1. Comedian Michelle Wolf assessment of White House Press Secretary Sarah Huckabee Sanders’ eye makeup at White House Corespondent's Dinner on 28 April 2018. -Michelle Wolf Jokes About Sarah Huckabee Sanders’ Eye Shadow https://www.thecut.com/2018/04/sarah-huckabee-sanders-eye-shadow-michelle-wolf-white-house-correspondents-dinner.html?utm_source=tw&utm_medium=s3&utm_campaign=sharebutton-t
2. Roseanne Barr's assessment of former Presidential Aide Valerie Jarrett's role in President Obama's administration through the editorialising of her physical presence.
I am truly sorry for making a bad joke about her politics and her looks." - Roseanne Barr compares black Obama aide Valerie Jarrett to an ape – and later apologizes (29May18) https://cnb.cx/2LHW4Rt
3. Samantha Bee's 'comedic' suggestions to Ivanka Trump on a method for changing President Trump's policy making. “Let me just say, one mother to another, do something about your dad’s immigration practices, you feckless c—. He listens to you. Put on something tight and low cut and tell him to f—— stop it. Tell him it was an Obama thing and see how it goes, OK?” - Samantha Bee apologizes after savaging Ivanka Trump with expletive-riddled rant (30May18) https://www.haaretz.com/us-news/samantha-bee-calls-ivanka-trump-feckless-c-nt-conservatives-cry-foul-1.6136341
When Toronto oncologist Pamela Goodwin first began searching for a link between obesity and breast cancer in the early 1990s, she was hunting out on the wilderness edge of her specialty.
But as the ranks of the overweight soared in the ensuing three decades, so has the evidence that it's strongly associated with more than a dozen forms of the disease.
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"At this point, I think the oncology community believes there's a link between obesity and (the) risk for most cancers," says Goodwin, head of the breast cancer program at Mount Sinai Hospital.
"And they believe that obesity contributes to the outcomes for many cancers."
Indeed, the cancer risks stemming from excess weight likely rival those of obesity related heart attacks, according to several large studies looking at the connection.
And an influential panel of the St. Gallen International Breast Cancer Conference — a semi-annual meeting that helps determine best practices for the disease around the globe — recommended weight loss and exercise programs be prescribed as part of a care package.
Frustratingly, despite massive public health efforts obesity rates, continued their relentless climb among adults in the United States over the past decade, a study published earlier this spring revealed.
(Canadian rates, though likely less severe on the upper end of the scale, typically follow those south of the border, Goodwin says.)
Goodwin, whose interest was piqued by a small number of intriguing but little-noted studies she read while doing a fellowship at Toronto's Princess Margaret Hospital a quarter-century ago, says most physicians and researchers dismissed a potential link at the time.
And Dr. Jennifer Ligibel, a Harvard University breast cancer physician and scientist, says it remained poorly understood until very recently.
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"It has gained much broader attention in the last few years," says Ligibel, who leads an American Society for Clinical Oncology panel that promotes awareness of the obesity link within the specialty.
However, "there has been a lack of understanding among physicians but even more in the general population."
Ligibel says a U.S. poll conducted eight years ago indicated only 7 per cent of the adult population knew of the weight-cancer connection.
A repeat poll conducted last year showed that knowledge had spread to 31 per cent of adults — numbers far smaller than those who were aware of the links between such things as smoking or sun exposure and cancer.
According to a research paper in March in the Journal of the American Medical Association, 40 per cent of the U.S. adult population is now obese.
Ligibel says a 2016 World Health Organization analysis of the myriad studies that had looked at obesity and cancer development showed that at least 13 types of the disease were associated with excess weight. And while she and Goodwin admit there is still no scientific proof that obesity causes cancer, they say there's overwhelming evidence that it's a significant factor.
"Every year there was more evidence," says Goodwin. "Every major study supported this being an important factor. I think there's enough evidence to be really concerned and to have spent my whole career focusing on this area."
The elusive "causal" link, Goodwin says, may well be drawn out of a large-scale study that she and Ligibel are now conducting in Canada and the U.S. that will look at the effects of a weight-loss program on breast cancer recurrence in obese women.
Known as the BWEL — or Breast Cancer Weight Loss study — the project is still in the enrolment phase but will eventually track some 3,100 patients over 10 years.
"We know that women who are overweight or obese when they're diagnosed with breast cancer have a higher risk of breast cancer recurrence compared to leaner women," says Ligibel, who adds that more than 100 studies have shown this particular connection.
"We're really interested in seeing if we can change that by helping women lose weight after they've been diagnosed with breast cancer."
The study will divide patients into two groups, both of which will receive standard breast cancer treatments and weight-loss advice, but only one of which will be entered in a two-year diet and exercise program.
Exercise, Goodwin says, is a double-barrelled weapon against cancer for obese people — not only ridding their bodies of risky fat, but also producing its own disease-fighting effects.
A higher, exercise-produced muscle mass, for example, will counter the types of cancer-boosting properties created in fat tissue, while physical activity helps to lower levels of some hormones known to abet tumour growth, she says.
And even modest weight losses can produce major effects, Goodwin says.
"We think losing as little as 5 per cent will lead to physiological changes that may improve health outcomes as well as breast cancer outcomes," she says.
The BWEL study "will give us the proof we need not only to show it's causal but to show it's reversible," Goodwin says.
Christine Friedenreich, a cancer epidemiologist with Alberta Health Services, is another pioneer in the obesity and cancer field, having studied the link for the past 27 years. And she is also excited about its emergence into the forefront.
Friedenreich, whose main research specialty is the effects of physical activity on cancer, says there have now been more than 400 studies conducted on that subject and that many show exercise reduces the risks for many forms of the disease.
"When we started our research in the early 1990s in this area, there was quite a lot of skepticism in the oncology community about how exercise could even be used with cancer patients," she says.
"The general feeling was these people are already very tired and we can't ask them to exercise during their treatment or post-treatment."
But Friedenreich says trial after trial showed that patients could not only exercise during chemotherapy and other treatments but that they felt better for doing so — and had better outcomes.
"Now we've gotten to the point where groups like the American Cancer Society and Canadian Cancer Society … are actually starting to come up with guidelines, kind of like exercise prescriptions," she says.
These guidelines are setting out things like exercise intensity, intervals and varieties for different types of cancers and symptoms, Friedenreich says.
One breast cancer patient who participated recently in Mount Sinai's Taking Charge exercise and healthy living program says it gave her new hope after the traumas of her diagnosis, surgery and chemotherapy. The program is geared to recovering cancer patients at the hospital.
Joyce, who did not want her full name used, says the program helped her feel better. "It's also allowed me to take control of my life back after all of that."
Finding ways to reverse or prevent weight-caused cancers is critical because the obesity epidemic that's gripped much of the western world is here for the long run, Goodwin says.
"We have an obesogenic society," says Goodwin, who edited the first issue of the prestigious Journal of Clinical Oncology devoted entirely to obesity and cancer in 2016. "And by that I mean we have ready access to cheap, high-calorie food, we have a culture that is based around eating" those foods, she says.
Goodwin says it's hard for many to navigate past those caloric hazards, especially while sitting in front of the electronic screens that now command much of our waking attention.
This is particularly true among the young, she says, increasing the potential for the epidemic to gain a generational endurance.
"I'm dating myself but when I went to school we had phys-ed classes every single day, we were active," Goodwin says. "And then we would walk to and from school ... but the kids now don't have that experience."
In its one bright spot, however, the March report — gleaned from the U.S. National Health and Nutrition Examination Survey — showed obesity rates had plateaued among young people in the years 2015 and 2016 compared to a 2007 and 2008 sampling.
The survey showed that 18.5 per cent of American youth aged 2 to 18 were currently obese, which was virtually identical to the numbers reported in the earlier study.
Alarmingly and unexpectedly it also showed that the percentage of obese adults had risen more than six points from the 33.7 per cent who were overweight in the 2007-2008 survey.
Neither Goodwin nor Ligibel believes an increased knowledge of obesity's cancer link can significantly reverse the epidemic in the way that the association between cancer and smoking caused tobacco use to plummet over the past five decades.
First of all, they say, the connection between cancer and smoking is much more profound than the one that links obesity and various forms of the disease.
"The link between smoking and cancer was a 12-fold elevation … so strong nobody can deny it," says Goodwin, head of Mount Sinai's breast cancer program. "With obesity and cancer it's a weaker link."
With breast cancer, for example, obesity is responsible for a 30-per-cent risk increase in postmenopausal women, Goodwin says.
"Obesity is a contributing factor rather than the major causal factor for breast cancer and for all the obesity-associated cancers," Goodwin says.
"Smoking is the major causal factor for lung cancer … and the other smoking related cancers."
More importantly, however, obesity is a far tougher nut to crack than smoking, Ligibel says.
"The message of 'don't smoke' is easier than the message of how you prevent someone from becoming obese," Ligibel says.
"The factors that have led to obesity increasing at the rate that it has in both of our countries are really kind of woven into the societal fabric."
In the absence of any foreseeable shift towards leanness, drug therapies might provide a partial solution.
The popular and inexpensive drug Metformin — used as a first-line medication for Type 2 diabetes — holds promise as a cancer-fighting agent.
In a bombshell discovery more than a decade ago, it was found that diabetics who were on the drug had lower cancer rates than those Type 2 patients who were not.
Metformin, which costs a nickel a pill, helps lower circulating insulin levels in the body, says Vuk Stambolic, a senior scientist at Toronto's Princess Margaret Cancer Centre. And that hormone, which is found at higher levels in obese people, is believed to be one of the key contributors to the cancer link, Stambolic says.
Indeed, insulin presents a double hazard to obese people with the disease, he says. Not only do they have a glut of insulin, but many breast, brain and colon cancer cells bristle with excess receptors for the hormone, Stambolic explains.
These receptors bind large amounts of insulin to the cells' surface, where the hormone activates pathways within that cause the cancer cells to divide and spread.
Similar, insulin-triggered pathways within the cancer cells may also prevent them from dying when they naturally would.
"So not only is (the cancer cell) more hardy in respect to production of new (cells), it's also more hardy in respect to not dying," Stambolic says.
Stambolic is currently helping to lead a large-scale study looking at the effectiveness of Metformin in combating breast cancers.
Known as MA.32, the Phase III study is run through the Canadian Cancer Trials Group and includes some 3,650 patients — 40 per cent of whom are obese — in Canada, the U.S., the United Kingdom and Switzerland.
The decade-old trial, — which divided patients into Metformin and placebo cohorts — is nearing completion. Results are expected in about two years.
Goodwin adds that the weight-loss programs can also have profound effects on insulin levels, with each 1-per-cent loss in body weight leading to a 3-per-cent drop in the hormone.
"If you have 5-per-cent (weight) reduction it goes down 15 per cent. If you have a 10-per-cent reduction it goes down 30 per cent," she says. "That may be enough to sort of move the needle."
Other potential pathways that could lead from obesity to cancer include the increased estrogen and inflammation levels found in many overweight people, Goodwin says.
High estrogen levels are a known contributor to the growth and spread of many forms of breast cancers.
And inflammation can alter the micro-environments that surround cancer cells in ways that can stimulate metastasis, Goodwin says.
"In an obese micro-environment we have an influx of inflammatory cells into the (fat) tissue and those inflammatory cells then directly impact the growth of the cancer cells," she says.
The inflammatory cells release a lot of enzymes known as cytokines and proteins that stimulate the growth and spread of cancer cells, Goodwin says.
Metformin also lowers inflammation in obese people, she says.
Ligibel adds that obesity can help compromise the immune system, which can play an active role in cancer prevention and suppression.
Like many researchers, Goodwin has had to scrape for funding, especially in her wilderness days.
And the $25-million Metformin trial was nearly dead on arrival because no company wanted to supply the generic drug.
That's when Barry Sherman, then the head of the Canadian drug giant Apotex Inc. stepped in.
"Barry Sherman, in a five-minute phone call, gave us free drug and, more importantly, placebo (pills) which cost him more money than the drug," Goodwin says of the pharmaceutical mogul, who was slain along with his wife Honey in their North York home last December.
"He had to stop the production line at the Mississauga plant every six months" to provide the placebo, she says. This went on for eight years.
As keen as Goodwin is to prove and promote the obesity-cancer link, however, she is just as determined to see that feelings of guilt over their illness not be heaped on top of the weight-shaming her patients often face.
"What I really worry about is … that people are getting the message that you caused your cancer, or worse, that you caused your cancer to come back," she says.
"Obesity, physical activity, body composition, these are contributing factors. But it's very unlikely that these factors alone were the cause of the cancers."
