PROBLEM: Consider the case of Yuki
Masuda.
Mrs. Yuki Masuda is a postmenopausal
48-year-old native Japanese housewife who has recently returned to Japan
after living in Canada for almost 20 years. Mrs. Masuda is approximately
15 kilos overweight. She has come to your office because she is a somewhat
worried about developing breast cancer later in life. Many of her friends
in North America have had relatives or acquaintances who have had breast
cancer, but she is not sure whether she should be overconcerned since she
understands that fewer Asian women develop this disease than women in the
West.
In interviewing Mrs. Masuda you discover that she likes to stay at home;
she doesn't exercise much; she is a moderate drinker; she eats quite a
bit of beef and pork; she cooks a lot of her food using sweet coconut oil
or margarine; she dislikes most vegetables; and she prefers to eat Western-style
desserts like rich cakes and ice cream.
"I love traditional Japanese food when
I go to restaurants," she says, "but at home my husband and I
are so used to Western cooking that I very seldom cook in the traditional
style." Mrs. Masuda tells you that occasionally she likes to eat three
or four desserts at one time. "I try to diet, I try to skip eating
breakfast," she says, "but after a few days of dieting like this,
I have to have something sweet and delicious. I'm not sure that dieting
will make much difference, in fact, since all the women in my family become
overweight as they get older. I am not interested in becoming slimmer or
more beautiful. I just want you to tell me what I can do so I don't get
cancer." Mammograms and other laboratory tests indicate that Mrs.
Masuda is cancer-free, but her LDL-level is above normal. So, in addition
to being overweight, tests indicate that she has consumed too many of the
wrong kinds of food.
Mrs. Masuda has come to receive your advice. You need to explain the basic
risk factors for her developing breast cancer as well as other health problems.
She needs to better understand the links between lifestyle choices like
diet and health problems like breast cancer. In addition to general ideas,
such as telling her to increase her intake of vegetables and fruits, you
need to suggest good reasons why she should moderate her food consumption
and vary the kinds of food she eats. Since Mrs. Masuda, overall, is a highly
logical person, it may be possible to convince her to introduce changes
in lifestyle that will improve her health. Please help her.
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BELOW for case analyses from second-year students at Miyazaki Medical College.