The adults are busy at work, the older children may be out with friends and the younger ones are ‘glued’ to the screen. Not an unfamiliar scene for a family and thus having a sit down family meal can be a rare occasion. Does it matter if we seldom sit down for family meals?

Researchers at University of Illinois at Urbana-Champaign performed a meta-analysis on 17 published studies examining the relationship between frequency of shared family mealtimes and nutritional health in children and adolescents (Pediatrics, published online May 2011; doi: 10.1542/peds.2010-1440). A total of 182,836 children and adolescents (mean sample age: 2.8 – 17.3 years) were studied. Children and adolescents who share ≥ 3 family meals / week are more likely to be of normal weight, have healthier dietary and eating patterns and are less likely to engage in disordered eating. The benefits of sharing ≥ 3 family meals expressed in percentage terms are – the odds for being overweight, eating unhealthy foods and disordered eating are reduced by 12%, 20% and 35%. Moreover the chance of the children and adolescents eating healthy foods is increased by 24%.

Having a sit down family meal provides a focal point for the whole family to slow down and catch up with each other’s activities for the day. Parents can ensure that the children have at least one decent nutritious meal a day. At the table, children get a chance to air their grievances about school and boast about their achievements. Parents can glean a lot of information on a child’s behaviour or mood from his / her interaction at the table. The benefits of a shared family meal are innumerable and known to our ancestors / elders. While we do not need scientific proof of the benefits, the study above certainly helps to remind us about the importance of having family meals.

‘How long do you take to perform this procedure / operation?’ - a question that I am frequently asked by patients and relatives in Singapore. Why? I wondered. To gauge the complexity of the procedure or to plan how much time to set aside to accompany the patient? Or it is really used to gauge how good the doctor is?  The shorter the time, the better the doctor. Is that a good indicator?

Let us take colonoscopy as an example. Colonoscopy has been shown to be an important and effective preventive procedure for colorectal cancer (CRC). It has been shown that endoscopists who take a longer time to withdraw the scope during endoscopy achieve a higher rate of adenoma polyp detection. (Adenoma polyp, if left untreated, will evolve into colon cancer over time.) Several studies have been done to look at which processes constitute good colonoscopy practice. However, few have been carried out to look at what parts of the practice affects patient outcome. For example, does the type of endoscopist and the setting where the procedure is performed influence patient outcome?

A recent study from University of Toronto studied individuals in Ontario diagnosed with CRC between 2000 and 2005 (Gastroenterology 2011; 140: 65 -72). The researchers determined how many of these individuals with cancer had had complete colonoscopies 7 to 36 months before the diagnosis. These patients were defined as having developed a post colonoscopy colorectal cancer (PCCRC). The researchers then determined if endoscopist factors, such as volume of endoscopy, polypectomy and completion rate, specialization and setting where the procedure was carried out, were associated with PCCRC. A total of 14,064 patients had had a colonoscopy within 36 months. Of these, 1260 (8.95%) had developed a PCCRC. Patients with a proximal cancer were more likely to have a PCCRC than patients with distal cancer. Non-surgeon and non-gastroenterologist endoscopist is associated with PCCRC. When the colonoscopy is performed in a non-hospital based setting, it is associated with PCCRC. Patients undergoing colonoscopy performed by an endoscopist with a completion rate of ≥ 95% were less likely to have a PCCRC than those patients who had colonoscopy by an endoscopist with a < 80% completion rate. For proximal PCCRC, endoscopists with a polypectomy rate ≥ 30% were less likely to have patients with PCCRC. The volume of colonoscopies performed by an endoscopist had no influence on the PCCRC rate.

To me, the study shows that the training of the endoscopist and how meticulously he performs the procedure will impact significantly on the outcome. To be meticulous you cannot be hurried. If you do not want to be hurried, you will take more time to complete the task.

My standard answer to the question ‘How long do you take to perform this procedure / operation?’ is “It will take as long as it is necessary to do a good job”. I will, howeve,r tell the patient a time range but I cannot be precise about how long the procedure will take.

I have had patients who moved onto a different doctor because ‘my time’ is longer than the other doctor’s. A patient has rights and the choice is his / hers.

The majority of people who develop cancer do not develop it because they possess a cancer gene. The most likely cause for the cancer is related to what our body has been exposed to through the years and these carcinogens increase our risk of developing cancers.

At the recent 9^th American Association for Cancer Research (AACR) International Conference of Frontiers in Cancer Prevention Research, researchers from the University of California studied 2265 women with breast cancer (Abstract B88, 8^th Nov 2010). These women, from northern California and Utah, were diagnosed between 1997 and 2000. About 80% had early-stage breast cancer. The study found that women who were current or past smokers were 39% more likely to die from breast cancer when compared to never smokers. As compared to never smokers, the risk of dying from non-breast cancer causes was increased 116% in current or past smokers. Further analysis of the data showed that body mass index (BMI), menopausal status and tumour HER2 status can adversely affect survival in this population of current or past smokers. Being postmenopausal, having a BMI < 25 kg / m² and having HER2-negative tumour will adversely affect breast cancer survival by 47%, 83% and 61%, respectively.

Researchers from Prague in Czech Republic presented their study on 533 female lung cancer patients and 1971 control subjects at the CHEST 2010: American College of Chest Physicians Annual Meeting (Abstract 9365, 2^nd November 2010). Milk and dairy products, vegetables and physical exercise were found to exert protective effects among smokers. None of these factors were protective for non-smokers. However, black tea was found to exert a protective effect on non-smokers.

Although smoking is known to cause cancers, heart and lung diseases, millions and millions of people worldwide are still puffing away. The best way to prevent getting ill health is not to smoke at all. To those smokers who have developed breast or lung cancers, there is still some things you could do to help yourself, albeit a little bit late. But like the saying goes ‘better late than never’.