I really want to help spare people dying unecessarily

Inarie Jacobs, based in South Africa, is a dietitian and early career researcher into nutrition and cancer

Being a WCRF Academy Fellow has given me an incredible opportunity to meet experts and researchers working in the field of cancer prevention and nutrition.

In my final year of studying dietetics at university, we had the opportunity to do our own mini research study. I really enjoyed the process, decided to do a master’s degree and became interested in public health nutrition. Research on dietary intake related to breast cancer risk is still lacking in low- to middle-income countries like South Africa, where rates of breast cancer are rising – despite being treatable when detected in the early stages, it is currently the second leading cancer in black South African women.

Meanwhile, urbanisation has seen traditional, more nutritious dietary patterns give way to a westernised one, including refined grains, sugar and processed foods. Over-nutrition in the form of obesity is a known breast cancer risk factor in post-menopausal women, whilst nutrient deficiencies in under-nutrition may be linked to an increased breast cancer risk.

My MSc research was affiliated to the South African Breast Cancer (SABC) study, and the bursary I received from WCRF while completing it was tremendously helpful. Our results showed that nutrient-rich, less energy-dense foods such as fresh fruit may decrease breast cancer risk while more energy-dense, nutrient-poor foods such as soup powders, potato chips and sauces may increase breast cancer risk in black South African women. This tallies with WCRF’s Cancer Prevention Recommendations for a healthy diet, and with the South African Food Based Dietary Guidelines.

However, it is also clear that obesity and overweight co-exist with low physical activity in black South African women, playing an important role in developing breast cancer. This can be modified through changes in behaviour and attitude, but we noted that high poverty rates play a key role when food choices need to be made, as ‘healthier’ (less energy-dense and nutrient-rich) food products cost more than ‘unhealthier’ ones in South Africa. We recommended affordable and sustainable interventions, and prioritising existing policies to promote healthy lifestyle choices, reduce obesity and increase physical activity. WCRF helped greatly in raising the profile of my research findings via a blog.

I am currently working at Bambisana Hospital as part of the community service year which all medical and allied health graduates complete in South Africa, often in very rural and disadvantaged areas. I’m helping to educate and treat inpatients, as well as outpatients needing dietary advice. Working with very sick patients, especially children and premature babies, can be challenging, but I like sharing my knowledge to help patients adapt to a healthier lifestyle, and seeing their nutritional status and wellbeing improve is very rewarding.

Until a few years ago, I didn’t pay much attention to being a healthy weight, exercising and eating nutritious food. But my work as a dietitian and my cancer prevention research have made me realise how much I took being healthy for granted. My dietary habits have changed a lot and I try my best to exercise on a regular basis. Hopefully I can influence people around me – if I can change my mindset about a healthy lifestyle and cancer prevention, so can others!

Being a WCRF Academy Fellow has enabled me to start building a network of scientists and researchers I hope to collaborate with in the future. I was chosen to complete a two-day master class on nutrition and cancer, held at Wageningen University in February 2019 in collaboration with WCRF and Wereld Kanker Onderzoek Fonds. Being young in a scientific and academic environment can sometimes feel overwhelming and intimidating, but meeting other students as well as experts was very inspiring. It made me realise that getting results in this field is a marathon and not a short sprint! I learned about the diversity of approaches to cancer research across the globe, and the different methods researchers are using.

Great work has recently been done by the National Department of Health in South Africa to establish and promote cancer prevention policies. South African public health organisations are currently promoting WCRF’s cancer prevention guidelines and the South African Food Based Dietary Guidelines. Meanwhile, foods such as fresh fruit and vegetables, dried beans, lentils and brown bread are already excluded from taxes, as an approach toward making healthier foods more affordable, while the tax on sugary beverages was also implemented as a method to reduce the ongoing high sugar consumption that may contribute to high obesity rates.

However, even though we have policies and platforms to create awareness of a healthier lifestyle, micro-nutrient deficiencies and low fruit and vegetable intake in South Africa remain worrisome and may lead to an increase risk for cancer and other non-communicable diseases. The government needs to prioritise behavioural change programmes, raising public awareness of cancer risk factors and nutrition education. WCRF’s NOURISHING policy database together with the Driving action to prevent cancer and other non-communicable diseases policy framework are excellent tools for this.

But so much more research is needed. I would like to follow up on the results of this study and look into the effect of micro-nutrients and breast cancer risk. I would also like to follow up on dietary patterns in South Africa and how it relates to breast cancer risk.

My maternal grandfather lost his battle against cancer in 2006. I was very young at the time, but I remember what impact his death had on my grandmother and mother. I also have friends who have lost parents due to preventable cancers – I really want to contribute to cancer prevention with further research, to help spare people dying unnecessarily.