foods and cancer
DESCRIPTION
Food choices can help prevent cancer and, when cancer has been diagnosed, nutrition can improve survival. These links between diet and cancer are nothing short of dramatic. And now you can learn how certain dietary patterns help people diagnosed with cancer live longer, healthier lives.TRANSCRIPT
Foods and Cancer
Neal D. Barnard, MDAdjunct Associate Professor of Medicine George Washington University School of Medicine
President, Physicians Committee for Responsible Medicine Washington, DC
Association of Dietary Fat & Breast Cancer
USA
SwitzerlandCanada
Denmark
Germany
Norway
New Zealand
FranceUK
SwedenAustralia
ItalyIsrael
Finland
Spain
Poland Hungary
Hong Kong
Yugoslavia
Romania
Japan
0
50
100
150
200
250
600 900 1200 1500
r=0.76
Bre
ast
Can
cer
Inci
den
ce(p
er 1
00,0
00 w
om
en, 4
5-69
yrs
)
Per Capita Fat Availability (kcal)from Prentice, et al. JNCI 1988
Western Diets and Breast Cancer in China
The Shanghai Breast Cancer Study
The “meat-sweet” pattern: meat dessertfish breadcandy milk
30% percent increased breast cancer risk
Cui X. Dietary Patterns and Breast Cancer Risk in the Shanghai Breast Cancer Study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1443-1448.
Excess body fat
Increasedestrogen activity
Cancer promotion
High-fat / low-fiber dietExcess body fat
Increasedestrogen activity
Cancer promotion
Women’s Health Initiative
48,835 participants, aged 50-79
Diet: 20% fat, ↑ vegetables, fruits, and grains
Fat intake fell from 38% at baseline… to 24% at 1 year, and to 29% at 6 years.
Prentice RI. JAMA. 2006;295:629-642.
Women’s Health Initiative
After 8.1 years:
Overall breast cancer risk ↓9% (not significant).Progesterone-receptor-negative tumor risk ↓24%.
Prentice RI. JAMA. 2006;295:629-642.
Fat Content(Percentage of Calories from Fat)
Leanest beef 29%
Skinless chicken breast 23%
Sea trout 32%
White tuna 16%
Broccoli 8%
Beans 4%
Rice 1–5%
Diet and Breast Cancer Survival
Women in Japan
Less likely to develop breast cancer, compared with women in U.S.
More likely to survive cancer, if it develops.
Wynder EL, et al. A comparison of survival rates between American and Japanese patients with breast cancer. Surg Gynecol Obstet 1963;117:196-200.
Body Weight and Breast Cancer Survival
Risk of recurrence or decreased survival:
26 studies: higher weight increases risk
8 studies: no increased risk
Overall, a high BMI increased 5-year mortality by 91%.
Included studies published 1990 – 2001.
Chlebowski RT. J Clin Oncol 2002;20:1128-43.
Body Weight and Breast Cancer SurvivalShanghai, China, 2006
1,455 women with breast cancer, aged 25-64
BMI 5-year survival< 23.00 86.5%23.00-24.99 83.8%≥ 25.00 80.1% (P = 0.02)
Tao MH. Association of overweight with breast cancer survival. Am J Epidemiol 2006;163:101-107.
Women’s Intervention Nutrition Study (WINS)
2,437 women with breast cancer
Ages: 48-79, all postmenopausal
Reduced fat (15% of energy) diet vs control
WINSDiet and Cancer Recurrence
All cancers ↓ 24%
Estrogen receptor - ↓ 42%
Estrogen receptor + ↓ 15%
WINS Study
Body Mass Index and Relapse (%)
<25 25-30 >300
5
10
15
20
25
30
35
8.9%9.8% 10.2%
Body Mass Index
Chlebowski RT, et al. JNCI 2006;98:1767-76.
Women previously treated for breast cancer,N = 957 intervention, 1424 control
12.8%
11.1%
16.2%
InterventionControl
% relapse
Women’s Healthy Eating and Living Study
3,109 pre- and postmenopausal women previously treated for breast cancer
7 clinical sites, enrollment 1995-2000
Women’s Healthy Eating and Living Study
Comparison diet (“5-a-day”): 5 servings of vegetables and fruits (<30% fat, 20 g fiber)
Intervention diet (“8-a-day”): 5 vegetable servings, 3 fruit servings
16 oz. vegetable juice (15-20% fat, 30 g fiber)
Vegetables and Fruits: “8-a-day” vs “5-a-day”
Mean follow-up: 7.3 years
Mortality
Intervention group (“8-a-day+”) 10.1%
Comparison group (5-a-day) 10.3%
Pierce JP. JAMA 2007;858:289-98.
“A diet high in vegetables and fruits apparently does nothing to prevent breast cancer from returning, according to a seven-year U.S. government study of more than 3,000 women.”
USAToday.com, accessed July 19, 2007
WHEL Study Vegetables-Fruits and Regular Walking
1490 women in comparison group Followed for 5-11 years
Mortality
↑ veg/fruit (7.6 servings) + ↑ activity 4.8%
↓ veg/fruit (3.4 servings) + ↑ activity 10.4%
↑ veg/fruit (7.2 servings) + ↓ activity 10.7%
↓ veg/fruit (3.1 servings) + ↓ activity 11.5%
Pierce JP. J Clin Oncol 2007;25:2345-51.
What about Soy Products?
Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
Soy and Breast Cancer
Meta-analysis of 8 studies in Asians and Asian Americans:
High soy intake: 29% ↓ risk of breast cancer.
High: 20 mg isoflavones
Low: 5 mg isoflavones
Wu AH. Br J Cancer. 2004;98:9-14.
Soy and Cancer Recurrence or Mortality in WHEL
<0.0
7
0.07
-1.0
1
1.01
-16.
33
>16.
330
1
P for trend = 0.02
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
Soy and Survival
High soy intake:
54% ↓ risk.
16.3 mg isoflavones = ½ cup soymilk or
2 oz. tofu
Soy and Cancer Recurrence or Mortality
<0.0
7
0.07
-1.0
1
1.01
-16.
33
>16.
330
1
P for trend = 0.02
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
Shanghai Breast Cancer Survival Study
Shu XO. JAMA. 2009;302:2437-43
Soy and Cancer Mortality
<20.
01
20.0
1-36
.50
36.5
1-62
.68
>62.
680
1
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
16.3 mg isoflavones = ½ cup soymilk or 2 oz. tofu
Soy and Breast Cancer Recurrence
<4.0
4.0
- 9.9
910
.0
0.0
0.5
1.0
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Nechuta SJ. Am J Clin Nutr. 2012;96:123-32.
After Breast Cancer Pooling Project
1. Women’s Healthy Eating & Living Study
2. Shanghai Breast Cancer Survival Study
3. Life After Cancer Epidemiology Study
9,514 breast cancer survivors
Kaiser Permanente Life After Cancer Epidemiology Study
Guha N. Breast Cancer Research & Treatment. 2009;118:395-405.
Daidzein
0
0.10
-7.7
7
7.78
-149
.59
149.
60-1
,453
.00
1,45
3.10
-9,5
96.5
4
>9,5
96.5
40
1
Daidzein Intake (mcg/d)
Haz
ard
Rat
io
Genistein
0
0.10
-6.9
9
7.00
-220
.61
220.
62-2
,184
.8
2,19
9.82
-13,
025.
87
>13,
025.
870
1
Genistein Intake (mcg/d)
Haz
ard
Rat
io
Glycetein
0-3.
61
3.62
-8.1
6
8.17
-14.
99
15.0
0-78
.53
78.5
4-79
5.39
>796
.39
0
1
Glycetin Intake (mcg/d)
Haz
ard
Rat
io
Soy Intake and Breast Cancer Recurrence
Nutrition & Breast Cancer Survival Summary
Reduced body fat → ↑ survival
Reduced dietary fat → ↑ survival
Vegetables & fruits + exercise → ↑ survival
Soy (~2 servings/day) → ↑ survival
Prostate Cancer
Milk and Prostate Cancer
Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
Physicians’ Health Study (Harvard)
≥ 2.5 servings/day of dairy products
20,885 physicians
34% increased risk
of prostate cancer
Relative risk: 1.34 (1.04-1.71)Chan JM. Am J Clin Nutr 2001;74:549-54.
Health Professionals Follow-up Study (Harvard)
83% of milk consumed was skim or lowfat
Giovannucci E. Cancer Res 1998;58:442-7.
> 2 servings/day of milk
47,781 health professionals
60% increased risk
of prostate cancer
Relative risk for advanced cancer: 1.6 (95% CI, 1.2-2.1)
Milk Affects Hormones
Milk
↑ IGF-I
↓ Vitamin D
“Insulin-like” = moves sugar into cells
“Growth factor” = encourages cell proliferation
Insulin-Like Growth Factor IInsulin-Like Growth Factor I
Men and women aged 55 to 85 years
Three 8-oz servings of milk for 12 weeks
Serum IGF-I levels: ↑ 10%
P<.001 Heaney RP. J Am Dietetic Asso 1999;99:1228-33.
Milk Drinking Raises Human IGF-IMilk Drinking Raises Human IGF-I
Vitamin DVitamin D
skin
Vitamin DVitamin D
skin
liver
Vitamin DVitamin D
skin
liverkidney
Vitamin DVitamin D
skin
liverkidney
intestine
Calcium
Vitamin DVitamin D
skin
liverkidney
prostate
intestine
Calcium
Vitamin DVitamin D
skin
liverkidney
prostate
intestine
Calcium
X X
X
Vegan Diet and Prostate Cancer
Preventive Medicine Research Institute
84 men with untreated prostate cancer, 1-year study
Control group:
PSA ↑ 6%
6 of the 43 participants required cancer treatment
Vegan group:
PSA ↓4%
No one required treatmentOrnish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174:1065-1069.
PhIP Structure*
* 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine)
Processed meats: Bacon Sausage Ham Hot dogs Deli meats
Nutrition and Cancer: Mechanisms• Low-fat diets reduce body weight
• Fiber increases hormone elimination
• Low-fat, high-fiber diets reduce hormone effects
• Isoflavones may reduce risk.
• Avoiding meat reduces carcinogen exposure
Complete Nutrition
Protein
Calcium
Vitamin B12
Acceptability
• No artificial calorie limits.
• No portion sizes.
• No carbohydrate-counting.
• Benefits encourage adherence.
Acceptability Acceptability is similar to that of other therapeutic diets.
• Men and women with heart disease (1992) • Young women with dysmenorrhea (2000) • Postmenopausal overweight women (2004)• Men and women with diabetes (2008)
Barnard ND, Scherwitz L, Ornish D. J Cardiopulmonary Rehab 1992;12:423-31.Barnard ND, Scialli AR, Bertron P, et al. J Nutr Educ 2000;32:314-9. Barnard ND, Scialli AR, Turner-McGrievy GM, et al. J Cardiopulm Rehab 2004;24:229-35.Barnard ND, et al. J Am Diet Assoc 2009;109:263-72.
Body Weight
P-value < 0.0001
Am J Health Promotion, In press
Waist Circumference
Am J Health Promotion, In pressP-value < 0.001