diet & other lifestyle factors in hereditary breast ......international differences in diet...

Diet & Other Lifestyle Factors in Diet & Other Lifestyle Factors in Hereditary Breast & Ovarian Hereditary Breast & Ovarian

CancersCancers

Nagi Kumar, Ph.D., R.D., FADANagi Kumar, Ph.D., R.D., FADAH. Lee Moffitt Cancer Center & Research Inst.H. Lee Moffitt Cancer Center & Research Inst.Senior Member/Professor, Oncologic SciencesSenior Member/Professor, Oncologic SciencesUniversity of South Florida College of MedicineUniversity of South Florida College of Medicine

Scientific Themes (Kumar Group/Lab)Scientific Themes (Kumar Group/Lab)(1) Contribution of psychological, social and (1) Contribution of psychological, social and physiological basisphysiological basis of obesity, body of obesity, body composition and the resulting modulation of composition and the resulting modulation of steroid hormones as it relates to cancer steroid hormones as it relates to cancer risk/survival; risk/survival; (2) The role of nutrients, nutrient(2) The role of nutrients, nutrient--derived derived agents and other nonagents and other non--toxic agents in cancer toxic agents in cancer chemopreventionchemoprevention, treatment and survival, treatment and survival; &; &(3) Understanding the (3) Understanding the biobio--behavioral etiology of behavioral etiology of cancer disparitiescancer disparities and developing and testing and developing and testing the safety and efficacy of novel trans disciplinary the safety and efficacy of novel trans disciplinary interventions to reduce, and ultimately eliminate, interventions to reduce, and ultimately eliminate, these disparities. these disparities.

Causes of CancerEstimate percentage of total cancer deaths attributable to established causes of cancer

TobaccoAdult diet/obesity

Sedentary lifestyleOccupational factors

Family history of cancerViruses/other biologic agents

Perinatal factors/growthReproductive factors

AlcoholSocioeconomic status

Environmental pollutionIonizing/ultra-violet radiation

Prescription drugsMedical procedures

Salt/other food additives/contaminants

0 5 10 15 20 25 30 35

3030

5

3

1

2

Source: Harvard Report on Cancer Prevention, Cancer Causes and Control, November/December, 1996

Current Treatment Strategies for BRCA1 Current Treatment Strategies for BRCA1 and BRCA2 Carriersand BRCA2 Carriers

Hormone ModulatorsHormone ModulatorsRiskRisk--reducing salpingoreducing salpingo--oophorectomy oophorectomy Prophylatic mastectomyProphylatic mastectomyGenetic CounsellingGenetic CounsellingSurveillanceSurveillanceExploring other options ..Lifestyle Exploring other options ..Lifestyle Factors..?Factors..?

Laboratory StudiesLaboratory Studies

International Differences in Diet International Differences in Diet & Cancer Incidence& Cancer Incidence

Africa, South Africa, South and Central and Central America, America, Caribbean,Caribbean,Japan, Japan, China, IndiaChina, India

Europe, Europe, USA, USA, Canada, Canada, Australia, Australia, New New ZealandZealand

5050--90% fruits, 90% fruits, vegetables, grainsvegetables, grains1010--25% meat, dairy25% meat, dairysugars, fats andsugars, fats andotherother

2525--55% fruits, 55% fruits, vegetables, grainsvegetables, grains4545--75% meat, dairy,75% meat, dairy,fats, sugars fats, sugars and otherand other

Migration Studies Migration Studies -- Comparison of Cancer Comparison of Cancer Incidence (Annual/million)Incidence (Annual/million)

S ite Jap an e sein Ja p an

Jap an e sein H aw a ii

U SC au ca s ia n

C o lo n 7 0 3 7 1 3 6 8

R e c tu m 9 5 2 9 7 2 0 4

B re a s t 3 3 5 1 2 2 1 1 8 69

Migration StudiesMigration StudiesIncidence of Breast Cancer in Japanese Incidence of Breast Cancer in Japanese

Women Rate per 100,000Women Rate per 100,000

0

10

20

30

40

50

60

Japan Hawaii(FirstGeneration)

Hawaii(Second

Generation)

Secular TrendsSecular Trends

Seventh Day Adventists in the USSeventh Day Adventists in the USVegetarian, noVegetarian, no--porkpork

50% lower mortality rate for Breast Cancer50% lower mortality rate for Breast CancerLower Colon Cancer/heart disease rates Lower Colon Cancer/heart disease rates than the US Populationthan the US PopulationAfrican populations in the USA African populations in the USA –– disparity disparity in cancer mortality and morbidityin cancer mortality and morbidity(W Africans, Jamaica, Bahamas, etc)(W Africans, Jamaica, Bahamas, etc)

Biological PlausibilityBiological Plausibility

Advances in Molecular Oncology/geneticsAdvances in Molecular Oncology/geneticsCarcinogenicity of environmental factorsCarcinogenicity of environmental factorsNutrients can alter genetic & epigenetic eventsNutrients can alter genetic & epigenetic events

Essential NutrientsEssential NutrientsPhytochemicals or allelochemicalsPhytochemicals or allelochemicals

(Bioactive secondary compounds in plants)(Bioactive secondary compounds in plants)--Zoochemicals Zoochemicals –– conjugated linoleic acid, nconjugated linoleic acid, n--3 fatty 3 fatty

acidsacidsObesity Obesity –– hormonal changeshormonal changesSun ExposureSun ExposureTobacco/chronic alcohol intakeTobacco/chronic alcohol intakeLack of Physical activityLack of Physical activity

Obesity & CancerObesity & Cancer

Obesity Trends* Among U.S. AdultsObesity Trends* Among U.S. AdultsBRFSS, 1985BRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%



No Data <10% 10%–14% 15%–19%



No Data <10% 10%–14% 15%–19% ≥20%



No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%



No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008

(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)

1999

2008

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Disease Risk/Consequences of Disease Risk/Consequences of Obesity = Rising Health Care costsObesity = Rising Health Care costsHypertension Hypertension StrokeStrokeRenal DiseaseRenal DiseaseGallbladder DiseaseGallbladder DiseaseDiabetes mellitusDiabetes mellitusPulmonary DiseasesPulmonary DiseasesOsteoarthritisOsteoarthritisGoutGoutBreast & endometrial Breast & endometrial Cancer

Abnormal plasma lipids Abnormal plasma lipids and lipoproteinsand lipoproteinsImpaired cardiac Impaired cardiac functionfunctionProblems during Problems during surgery with anesthesiasurgery with anesthesiaSleep apneaSleep apneaInflammation Inflammation

Cancer

Weight Gain in Adult Years and Risk Weight Gain in Adult Years and Risk of Heridetary Cancersof Heridetary Cancers

Progressive Weight Gain Through AdulthoodProgressive Weight Gain Through Adulthood

Body Fat DistributionBody Fat Distribution

““Perils of PortlinessPerils of Portliness””--Consequences of Consequences of android/abdominal obesityandroid/abdominal obesity

Breast CancerBreast Cancer--Risk x5 foldRisk x5 foldEndometrial cancerEndometrial cancerPolycystic ovary syndromePolycystic ovary syndromeCVD/CAD/HypertensionCVD/CAD/HypertensionGallbladder DiseaseGallbladder DiseaseAdult onset DiabetesAdult onset DiabetesInsulin resistanceInsulin resistanceMetabolic Syndrome Metabolic Syndrome Adult weight gainAdult weight gainHighly correlated with Highly correlated with

visceral fatvisceral fatWeight gain in the 30Weight gain in the 30’’ss

((Kumar et al)Kumar et al)

Potential Mechanisms ProposedPotential Mechanisms Proposed

Mechanisms proposed Mechanisms proposed ––adipose tissueadipose tissue--induced increased concentrations of induced increased concentrations of estrogens and insulin, thyroid dysfunction, estrogens and insulin, thyroid dysfunction, bioavailable insulinbioavailable insulin--like growth factors, leptin, and like growth factors, leptin, and cytokines. cytokines.

Reduced immune functioning, Reduced immune functioning, Chemotherapy/Other preventive therapy dosingChemotherapy/Other preventive therapy dosingDifferences in diet and physical activity in obese and Differences in diet and physical activity in obese and nonobese patientsnonobese patients

Body Composition/Hormones in Breast Body Composition/Hormones in Breast Cancer Survival (Kumar et al, Cancer Survival (Kumar et al,

Cancer,2002)Cancer,2002)

Android Obesity Android Obesity -- risk and for survivalrisk and for survivalObesity at diagnosis Obesity at diagnosis -- adverse prognostic adverse prognostic indicatorindicatorAbdominal Obesity at diagnosis Abdominal Obesity at diagnosis -- Hazard Hazard ratio of 2.5 ratio of 2.5 Risk of recurrence Risk of recurrence -- 1.331.33--1.5 times higher 1.5 times higher --obese vs nonobese vs non--obeseobese1.6 times greater risk of death in gainers vs 1.6 times greater risk of death in gainers vs nonnon--gainersgainers

Android Obesity at Diagnosis and Android Obesity at Diagnosis and Risk of Breast Carcinoma SurvivalRisk of Breast Carcinoma Survival

Android ObesityAndroid Obesity-- What do we know?What do we know?Central/Android Obesity is an independent Central/Android Obesity is an independent powerful predictor of disease, including Breast powerful predictor of disease, including Breast CancerCancerCentral/android obesity is highly correlated to Central/android obesity is highly correlated to visceral obesityvisceral obesityWaist:Hip Ratio >0.8Waist:Hip Ratio >0.8--Android ObesityAndroid ObesityAlters steroid hormone profileAlters steroid hormone profileGeneticGenetic-- similarities w/firstsimilarities w/first--degree relativesdegree relatives--significancesignificanceWeight loss in early adult life (age 18 to 30) protects Weight loss in early adult life (age 18 to 30) protects against earlyagainst early--onset BRCAonset BRCA--associated breast cancers.associated breast cancers.Weight gain should also be avoided, particularly Weight gain should also be avoided, particularly among BRCA1 mutation carriers who elect to have at among BRCA1 mutation carriers who elect to have at least two pregnancies.least two pregnancies.

Change in Body Composition with Change in Body Composition with weight loss weight loss –– Yes, There is Hope!Yes, There is Hope!

It is not all Gloom & Doom !It is not all Gloom & Doom !Carcinogenesis is a complex biological Carcinogenesis is a complex biological process, process, genetically determinedgenetically determined and and environmentally modulatedenvironmentally modulatedNutrition, Physical Activity and other Nutrition, Physical Activity and other lifestyle factorslifestyle factors may play a Critical may play a Critical Role in modulating carcinogenesisRole in modulating carcinogenesisVariations in penetrance between Variations in penetrance between individuals who are carriersindividuals who are carriersFactors other than gene mutation may Factors other than gene mutation may influence the risk in susceptible womeninfluence the risk in susceptible women

Nutrients as Nutrients as ””Chemoprevention Chemoprevention AgentsAgents””--The promiseThe promise

A DietA Diet--Derived agent that can prevent Derived agent that can prevent the induction and inhibit the the induction and inhibit the development of preinvasive and development of preinvasive and invasive cancer and its progression.invasive cancer and its progression.AntiAnti--promotion and Antipromotion and Anti--progression progression agentsagents that prevent the growth and that prevent the growth and survival of cells, already committed to survival of cells, already committed to become malignantbecome malignant

PhytochemicalsPhytochemicals or allelochemicalsor allelochemicals(Bioactive secondary compounds in plants)(Bioactive secondary compounds in plants)

--ZoochemicalsZoochemicals –– conjugated linoleic acid, nconjugated linoleic acid, n--3 fatty acids3 fatty acids

Cell Fate:Cell Fate:Rationale for ChemopreventionRationale for Chemoprevention

APOPTOSIS(ProgrammedCell Death)

MATURATION/DIFFERENTIATION

PROLIFERATION

CHEMOPREVENTION:

••••

Mutagenesis

Programmed DeathMaturation/DifferentiationProliferation

MUTAGENESIS

Chemoprevention Chemoprevention --OpportunityOpportunity

In most epithelial tissues In most epithelial tissues ––Accumulating mutations (i.e.,genetic Accumulating mutations (i.e.,genetic progression) and loss of cellular control progression) and loss of cellular control functions functions Progressive phenotypic changes from normal Progressive phenotypic changes from normal histology histology Early pre cancer (intra epithelial neoplasia Early pre cancer (intra epithelial neoplasia --IEN) IEN) Increasingly severe IEN Increasingly severe IEN --Superficial cancer and finally Superficial cancer and finally Invasive cancer.Invasive cancer.

Carcinogenesis: A MultiCarcinogenesis: A Multi--step Processstep Process

NORMAL DYSPLASIA CARCINOMAin situ

MALIGNANTCARCINOMA

connectivetissue

basa

l lay

er

basal laminadifferentiating cells with

condensed nuclei

Epidemiological Evidence on Epidemiological Evidence on Diet CancerDiet Cancer

Dietary factorsDietary factors--used alone or in used alone or in combination to prevent combination to prevent

Occurrence of cancerOccurrence of cancerMetastatic progressionMetastatic progressionTreatment of CancerTreatment of Cancer

May be able to produce chemotherapeutic May be able to produce chemotherapeutic effects with a effects with a relatively lower toxicityrelatively lower toxicity

Opportunity and need for identification of Opportunity and need for identification of Nutrients as agents for chemopreventionNutrients as agents for chemoprevention

Long LatencyLong LatencyHigh IncidenceHigh IncidenceSignificant Morbidity & MortalitySignificant Morbidity & MortalitySeveral promising nutrientsSeveral promising nutrientsCurrent agentsCurrent agents-- high toxicityhigh toxicityScreening complexity (When? How? Screening complexity (When? How? What? Effectiveness?)What? Effectiveness?)

AntioxidantsAntioxidants

Antioxidant NutrientsAntioxidant NutrientsSTABILIZATION OF CELL MEMBRANESTABILIZATION OF CELL MEMBRANEREGULATION OF OXIDATION REACTIONS, REGULATION OF OXIDATION REACTIONS, CRITICAL FOR CELL STRUCTURECRITICAL FOR CELL STRUCTURECritical for Critical for Cell FUNCTIONsCell FUNCTIONs--> > Systems functionSystems functionOxidative stress loads maybe Oxidative stress loads maybe elevated in carrierselevated in carriersNeed to meet increased needsNeed to meet increased needsStructure is critical for FunctionStructure is critical for Function

Angiogenesis Angiogenesis ––> Carcinogenesis> CarcinogenesisNutrientsNutrients––pro or antipro or anti--angiogenic angiogenic

Nutrients that are promising in preventing Nutrients that are promising in preventing Cancer, ageing and other diseasesCancer, ageing and other diseases

Soy IsoflavonesSoy Isoflavones (Breast, Prostate, Lung)*(Breast, Prostate, Lung)*Carotenoids Carotenoids (lycopene, (lycopene, ßß--Carotene)(Prostate)*Carotene)(Prostate)*Green teaGreen tea polyphenols *polyphenols *Calcium(Colon)Calcium(Colon)IndoleIndole--33--carbinol(Breast)carbinol(Breast)Curcumin(Colon)Curcumin(Colon)Allylic sulphides Allylic sulphides ––garlic,onion(oral)garlic,onion(oral)Folate (Colon)Folate (Colon)Tannic Acid*Tannic Acid*Selenium/Vitamin ESelenium/Vitamin ENN--3 fatty acids*3 fatty acids*Resveratrol/anthocyanins*Resveratrol/anthocyanins*B Vitamins/C, Vitamin EB Vitamins/C, Vitamin E

Fruit & Vegetable Consumption of adults and Fruit & Vegetable Consumption of adults and Children in the US (CDC 2009)Children in the US (CDC 2009)

--The challengeThe challenge50 states & DC 50 have not achieved 50 states & DC 50 have not achieved national objectives for fruit and vegetable national objectives for fruit and vegetable consumption of 5 a day for better health consumption of 5 a day for better health 32.6% of adults consumed fruit two or 32.6% of adults consumed fruit two or more times per day and 27.2% ate more times per day and 27.2% ate vegetables three or more times per dayvegetables three or more times per dayPotato is the #1 vegetable of choice!Potato is the #1 vegetable of choice!Vegetables were also cooked with high fat Vegetables were also cooked with high fat meatsmeats

Nutrients for Chemoprevention

Popular Demand/Epidemiology

Political Support/Advocacy groups

Clinical Trials, Phase II, III

[Cost-Effectiveness/Health Service]

[Basic Science/Animal/in-vitro]

[Scientific Acceptance]

Health Policy/Reimbursement/Politics

Change Healthcare Delivery

CONVENTIONAL/ORTHODOX

Epidemiology

Cellular, in-vitro

Animal models

Clinical Trials, Phase I, II, III

Cost-Effectiveness/Health Science

Health Policy/Reimbursement/Politics

Change Healthcare Delivery

(Eisenberg, 2003-modified)

Paradigms of Health Care DeliveryParadigms of Health Care Delivery

Where do we go from here?Where do we go from here?

What can you What can you DoDo??

Recommendation #1: Reduce Recommendation #1: Reduce Caloric IntakeCaloric Intake

Japanese in Okinawa Japanese in Okinawa islandisland““hara hachi buhara hachi bu””-- ““belly belly 80% full80% full””Doubled the number of Doubled the number of functional Centurionsfunctional Centurions

Relatively longer life Relatively longer life spans spans --consistentlyconsistentlyQuantities / Quantities / ““Portion Portion DistortionDistortion””

Cheese is a garnish/appetizer Cheese is a garnish/appetizer --not food!not food!

BAGELBAGEL20 Years Ago Today

140 calories 3-inch diameter

Calorie Difference: 210 calories

350 calories6-inch diameter

CHEESEBURGERToday20 Years Ago

590 calories333 calories


SPAGHETTI AND MEATBALLS20 Years Ago Today

1,025 calories2 cups of pasta with sauce and 3 large meatballs

500 calories1 cup spaghetti with sauce and 3 small meatballs


Choose Lean Meats, Chicken or Sea Choose Lean Meats, Chicken or Sea FoodFood

Beef/PorkBeef/Pork

Limit intake of Beef & Limit intake of Beef & PorkPorkRick source of Rick source of Cholesterol & LDLCholesterol & LDLTrim off visible fats Trim off visible fats (Triglycerides)(Triglycerides)Select leaner cuts Select leaner cuts $$$$$$$$

Good Fats with proteinGood Fats with protein

Fats found in seafood, especially the redder fish, Fats found in seafood, especially the redder fish, is rich in is rich in Omega 3Omega 3–– fatty acidsfatty acids. .

Watch those Desserts & Watch those Desserts & ““empty Caloriesempty Calories””

Apple pie and Carrot Cake donApple pie and Carrot Cake don’’t count as t count as Fruits!Fruits!Ice milk/yogurts Ice milk/yogurts -- in place of Ice Creamin place of Ice CreamDove bars Dove bars -- they stand alone!they stand alone!Fresh Fruits make great DessertsFresh Fruits make great DessertsAvoid Avoid ““empty caloriesempty calories””

Sodas, Beers, fruit flavored juicesSodas, Beers, fruit flavored juices

Mechanism:Mechanism:Genetic Vulnerability/susceptibilityGenetic Vulnerability/susceptibilityAlcohol metabolizing enzymes Alcohol metabolizing enzymes ––variations among individualsvariations among individualsOther confounders Other confounders –– diet/smokingdiet/smokingIncreased oxidative stressIncreased oxidative stressChronic alcohol use impairs not only Chronic alcohol use impairs not only gut and liver functions, but also multigut and liver functions, but also multi--organ interactions, leading to organ interactions, leading to persistent systemic inflammation persistent systemic inflammation Depletes folic acid,Depletes folic acid, riboflavin, Zinc and riboflavin, Zinc and retinoic acidretinoic acid

Limit Alcohol Limit Alcohol -- Alcohol and Alcohol and Cancer RiskCancer Risk

Fast Foods Fast Foods -- Sudden FoodsSudden Foods--SUPERSIZING!SUPERSIZING!

Item Calories FatsBK Db Whopper w/Cheese

950 63

BK Whopper 630 39

Mc Big Mac 510 26

Mc ¼ pounder w/Cheese

520 29

OM ¼ pound Hot Dog

360 34

#2 Improve Bone Strength#2 Improve Bone StrengthApproachApproach-- HRT, Nutrition & Physical ActivityHRT, Nutrition & Physical ActivityAntiAnti--osteoporotic minerals & vitaminsosteoporotic minerals & vitamins

Calcium, phosphorous, Magnesium, Vitamins Calcium, phosphorous, Magnesium, Vitamins A & DA & DVitamin D 700Vitamin D 700--800 IU/day for prevention of 800 IU/day for prevention of bone loss bone loss

Physical ActivityPhysical ActivityResistance TrainingResistance Training

Hormone replacementHormone replacementLong term interventionsLong term interventions--Timing Timing ––Early startEarly start-- 3030--5050’’ss

OsteoporosisOsteoporosis-- Declining spinal curvatureDeclining spinal curvature3 million osteoporosis3 million osteoporosis--

associated fractures associated fractures Bone within the vertebral Bone within the vertebral column, the hip, and the column, the hip, and the forearm near the wrist. forearm near the wrist. Affects Physical FunctionAffects Physical Function

Fractures with minimum Fractures with minimum TraumaTrauma--80% are women80% are womenTeethTeeth-- (Bone w/enamel)(Bone w/enamel)Current or former smokers and Current or former smokers and

those on hormone those on hormone deprivation therapiesdeprivation therapies--more more vulnerablevulnerable

Choose low fat Dairy ProductsChoose low fat Dairy Products--Excellent for Bone HealthExcellent for Bone Health

Milk/Milk/--cheeses/cheeses/--yogurtsyogurtsLactose intoleranceLactose intolerance--ProbioticsProbioticsGet your Bone Mineral Get your Bone Mineral Density CheckedDensity Checked

High Fat Dairy ProductsHigh Fat Dairy Products

#3 Prevent Muscle Loss#3 Prevent Muscle Loss-- SarcopeniaSarcopeniaSign of physical ageingSign of physical ageing22% 22% --23% decline between ages 23% decline between ages 3030--70 without purposeful exercise70 without purposeful exercise(NIA(NIA))Loss of steroid hormonesLoss of steroid hormones

Just as important as preventing Just as important as preventing bone lossbone lossPurposeful Physical ActivityPurposeful Physical ActivityResistance TrainingResistance Training

Endurance Endurance FlexibilityFlexibilityCardioCardio--respiratoryrespiratory

Protein statusProtein status--QualityQuality of of nutrients must not be nutrients must not be compromisedcompromised

Hormone Replacement TherapyHormone Replacement Therapy

Benefits of Purposeful Physical Benefits of Purposeful Physical ActivityActivity

Increased blood volumeIncreased blood volumeStrengthened heart Strengthened heart musclemuscleLowered resting heart Lowered resting heart raterateIncreased stroke volumeIncreased stroke volumeImproved VOImproved VO22 maxmaxImproved circulationImproved circulationLowered blood glucose Lowered blood glucose levels

Increased energy Increased energy expenditureexpenditureReduced stressReduced stressImproved mental healthImproved mental healthStrengthened immune Strengthened immune systemsystemImproved cardiovascular Improved cardiovascular fitnessfitnessReduced body weightReduced body weightIncreased bone massIncreased bone massImproved blood lipids

levelsImproved blood lipids

#4 Select a minimum 8#4 Select a minimum 8--10 Fruits 10 Fruits & Vegetables/day& Vegetables/day

#5 Select whole grain breads/cereals#5 Select whole grain breads/cereals

2020--30 grams of fiber intake is recommended/day30 grams of fiber intake is recommended/dayAmericans consume less than 50% of fiber Americans consume less than 50% of fiber Americans spend the most on laxativesAmericans spend the most on laxativesHighest incidence of diverticulosis in the USHighest incidence of diverticulosis in the US

#6. Food #6. Food vs.vs. Vitamins??? Vitamins??? Multivitamins/MineralsMultivitamins/Minerals

Most reliable way to make sure that Most reliable way to make sure that you are getting your minimumyou are getting your minimumLook for USP label Look for USP label --Take with a meal for maximum utilityTake with a meal for maximum utilityUse a mainstream labelUse a mainstream labelNo megadoses recommended(x10 No megadoses recommended(x10 times USRDA)times USRDA)

#7 Select a fat that is a mono#7 Select a fat that is a mono--unsaturated ?unsaturated ?

Unsaturated fatsUnsaturated fats--Saturated FatsSaturated FatsTrans fats(margarine)Trans fats(margarine)Mono unsaturated fatsMono unsaturated fats

Olive OilOlive OilCanola OilCanola Oil

Fats found in canola and olive oil are called Fats found in canola and olive oil are called monosaturated fats ormonosaturated fats or omegaomega--9 fatty acids9 fatty acids..These oils have been shown to These oils have been shown to protect protect against heart disease and cancer.against heart disease and cancer.

Low fat dressings and Low fat dressings and mayonnaisemayonnaise-- Best OptionBest Option-- Olive Olive

Oil & VinegarOil & Vinegar

#8 Stop Smoking (exposure to2#8 Stop Smoking (exposure to2ndnd

hand smoke & tobacco productshand smoke & tobacco productsCigarette smoking causes Cigarette smoking causes 87 percent of 87 percent of lung cancer deathslung cancer deaths and is responsible and is responsible for most cancers of the for most cancers of the larynx, oral larynx, oral cavity and pharynx, esophagus, and cavity and pharynx, esophagus, and bladderbladder..Secondhand smoke is responsible for Secondhand smoke is responsible for an estimated an estimated 3,000 lung cancer3,000 lung cancer deaths deaths among U.S. nonsmokers each yearamong U.S. nonsmokers each yearTobacco smoke contains thousands of Tobacco smoke contains thousands of chemical agents, including over chemical agents, including over 60 60 substances that are known to cause substances that are known to cause cancercancer““SnusSnus””NIH 2005NIH 2005

#9 Avoid Sun Exposure #9 Avoid Sun Exposure & Tanning beds& Tanning beds

Do not sunbathe & Avoid Do not sunbathe & Avoid unnecessary sun exposure, unnecessary sun exposure, especially between 10:00 a.m. and especially between 10:00 a.m. and 4:00 p.m., the peak hours for harmful 4:00 p.m., the peak hours for harmful ultraviolet (UV) radiation. ultraviolet (UV) radiation.

When outdoors, use When outdoors, use sunscreens rated sunscreens rated SPF 15 or higherSPF 15 or higher. Apply them . Apply them liberally, uniformly, and frequently. liberally, uniformly, and frequently.

When exposed to sunlight, wear When exposed to sunlight, wear protective clothingprotective clothing such as long such as long pants, longpants, long--sleeved shirts, broadsleeved shirts, broad--brimmed hats, and UVbrimmed hats, and UV--protective protective sunglasses. sunglasses.

Wrinkles/skin cancer/eyesWrinkles/skin cancer/eyes75% increased risk of skin cancer75% increased risk of skin cancer

http://www.skincancer.org/prevention/spf.php



##10 Skin 10 Skin ––the largest organ in the the largest organ in the body body –– indicator of health and indicator of health and

DiseaseDiseaseNutritionNutritionHydrationHydrationSun exposureSun exposureExerciseExerciseTobaccoTobaccoAlcoholAlcoholStressStressDiseasesDiseasesAgeAge……....Cherish & Preserve Cherish & Preserve it!it!

Most chronic diseases including Most chronic diseases including Cancer result fromCancer result from……..

Genetic endowmentGenetic endowmentSocial & environmental conditionsSocial & environmental conditions

Including advances in MedicineIncluding advances in MedicineIndividual behaviorsIndividual behaviors

In SummaryIn Summary…….Promise.PromiseBiologically feasible to Biologically feasible to prevent cancerprevent cancerBody Composition & Obesity Body Composition & Obesity contribute to the contribute to the progression of certain cancersprogression of certain cancersPhysical activity and weight reductionPhysical activity and weight reductionmodulates cancersmodulates cancersPopulations that consume a predominantly Populations that consume a predominantly plantplant--based dietbased diet have the lowest incidence of have the lowest incidence of cancerscancersNutrients and NutrientNutrients and Nutrient--derived agentsderived agents have a have a significant role in Cancer Preventionsignificant role in Cancer PreventionThe best data appears with wholesome, fresh, The best data appears with wholesome, fresh, variety of foods in a daily dietvariety of foods in a daily diet-- not supplements.not supplements.

diet & other lifestyle factors in hereditary breast ......international differences in diet...

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