How your lifestyle impacts your likelihood of developing cancer


AUGUSTA, Ga. (WJBF) – The Means Report turns its attention to Breast Cancer in this episode. We look at the disease itself, and we look at making healthy lifestyle choices. There is a person dedicated to helping you do that, and we can walk you through what a huge difference those kinds of choices can make in your life and in your well-being. Indeed, stopping cancer, perhaps, before it starts.

Brad Means: I can’t think of a better person to help us navigate those waters than Dr. Martha Tingen. She’s back on The Means Report. Last time talked about smoking, this time breast cancer. She’s an associate director over at the Georgia Cancer Center. Dr. Tingen, thanks for your time. I appreciate you.

Dr. Martha Tingen: Absolutely.

Brad Means: Let’s just look at breast cancer from the 30,000 foot view if we can. There’s so much awareness. There’s a month dedicated to it. There are pink ribbons everywhere. There’s a Miracle Mile Walk. Have you seen fewer patients come through the door? Are we making a dent in it?

Dr. Martha Tingen: We’re definitely makin’ a dent in it. People, women are beginning to say “Hey, this is for real. “I need to think about it.” They’re thinking about, has her mother had it, they’re thinkin’ about, has her grandmother had it, has her sister had it, has their aunt had it? So yes, we are beginning to make a dent in it because of all the publicity, and because people are getting more interested in their own health care.

Brad Means: Okay, so if your mother or grandmother or some relative had it, are you definitely going to get breast cancer?

Dr. Martha Tingen: Absolutely not. So there is genetic testing available for those people that are at risk. That is not everybody. But family history can mean a lot, and what family history really should say to someone that is younger is, if you do have a relative, perhaps you should get a mammogram earlier than would be the normal recommendation. So pay attention to what’s happening around you with your family, and it might make a big difference for your health, long run.

Brad Means: What else causes it? I don’t want to step on our second segment, which is all about the right choices that we can make with our lifestyles to try to ensure that we’re cancer-free, but what are some other causes other than, or indicators even, besides heredity?

Dr. Martha Tingen: This’ll probably shock a lot of people, but I’m a bilateral breast cancer survivor myself, and that may or may not shock people, but I’ll never forget the day my surgeon told me, and I was in his office after a breast biopsy. The first question, he said, “Martha, how much are you drinkin’ these days?”

Brad Means: First of all, you have to lie when the doctor asks that.

Dr. Martha Tingen: No, I always say be honest, I mean–

Brad Means: And I’ve heard they always double it, but go ahead.

Dr. Martha Tingen: And I looked at him and I said, “Why are you asking me about drinking? “But it’s fine with me. “I’m very comfortable with it. “I don’t drink anything.” And he said, “Are you jokin’ me? “How many glasses of wine a day do you have “when you go home from work?” I said, “I honestly, Dr. Cooper, I don’t drink anything.” And I said, “What does this have to do “with our breast cancer discussion?” He said, “Martha, it is 100% predictive, “as a woman ages with each year of life, “if they drink on a regular, daily basis, “even on a weekly basis several times a week, “if they live long enough, they will get breast cancer.” I was appalled. I had no idea, Mr. Means, that’s the way things worked.

Brad Means: And here you are, not touchin’ it?

Dr. Martha Tingen: Not touchin’ it.

Brad Means: And have bilateral breast cancer.

Dr. Martha Tingen: Right, right.

Brad Means: How long ago was that?

Dr. Martha Tingen: That was actually, I was diagnosed in 2013, so thank the Lord, I’m still here today.

Brad Means: Amen.

Dr. Martha Tingen: I will say that I was quite my own patient advocate. I think I made several of my physicians very angry, because I initially was just diagnosed with a small lump in my right breast, and I demanded, literally demanded, that I had further testing to make sure I didn’t have it in my left. I have so many friends and so many people I know that are diagnosed with one-sided breast cancer, and in three years, five years, they all of a sudden, have it in the other side. So I’m a nurse, and I’m a scientist, and I’m a big investigator. So I immediately started doin’ my own study on myself. And so the last time I said to my doctor, I said, “You have two choices today. “You can either order me an MRI, “or either you can suggest to me who you’d like me to go to. “I’m not movin’ any further in my treatment “until I know for sure what we’re dealing with.” So what ended up happening, I actually had two cancers in my right breast and two in my left. So three that had been undetected.

Brad Means: What about women who don’t do their own research, who don’t have an advocate? How are they supposed to handle that kind of a diagnosis, just one breast only?

Dr. Martha Tingen: Well, what I am encouraging everybody that is watching your show today is to do their own research, to ask questions, to ask questions, to ask questions. Go online to the American Cancer Society’s website, to the National Cancer Institute’s website, to our cancer website at the Georgia Cancer Center. Find out all the information you can and ask all the questions you can. So I was told the tumor board didn’t think I needed to do that. And I said, “There is just a voice in me “that feels like I need to know.” And I said, “I hope I get a clean report.” But I didn’t get a clean report. And then the other thing is if you find out you do have breast cancer, there are really lots of options.

Brad Means: Sure, there are.

Dr. Martha Tingen: There’s lots of options.

Brad Means: What if you have the BRCA gene mutation, that indicates that you’re probably gonna get breast cancer? Take action right then, or wait?

Dr. Martha Tingen: So if you have the BRCA gene, that is a serious conversation you need to have very soon with your physician, as well as a genetic counselor. That is not anything to ignore. Based on your genetic status, based on your family history, they will make some recommendations, and that puts you in a whole different trail than someone who is not BRCA positive.

Brad Means: What about your relationship with your family doctor, if someone is diagnosed with breast cancer? Our family doctor, typically, is a person with whom we’re the most comfortable. Do you lose touch with him or her once you go down the breast cancer path? Do you have to say goodbye to them and go the full oncology route?

Dr. Martha Tingen: Oh, no, no, no, no, no. So to me, primary care, I call them the gatekeepers of health. And so I have a wonderful internal medicine physician, and I literally have the greatest and utmost respect for him, and so he was with me in this journey. Did he make the decisions regarding my breast cancer treatments, and what I was gonna receive and all? Absolutely not. But I kept my regular appointments with him. He was just as engaged as he could be. He was, to me, a real support in my process. So no, I mean, absolutely not. You’re dealing then, with multiple physicians, but each one has their real own unique niche.

Brad Means: They’re always, that primary care doctor, gonna be by your side.

Dr. Martha Tingen: Yes, and not only that, but he sees the whole picture.

Brad Means: I was gonna ask you about something that confuses me. For the longest time, it seems that we heard women should start getting mammograms at 40. And then the number changed. And then it was optional at a certain age, semi-mandatory at another age. What do you have to say about, when it really is time to start getting mammograms, and then how often should you?

Dr. Martha Tingen: So the U.S. Preventive Task Force has changed its mind several times, and this is what I say to every female. If you have any concerns, that you might have breast cancer, to talk with your physician about it, and I think most physicians always want to err on the side of caution and safety. And if they have a female coming to them with concerns about needing to be, have a mammogram ordered, I think they would order it for them.

Brad Means: What about the insurance company? Might they say, “Nope, doesn’t meet our guidelines. “You don’t need one yet.”

Dr. Martha Tingen: And so for those people, you have to make a decision. If your doctor orders it and it is refused by insurance, there’s some things, I always ask the question, “How do you put a price tag on life?”

Brad Means: Well how much are those things, straight up, if it’s out of pocket?

Dr. Martha Tingen: Oh, gosh, out of pocket, if you had a mammogram, I’m takin’ a wild guess because I haven’t looked this up for awhile, but my guess is it’d probably be over $100. And remember, every test you have, you get a technical fee for the actual person, the facility that is performing it. You might get a fee for the person that’s actually doin’ the exam, and then you get a third bill for the radiologist, who’s reading it. So you’re looked at three fees. So, I was referring only to one of those fees, so it could be a lot more. However, typically, if your physician orders it, it is documented, and you need it, insurance is gonna cover it.

Brad Means: Probably my last question for this segment before we go on into the world of lifestyle choices, and that is, are breast self-exams, BSE’s, still the first line of defense? You don’t have to wait to go to the doctor for that.

Dr. Martha Tingen: Absolutely not. I strongly encourage breast self-exams. It is a key thing to do. There’s very specifics about timing of the month that’s the best time to do that. If you feel a lump, I don’t care how small it is, anything unusual about your breast, you should immediately go see your doctor, your OBGYN doctor, and have him funnel you in the right way, or your primary care doctor, if you do not have a OBGYN doctor, 100% yes. Breast self-exams don’t go away, axial or under the arms feeling, all that, very, very important.

Brad Means: All right, good advice for sure, Dr. Tingen. When we come back, we’re gonna talk about a relatively new role for Dr. Tingen. It’s a role that encourages you to make better lifestyle choices. Did you know that four out of 10 women who get cancer may have been able to prevent it, due to modifiable risk factors. How ’bout that? If you just change a couple of things in your life, maybe you’ll live longer. We’ll break all that down on The Means Report.

Part 2

Brad Means: Welcome back to The Means Report, everybody. Dr. Martha Tingen is our special guest today, from the Georgia Cancer Center. We talked about breast cancer, in general, in our first segment. Now we’re gonna talk about choices that we all can make to perhaps prevent us from getting it, or at least reduce our risk. Dr. Tingen, just in our conversation during the commercial, it struck me that people shouldn’t drink a lot.

Dr. Martha Tingen: Yeah that’s right. Yeah, so that’s one of many lifestyle risk factors for cancer. So what we’re tryin’ to do at the Georgia Cancer Center is put together a phenomenal research program and community engagement and partnership program to address what I call risk factors that we can enhance, protective factors, and prevent people from ever getting cancer. That’s the goal.

Brad Means: Yeah, but if you prevent people from ever getting cancer, do you still have a job?

Dr. Martha Tingen: Yeah I do, I do. Because unfortunately, probably not in my lifetime, will we be able to achieve that, but yeah, there’ll still be people that are smoke that are still alive, and so that’s one of my big things, I’m always tryin’ to get people to quit smoking. So we’re really focusin’ on basically five things. We’re focusing on tobacco. So tobacco, as you may know, causes, is related to 16 cancers. 16 different cancers. Causes 90% of all lung cancers, which are the number one cause of cancer deaths.

Brad Means: Tobacco is horrible. What are the other four?

Dr. Martha Tingen: The other four are obesity. Most people don’t realize it Brad, but 13 cancers are related to obesity, and obesity is the result of 40% of all cancers in the whole United States.

Brad Means: Let me stop you right there.

Dr. Martha Tingen: 40%, that’s a lot.

Brad Means: What is the connection between weight gain and the likelihood of breast cancer recurrence?

Dr. Martha Tingen: I am so glad you asked me that. At my first follow-up appointment, after I’d had surgery, and I was beginning, my doctor said, “I want to share somethin’ with you “that’s kinda not very good news,” but he said, “every woman that’s diagnosed “with breast cancer,” he said, “the likelihood is they gain, on average, 15 pounds.” I said, “You’re kidding me?” He said, “No, that’s just the way it is.” And he said, “I want you to know Martha, “for every pound you gain,” he said, “you’re not overweight now, “but for every pound you gain, increases the likelihood “that your cancer will return somewhere else in your body.”

Brad Means: Just from weight gain.

Dr. Martha Tingen: Just from weight gain. So, for me, that was like, big, bad news. So, I went on a very healthy plan. I’m really big on, most people do eat garbage each day, and so I went on a healthy plan, and I lost 20 pounds. And I’m thankful to say I’ve kept it off, because if my cancer ever does return, it’s not gonna be because of obesity.

Brad Means: No, it sure won’t be, and way to go on that. I know it’s difficult. It’s a life long journey.

Dr. Martha Tingen: It is.

Brad Means: Tobacco, obesity, what are the other three things we hate?

Dr. Martha Tingen: We said alcohol. And what people don’t realize is, I mentioned earlier breast, also related to the liver, also related to colorectal cancer, also related to esophagus cancer, our swallowing tube, and also related to stomach cancer.

Brad Means: And so should you just quit drinking, or just, is there a certain number we can have each day?

Dr. Martha Tingen: I say the best of all is to be a good, old-fashioned teetotaler. That’s my personal opinion. I’m not bein’ judgmental of anybody that does drink. I think people should note, there’s a risk, high risk associated with cancer, especially for women with potential for breast cancer, as I shared earlier, and liver cancer, especially.

Brad Means: Dr. Tingen, everything causes cancer, doesn’t it? Everything causes cancer!

Dr. Martha Tingen: I don’t really subscribe to that. I think we do identify the main causes through lots and lots of research. Another one that often gets overlooked, that people are not aware of, is sunlight and ultraviolet exposure. So really, sunburns. Did you know that sun exposure is cumulative? I’m not sure, as a baby, if you were burned many times or not.

Brad Means: I was, like, two bad burns!

Dr. Martha Tingen: This is the deal. Your skin never recovers from that. The redness may go away, but the damage to your skin never recovers.

Brad Means: What’s the solution, before you get burned? Sunscreen every day of your life?

Dr. Martha Tingen: The solution is to, you always use sunscreen that has a UV factor, what’s recommended, a minimum, is 15. The best is 30 or above.

Brad Means: All right, let me try to break each one of these categories down. You talk about sunscreen. Women, a lot of their makeup has it in it. A lot of their foundation does.

Dr. Martha Tingen: That’s exactly right.

Brad Means: What about guys? Are we supposed to rub lotion on our hands and face every single morning?

Dr. Martha Tingen: If you’re gonna be in the sun a lot, absolutely. Put on some good sunscreen.

Brad Means: That’s a total pain.

Dr. Martha Tingen: I know it’s a total pain. Most of you’d be shocked how many people get burned on their necks. You see people with farmer’s tans. Take their shirt off and their chest is white, but yes, sunscreen is a really big deal. Nine to 10 skin cancers are directly related to UV exposure. And there’s one other one that we cannot miss for prevention of lifestyle, and that’s the human papillomavirus, often referred to as HPV. Linked, most of all, related to cervical cancer. Big predictor of potential cervical cancer.

Brad Means: Should teenagers get the shot?

Dr. Martha Tingen: Teenagers should get the shot. The shot has shown incredible, incredible results in bein’ preventive.

Brad Means: I once heard a mother say, “I’ll never let my daughter get that “because she’s not promiscuous.”

Dr. Martha Tingen: I think that’s wonderful, she’s not promiscuous. I think that’s great. However, there are some people that may get the virus and it may, it usually is spread that way, but if you knew that you could take a pill and it might prevent you from gettin’ a a cancer one day, even though you didn’t think you were at risk, would you take the pill or not?

Brad Means: I’d take it 100%!

Dr. Martha Tingen: That’s kinda my answer for the people that are not HPV-positive about takin’ things.

Brad Means: So when someone comes to you at the Georgia Cancer Center and they say, “Look, help me with my lifestyle. “Help me be at a lower risk.” What do you do, do you sort of become a personal trainer?

Dr. Martha Tingen: I like to say a coach. I would really love for our team, we have a wonderful team of about 20 people that work in cancer Prevention and Control, who are very focused on addressing health disparities, which is another whole topic that I’d love to talk about with you one day. We wanna just absolutely help everybody make the best choice for their health, every day. I’ll just give you a quick thing. Have you heard of Red Ribbon week?

Brad Means: Red Ribbon week, I thought that was a heart disease thing? Is it?

Dr. Martha Tingen: No. Red Ribbon week is a national week across the entire nation based on a young, great guy that was passionate about students not becoming involved in drugs. So because tobacco is a drug, very addictive, kids are vaping like ever–

Brad Means: I was gonna ask you about that.

Dr. Martha Tingen: The CDC just released yesterday, it was, a new name, a medical diagnosis, called EVALI, E-V-A-L-I, standing for E-cigarette Vaping Associated Lung Injury. We now have 26 deaths across 49 states, over 1,226 hospital admissions. So help me understand, Brad, how we get bad romaine lettuce from a country. It gets pulled off every shelf, out of every Panera Bread, out of every associated thing, and nobody eats it, but we’ve had 26 deaths from vaping, and everybody is still puffin’ away.

Brad Means: My high school friends would tell you that it’s because the stuff that’s killin’ people is the black market additives, not the over-the-counter stuff.

Dr. Martha Tingen: They’re smokin’ the good stuff right?

Brad Means: Correct.

Dr. Martha Tingen: Yeah, well, that’s not necessarily true. All those people that are dead, I’m sure they thought they were smokin’ the good stuff too.

Brad Means: You never know what’s in it.

Dr. Martha Tingen: You never know what’s in it.

Brad Means: It’s liquid, it’s just, I don’t get why it’s so popular, but it is.

Dr. Martha Tingen: And at a recent event I was at, people are now putting THC oil in it. You know what that is.

Brad Means: I do.

Dr. Martha Tingen: A very big form of marijuana that makes you feel the greatest high. And if you are found with that, it’s a felon. That’s kind of a big deal. Whereas, if you’re traditional marijuana, it’s considered a misdemeanor.

Brad Means: I know, what happened to simple Marlboro Lights, when we were kids?

Dr. Martha Tingen: I know, I know. The great news is, smoking has gone down like crazy. But the very bad news is, all of our efforts toward you smoking have been erased. That’s not my word. That’s the Center’s for Disease Control word, with the onset of vaping.

Brad Means: Dr. Tingen, it seems that if you’re managing someone’s lifestyle, or serving as their coach, that it’s a lifelong commitment, if you’re trying to keep them cancer free. Do we stick with you forever?

Dr. Martha Tingen: I’d love for you to stick with me forever. I think the biggest message of all we can do is as parents, would you please role model healthy behaviors for your children? Children love their parents, they love them, regardless, almost of how they’re treated. And I have lots of games I play. When I go to the grocery store, I look at the person pushin’ the cart and I see what’s in their buggy. It’s usually pretty predictive. The other thing that I think’s really sad, is there is data that shows, Brad, if families will eat one meal a day together, with every electronic device down, nobody’s on their game, nobody’s on their iPad, nobody’s on their iPhone, nobody’s talkin’ through a thing in their ear, and engaging, they have a conversation like you and I are, it can prevent up to 60 to 70% of any type of drug abuse. And when I say drug abuse, I’m including tobacco here.

Brad Means: Just having conversations.

Dr. Martha Tingen: One meal a day! So we actually have a big program in the community called The Strengthening Families, and it starts with those families eating a meal together.

Brad Means: Let me ask you this, and I’m not trying to be flippant, I’m trying to try to help people who are watching, who might say, “Look, I can’t change. “I’m an overeater, a drinker, “a smoker, a person who loves to get tan. “Can’t you do all those things, “perhaps, away from your children? “Put your beer in a cup, smoke on the porch, “eat a pizza after they’ve gone to bed, “and still be a good parent? “Do we have to undergo a complete transformation “to be a role model?”

Dr. Martha Tingen: You know what I say, “I want you to live a long time “to be a good role model and to be a great parent.” That’s what I say. Kids are very smart. The vast majority of children that take up the habit of tobacco, get it from a loved one. They’re perceptive, they’re very perceptive. So, I’m really, and we can help you. If you’re havin’ struggles with alcohol, there are numerous places that can be very successful. If you’re havin’ trouble with vaping, cigarettes, Georgia’s Cancer Center has a phenomenal smoking cessation clinic. We will help you with getting you physically unaddicted, and we will help you with getting you psychologically unaddicted.

Brad Means: Can we bring all the teenagers to you, and you’ll fix them?

Dr. Martha Tingen: Well, I would love to have a home that big, because that’s how much I love children.

Brad Means: No, at the Cancer Center. Whatever it takes.

Dr. Martha Tingen: But anyway, these are really, so this is what’s happening in children today, as early as 10 and 11 years old. We are seeing children bein’ put on medications that people normally would not have been prescribed until they were in their 40 or 50s, because they are developing what’s called early anti SIDAs of an adult onset disease, early in life.

Brad Means: We want you, ladies and gentlemen, to get in touch with Dr. Tingen and her team. They can make a huge difference when it comes to helping you live longer so you can be a role model, and certainly helping to reduce those risk factors. Thank you for everything you’ve done.

Dr. Martha Tingen: Do you want me to at least give the cessation phone number?

Brad Means: We can give it, or we can put it on the screen. Say it real quick.

Dr. Martha Tingen: Okay, it is 706-721-0456.

Brad Means: 721-0456, call it right now or call it, if this is airing on a Sunday, the next business day. Bless you, and thank you for what you do.

Dr. Martha Tingen: Thank you for havin’ me.

Brad Means: Absolutely, Martha Tingen, Georgia Cancer Center.

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