Transcribed using AI transcription. errors may occur. Contact Mikki for clarification

00:00
Hey everyone, it's Mikki here, you're listening to Mikkipedia and this week on the podcast I speak to Dr Terry Boyle.

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I'm stoked that I get the opportunity to chat to epidemiologist Dr. Terry Boyle from the University of South Australia, all about cancer risk and exercise. So we talk about more broadly the increase in cancer cases worldwide and what might be at the heart of that increasing prevalence, including the overall risk of sedentary behaviour. We also talk about what sedentary behaviour actually is. So...

00:41
how we define that and why it might be increasing the risk of different types of cancers. We also discuss exercise in depth, how it can help both psychologically and physically someone who is going through cancer treatment, the relationship between exercise and cancer risk and some of the misconceptions that might be out there about using exercise alongside other therapies for cancer to help improve.

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overall health and wellbeing. Dr Boyle and I also discuss looking at lifestyle and genetic factors and how important these are at cancer risk and then briefly touch on the recurrence of cancer and what might impact someone's risk of getting a secondary cancer or getting another cancer diagnosis after having one diagnosis. So I found this a super interesting conversation, really different from the

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conversation I had with Professor Tom Seyfried, but I think a really important exploration of some of the lifestyle contributors and just the epidemiological data around cancer. And Dr Boyle and I discuss, you know, the quality of this data because of course we know that with regards to nutrition epidemiology you can't take much away from that data. So I think you're gonna find this a super interesting conversation. So I have a link to Dr Boyle's profile at University of

02:06
South Australia and he is an epidemiologist in the Australian Centre for Precision Health. He has a broad interest in lifestyle factors and chronic disease with a focus on the role that physical activity and sedentary behaviour play in cancer risk, cancer survival and cancer survivorship. While he conducts research on a range of cancers, his recent studies have been on blood cancers such as non-Hodgkin lymphoma.

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Terry received his PhD from University of Western Australia in 2012, then received fellowships from the Australian National Health and Medical Research Council and the Canadian Institutes for Health Research, which gave him the opportunity to spend two years at the British Columbia Cancer Agency at the University of British Columbia in Vancouver in Canada, and he joined University of South Australia in October 2017.

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Terry has a range of experience in epidemiological and biostatistical methods, including multiple imputation, meta-analysis, and a whole bunch of other statistical methods, which allows him to analyse data sets and make inferences from that. This is what we discuss in this podcast here. Before we crack on into the interview though, I would like to remind you that the best way to support this podcast is to hit subscribe on your favourite podcast listening platform.

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because that increases the visibility of Micropedia and amongst literally thousands of other podcasts that are out there. So more people get the opportunity to learn from the research that's currently being explored from people like Dr. Terry Boyle. All right team, enjoy this conversation.

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I totally appreciate it. So Terry, you're a senior lecturer in cancer epidemiology. Can you just start by giving us a little bit of your background and how you got into the field of investigating population risk of cancer with lifestyle? Like, how'd that come about? Yeah, sure. To be honest, I kind of fell into it. So I got a research assistant job.

04:12
probably it was probably about five or so years after my actual undergraduate degree, which was in human movement and exercise science. That's my kind of undergraduate background. Yeah, so I got a research assistant position on a case control study looking at risk factors for colorectal cancer at the University of Western Australia. And I guess that was my kind of first taste of epidemiology and cancer research. And I just like a month or so into that position,

04:41
Avenue I wanted to pursue as a career. And I was working with some excellent epidemiologists and mentors, a professor at Linford, chief professor Jane Hayworth there. And then they were excellent people. So then I went into do a PhD using data from that study, looking at physical activity and risk of colorectal cancer, and also sedentary behavior and risk of colorectal cancer. And then I guess since then, I've really continued that.

05:07
of avenue of research looking at those lifestyle related risk factors and predominantly cancer risk or also cancer survivorship and cancer survival and again more broad I guess chronic disease more broadly as well and I guess yeah I guess I find it really rewarding to work in this area because you know cancer is something that affects everyone you know on a personal level either to my grandparents passed away from cancer which are you know probably

05:36
we know now probably preventable cancers. So it's really rewarding to play a very, very small role in trying to work out how we can prevent cancer and how we can improve the quality of life and quantity of life in people who've been diagnosed with cancer. Yeah, nice. And you know, nutrition is my background and in nutrition, epidemiology is what is relied upon to give us data that informs public health.

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recommendations and also it also informs newspaper headlines and clickbait media and all the rest of it. Yeah. And I guess one of the probably fair criticisms in nutrition epidemiology is that it's not based on great data. So what's it like in the field of cancer? I think it's, yeah, I guess when you're talking about nutritional epidemiology and physical

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to a less as well. I guess they're really challenging things to measure. So I think that's, yeah, that really raises a lot of challenges. And I guess, and also it's because, yeah, like you say, we to kind of know about how things like nutrition and physical activity influence those chronic diseases like cancer and cardiovascular disease and so on and so on. It's really, really difficult to do a randomized control trial, which has been a

07:03
kind of the gold standard for looking at what causes what. So yeah, we really rely on those, on observational epidemiological studies when, yeah, and there are certainly lots of challenges and things that you need to think about. That's one of the areas that I, one of the aspects I really enjoy is thinking there are all these methodological challenges that we need to think about. Yeah, so I know we have lots of.

07:30
time thinking about confounding and different kinds of biases and measurement of how we can better measure those exposures. Yeah. And I also think, you know, like scientists, epidemiologists always go in thinking, like the type of studies that are conducted, like, as I understand it, they are hypothesis generating. That's like, well, this is super interesting. I wonder where this leads. Whereas often what people in who might be...

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clicking on a clickbait headline, what they'll be reading is almost like, oh, this is a foregone conclusion. Whereas the people doing the science are like, well, super interesting. Let's head down this road, I imagine. Yeah, I think, yeah. Yes, sometimes I think there's a big difference, I think, sometimes in what the researchers might write about in their manuscript or their studies versus what then goes on to get reported on the media. And I think there's going to be studies that yet sometimes that's not like, I think that sometimes that is the fault of researchers and

08:26
PR departments at universities. So it's definitely not fair to lay the blame on journalists there. But I think as a guest, I know I'm always quite cautious when I'm talking about the results of studies that I've done. Given, yeah, it's just one study. And I think I guess what you like to see in epidemiology when we're doing these kind of observational studies is really lots and lots of studies, maybe conducted in different populations and even that have...

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even different kinds of studies or different kinds of study designs, but all showing the same kind of results. And that can kind of give you, that gives a lot more confidence in your, whether a particular exposure is increasing or decreasing the risk of a particular cancer. Yeah, nice one. So Terry, I want to ask you sort of some broad questions about cancer and cancer risk, and then narrow it down to an area, which I know you've done quite a bit of research in, which is of course sedentary behavior. First of all, what is lifetime risk?

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of cancer and actually what does that mean? I think that's a question I've got as well. And then how has it changed over time? Yeah, so in terms of lifetime risk of cancer, so I'm just going to talk about Australia because I guess that's what I'm more familiar with, but I'm sure the results, I think the figures would be very, very similar in New Zealand and probably most developed countries around the world. So in Australia, so I think the latest information I could find was from 2022 and it's estimated that around...

09:51
So, lifetime risk is 43%, basically. So that really means that if everyone in the population lived to the age of 85, then around and based on the cancer rates that we see today, then around 43% or two in five of those people would be diagnosed with a cancer before they turn 85. Wow. That's it. And it's a bit higher in males and a little bit lower in females, as we know that males are at higher risk of cancer than females.

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how that's changed, that lifetime risk of cancer has changed. It's actually been pretty steady over the last 20 or so years. So I looked at in around 2014, it was very, very similar. So the lifetime risk was, or the risk of being diagnosed with cancer before the age of 85 was about one in two for males and one in three for females and overall about two and five. And similarly about 10 years before that in the kind of mid 2000s, it was

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really quite similar to that as well. So that lifetime risk seems to have been pretty steady over the last 20 or so years. When you actually think about the number of new cases though, that has increased massively over the last 20 or so years. So I think it's increased about 90%. But that's probably due just to the growing population and also the aging population. So the actual, at the absolute level, the number of cases has absolutely increased, but it seems like the incidence rate...

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has seems to have been fairly steady over the last maybe 10 to 20 years. Yeah. Terri, what is it that places males more at risk than females? Do we know? I think probably a lot of it, I think, is just due to the common types of cancer that are males and females. I think prostate cancer is, I think the incidence is a bit higher than female breast cancer. And I guess also there's probably some risks.

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some respect elements, I guess, historically smoke, like lung cancer rates are higher among males than females, even now still. And that, I guess, historically, because males were much more likely to smoke than females. Yeah, yeah. Yeah, interesting. And it's interesting how you say that the absolute numbers have increased despite the lifetime risk staying the same. Out of the cancers that people are being diagnosed with,

12:09
Have there been an increase in some cancers versus others? Like, I don't know, I wonder whether lung cancer has, why I wouldn't know where lung cancer was in light of the changes in smoking and whether it's had a time to decrease yet, but what's changed? Anything changed in the types of cancers that people are being diagnosed with? Yes and no. In terms of the most common type of cancers, if you look back 20 or so years ago, the five most common, five most...

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commonly diagnosed cancers would breast cancer, prostate cancer, colorectal cancer, lung cancer, and melanoma. And nowadays, they are still absolutely the top five most commonly diagnosed cancer. But there are some cancers where the incidence rate has increased over the last few decades. And I guess some examples of thyroid cancer, liver cancer, kidney cancer. And conversely, there's some cancers for which we have seen a decline in incidence. And interesting that you mentioned lung cancer, because that's absolutely one.

13:08
Among males, the lung cancer rates have been decreasing, but among females, they've actually been increasing. And that's probably almost exclusively driven by those historical changes in smoking rates. So males were much more likely to smoke. Yeah, so I guess they had... And lung cancer is still much more common in males than females. So I guess it kind of had a... There's a higher point for it to start decreasing from, I guess, if that makes sense. And another example, more recent example is cervical cancer.

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the HPV vaccine and that's seen a quite sharp drop in incidence among cervical cancer in young women, so females under 30, which is a really positive public health story, I think. Yeah, that's amazing. And what about, Terry, you mentioned that thyroid cancer and liver cancer has increased. I mean, it's fine if you don't know, but any ideas why that would be? Yeah, no, I don't, to be honest. Yeah, I haven't actually ever...

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done any research into either of those cancers. Yeah, so I don't, yeah, that's not something I can really talk about, sorry. Yeah, it's interesting though, isn't it? Yeah. I mean, I think probably part of what we're seeing in Australia in terms of those, maybe those different increases in some of those rare types of cancer, some of that is probably driven by just by migration patterns. So, you know, with people with different ethnicities have...

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higher risks of some particular diseases for lots of different reasons. So sometimes they kind of, when they move to Australia, they kind of bring that increased risk for that particular cancer with them. So sometimes those kind of migration patterns can, I think, can play a part in the kind of cancers that we see. Yeah, yeah. No, that makes perfect sense. And are people being diagnosed younger nowadays, or is it just that we hear more about it because of what we see on the news or?

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social media or I don't know, those headlines that we were sort of talking about. Yeah, I've noticed that as well in the headlines in the last few years that there seems to be quite a few stories coming up about the younger people being diagnosed with cancer more often. So I had a look into that and yeah, there absolutely has been an increase in incidence in cancer among younger people. So people, adults age under 50. So in the

15:27
There was a report from the American Cancer Society last year where they really found this quite a clear shift in the demographics of people diagnosed with cancer. It's increasingly shifting from older individuals to middle-aged individuals. Cancer is absolutely still much more commonly diagnosed among older adults, but there certainly seems to be an increase in incidence in early onset cancers.

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just from earlier this year, which looked at the incidence of early onset cancers at a global level and they found that they'd increased by about 79% from between 1990 and 2019, which is a really huge increase in incidence among older adults. And in particular, breast cancer, tracheal cancer, bronchus and lung cancer, stomach cancer and colorectal cancer in particular, it seemed to be causing the...

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most disease and death in that younger age group. So I think there's lots of research going on at the moment trying to work out what's driving the increased rate of these early onset cancers. And of course your area is in sort of lifestyle, well I think lifestyle, looking at like physical activity, a large part of that. Like if you put your epidemiology hat on, do you sort of think, you know what, like given the modern lifestyle, this is why I would immediately think that's got to be a lifestyle shift rather than a genetic change because...

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hasn't been enough time for it to be genetically based, but I'm keen to hear, you know, like, are you, like, what are your thoughts? Yeah, I think my thoughts are, I think are very similar to yours. I think, yeah, we're given, yeah, that kind of amount of time. It doesn't, yeah, the genetic aspect, maybe doesn't really seem to, there might be a small aspect, but I think in the, yeah, the hypothesis seems to be more that it's driven by, yeah, like you say, modern lifestyle, the increased rates of obesity, yeah, decreased.

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physical activity levels and all of those kind of things. Yeah, Terry, on that with physical activity, I'm super interested to explore the idea of, or that your research area about sedentary behavior and of course the role that exercise can play in the management of and potentially treatment of cancer. But first, can you remind us what sedentary, like the definition for sedentary behavior? Because I wonder whether people...

17:52
really understand what that means to be sedentary. Yeah, sure. So I guess the sedentary behaviour over the last 10 or 20 years has really kind of popped up and received a lot more research attention as an independent risk factor that's distinct to not doing enough physical activity. So when we talk about sedentary behaviour, I'm going to use the sedentary behaviour research network definition because it's a really nice definition.

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the, and I'll quote it, so it's any sedentary behaviors, any waking behavior characterized by an energy expenditure that's less than 1.5 metabolic equivalent tasks while in a sitting or reclining posture. So it's kind of the three elements there are, do you have to be awake? The sleep isn't classified as sedentary behavior. It's when you're expending really low amounts of energy and while you're in that sitting or reclining posture. So yeah, I guess.

18:48
any, I guess, maybe what we're doing now, I think, would be classified as sentry behaviour. If you're a Formula One driver or something like that, where you are, you're awake, hopefully, and you're in a sitting or a gliding posture, but they expend huge amounts of energy. So that wouldn't be, even though they're sitting, that wouldn't be classified as sentry behaviour because it's, yeah, they're expending vast amounts of energy. Well, that's interesting, isn't it? Because I agree with you, and I, you know, when I

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they relate to me their role and that's largely sort of knowledge based career. So they're sitting in a computer, you know, in front of a computer, but they're thinking a lot. And then they're like, well, I mean, yeah, I'm sedentary, but you know, surely I'm, you know, expending something because of all of the, you know, my brain's doing all the work. Like, is that still sedentary behavior?

19:38
I think that would be still going as high as I find it in centre areas. Probably more the physical aspect of energy expenditure, maybe rather than the mental energy expenditure. Yeah, nice one. Although people do say your brain uses 20% of your overall energy expenditure over a day. That's right. And do you know what percentage of people are sedentary for Australia?

20:08
you may have data for. Yeah, that's good. That's a deceptively tricky question because I don't think there's really an established definition of what might be classified as high sedentary times. I think I was involved in writing a chapter for a book called Centrobehavioral Epidemiology. And one of the other chapters, I think, was really looking at this kind of descriptive epidemiology of centroid behavior. And they found that they looked at

20:37
literally thousands of studies from around the world and on average or the median estimate of total daily sitting time was about six and a half hours a day. But it's important to think about how sedentary behavior was measured. So when they looked at studies which use self-report to measure sitting time, the median was 5.6 hours a day. But when they looked at studies that had used some kind of device to measure sitting time, it was eight, the median was 8.3 hours a day. So you can kind of see.

21:04
Like we're talking about earlier, how the challenges in measure things, that's kind of a really good example there of how the way you measure something can give you a different estimate of what someone's sitting time actually is. And I guess, yeah, like I said, there's not really an established definition of what high sedentary time is, but I think from studies which have looked at sedentary behavior and risk of mortality, it seems to be risk of mortality starts to increase at around that.

21:32
like more than six to eight hours of sedentary time a day. And I think, again, based on what the authors of that particular chapter looked at, I think they found the median prevalence of high sitting time was around 32% across all of it when you kind of look at all of those studies as a whole. So yeah. Yeah. That's a huge section of population, which, you know, six hours though isn't...

22:01
I mean, no, it is, it's like a quarter of your day, but of course, ideally, you'd be eight hours of that would be in bed. But if I think about like the average working average in rotation marks, working day of about eight hours, and a large portion of the population would be sitting for that work, and then they'd be driving to work, and then they might be sitting down watching TV afterwards. They might go to the gym at some point during the day, or go for a run, but you're still

22:31
in that low activity state? Yeah, absolutely. And I'm sure I would put myself in that category, absolutely, where you're sitting in front of a computer all day. And then, yeah, so yeah, I think it's pretty easy to rack up six or eight or more hours of sitting time a day. So I guess that's something to be conscious of. And I think there's some research that shows that perhaps

22:58
trying to avoid prolonged bouts of sitting can be potentially beneficial. So, um, yeah, to not sitting for more than 20 or 30 or minutes, 20 or 30 minutes a time. That's kind of, that's something I'm, since I've done research on secondary behavior, that's something I've been kind of being conscious of, of trying not to sit for your really long periods of time, making it easier said than done, but wherever possible. Are you on a Swiss ball right now? Sorry.

23:22
Are you on a Swiss ball right now? No, no, no, sorry. I'm on a rotating chair. Oh, nice one. Yeah, yeah. Maybe around a little bit. Probably a nervous tech. Hey, so Terry, it's interesting, right, because sedentary behavior comes up a lot with when we think about obesity risk, the risk of type 2 diabetes. I spoke to David Dunstan actually. Yeah, yeah, yeah. A year or so ago. Yeah, yeah. And it was really, really interesting.

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and of course cardiovascular disease. And it feels like such an important sort of dial mover, but I find it interesting that today, you say, well, there's no real clear definition of this or this. Like what is holding the research back and being really definitive about what it actually is so we can therefore be more definitive about, I guess, sharing that information with people and bringing more public awareness, I guess.

24:21
I think a lot of it probably comes down to that kind of measurement issue where we know, I guess when you're using, so most studies to date have used self-reported sitting time or self-reported time watching TV or something like that. And we know this kind of element of measurement error that's involved in those kinds of things. And I guess because it's, I guess, I wouldn't say it's in its...

24:51
infancy still, but it's definitely, I guess, quite as a field, it's kind of quite young, particularly when you compare it to something like physical activity epidemiology, which has been going on for 30 or 40 years. So a lot of the big cohort studies haven't, like which were started in the fifties or sixties or seventies, they didn't really measure or have any information about sitting time. So yeah, we, I guess there probably isn't just the

25:20
vastness of studies, which we see for something like physical activity to get to be able to be more confident in how sedentary behaviour is affecting these particular health outcomes and particularly how much sedentary behaviour is detrimental. Yeah, because it feels like you sort of need a huge research grant to do some huge research.

25:44
observational trial where everyone gets Apple Watches or something, and you get like 100,000 people when you get their data over two years. That's a good idea. Yes, absolutely. And I mean, there are some more recent cohorts or, and I guess the UK Biobank is an example of that where they had, I think, 100,000. So they had, that was a cohort study in the UK of about half a million people. And they also had a subset of...

26:10
of that sample, so 100,000 people, which is a very big subset who wore an accelerometer for seven days on their wrist. So again, it's not the best measure of sedentary behavior, but it's perhaps better than self-report though. Yeah. Yeah. And I mean, I think people probably understand that sitting around a lot isn't that great for your health. What is the impact of sedentary behavior potentially on cancer risk?

26:39
Yeah, so again, that's something we don't really know all that much about. So yeah, so when we were putting together that chapter, or there was actually an update of that chapter a couple of years ago, we tried to find all the studies we could find that had looked at sedentary behavior and risk of different types of cancers. And we found there were about 120 or so that had looked at 21 different cancer sites and kind of based on the evidence from all of those studies.

27:08
we found that the higher levels of sedentary behaviour were associated with a small risk increase for some cancers, so colon cancer, endometrial cancer, ovarian cancer, and pancreatic cancer. Yeah, but we didn't have a huge amount of confidence in what those risk estimates actually were just because of the small number of studies which have been conducted to date. And then there was also a small increase for breast cancer, but again, yeah, that's just not really the...

27:37
the vastness of studies at the moment to have huge amounts of confidence in what those breast cancerous actually may be. Yeah. You know, if I think about sedentary behaviour, I think about its impact on excess body fat, poor metabolic health, and whether that is part of that relationship that might be driving cancer risk, which I know from a research perspective, you might not be able to see, I don't know, or can you?

28:06
Yeah, I mean, I guess what we do as epidemiologists is postulate or hypothesize about those potential biological mechanisms. And we look at experimental studies. And I know, as you say, they talk to David Dunstan and he's the baker, they've done lots of those kind of studies. So I guess in terms of how a syndrome behavior could potentially increase risk of different types of cancers, it's some of those things that you measured like...

28:33
body composition, so you increase adiposity or increase risk of obesity if you're more sedentary, or have higher levels of sedentary behavior, and also the impact of sedentary behavior on things like sex hormones, metabolic function, and inflammation and immune function. We know all of those things play a role in carcinogenesis or the development of cancer. So that's how we think that sedentary behavior could potentially be affecting cancer risk.

29:03
when researchers, when they're trying to isolate one particular factor as being, how important is this one particular thing? Whereas often behaviors cluster and it's patterns, right? So if someone is more sedentary, maybe they also are more inclined to eat less fruit and vegetables or to drink more alcohol or do less physical activity, which is in itself potentially a risk, like is associated with risk. So, and is it important to understand these independent risks?

29:33
factors or is it more important just to understand patterns of behaviour? That's a really good question. I think I'm going to sit on the fence and say both. I think both are things that are really important. That's your classic academic. Yeah. Yeah, but I think that's a really good point though because yeah, I guess that's absolutely one of the challenges when we are looking at, yes, how physical activity influences the risk of a particular cancer. We know that there's lots of different risk factors.

30:02
for different types of cancers and lots of those are lifestyle related. So it can be quite challenging to isolate how one particular risk factor affects a particular cancer. So I guess that's when we really need to think about confounding and really put in our causal inference hat and think about the difference between confounders and what might be mediating or biological pathways and those kinds of things to try and build statistical models which we think are most appropriate for that research question.

30:32
Yeah, interesting. And that's so interesting how you talk about it because of course, that's what you do. You're looking at like, I mean, I know you do more than this, but just in that instance, you look at data, you build statistical models to try and then you must swap things in and out to sort of see how much of something explains something else. I don't know, like it seems very complex, which I admire hugely.

31:00
Exactly. On no sedition. Yeah, there's definitely, yeah, there's, yeah, and like I said earlier there, we really spend lots of time thinking about confounding as epidemiologists and, yeah, to kind of trying to think about that. Yeah, I guess things like biological pathways and that kind of.

31:22
that kind of exposures and outcomes and what things are causing those particular exposures and what things are causing the outcome that we're interested in and that kind of interplay between all of those things. So yeah, we certainly spend a lot of time trying to take that into account as best we can. Yeah, sitting at your desk, working out algorithms. Spending a lot of mental energy. Exactly, but not as much as a Formula One driver. Exactly.

31:51
So if I think about flipping it on its head and thinking about activity, are there any misconceptions around physical activity for cancer patients? This is an entirely different subject now, I've moved on. What are some risks and like other misconceptions around the risks or benefits for physical activity for people with cancer? Yeah, I think there absolutely are. And I

32:20
where we know that like if you think back to probably 30 odd years ago, cancer patients, if you're diagnosed with cancer, I think the general advice was to rest, avoid physical activity, avoid strenuous activity as it was thought to probably be harmful to people who'd been diagnosed with cancer. But I think that the kind of early exercise oncology research, looking at how physical activity and exercise in cancer patients, which kind of started in the 90s and

32:50
2000s really started to challenge that misconception or that advice about avoiding activity. So I think there's still some uncertainty. Maybe it's kind of a hangover from, I guess, those misconceptions sometimes take a long time to go away. But I think there is some still uncertainty around there.

33:14
safety and suitability for exercise and physical activity in general for people with cancer and also a lack of awareness about all the benefits that exercise does have for people with cancer. Yeah. And what are those benefits? There's a huge number of benefits and there's been, and I think over the last 20 to 30 years,

33:43
exploded. So there's lots and lots of really good evidence showing that exercise and I guess, and specific doses of aerobic exercise or aerobic plus resistance training can improve lots of really common cancer related health outcomes like, and also not just physical health outcomes. So we're thinking about mental health outcomes as well. So things like anxiety, depression, symptoms, fatigue, physical function, health related quality of life.

34:12
I think also reduces risk of lymphedema as well and other kind of outcomes. There's also evidence, not as strong as some other outcomes, but things like peripheral neuropathy and perceived cognitive function as well. So I think, yeah, so this is just like a myriad of benefits, I think, for exercise and physical activity after the cancer diagnosis. There's also...

34:37
And also in terms of actually increasing survival as well after being diagnosed with the cancer. So from observational studies, there's quite an accumulation of accumulating evidence that physical activity can improve survival in people with colorectal cancer and breast cancer and prostate cancer. And I know there's all of those, there's actual randomized controlled trials going on as we speak. So I guess, you know, to give more.

35:05
generate stronger evidence about how exercise can potentially improve mortality in people diagnosed with those cancers. And I think there's lots of people, including me, who are very much looking forward to seeing the results of those RCTs. Yeah, sure. And is it, Terri, is it for people who were previously or would consider themselves active people, or is it more beneficial for active people over people who were formerly sedentary? Like, is there a difference there between level of benefits?

35:35
I think in terms of cancer, for cancer patients, I think, um, I think in the general population, and I think it would be the same in, in, in people diagnosed with cancer, absolute, like I said, a population level, absolutely the kind of the biggest bang for your buck is if you go from the biggest, the most improvements you might see in health, uh, when you go from doing nothing to doing something and something can be a very, very low level of activity. But yeah, that's that, when you kind of think about how physical activity can improve.

36:02
reduce cancer risk or improve these health outcomes is definitely that kind of initial step from going from doing nothing to doing something is where you really see the big health outcomes and for most of those health outcomes it's absolutely kind of the more you do and the more these health outcomes will improve and the more your risk of these things like cancer are going to decrease as well. Yeah yeah that's yeah what a great point because it's where you're even though we were talking about the management of all this collectivity throughout

36:31
treatment, it's obviously there's a risk reduction for people to be active to help reduce risk of being diagnosed with cancer as well. Yeah, yeah, absolutely. Yeah. And that's somewhere where, like I said, my earlier, my PhD was on physical activity and risk of colorectal cancer. And there's been for lots and lots, there's been literally hundreds of probably thousands of studies looking at physical activity and reduced risk of...

36:59
lots of different cancers. And I think there's really, really good evidence now that physical activity reduces the risk of a wide range of cancers. Yeah. And there was a review which came out a couple of years ago, which looked at all these studies that looked at physical activity and reduced risk of different cancers. And I think they concluded there was really strong causal evidence that being physical activity reduces the risk of seven different types of cancers. So breast cancer, colon cancer, bladder.

37:27
endometrial kidney, esophageal adenocarcinoma and gastric cancer. And then also, and moderate or weaker evidence for an additional eight different cancer sites. And they were non-Hodgkin lymphoma, rectal cancer, head and neck cancer, myeloma, myeloid leukemia, liver, small intestine and gallbladder cancer. So that's, I think how much, they're all together 15 different cancer sites. That's right. Yeah. So those, and given...

37:54
There are a really large number of studies that have been conducted on some of those cancers. I think we can be quite confident that being physical activity is absolutely beneficial for reducing cancer risk. You know, Terry, I hear information like that and I'm aware of it and I'm an active person myself. And I feel really lucky actually that I discovered that being active was awesome when I was like a teenager. You know, so I've had decades of being active and I really feel for people who aren't in my position where it's...

38:23
feels like a hard task to become active. Though, with the data that is available on prevention for so many chronic diseases, like I still, if I say it baffles me that more people aren't active, like I said, like that's not motivation enough is I often, I'm like, wow, really? That's not going to motivate you to do it? I don't know. Do you, you're in the field. Do you feel similarly?

38:49
Yeah, I guess I do to an extent. I mean, yeah, I don't really do much work in terms of physical activity interventions, trying to increase physical activity. Yeah, but I do. And I know there's lots of thought and lots of discussion about the best kind of health promotion messages and guidelines and how we can get people to be or how we can get the population to be more physically active as a whole.

39:19
physical activity levels I think are pretty stable. So there's not, it seems to be a very challenging thing to do to increase physical activity levels. And I guess, I think it all, as I put my public health add on, public health add on, public health add on, that's difficult to say. And we think about things like the social determinants of health. So I think, yeah, I think I'm like you, or I'm maybe like in a quite privileged position in terms of...

39:46
I mean, knowing about the benefits of physical activity and being able to, um, you know, to be physically active. But we think, you know, we know lots about, you know, the postcode that people are born in influences their health outcomes and also how, how, how easy it may be for them to do things like, you know, go to a gym or, and that kind of, what kind of infrastructure is in their area to allow them to be physically active, like walking paths and bike paths and those kinds of things. So I think it's also important to kind of think.

40:14
more broadly rather than putting it solely at that kind of individual level. Yeah, for sure. And it's definitely worth mentioning probably that just because you're physically active doesn't necessarily prevent you from getting cancer. Because of course, so many people who live very healthy lifestyles are still diagnosed with cancer. So I guess it's not like it's a get out of jail free card. Of course, I want to acknowledge that, but it's not like an alternative.

40:42
Yeah, yeah, absolutely. Yeah. Yeah. 100% reiterate that. And I think, yeah, that's, I guess, one of the challenging things about cancer is that kind of element of randomness. Yeah. Or chance. And yeah, whether that's things, whether that is random, randomness or things that we don't understand fully yet. Yeah. And I'm sure everyone knows people that have done all the right things and have still ended up being diagnosed with some kind of cancer. Yeah, yeah, for sure.

41:10
Before we move on into looking at resistance training particularly, I think you raised a really good point when you were talking about the benefits of physical activity. Just benefits in everyday life is of course for our mental health and how good we can feel. And as I understand it, people who go through a cancer diagnosis really benefit from that psychological aspect of being physically active. Yeah, that's right. And I guess...

41:39
Yeah, so things like anxiety and depression and fatigue and those kind of things are much more, if you have been diagnosed with cancer, you're generally at a higher risk of experiencing one or more of those mental health related challenges because of the side effects of cancer and treatment and those kinds of things. So I think that's really positive news that there's quite good evidence showing that engaging in physical activity, be it aerobic or resistance training, can help.

42:08
to improve those kind of common cancer related side effects. Yeah. And Terry, with regards to research and weight training, and particularly resistance training, what does the research tell us about the relationship there with cancer and resistance training? For resistance training and risk of cancer, I think there's only really been, I think, I'd probably say less than 10 cats.

42:36
tests are less than 10 studies which have looked at this. So I don't think we really know too much about how you're engaging in weight training. I guess when we're talking about weight training and just training with thinking about those kinds of exercises which strengthen the muscles really. So things like weight training, even things like yoga and Pilates I think can kind of fit under that broad muscle strengthening exercise umbrella. Yeah, there's been a few studies on colorectal cancer and they've generally found that...

43:05
engaging in your resistance training and muscle strengthening exercises may decrease the risk of colorectal cancer, but for other cancer types, it's probably a bit early to know what may be, whether there's any associations going on there. Yeah. And your, because you did, did you do a randomised controlled trial in this? No, no, not a randomised controlled trial, but I did do a, or was involved in a, a, a

43:33
systematic review and then also an actual study where we looked at resistance training or weight training and risk of mortality, so all-cause mortality and then cancer-specific mortality and cardiovascular mortality. Yeah, that's right. And that was the one where women tended to respond better than men, is that correct? Yeah, that's right. In the study where we used data from a big cohort study from the United States.

44:02
collaborators from the National Cancer Institute in the US. So we found that engaging in any amount of weight training was associated with a lower risk of all-cause mortality as well as cancer mortality and cardiovascular mortality. There were risk reductions around 6% to 10%. So not enormous, but definitely still quite meaningful. Yeah, and interestingly, and like you mentioned, we found larger mortality risk reductions among females than males.

44:30
and we don't really know why that is. We didn't really think of any reason for that. And I think there's other studies which have looked at those potential sex differences, haven't really found any difference. So yeah, it could potentially just be a chance finding rather than anything real. But I think we really need more studies to see if there is a difference.

44:59
super interesting that any amount of resistance training and under that umbrella, we're thinking yoga, pilates, you're in a gym, you're using bands or any type of muscle strengthening exercise in that state is going to be beneficial. Yeah, that's right. Yes. In that study, I was just talking about we only had even information specifically about weight training. So I guess, which would traditionally be the kinds of, I guess, using weight machines and those kind of things at the gym or dumbbells and barbells, that kind of thing at home. But in the

45:29
in the systematic review we did of all the studies which have looked at every assistance training they had. Um, yeah, most of those had, yeah, those other kinds of, um, muscle strengthening exercises under that broad umbrella of resistance training, yeah, things like yoga and Pilates. Yeah. Yeah. And it doesn't really seem to require much, um, in terms of that, what that dose response, but yeah, again, I guess maybe like with physical activity, it's, it's really going from, if you go from doing nothing to doing

45:57
some level of resistance training, then you're going to see some health benefits in terms of reducing your risk of mortality. Yeah. And did you know the sort of pre exercise history of the participants per se in the study that you did particularly? No, we only really had information about weight training at that one point in time in that baseline measure. And I think that's definitely an avenue for

46:25
future research where if you can have, if you have information about resistance training at multiple time points and that gives you, again, thinking back to the measurement kind of issues as well, that also gives us a lot more kind of more robust estimate of how much your resistance training, for example, people are doing if we have information at like three or four different time points, two years apart or something like that. Yeah, for sure.

46:53
Like muscle cacaxia and that loss of muscle mass across the treatment of cancer. Is this one area where you think the weight training could be beneficial? Is that something that any of your research has investigated? I haven't really done much in terms of resistance training in people with cancer. I haven't done any research in that, but I think that's definitely, yeah, but I think one of the reasons that you have resistance training can potentially be useful for and

47:22
health outcomes in people with cancer is that by doing exercises that are strengthening your muscles, it is helping to reduce things like cocaxia and those kind of things. And then I think also allowing you to actually do aerobic physical activity as well. Yeah, so I think there's absolutely a synergy I think between resistance training and aerobic

47:52
I think they probably both lend themselves to improvements in the other. Yeah, nice one. And I guess from like, I have a bit of knowledge on, I guess, the number of people who might do resistance training in the general population, not a lot, which means that probably there's a lot to be gained, as you said, like novices in the area. If you were in that situation, hadn't yet done resistance training, then you've got a lot of potential benefit from doing it in the case of, you know,

48:21
whilst you're undergoing treatment, et cetera. Yeah, yeah, absolutely. Like you mentioned, I think in the general population, the prevalence of weight training is, I think it's less than 20%. Yeah. It's very, very low. So I guess, yeah, I think if there are those potential, I guess via mortality benefits for the general population or those more, your benefits in more particular health things for people with cancer, if at a population level, given the low prevalence at the moment, there's definitely potential to increase.

48:50
improve lots of those health outcomes at the population level by increasing prevalence. I actually started doing weight training after being involved in that study. Oh, did you? Nice one. That's good. One of my questions was going to be like, how has your research sort of changed the things that you do in your life? So obviously, that's one of them. Yeah, absolutely. Yeah, I think like I mentioned before in that, you're doing a PhD on sedentary behaviour and I guess that was back, you know.

49:19
15 or so years ago when sedentary behaviours. Research was really starting to kind of take off. So yeah, actually reading all of those studies and understanding that difference between sedentary behaviour and not doing enough physical activity. I think that absolutely changed my health behaviours. Yeah. You have a standing desk, Terry. I do. At home, I don't.

49:41
So I'm at home at the moment, so I'm sitting, but at my work, I have a set stand desk. Oh, that's good. But yeah, for confession, it's in the set position rather than the stand position. Oh, what I find for me personally is that I can do standing when I'm doing interviews is really fine, or I'm doing messaging with some of my clients or my groups. But if I have to actually think, and then if I'm prepping for an interview or if I'm doing some writing, I have to sit. I'm not one of these people who can walk in pairs.

50:10
and think at the same time like I just cannot do that multitasking. Yeah, I'm exactly the same. Yeah, so if I'm doing data analysis or writing a manuscript or something like that, I have to engage my brain a bit more than normal. I find sitting much more conducive to that. Yeah, 100%. Hey, Terry, one other study I wanted to ask you about was one that I saw related to like both, I think,

50:36
polygenic risk for cancer. I'm not sure if I've said that correctly, but where you're looking at, where your research group were looking at multiple genes and risk of cancer, I think that's right. Can you just give me a little bit of a background into what you guys were actually looking at in that study? Because I think people would find it really useful to understand more about what the research is really interested in.

51:02
Yeah, sure. So I guess what we're really interested in that study was looking at the combined effect of genetic risk factors for cancer and lifestyle related risk factors for cancer. Yeah, so like we've talked about, we know there's lots of lifestyle factors that are associated with the risk of lots of different cancers. And we also know that genetic factors also have an important role in the development of cancer. So what we, I guess, really wanted to look at in that study was whether the relationship between...

51:30
those lifestyle related risk factors and cancer risk differed by genetic risk and also whether there might be particular population subgroups. So for example, those who are at high genetic risk of cancer, whether they may benefit more or benefit less from lifestyle intervention programs or by adhering to lifestyle recommendations. So that was kind of the rationale for why we went about doing that study. Yeah. How do you even investigate that?

51:57
I rely on people who are much more expert in genetic epidemiology than I am, so the other members of the team. But I guess in terms of actually understanding what someone's genetic risk is, yes, like you mentioned, we used polygenic risk scores and I'll have my best go at explaining what that is. Do it. I would understand anyway, so it doesn't even matter. So basically, you know, there's hundreds of... Humans have hundreds of thousands of genetic

52:27
variants and through what are known as genome-wide association studies, researchers can investigate which of those genetic variants is associated with the risk of a particular disease or a particular trait. But on their own, those individual genetic variants typically have very, very little impact on the risk of a particular disease, for example, of particular cancer. But when we actually look at them, assess them collectively.

52:55
And that's what we're doing when we use a polygenic risk score. We're kind of looking at all of those genetic variants and how they influence a cancer kind of as a whole. Then we can see that they actually do having a greater number of those genetic variants can quite substantially increase the likelihood of developing some cancers. So yeah, they really have that kind of utility in helping to identify people who may be at a higher genetic risk of particular cancers.

53:21
Yeah. And then of course, you mentioned that you then look at them through the lens of the lifestyle behaviors that also place someone at additional risk. So what kind of lifestyle behaviors and actually what kind of, I guess, ultimately, what were the strongest associations that you found, that your team found? In terms of, yeah, so we looked at lifestyle as a whole. So rather than looking at the individual risk,

53:50
Rather than looking at individual risk factors, we looked at adherence to lifestyle recommendations as a kind of index that we used. There's an organization called the World Cancer Research Fund, which is really the authoritative body on these lifestyle-related risk factors and cancer risk. They have put together some recommendations for these lifestyle-related risk factors to prevent optimal cancer prevention.

54:19
things, takes into account things like physical activity, being a healthy weight, eating whole grains, vegetables and fruit and vegetables, limiting intake of fast food, limiting intake of red meat and processed meat, limiting sugar sweetened drinks, limiting alcohol consumption, not smoking and being sun smart. So we basically we kind of use those to develop a lifestyle index.

54:47
based on we didn't have information on all of those. So we used the UK Biobank, that study that I talked about earlier. Yeah. So the information that we did have all of those, we kind of essentially created a lifestyle score for each individual based on how closely they adhere to the recommendations for each of those individual risk factors. I can't imagine many people would have like had close to all of those factors. Am I right?

55:14
I suspect you are. I don't have that information on hand here. I would be surprised. I think that the maximum score that someone could get was seven. So if they ticked off everyone, I suspect there weren't very many sevens. But off the top of my head, I don't know. That's a good question. Yeah. In my PhD, one of the things I looked at was a cluster of just like four behaviors slash health outcomes.

55:42
the usual ones, fruit and veg, physical activity, alcohol, B, or not smoking and BMI or something like that. And they were like, I don't know, maybe 4.1% of the population or based on the data that we have and use it like tiny, tiny amount of people actually do all the things which we are suggested to do. So yeah, I suspect I would be like you surprised if lots of people were doing everything right, quote unquote. Yeah.

56:11
from your paper, and of course we will pop the link to this in the show notes. There were no, as I understand, there was no evidence for multiplicative interactions, so multiple interactions, but there were significant additive interactions for certain cancers. So can you just briefly outline what those were and what that means? What does it mean when something's an additive risk factor? Yeah. Yeah, sure. Again, this is something that...

56:39
Well, these are that difference between multiplicative. I have troubles. I mean, that's multiplicative interaction, additive interaction. It's really subtle. And to be honest, I have to kind of go back and read papers for about an hour or so to really understand, to get my head into that space. But I guess basically, again, I will have a go at explaining this. Well, we're I guess when we're talking about interaction in general, that we're basically kind of looking at the combined effect of two or sometimes more to sometimes more than two exposures or risk factors on a particular health outcome.

57:10
and whether the effect of one of those exposures on a health outcome is different in different types of people. So I guess we're kind of really thinking is the whole of the combined effects of those two things more or less than the sum of the two individual parts or of the product of the individual parts and that kind of sum or product is really the difference between additive and multiplicative interaction. So if we're...

57:34
If we're testing whether the combined effect of two things is more or less than the sum of the individual parts, so adding them together, then that's where we're testing for additive interaction. And if we're thinking about whether the combined effect of those two exposures is more or less than the products and we multiply them together, then that's when we're looking at multiplicative interaction. So it's kind of like if you've got two things, if it's a multiplicative, you'd get this absolute explosion in terms of risk.

58:03
Like it's way more than the sum of those two things together. It's actually like, whoa, these two things together are really increasing risk over and beyond or decreasing risk above and beyond what you would expect. Yeah. So yeah, so if it's multiplicative interaction, then yeah, it's more than the product of those things. Yeah, yeah, yeah. Yeah, that's right. So again, so it's been, I think historically it's been much more common to look at multiplicative interaction and perhaps because that's from a statistical.

58:32
perspective or analysis perspective, that's much more straightforward to do than it is to additive interaction. But there's quite good arguments, I think, that assessing additive interaction is probably more relevant from a public health perspective, and even for clinical decision making. Because when we're looking at additive interaction, it's really giving us insight into whether there might be population subgroups, which may be best to treat or to deliver an intervention in.

59:01
in this study we decided to look at, we looked at both multiplicative and additive interaction, but with I guess what that additive interaction and test is giving us information about whether following lifestyle recommendations could potentially prevent more cases or fewer cases of cancers in people with a higher genetic risk of cancer than in the same number of people with a low number of, like in the same number of people with a low genetic risk of cancer. Yeah. And

59:29
As I understand it, there were some cancers, there were some significant findings for. Can you brief us on them, Terry? Yeah, so overall we found that the great adherence to lifestyle recommendations was associated with a lower risk of overall cancer and also of eight specific cancer types. So we looked at 13 common cancers and we found significant risk reductions for eight of those. So there were colorectal cancer, postmenopausal breast cancer.

59:57
Lung, kidney, uterine, pancreatic, bladder and oral cavity cancers. Yeah, so for all of those cancers, yeah, it's greater adherence to lifestyle recommendations was associated with a reduced risk of those things. And that was independent of genetic risk. So that didn't, so regardless of whether you're at a low genetic risk of cancer or a high genetic risk of cancer, adhering to those lifestyle recommendations lowered your risk of those particular cancers. Nice.

01:00:26
into consideration that the genetic component, there were some significant findings there as well? Yeah, that's right. Yeah. So for some specific cancers, I think that's a colorectal cancer, breast cancer, and pancreatic cancer, we found that adherence to lifestyle recommendations for cancer prevention may be of even greater benefit for those who are at a high genetic risk, high genetic risk for those particular cancers. Yeah. And so from like when...

01:00:56
you guys conduct studies like that, like it could have significant public health implications right for how you might then target specific populations and the public health messages that they might get. Is that where this kind of research heads? Like what can we do with this information I guess? Yeah I think, yeah I guess that's the idea is you might accumulate evidence from these kind of studies to get more confidence in the results and yeah I guess that can potentially

01:01:26
you have sections of the community or those who are at high genetic risk of cancer, who may be more likely to get more bang for their buck, so to speak, out of being physically active and not smoking and all of those kind of things. So I think there's definitely potential for public health messaging and those kind of things to maybe target those people who are at high genetic risk of cancer. I think really the thing I was most excited about.

01:01:54
from this study was actually finding that the risk reductions for all those different types of cancers was independent of genetic risk, so it didn't really matter. Even if you were at high genetic risk of cancer, you still know that following those lifestyle recommendations can reduce your risk of that cancer, which I think is a really powerful message, I think. Oh, 100%. You're right. And because this means you don't necessarily have to go and pay out of pocket for...

01:02:23
genetic testing to discover what your risk is to then go, is it a really good idea if I go do resistance training and stop smoking? And I mean, even saying that, I mean, of course, it's a good idea to do resistance training and stop smoking, but I think messages, you're right, messages like that, like the whole lifestyle message has real possibility for people who may need, I don't know, additional motivation or something to get out and actually do things to help reduce risk for overall negative health outcomes, I don't know.

01:02:53
Yeah, yeah, absolutely. Yeah, I agree 100%. And yeah, I think it's, um, I guess, yeah, but perhaps there's a kind of a misconception that if you are at a high genetic risk of some of these cancers and there's not really much you can do about that. Whereas, yeah, I think, yeah, I think, you know, like studies like ours, yeah, so that, yeah, there, there are actions that you can, you know, take in your, take in your life or changes you can make to your lifestyle that, that can actually have an effect on your.

01:03:18
risk of developing a particular cancer. Yeah, nice. And now all we need really, Terry, are like multi-billion dollar marketing campaigns given to that public health can roll out that are as compelling as say McDonald's. And then we may see some sort of traction in that public health space. Yeah, I think that's the dream of people working in public health here. I think the reality is that, you know, in Australia, and I'm sure I'm...

01:03:46
New Zealand is the same. Yeah, the actual kind of from a government or federal budget perspective, the amount of money that goes towards prevention is very, very small. Yeah, for sure. Unfortunately. I know. So Terry, where next or what are you focused on now with regards to your work in this particular field? At the moment, I'm working on a few different things. At the moment, I guess one is looking at using the UK Biobank.

01:04:14
I have a PhD student who's looking at physical activity and risk of cardiovascular disease and also looking at how physical activity might influence a survival in people who've been diagnosed with different types of cardiovascular disease. I think that's, yeah, we're seeing some really exciting results for those studies. I've got a kind of a new research interest is looking at...

01:04:40
hopefully applying for grant funding to look at risk factors for second cancers, which is kind of a new area for me, but I'm quite excited and hoping to get some funding to be able to look at that kind of thing. That's right, because you wrote, was it for the conversation? Or was a publication earlier this year looking, asking the question, if I have one cancer, what's my risk of giving

01:05:10
cancer recurrence or the same or different type of cancer, right? Yeah, that's right. Yeah, so I co-wrote that with a postdoc from We Hide the World for Eliza Hill Institute. I hope I said that correctly. Something like that. Yeah, and that's not something... I guess for that article, I was looking specifically at that second...

01:05:38
that second thing you mentioned. So if you've been diagnosed with one cancer, what are you at a higher risk of being diagnosed with a second unrelated cancer? Yeah. That's not something I'd really looked into very much before. But yeah, I guess through writing that, in doing the research to write that article, I found that there's quite good evidence that if you have been diagnosed with some kind of cancer, that you are at a higher risk of developing a second primary cancer. And estimates from Australia...

01:06:07
suggest that risk increases somewhere between 6% and 36%. And varies quite a lot by the type of initial cancer that you may have been diagnosed. But yeah, as a kind of overall, that seems to be where that is. One thing that really surprised me was that of all the cancers that are diagnosed today, at least in Australia, and again, I'm sure the same in New Zealand and most developed countries, around one in five of those are diagnosed in people who have a previous cancer diagnosis.

01:06:37
diagnosed in someone who's already had cancer before, which I'm still even saying that now I'm still really surprised that that figure is as high as it is. And a lot of that is driven by improvements in treatment, improvements detection and those kinds of things. So people with cancer are living longer than ever before. But yeah, I guess the unfortunate consequences that is that they are more likely to develop a second cancer just because they're lim-

01:07:05
just because they're living longer. Yeah. And Terry, what is your project hoping to investigate? What is your grant looking at? Yeah, it's really to look at those kind of lifestyle-related factors, I guess, to do some similar work where we get developing those kind of lifestyle indexes to look at whether adhering to those lifestyle recommendations as a whole can potentially reduce your risk of developing a second cancer and also, I think, looking at those...

01:07:35
those risk factors individually as well, because there's not a huge amount of research out there that has looked at those kind of modifiable risk factors and what role they could play in development of a second cancer. Nice one, Terri. And I've got to say, in this particular area, I don't think you'll ever be short of a research question or anything like that, because it seems like for every question that is answered, another five seem to pop up, you know, when it comes looking at chronic disease and the rest of it, and particularly cancer. Like, I don't know.

01:08:04
And I know that there are inroads being made in certain areas of treatment and whatever, but then it seems like there's an explosion of cases and I don't know, it feels all a bit... I understand it's something that might be on people's mind quite a bit because as you say, people know someone with cancer, then themselves have been diagnosed with a cancer and it seems prevalent really.

01:08:25
Yeah, that's right. And like you say, I guess, yeah, that's one of the, one of the, one of the things I enjoy working about working in cancer is, yeah, we have this, you know, there's lots of different cancers to study. And lots of them have quite different risk factors. And we also know like some cancers like colorectal cancer, where we, there are lots of established risk factors that we know about where there's other cancers. I guess, like I've done some work in non-Hodgkin lymphoma where, yeah, the, the, there's just, yeah, the evidence isn't really there for a lot of the, for.

01:08:54
in terms of risk factors. So yeah, I enjoy that challenge. Yeah. It's like job security if there's funding. I guess so, yes. Yeah, it's just a matter of getting the funding to actually do the research. Yeah, totally. Hey, Terry, thank you so much for your time this afternoon. I really appreciate it. I will put a link to your research gate and your Twitter and of course, your bio in the show notes.

01:09:21
Is there a webpage or anything where people can find out more about what your research group is up to? Where is the best place to find out that sort of emerging stuff? Yeah, probably the best is my UniSA staff profile. That would probably be the most comprehensive information and that's, yeah, and the most up to date information. Yeah. Awesome. Terri, thank you so much. That's okay. My pleasure. Thank you. Yeah, you're welcome. And enjoy the rest of your afternoon. Thanks.

01:10:00
Alrighty, hopefully you enjoyed that chat that I had with Dr. Terry Boyle and just some super interesting research coming out there which just gives us indication and look there's probably a lot of it might make logical sense that if you live a healthier lifestyle then you're going to be at less risk of diseases like cancer but I really like knowing some of the ins and outs of that research so I hope that you got something from that interview as well.

01:10:28
Alright team, next week on the podcast I speak to Daniel Rolands who is a running coach all about training for ultras because you know that's something I'm super interested in. So I look forward to sharing that with you. Until then though you can catch me over on Instagram, threads and Twitter @mikkiwilliden, Facebook @mikkiwillidenNutrition or head to my website mikkiwilliden.com

01:10:56
Alright team, have the best week. See you later.