The nation was stunned on Monday when the World Health Organization announced that hot dogs are not healthy…said no one, ever. We all knew—or at least had a sneaking suspicion—that those little tubes of mushy meat product were a questionable dietary choice at best. But if I’m completely honest with myself, sometimes they just hit the spot. And sometimes they’re the only thing those little maniacs that terrorize my husband and me on a daily basis (a.k.a. our offspring) will eat. You know I’m right.

So why the uproar? Is it because the WHO report used the “c-word?” Or because they compared processed meats to cigarettes? Or perhaps because they told us eating processed meats increased your risk of cancer by a whopping 18%? Probably all of the above, plus the fact that it got so much press (thanks, Mark Zuckerberg). Imagine if a report came out tomorrow about smoking. It would be loaded with terrifying (and real) statistics like “smoking increases your risk of lung cancer 25-fold” and “smoking causes 90% of all lung cancers.” It would, rightfully so, get a lot of attention.

I have compiled a list of Frequently Asked Questions about the report and shared it below. For educational purposes, the WHO definition of processed meat is “meat that has been transformed through salting, curing, fermentation, smoking, or other processed to enhance flavor or improve preservation.” Okay, now we know. Moving on.

1. Does the study apply to me? Probably, but maybe not. As a physician, you want a research study to use a population of patients that is similar to the one you treat. Otherwise, it’s less helpful (and, at times, completely useless). The WHO combed through over 800 epidemiological studies, which were done in multiple countries spanning several continents. Many ethnicities and diets were included in the mix. That’s good, right? Well, yes. It means that the information is probably generalizable for a lot of people. It also means they compiled data from many different studies to include lots and lots of people, which typically strengthens research. But it can also potentially water down the data. Let me show you what I mean:

-Situation 1: In a Pennsylvania town, which is predominantly Amish, almost everyone consumes only food that can be produced within the community without using modern conveniences. However, a small portion of the population eats 50 grams of processed meat daily. The difference in health between the Amish folk and the processed meat lovers will likely be drastically different for reasons other than the differences in processed meat consumption.

-Situation 2: In a poor Southern town, the population tends to eat more affordable foods which tend to be less healthy overall. In this group, the difference in health between someone who eats 50 grams of processed meat and someone who does not will probably not be very different.

Now, average the two studies. See what I mean? This is an extreme example, but it illustrates what the WHO scientists did in their analysis. Which is fine, because they’re the World Health Organization. But when you try to apply their research to a specific population (i.e. Americans), just be careful that you don’t under- or overestimate the impact of the thing being studied. My point is this: We are in America. Americans tend to have a Western diet which can differ drastically from the diets followed in other countries.

2. Have I already screwed the pooch and given my child cancer because of that week he ate only hot dogs for every meal? No.

3. An 18% increased risk of cancer sounds like a lot. What does that really mean? You’re right, it does sound like a lot. But it’s all relative. If your lifetime risk for developing colorectal cancer is 80%, then an 18% increase brings your risk up to a whopping 94.4%! Ain’t nobody got time for that. Likewise, if your risk is 0.5% (hardly worth worrying about), then an 18% increase brings that up to 0.59% (still hardly worth worrying about). Something else will most likely kill you. In reality, the average lifetime risk of developing colorectal cancer is 1 in 20, or 5%. So, a daily diet rich in processed meats would be associated in a nearly 1% increase in colorectal cancer.

Just being human puts you at 5%. Adding processed meats adds another 0.9%.

4. But seriously, though. Cancer is no joke. That’s not a question, but whatever. I get your point. And I agree with you that cancer is no joke. But here are some things to consider:

-Colorectal cancer is a cancer that can be screened for. This means that more cancers are found at early (i.e. treatable and even potentially curable) stages. This is one of many reasons it’s different from a cancer like lung cancer (see below for others).

-Speaking of colorectal cancer screening, it is estimated that if everyone received screening for colorectal cancer according to the guidelines, it would result in a 40% decrease in cancer. That’s because colonoscopies not only allow us to take a look at the colon to see if there are any cancers there to be treated, it also allows us to remove precancerous lesions before they ever cause problems to begin with.

An ideal screening test is applicable to most of the population, screens for a relatively common disease, and changes outcome by diagnosing disease at an earlier stage or preventing the disease altogether.

But anyway, back to my original point: Colorectal cancer screening can reduce your risk from 5% to 3%. That’s a 2% absolute risk reduction. More than two times the increased risk attributed to processed meats.

5. Is eating processed meats the same as smoking a cigarette? The WHO compared the two because they both result in exposure to carcinogens that have been linked to cancer and they both have shown to be associated with an increased risk of cancer in epidemiologic studies. But I want to give you some perspective. The WHO scientists attributed an 18% increase in colorectal cancers to eating 50 grams of processed meats daily. Cigarette smoking results in a 15-30 fold increased risk of lung cancer (the wide range has to do with amount of exposure, both in years and packs per day). Said another way, that’s a 1,500-3,000% increase. Wow. Even the low end of that range is something I want nothing to do with.

And here’s one more little statistic nugget for you: the IARC says there were 34,000 deaths attributable to processed meats in 2012, and 8.2 million cancer deaths total. Feel free to check my math, but, by my calculations, that works out to 0.4% of all cancer deaths (not all deaths) caused by excessive processed meat consumption. On the other hand, smoking is blamed for about 30% of all cancer deaths. So yeah, that’s 2.5 million.

Bottom line, everything can be bad for you if taken in a high enough quantity. Literally everything. Illicit drugs? Of course. Medications? Certainly. Foods high in fat/carbs/etc? Uh-huh. Water? Yes, even water. Processed foods lie somewhere on that spectrum, closer to the other harmful foods than either illicit drugs or water.

Did I write this piece to make light of cancer or to give blanket permission to eat whatever you want “all day err day?” Of course not. But I give each and every one of the [five] people reading this article permission to not be perfect 100% of the time. And if you are in fact reading this, you probably already think about what you put in your body day in and day out, and you probably don’t eat 50 grams of processed meats a day. If you do…stop it! It’s bad for many reasons, not just for increasing your cancer risk. But if you have the occasional hot dog, don’t kill yourself over it. The most successful dieters are the ones for whom nothing is completely off limits.

Processed meats are just one of many things in this world that contributes to your daily risk of dying. Here are some others: Car crash, plane crash, train crash, bus crash, bike crash, stabbing,… okay, the internet is telling me I’m running out of space, so I’d better wrap it up.

In conclusion, there’s enough badness out there to keep you worrying 24/7. Just try to do your best, make good decisions most of the time, and enjoy living.

That is all.

I referred to the following when writing this:

“Cancer Facts & Figures 2014”

Cancer.org

“Carcinogenicity of consumption of red and processed meat.” Véronique Bouvard, Dana Loomis, Kathryn Z Guyton, Yann Grosse, Fatiha El Ghissassi, Lamia Benbrahim-Tallaa, Neela Guha, Heidi Mattock, Kurt Straif on behalf of the International Agency for Research on Cancer Monograph Working Group. Published Online: 26 October 2015

CDC.gov

International Agency for Research on Cancer

“Long-term colorectal-cancer incidence and mortality after lower endoscopy.” Reiko Nishihara, Kana Wu, Paul Lochhead, Teppei Morikawa, Xiaoyun Liao, Zhi Rong Qian, Kentaro Inamura, Sun A. Kim, Aya Kuchiba, Mai Yamauchi, Yu Imamura, Walter C. Willett, Bernard A. Rosner, Charles S. Fuchs, Edward Giovannucci, Shuji Ogino, Andrew T. Chan, New England Journal of Medicine, September 19, 2013, 369:1095-1105

My brain

WHO: Processed meat cancer report message ‘misinterpreted.’ The Irish Times. Friday, October 30, 2015.