Transcript - International Academy of Nutrition

CANCER
QUESTIONS
AND
CONTROVERSIES
A Seminar by Robert Buist PhD
Copyright © 2012 International Academy of Nutrition
Current cost of cancer research
in US:
US $110 billion/year
($1 trillion spent since 1971)
25% breast cancers diagnosed
are slow-to-develop (ductal or
lobar carcinomas
2% become malignant
CISS 24(3)11 (2004)
80% of all DCIS’s (ductile
carcinoma-in-situ) never
become invasive even if left
untreated
Townsend p124 June 2004
More than half of women
diagnosed with breast cancer at
Roswell Park Memorial Centre
Hospital had benign lesions that
were unable to spread
80% of all DCIS’s (ductile
carcinoma-in-situ) never become
invasive even if left untreated
Townsend p124 June 2004
Fibrocystic Breast Disease
PREVENTION
 No caffeine, coffee, choc
 No dairy products
 Low fat diet
 Omega-3 Fish Oil 3g/day
 Fresh fruit and veg 7serve
 No alcohol
Only one in six biopsies
revealed cancer after a positive
mammogram
CISS 24(3)11 (2004)
Cochrane Review of
Mammography
1. No reliable evidence that screening for
breast cancer reduces mortality.
Olsen & Gotzsche 2000
2. Cochrane Review confirmed these
findings that mammography did not
reduce all cause mortality
Olsen & Gotzsche Lancet 358, 1340-42 (2002)
SCREENING CAUSES
INCREASED MASTECTOMY
AND LUMPECTOMY
Screening identified slow-growing
tumours that would never develop into
tumours
Even cancerous pathology tests may not
mean development of life-threatening
tumours
Olsen & Gotzsche Lancet 358, 1340-42 (2001)
Mammogram End Points
should be OVERALL Mortality
Treatment of early cancers by
tumourectomy and radiotherapy might
increase the likelihood that deaths
among screen-detected breast cancer
cases will be misclassified as deaths
from other causes, especially other
cancers
Lancet 358, 1340 (2001)
Seven Randomised Trials
for Screening Mammography
There is NO survival benefit of mass
screening for breast cancer
Gotzsche et al, Lancet 355, 129-34 (2000)
NIH 1997 consensus conference
recommend against routine
screening mammography for 4049year olds
N Engl J Nutr 336,1180-3 (1997)
Subjects between 40-50 years
who had a yearly mammogram
showed a 36 to 52% INCREASE in
breast cancer mortality
Lancet 1992
The number one enemy of
the cancer patient is:
metastasis
Townsend p125 June 2004
Needle Biopsies
There is a clear danger of
seeding needle tracks with
malignant cells which may enter
vascular channels or even be
transported to lymph nodes.
Danish Med Bulletin 25(2) 82-87 (1978)
Problems with Surgery
 Cell debris stimulates tumour growth
 Inflammation promotes tumour cells
 Post op bacterial infections (endotoxin)
 Cauterisation is tissue damage
(inflammation)
 General anaesthesia potentiates
tumour growth
Int Clin Nutr Rev 8(2) 62-68 (1988)
Cancer cells were found in
59% of samples of blood lost
by patients during surgery
for lung, ovarian, colon,
oesophageal and other cancers
Dr Fedorine, Sydney Morning Herald, June 13, 2001
Pelvic Radiation Therapy for
Rectal Cancer
 8000 patients enrolled in 14 preoperative
and 8 postop randomised trials.
 5 year survival was marginally better in
those who received radiotherapy (62.2%
vs 63.3% dead (p=0.06)
 Reduced local recurrence not overall
survival.
Lancet 358, 1285 (2001)
Randomised controlled trials
compare one chemotherapeutic
agent with another
We need to compare agents with
doing nothing (or with a placebo)
or with approaches using
alternative therapies
Townsend Letter for Doctors Feb-Mar (2004) pp 99-108
Approx 20 chemotherapeutic
agents have been shown to
cause cancer
(50 more are suspect)
Survivors of ovarian cancer treated
with chemo have 100 times higher
incidence of leukaemia. This is
worsened when combined with
radiation
Chemotherapy may produce good
initial results but frequently poorer
long-term prognosis
Tumour regression by itself is a bad
predictor for progression of disease
Regression is not likely to improve
survival
Townsend p33 2004
Breast cancer tissue samples
were co-cultured with patients’
lymphocytes:
After 12 yearsA. Lymphocytes that had no reaction
- 47% women had died
B . Lymphocytes that were stimulated and
proliferated - 95% women still alive
Dr James McCoy Annals NY Acad Sci 1993
Cancer Prevention is not
Cancer Diagnosis
Mammograpy, breast palpation, PSA,
scans,endoscopy, X-rays, PAP smear,
biopsy, tumour markers - AFP, HCG,
PSA, [CEA for colorectal], paraprotein
[myeloma]
These are not Preventive Medicine
Prostate Cancer Incidence
and PSA
Since introduction of PSA screening in
US, incidence has doubled between 198387 and 1993-95 (55 to 110 per 100,000)
In UK:
less PSA screening - less incidence
Lancet 359, 1341-1342 (2002)
Prostate Cancer Survival
after 10 Years

Watchful waiting - 91.5% (223 men)

Radiation therapy - 77% (682 men)

Radical Prostatectomy - 90% (1143 men)
(but depends on tumour size and differentiation)
Seven times as many cancer
tumours are discovered during
autopsy than are discovered
during a person’s lifetime
Townsend p124 June 2004
Strength of recommendation:
A. PAP Smear
High costs, data unreliable
A. Mammography>50yrs Better evidence
C. Mammography <49yrs No evidence screening
reduces mortality
B. FOBT,Colonoscopy & Sigmoidoscopy
No reduction in overall mortality
D.
PSA
An unproven intervention
not specific
D. Lung CT scan
No evidence of reduced mortality
Thomas G Gates (Am Fam Physician 2001;63:513-22)
Cancer delay by decrease in
mutation rate
Type of
Cancer
Age (year)
of cancer
Hepatoma
Lung
Prostate
10
35
40
Average age
of death
Age of death
if mutation rate
is halved
50
55
85
90
75
130
The Handbook of Preventive Medicine Florence & Setright Kingsclear 1994
Blueberries rich in Anthocyanins
 Greater firepower
against cancercausing free radicals
than 40 other fresh
fruits and vegetables
Research by the Human
Nutrition Research
Centre on Aging
DO NOT USE SINGLE
PHYTONUTRIENT SUPPLEMENTS
Beta carotene 30mg (Scand. Study)
Lycopene (tomato paste)
Lutein (egg yolk)
Quercetin (onions)
Genistein (carcinogenic)
Carotenoids, flavonoids & polyphenolics
are involved in competitive inhibition.
HerbalGram 62, 54-55 (2004)
Effects of single flavonoids
Single flavonoids (quercitin, fisetin, flavone, luteolin
and genistein) cross the placenta and induce DNA
cleavage and infant leukemia.
These same chromosomal translocations involving the
MLL gene are present in 80% of infants (<1yr) with
Acute myelogenous and acute lymphoblastic
leukemia.
NOTE: Glycosylated/methylated bioflavonoids and
flavanones/flavanols do not cause these problems
Proc Natl Acad Sci (USA) 97 (9) 4790 - 4795 (2000)
Antioxidants in Cancer Therapy; Their Actions
and Interactions With Oncologic Therapies
Davis W. Lamson, MS, ND and Matthew S. Brignall, ND
….exogenous antioxidants alone produce beneficial
effects in various cancers... animal and human studies
demonstrate no reduction of efficacy of chemotherapy
or radiation when given with antioxidants. In fact,
considerable data exists showing increased
effectiveness of many cancer therapeutic agents, as
well as a decrease in adverse effects, when given
concurrently with antioxidants.
Altern Med Rev 1999;4(5):304-329
Food oils which promote
CANCERS
High linoleic acid-containing oils and
trans fatty acids (TFA) (corn, soya,
safflower, sunflower, margarine)
Oils which prevent cancer:
High lauric acid containing oils (coconut and palm),
omega-3 oils (fish, flax seeds, nuts)
Townsend 102-194, June 2002
Monounsaturated fats
cut breast cancer risk
Every 5 gram increase in dietary
polyunsaturated fat INCREASED by 69%
the the relative risk for invasive breast
cancer.
Conversely, for each 10g increment of
monounsaturated fat, the relative risk for
invasive cancer DECREASED by 45%
Archives of Internal Medicine 158,41-45 (1998)
ANTICANCER EFFECTS
OF OMEGA-3 OILS
 Low breast and prostate cancer in Japan
 Reduction in colonic adenomas
 Inhibition of promotion and progression
 Reduction in inflammatory eicosanoids
(PGE2, leukotriene B4, 12 OH eicosaetraenoic acid)
 Decreases oestrogen production
(PGE2 stimulates aromatase P450 which
converts 19-carbon steroids to oestrogens)
Alpha-linolenic acid
RISK FACTOR for breast cancer when:
 low dietary linoleic acid (GLAor
EPA)
 oxidised
 diet high in alcohol, saturated fats
 stress levels high
Better to add ground whole linseeds to diet less oxidation and high lignan content
(enterolactone and enterodiol) blocks
oestrogen and oestrogen dependent tumours.
Results of 47,866 Men Study
…”High alpha-linolenic acid (ALA) intake is
associated with an increased risk of
advanced prostate cancer.”
In contrast EPA and DHA intakes may be
associated with a decreased risk of total
and advanced prostate cancer.
Am J Clin Nutr 80, 204-16 (2004)
ALA Function Different to EPA
 ALA less effective in displacing AA from cell
membrane phospholipids and inhibiting
prostaglandin synthesis.
 ALA has little conversion to EPA and almost
zero conversion to DHA (may decrease DHA
levels)
 ALA has little influence on immune function
and inflammatory cytokine production.
Genistein and Daidzein
block TAMOXIFEN
(at low not high concentrations)
1. Better to tell women on Tamoxifen
to avoid low levels of soy
2. High soy eaters (70g/day) not on
Tamoxifen have lower levels of
breast cancer
and genistein acts as an agonist in oestrogen-dependent target cells
promoting breast cancer cell proliferation at low concentrations
Black Cohosh (40mg extr/day)
safely and effectively treats hot
flashes in women with a history
of ER-positive breast cancer
taking tamoxifen
HerbalGram 62,20-21 (2004)
Psychoneuroimmunology
& Cancer
Factors affecting outcome:
 Practitioner attitude
 Social Isolation/Group support
 Fighting spirit/helplessness
 Optimistic/pessimistic attitude
 Will to live/faith
Lancet 1(8431) 750 (1985)
Clin Oncol 21(3) 543-8 (2003)
COLORECTAL CANCER & STRESS
Of 569 colorectal cancer patients those
who experience on-the-job aggravation
were 5.5 times as likely to develop cancer
(compared with 510 matched health
controls).
Epidemiol 495) 407-14 (1993)
Factors Predisposing to
Gastric Cancer
242 Japanese gastric cancer patients
(484 controls)
*Eating quickly
*Overeating
*Stress
*Long working hours
*Irregular sleeping
*Grey hair in males
*Having dentures
*Lack of teeth
Oncol Rep 5(5) 1191-4 (1998)
#Psychological factors
positively associated with
lung cancer (preclinical)
 Uncontrollable bursts of emotion (OR 1.8)
 Poor working circumstances - including
bad relationships with colleagues and
superiors (OR 1.4)
 Long term depression (OR 4.1)
#Study involved 750,000 including 309 lung cancer cases.
Chung Hua Liu Ksing Ping Hsueh Tsa Chih 18(5) 289-92 (1997)
Breast Cancer and
Social Isolation
A population based sample of 525 black
and 486 white women with newly
diagnosed breast cancer
 Fewer close friends and relatives (RR 2.1)
 Fewer sources of emotional support (RR1.8)
Cancer Epidemiol Biomarkers Prev 3(3), 253-9 (1994)
Chronically elevated levels of
cortisone accompany the
perception of loneliness which
in turn reduces the immune
defences of the body against
malignant progression.
CANCER CELLS CAN REMAIN
DORMANT - WHY?
WHAT FACTORS RETARD
CANCER GROWTH?
SOYA MILK &
PROSTATE CANCER
Men who consumed soya milk
more than once daily had a 70%
REDUCTION in risk of prostate
cancer
Cancer Causes and Control 9, 553-557 (1998)
LOW BLOOD LEVELS OF CoQ10
in
Cancer of breast, lung, prostate,
pancreas, colon, kidney, head
and neck
Also in myeloma and lymphoma
Folkers K. Biochem Biophys Res Comm 224(2) 358-61 (1996)
CoQ10 improves survival
32 Breast cancer patients,18 months on CoQ10
90mg daily (plus other antioxidants, vitamins
and minerals plus surgery, radiation and chemotherapy)
Survival rate - 100% over 24 months (Expected 6 deaths)
Remission - 6 patients. Decreased use of pain
killers, improved quality of life, no weight loss.
Molecular Aspects of Medicine 15S, S231-S240 (1994)
Incomplete Removal of
Breast Tumour in 2 Patients
3-4 months of high dose CoQ10
(390 and 300mg/day) resulted in
complete regression of both
residual breast tumours.
Biochem Biophy Res Comm 199(3) 1504-1508 (1994)
High Dose CoQ10 and
Tumour Remission
3 Breast cancer patients on 390mg
CoQ10/day for 3-5 years.
Patient 1 - complete remission of liver metastases
Patient 2 - remission of tumour spread to chest wall
Patient 3 - no microscopic evidence of remaining
tumour after mastectomy
Biochem Biophy Res Comm 212(1) 172-177 (1995)
VITAMIN D
NONCALCAEMIC FUNCTIONS
Most cells in the body have nuclear
receptors for 1,25(OH)2D e.g. heart,
stomach, panceas, brain, gonads
and activated T and B lymphocytes.
Vitamin D (1,25) can down regulate
hyperproliferative cell growth.
ANTI CANCER EFFECT OF 1,25OH2D
Sunlight or dietary vitamin D leads to
increased 25-OH2 Vitamin D which acts
as a substrate for 25OH2D-1-hydroxylase
in colon, breast, lung, prostate, etc. to
produce 1,25OH2D which acts to regulate
cell growth and decrease proliferative
activity.
Am J Clin Nutr 79, 362-71 (2004)
Normal cells can convert 25(OH)D to 1,25(OH)2 D
Am J Clin Nutr 79, 368 (2004)
Colon Cancer Diet
 Worst - high fat, low fibre, high
refined carbs (increase betaglucuronidase)
 Best - high protein, higher in
unrefined carbs, lower in fat and rich
in fibre (lowers beta-glucuronidase)
Nutr Cancer 27(3),250-255(1997)