight.

- If you are female, then have children and breast feed if possible. Longer durations of breastfeeding are more effective. Having more children is also more effective. (One may balk at this, but there is a lot of supportive data about long term breast cancer risk)

- Exercise. There is only (a ton of) observational data, but exercise is so universally beneficial. Going from nothing to a bit of exercise has a bigger impact than going from a bit of exercise to a lot. Most people over do it. Do cardio and resistance training. Try to do something every day.

- Avoid supplements designed to have antioxidant properties (based on data suggesting harm from controlled trials, and no clear benefits).

Maybe:

- Move closer to the equator.

- Avoid obesity (note this is complicated... obesity itself may not be the problem. Obesity is protective for some cancers, and this varies by age).

- Get checked for Hepatitis B and C, particularly if you have risk factors or were born/grew up in an endemic country.

- If you get chronic reflux or heartburn, consider pushing for your doctor to investigate further (usually a gastroscope) and do an H pylori test. This is particularly if you were born/grew up somewhere with a higher chance of exposure. If you have it, take the eradication therapy.

- Try to maintain metabolic health. This is highly personal and hard to give general advice around. Eg. South east asian/Subcontinental people can be metabolically ill despite not being overweight. Investigations here could vary from checking for insulin resistance (eg HOMA-IR calculation from a blood test), gettinga DEXA scan to look for visceral fat, or in the extreme case continuous glucose monitoring to look for foods which really spike your blood glucose. The interventions are exercise, sleeping well, and potentially avoiding foods which spike your sugar (or scheduling exercise after eating such foods). Soon we will have a better idea if certain personalised dietary interventions may be beneficial.

[soramimo]

> Investigate your family history of cancer. If there are multiple people on one side of the family getting cancer (particularly breast + ovarian + pancreatic, or colon + gastric) then consider getting genetic testing/discuss with a doctor.

Can you elaborate on how you see this being actionable? Perhaps an increased cadence of screenings?

[Gatsky]

Yes, tailored screening is one aspect. Prophylactic surgery is another option. There are also pharmacological measures eg tamoxifen to reduce risk of breast cancer in BRCA1/2 carriers. Then there are clinical trials of preventative interventions eg denosumab in BRCA carriers.

[boyka]

Thanks for the thorough overview.

Can you elaborate on

- risks for Ashkenazim

- which plant families actually contain notable amounts of AA? I.e., do all ginger types pose a risk?

[Gatsky]

Ashkenazim have relatively high rates of inherited BRCA1 and BRCA2 mutations. These are associated with high lifetime risk of breast and ovarian cancer, but also prostate and pancreatic cancer. If someone with Ashkenazi heritage gets one of these cancers, they are reflexively tested for BRCA1/2 mutations. There are various mitigating strategies, so it is worth finding out I think, but the right way to go about it is to see a genetic counsellor.

About the AA, it seems to be herbal supplements that are the primary concern (see https://www.accessdata.fda.gov/cms_ia/importalert_141.html). Normal ginger is fine, wild ginger is the problem. Wild ginger isn’t used in cooking as I understand it.