Lifestyle and Cancer

Lifestyle and Cancer: Lifestyle and Cancer: Chris Lewis, M.D. Lela Lewis, M.D., M.P.H. Lifestyle and Cancer: What can be done? Chris Lewis, M.D. Lela Lewis, M.D., M.P.H. NOTE:  CAUTION: These talks are for your information only and do not serve to create a doctor-patient relationship, if you are ill or on medication and wish to significantly change your lifestyle you should do so under the direction of your regular physician. OUTLINE 1. Briefly review pathogenetic factors in oncogenesis. 2. Describe the influence of lifestyle on cancer incidence. 3. Explore lifestyle's impact on cancer survival. Statistics  As of January 2005, cancer deaths outnumbered deaths from heart disease  In individuals less than 85yo  476,009 cancer deaths  450,637 deaths from heart disease  American Cancer Society. Cancer Statistics 2005. Available at: http://www.cancer.org/docroot/MED/content/MED_2_1x_Cancer_Statistics_2005.a sp?sitearea=MED. Accessed January 2005. Statistics  Estimated 1,372,910 new diagnoses of cancer last year, and 570,260 deaths from cancer.  American Cancer Society. Cancer Statistics 2005. Available at: http://www.cancer.org/docroot/MED/content/MED_2_1x_Cancer_Statistics_2005.a sp?sitearea=MED. Accessed January 2005. Cancer Deaths Women Lung Breast Colon and Rectum Pancreas Colon and Rectum Prostate Men 2006 Estimated US Cancer Deaths* Lung & bronchus Colon & rectum 31% 10% Men 291,270 Women 273,560 26% Lung & bronchus 15% Breast Prostate Pancreas Leukemia 9% 6% 4% 10% Colon & rectum  6% Pancreas  6% Ovary  4% Leukemia Liver & intrahepatic 4% bile duct Esophagus Non-Hodgkin lymphoma Urinary bladder 4% 3% 3%  3% Non-Hodgkin lymphoma  3% Uterine corpus  2% Multiple myeloma  2% Brain/ONS 23% All other sites Kidney All other sites 3% 23% ONS=Other nervous system. Source: American Cancer Society, 2006. Common Cancers Lung cancer #1 killer:  163,500 estimated deaths for 2005. Prostate Cancer most common cancer in men:  >232,000 men are expected to be diagnosed with prostate cancer Breast cancer most common cancer in women:  >211,000 women are expected to be diagnosed with breast cancer this year. American Cancer Society. Cancer Statistics 2005. Available at: http://www.cancer.org/docroot/MED/content/MED_2_1x_Cancer_Statistics_2005.asp?siteare a=MED. Accessed January 2005. Cancer Trends  Prostate and female breast cancer rates have continued to rise.  Lung cancer incidence in men continues to decrease in men.  In women, lung cancer rates have been increasing for past years but are finally leveling off.  Jemal A, et al. CA Cancer J Clin 2005;55:10-30. Cancer Statistics. Cancer Incidence Rates* for Men, 1975-2002 Rate Per 100,000 250 200 Prostate 150 100 Colon and rectum Lung 50 Non-Hodgkin lymphoma Urinary bladder Melanoma of the skin 0 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005. Cancer Incidence Rates* for Women, 1975-2002 Rate Per 100,000 250 200 150 Breast 100 Colon and rectum Lung Uterine Corpus Ovary 50 0 1975 Non-Hodgkin lymphoma 1978 1981 1984 1987 1990 1993 1996 1999 2002 *Age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2002, Division of Cancer Control and Population Sciences, National Cancer Institute, 2005. Causes  1/3 of all cancers are related to smoking  1/3 of cancers related to poor diet, lack of exercise, and obesity. American Cancer Society. Cancer Statistics 2005. Available at: http://www.cancer.org/docroot/MED/content/MED_2_1x_Cancer_Statistics_ 2005.asp?sitearea=MED. Accessed January 2005. Where does cancer come from? Physiology: The Key to be Disease Free! Inherited Mutations P53 tumor suppressor Li-Fraumeni Syndrome cell cycle regulation, apoptosis signaling through adhesion molecules to nucleus repair of double strand breaks by association with Rad51 protein DNA mismatch repair transmembrane receptor tyrosine kinase for glialderived neurotrophic factor (GDNF) brain tumors, sarcomas, leukemia, breast cancer colon cancer APC tumor suppressor Familial Adenomatous Polyposis BRCA1 tumor suppressor Familial Breast Cancer breast and ovarian cancer MSH2 and MLH1 tumor suppressors RET protooncogene Hereditary Nonpolyposis Colorectal Cancer type 1 (HNPCC1) Multiple Endocrine Neoplasia Type 2 colorectal cancer medullary thyroid cancer, type 2A pheochromocytoma , mucosal hartoma Inherited mutations  The mutation can be passed from generation to generation.  This type of mutation is a major factor for only 5% to 10% of cancers. Acquired mutations  90-95% of cancers are caused by acquired mutations.  These types of mutations, unless they occur in germ cells, cannot be passed on to one‘s children. The Guard P53 tumor suppressor gene  The p53 protein senses DNA damage and can halt progression of the cell cycle in G1.  The p53 protein is also a key player in apoptosis.  Kimball, JW. http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/T/TumorSuppressorGenes.htm l#p53 Acquired February, 2005. The Guard  Both copies of the p53 gene must be mutated for this to fail so mutations in p53 are recessive.  Cells which contain only mutant versions of the protein can live on — potentially developing into a cancer.  More than half of all human cancers have p53 mutations and have no functioning p53 protein.   Kimball, JW. http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/T/TumorSuppressorGenes.html# p53 Acquired February, 2005. Science 266:1821-1828, Cell Cycle Control and Cancer DNA Damage  Mutations occur when genes encoding cell cycle controlling proteins are damaged. What Damages DNA? Inflammation Leads to DNA Mutation  Inflammatory cells produce reactive oxygen and nitrogen species.  Oxidative and nitrative DNA damage from inflammatory processes lead to carcinogenesis.   Kawanishi S, et al. Biol Chem. 2006 Apr;387(4):365-72. Oxidative and nitrative DNA damage in animals and patients with inflammatory diseases in relation to inflammation-related carcinogenesis. Ness RB, et al. J Natl Cancer Inst. 1999 Sep 1;91(17):1459-67. Possible role of ovarian epithelial inflammation in ovarian cancer. Colon Cancer and Inflammation  90% of Colon cancer is due to inflammation from:  Oxidizing free radicals in the diet (e.g. heated oil)  Reactive oxygen and nitrogen molecules (Nitric oxide) from immune cells  Anything which slows passage of digested food through the colon (low-fiber diet)  These cause DNA mutations in genes such as p53 and other DNA repair genes resulting ultimately in Cancer.  Itzkowitz SH and Yio X. Am J Physiol Gastrointest Liver Physiol. 2004 Jul;287(1):G7-17. Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Autoimmune Disease and Cancer  Autoimmune Inflammatory Bowel Disease (Crohn‘s and Ulcerative Colitis) is accociated with increased rates of colon cancer.  Itzkowitz SH and Yio X. Am J Physiol Gastrointest Liver Physiol. 2004 Jul;287(1):G7-17. Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Inflammation and Gastric Cancer Stomach inflammation caused by:  Salted foods (>3 gm Na/day)  Pickled foods  Smoked foods  A high-fat, low-fiber diet All of these are associated with increased incidence of stomach cancer   Naylor GM, et al. Gut. 2006 Apr 7. Why does Japan have a high incidence of gastric cancer? A comparison of gastritis between UK and Japanese patients. Ernst P. Aliment Pharmacol Ther. 1999 Mar;13 Suppl 1:13-8. Review article: the role of inflammation in the pathogenesis of gastric cancer. Prostate Inflammation and Cancer  Prostate inflammation/prostatitis is now known to be linked to prostate tumorigenesis.   Nelson WG, et al. J Urol. 2004 Nov;172(5 Pt 2):S6-11; discussion S11-2. The role of inflammation in the pathogenesis of prostate cancer. Sugar LM. Can J Urol. 2006 Feb;13 Suppl. Inflammation and prostate cancer. Inflammation and Ovarian Cancer  Epidemiologic data relates pelvic inflammatory disease with ovarian cancer.  Ness RB, et al. J Natl Cancer Inst. 1999 Sep 1;91(17):1459-67. Possible role of ovarian epithelial inflammation in ovarian cancer.  Ness RB, et al. Epidemiology. 2000 Mar;11(2):111-7. Factors related to inflammation of the ovarian epithelium and risk of ovarian cancer. Metabolic Syndrome and Cancer  Study of 1,800 women  57% of total calories from carbohydrates linked to a 220% increased risk of breast cancer  Link discovered between refined carbohydrates and breast cancer  Secondary to rapid rise in insulin.  High levels of insulin support rapid growth of tumors.  J of Cancer Epidemiology, 2005 How can we protect our DNA? Antioxidants  Antioxidants protect DNA by neutralizing free radicals.  Vitamins C, E and beta-carotene are antioxidants naturally found in fruits, grains, nuts and vegetables.  The minerals selenium and zinc:  Improve immune function  Protect against oxidation and DNA damage A Last Line of Defense: Natural killer and other immune cells fight cancer by targeting and destroying cells that have undergone malignant degeneration. What Can We do?  In addition to early cancer detection and prompt treatment, what else can be done to help prevent and fight cancer? If you are tired of worrying about cancer  You want rest . . . JESUS says… “Come unto to me all ye that labor and are heavy laden, and I will give you rest.” Matthew 11:28 Rest to Body, Mind and Soul! WATE R A N T R E S T tm W AIR N T R E S T tm W A NUTRITION T R E S T tm W A N T EMPERANCE R E S T tm W A N T REST E S T tm W A N T R EXERCISE S T tm W A N T R E SUNSHINE T tm W A N T R E S TRUST IN DIVINE POWER tm REMEMBER: Water Dehydration and Cancer  Dehydration increases the risk for cancers of the breast, colon, and urinary tract.  Decrease risk of cancer by drinking 8 glasses of water each day.   Kleiner SM. J Am Diet Assoc 1999 Apr; 99(4):411. Water: an essential but overlooked nutrient. Manz F, and Wentz A Nutr Rev. 2005 Jun;63(6 Pt 2):S2-5. The importance of good hydration for the prevention of chronic diseases. Fresh Air Air Pollution and Breast Cancer  Women born in areas of New York with high concentrations of air pollution are 2.4 times as likely to develop breast cancer. Bonner MR, et al. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):53-60. Breast cancer risk and exposure in early life to polycyclic aromatic hydrocarbons using total suspended particulates as a proxy measure. Air Pollution and Throat Cancer  Ozone, a common air pollutant, significantly increases laryngeal cancer.  Pereira FA, et al. J Air Waste Manag Assoc. 2005 Jan;55(1):83-7. Influence of air pollution on the incidence of respiratory tract neoplasm. Air Pollution and Cancer Diesel exhaust stimulates increased concentrations of cytokines.  Results in inflammation  Ultimately results in DNA damage and lung cancer. Mutat Res. 2004 Aug 8;562(1-2):119-31. Inflammatory and genotoxic effects of diesel particles in vitro and in vivo. Fetal Exposure to Diesel Exhaust Causes Cancer  Diesel exhaust:     Crosses the placenta Causes DNA deletions in mice fetuses Fetal cells divide rapidly RESULT: Increases risk of cancer TAKE HOME POINT: Diesel exhaust in utero puts the fetus at risk. Reliene, R, et al. Mutat Res. 2005 Mar 1;570(2):245-52. Diesel exhaust particles cause increased levels of DNA deletions after transplacental exposure in mice. Radon Deaths in USA   U.S. Environgmental Protection Agency. http://www.epa.gov/iaq/radon/pubs/citguide.html. Obtained 21 March, 2005. * Radon is estimated to cause about 21,000 lung cancer deaths per year, according to EPA's 2003 Assessment of Risks from Radon in Homes (EPA 402-R-03-003). The numbers of deaths from other causes are taken from the Centers for Disease Control and Prevention's 1999-2001 National Center for Injury Prevention and Control Report and 2002 National Safety Council Reports. Fresh Air in Every Room... To Avoid Radon  Studies show that residential radon is the second leading cause of lung cancer death.  Radon enters the home from the ground  The principal source of exposure to ionizing radiation in most countries. 1. 2. 3. Pershagen G N Engl J Med. 1994 Jan 20;330(3):159-64. Residential radon exposure and lung cancer in Sweden. Lubin JH, et al. Int J Cancer. 2004 Mar;109(1):132-7. Risk of lung cancer and residential radon in China: pooled results of two studies. Krewski D, et al. Epidemiology. 2005 Mar;16(2):137-145. Residential Radon and Risk of Lung Cancer: A Combined Analysis of 7 North American Case-Control Studies. Take-home Points: RID YOUR HOUSE OF RADON and Air Pollution 1. As far as possible get fresh air 2. Every room in the house should have fresh air.   Open your windows Walk in open, fresh air Nutrition Nutrition Western Diet increases Breast Cancer  Asian countries, such as Japan, have low rates of breast cancer, while Western countries have breast cancer rates that are many times higher.  When Japanese girls are raised on westernized diets, their rate of breast cancer increases dramatically.       Armstrong B, Doll R. Int J Cancer 1975;15:617-31. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Hirayama T. Prev Med 1978;7:173-95. Epidemiology of breast cancer with special reference to the role of diet. McCann SE, et al. Int J Cancer. 2004 Sep 1;111(3):440-3. Dietary lignan intakes and risk of pre- and postmenopausal breast cancer. Freudenheim JL, et al. J Natl Cancer Inst. 1996 Mar 20;88(6):340-8. Premenopausal breast cancer risk and intake of vegetables, fruits, and related nutrients. Creton S, et al. Toxicol Sci. 2005 Jan 5. A mechanistic basis for the role of cycle arrest in the genetic toxicology of the dietary carcinogen 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP Weisburger JH. J Am Diet Assoc. 1997 Jul;97(7 Suppl):S16-23. Dietary fat and risk of chronic disease: mechanistic insights from experimental studies. High Fat Diet Increases Risk for Most Common Cancers 1. High dietary fat increases the risk of prostate cancer 2. Diets high in animal fat significantly increases the risk for breast cancer.   Fleshner, N., et.al. Dietary Fat and Prostate Cancer. Journal of Urology. 6/11/2004 Armstrong B, and Doll R. Int J Cancer 1975;15:61731. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Dietary fat and mammary carcinogenesis. Rose DP, et al. International comparisons of mortality rates for cancer of the breast, ovary, prostate, and colon, and per capita food consumption. Cancer 1986;58:236371.  Help your body fight cancer with a Low Saturated Fat Diet In post-menopausal women, the higher the saturated fat in the diet:  The shorter the breast cancer survival  The higher the rate of metastasis Take Home Point: Improve Cancer Survival by decreasing dietary fat. Verreault R, Brisson J, Deschenes L, Naud F, Meyer F, Belanger L. Dietary fat in relation to prognostic indicators in breast cancer. J Natl Cancer Inst 1988;80:819-25. Jaiswal McEligot A, et al. Nutr Cancer. 2006;55(2):132-40. Dietary fat, fiber, vegetable, and micronutrients are associated with overall survival in postmenopausal women diagnosed with breast cancer. Help your body fight cancer with a High-fiber, Vegetable-rich Diet In post-menopausal women, the higher the fiber and vegetable content:  The longer the breast cancer survival Take Home Point: Improve Cancer Survival by increasing dietary vegies. Jaiswal McEligot A, et al. Nutr Cancer. 2006;55(2):132-40. Dietary fat, fiber, vegetable, and micronutrients are associated with overall survival in postmenopausal women diagnosed with breast cancer. Help your body fight cancer by Losing weight while eating a low-fat diet  Women in the highest tertile of BMI had a 1.9-fold higher risk of dying from their breast cancer compared with those at the lowest tertile.  2.0-fold higher risk for the highest tertiles of total fat, saturated fat, and monounsaturated fat intake.  Zhang S, et al. Cancer 1995 Jul 15;76(2):275-83. Better breast cancer survival for postmenopausal women who are less overweight and eat less fat. The Iowa Women's Health Study. Good Fats Lower Risk of Cancer  Omega 3-oils prevent cancer.  Best source of omega 3 oils:  Flax seed, walnuts, olive oil Cooking Meat and Cancer  Cooking meat produces the dietary carcinogen 2-amino-1-methyl-6phenylimidazo[4,5-b]pyridine (PhIP).  RESULT: Mutates DNA until p53 overwhelmed. FINAL RESULT: Prostate, Colon and Breast cancer.  Creton S, et al. Toxicol Sci. 2005 Jan 5. A mechanistic basis for the role of cycle arrest in the genetic toxicology of the dietary carcinogen 2-amino1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). Plant Food versus Meat  Cancers of the colon and prostate are nearly 2x as common in non-vegetarians vs. vegetarians.  Frequent beef consumers also have higher risk of bladder cancer. Fraser GE. Am J Clin Nutr. 1999 Sep;70(3 Suppl):532S-538S. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Meat Increases risk of Colon Cancer  A diet rich in meat increases growth of clostridium bacteria.  Convert primary bile acids to carcinogenic secondary bile acids  1. 2. 3. RESULT: Higher rates of Colon Cancer Pai R, et al. Mol Biol Cell. 2004 May;15(5):2156-63. Epub 2004 Mar 5. Deoxycholic acid activates beta-catenin signaling pathway and increases colon cell cancer growth and invasiveness. Kitahara M, et al. Microbiol Immunol. 2001;45(3):263-6. PCR detection method of Clostridium scindens and C. hiranonis in human fecal samples. Rastall RA. J Nutr. 2004 Aug;134(8 Suppl):2022S-2026S. Bacteria in the gut: friends and foes and how to alter the balance. FIBER FUN:  Fiber speeds the passage of food through the colon.  Fiber promotes growth of healthy gut bacteria  Reduces production of carcinogenic bile acids. World Cancer Research Fund. American Institute of Cancer Research. Washington, DC: 1997. Food, Nutrition, and the Prevention of Cancer: A Global Perspective. Milk Increases Prostrate Cancer Risk  Numerous studies show that:  Milk consumption significantly increases the risk of prostate cancer Qin, Li-Qiang, et.al., Milk Consumption Is a Risk Factor for Prostate Cancer: Meta-Analysis of Case-Control Studies. 5/07/04. Journal: Nutrition and Cancer. 48 (1): 22-27. Soy Milk an Alternative to COWS MILK Lowers RISK OF PROSTATE CANCER!!!  Soy Isoflavanoids are antioxidants  Soy lowers the risk of prostate cancer  Shown to slow cancer progression “You want me to give up what?” Legumes and Fruit Protective  Legumes (peas, lentils, garbanzos (chick peas), kidney beans…) decrease risk of colon and pancreatic cancer.  Fresh and dried fruit lower risk of Lung, Prostate, and Pancreatic cancers. Fraser GE. Am J Clin Nutr. 1999 Sep;70(3 Suppl):532S-538S. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventhday Adventists. Fruits and Vegetables and Pancreatic Cancer Prevention  Prospective cohort of 36,616 women and 45,306 men.  Subjects with the highest amount of dietary folate intake were 75% less likely to develop pancreatic cancer.  NO benefit from folate suplement or folatefortified foods!  Journal of the National Cancer Institute 2006;(98):407-413. Black Beans Help Fight Cancer Chemicals known as tannins found in black-bean inhibit colon, breast and prostate cell proliferation. TAKE HOME POINT: Eat your black beans and FIGHT CANCER GROWTH. Cancer Lett. 2005 Feb 10;218(2):153-62. Inhibition of Caco-2 colon, MCF-7 and Hs578T breast, and DU 145 prostatic cancer cell proliferation by water-soluble black bean condensed tannins. Foods that Fight the Growth of Prostate Cancer  Avocado  Inhibits prostate cancer cell growth  Pomegranates  Suppress prostate cell growth proliferation 1. 2. Qing-Yi, Lu, et.al. Inhibition of prostate cancer cell growth by an avocado extract: role of lipid-soluble bioactivity. Journal of Nutritional Biochemistry. 16(1). 1/29/05. Pomegranate Extracts Potently Suppress Proliferation, Xenograft Growth… Journal of Medicinal food. 4/12/2004, 7(3); 274-283. Antioxidants Lower Risk of Breast Cancer  Antioxidants stabilize DNA.  5 Servings of Fruits and Vegetables per day lower the risk of Breast Cancer.  Best results with fruits and vegetables high in Vitamin A and vitamin C.  Zhang S, et al. J Natl Cancer Inst. 1999 Mar 17; 91(6):547-56. Dietary carotenoids and vitamins A, C, and E and risk of breast cancer. Raw versus Cooked  Raw vegetables high in antioxidants vitamin C, folate, β-carotene, and zinc decrease risk of breast cancer.  However: Cooked vegetables do not protect DNA  Breast Cancer Take Home Point: As far as possible eat raw vegetables and fruits and LOWER risk of CANCER.  Adzersen KH, et al. Nutr Cancer. 2003;46(2):131-7. Raw and cooked vegetables, fruits, selected micronutrients, and breast cancer risk: a casecontrol study in Germany. Do Antioxidant Supplements lower the risk of Breast Cancer? NO! Vitamin A, C, E supplements do NOT prevent breast cancer. Take Home Point: Help your body prevent cancer by using whole fruits and vegetables. Freudenheim JL, et al. J Natl Cancer Inst. 1996 Mar 20;88(6):340-8. Premenopausal breast cancer risk and intake of vegetables, fruits, and related nutrients. Plant Based Diet  Lignans are found in plant products.  Elevated dietary amounts associated with lowered risk of breast cancer.  Lignans lower estrogen. Take Home Point: Elevated lignans prevent breast cancer. McCann SE, et al. Int J Cancer. 2004 Sep 1;111(3):440-3. Dietary lignan intakes and risk of pre- and postmenopausal breast cancer. Pickling and Spices Increase the Risk of Stomach Cancer  Spices  Pickling with vinegar  Salt in high quantities > 3g/day increase the risk of stomach and intestinal cancer Ernst P. Aliment Pharmacol Ther. 1999 Mar;13 Suppl 1:13-8. Review article: the role of inflammation in the pathogenesis of gastric cancer. Take-home Message: The more closely your diet resembles the original diet in Eden, of fresh fruits, grains, nuts, and vegetables, the lower your risk of cancer. (Genesis 1:29) Temperance Alcohol is Damaging  Alcohol increases DNA mutations:  RESULT: Increased risk of cancer of the lip, mouth, throat, larynx and esophagus.  More than additive risk when combined with tobacco. National Health and Medical Research Council (NHMRC) (2001). Australian Alcohol Guidelines: Health Risks and Benefits. NHMRC, Canberra. Alcohol increases Liver Cancer  Alcohol and other causes of hepatitis increase the risk of liver cancer. O'shea RS, McCullough AJ. Clin Liver Dis. 2005 Feb;9(1):103-34. Treatment of alcoholic hepatitis. Alcohol Raises Stomach Cancer Risk  Alcoholic gastritis increases stomach cancer risk.  Xiang Z, Si JM, Huang HD. World J Gastroenterol. 2004 Nov 1;10(21):3212-4. Chronic gastritis rat model and role of inducing factors. Alcohol Causes Pancreatitis  Alcohol is the #1 cause of pancreatitis, a precursor to pancreatic cancer.  Smoking, alcohol, daily baby aspirin, and a low folate diet are the only known risk factors for pancreatic cancer.  Suspected causes include physical inactivity, pesticide exposure, and refined carbohydrate.   –  Jura N, et al. Cell Res. 2005 Jan;15(1):72-7. Chronic pancreatitis, pancreatic adenocarcinoma and the black box in-between. Michaud DS. Minerva Chir. 2004 Apr;59(2):99-111. Epidemiology of pancreatic cancer. Schuermhamer, E. A prospective study of ASA use and the risk of pancreatic Cancer in women. National Cancer institute. 2003; 96;22-28. Journal of the National Cancer Institute 2006;(98):407-413. Women are more sensitive to alcohol and tobacco  Low-to-moderate use of alcohol increases risk of female breast cancer. TAKE HOME POINT: A glass of wine a day increases breast cancer risk. 1. 2. 3. 4. National Health and Medical Research Council (NHMRC) (2001). Australian Alcohol Guidelines: Health Risks and Benefits. NHMRC, Canberra. Alcohol in Australia: Issues and Strategies. (2001) Commonwealth Department of Health and Aged Care, Canberra. Laslett A, Donath S, and Dietze P (2002). Long term consequences of alcohol consumption. In: National Alcohol Research Agenda. Commonwealth Department of Health and Ageing, Canberra. Single E, Ashley M, Bondy S, Rankin J and Rehm J (1999). Evidence Regarding the Level of Alcohol Consumption Considered to by Low-Risk for Men and Women. Commonwealth Department of Health and Aged Care, Canberra. Alcohol and Breast Cancer  Women who consume more than 1 drink per day had 20% higher circulating estrogen levels compared with non-drinkers, which means higher risk of breast cancer.  consumption of fruits, vegetables, and whole grains showed inverse associations with androstenedione levels.   Maskarinec G, et al. Public Health Nutr. 2006 Oct;9(7):875-81. Alcohol and dietary fibre intakes affect circulating sex hormones among premenopausal women. Kaaks R, et al. J Natl Cancer Inst. 2005 May 18;97(10):755-65. Serum sex steroids in premenopausal women and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). Tobacco Increases the Risk of the Following Cancers:         Lung Oral Cavity Nasal Cavities Larynx Pharynx Esophagus Stomach Liver        Pancreas Kidney Bladder Uterine Cervix Colon Myeloid Leukemia University of Texas M.D. Anderson Cancer Center. http://www.mdanderson.org, acquired 3/05/05. Short Tobacco Smoke Exposure  Tobacco smoke causes DNA deletions  Result: CANCER  ONLY 4 hours of intra-uteri cigarette smoke increases DNA deletions and cancer IN FETUS  Second-hand tobacco smoke causes the same cancers as first-hand smoke. TAKE HOME POINT: Completely avoid tobacco exposure, especially if pregnant.   Jalili T, et al. Cancer Res. 1998 Jun 15;58(12):2633-8. Cigarette smoke induces DNA deletions in the mouse embryo. Husgafvel-Pursiainen K. Mutat Res. 2004 Nov;567(2-3):427-45. Genotoxicity of environmental tobacco smoke: a review. Caffeine may increase risk of carcinogenesis  Caffeine appears to deregulate cell cycle progression allowing cells with mutations to progress in the cell cycle.  Qin J, et al. Anticancer Res. 2004 SepOct;24(5A):2991-5. Down-regulation of cyclin E expression by caffeine promotes cancer cell entry into the S-phase of the cell cycle. BMI and Cancer Risk  High Body Mass Index (BMI) raises risk of breast cancer.  Central obesity increases pancreatic cancer.  Patel AV, et al. Cancer Epidemiology Biomarkers Prev. 2005 Feb;14(2):459-66. Obesity, recreational physical activity, and risk of pancreatic cancer in a large u.s. Cohort.  Shu XO, et al. Int J Cancer. 2001 Nov 1;94(3):449-55. Association of body size and fat distribution with risk of breast cancer among Chinese women. Take-home Message: Practice Temperance: Avoid entirely substances harmful to the body and use judiciously those things which are beneficial. RESULT: Improved health and cancer prevention. Rest Regular Sleep Decreases Cancer  Regular sleep at night decreases risk of breast and colon cancer.  Regular sleep increases melatonin, which is anti-estrogenic  Leads to a normal cortisol cycle  This helps regulate cancer-fighting natural killer cells.  Take Home Point: Improve sleep habits and lower cancer risk.  Stanford University Medical Center. 2003 October 1: http://mednews.stanford.edu. LINK BETWEEN SLEEP, CANCER PROGRESSION EXPLORED BY STANFORD RESEARCHER Get Dark Sleep  Being totally blind = 36% lower risk of breast cancer in women.  Early blindness in women is especially protective against breast cancer (49% lower risk than sighted women).  Nighttime exposure to light interrupts melatonin secretion. British Journal of Cancer March 2001;84:397-399. Sleep In TOTAL Darkness to Decrease Cancer Risk Sleep in Total Darkness and Male Cancer  Blind men had a lower incidence of prostate, stomach, colon, rectum, skin and lung cancers. Take Home Point: Sleep in total darkness and decrease cancer risk Science News October 17, 1998 154:248-250. Night Shift Workers  Nurses Health Study:  Irregular hours of sleep in rotating shift workers were found to have increased risk of breast and colorectal cancer.  TAKE HOME POINT: As far as possible get regular hours of sleep.  Schernhammer ES, et al. J Natl Cancer Inst. 2001 Oct 17;93(20):1563-8. Rotating night shifts and risk of breast cancer in women participating in the nurses' health study. Comment in: J Natl Cancer Inst. 2001 Oct 17;93(20):1513-5. J Natl Cancer Inst. 2002 Apr 3;94(7):530; author reply 532-3. J Natl Cancer Inst. 2002 Apr 3;94(7):531-2; author reply 533-4. Schernhammer ES, et al. J Natl Cancer Inst. 2003 Jun 4;95(11):825-8. Night-shift work and risk of colorectal cancer in the nurses' health study.  Take-home Message: GET Regular Sleep at night, without light, and decrease the risk of multiple types of cancer. Exercise Exercise Lowers Risk of Breast Cancer  STUDY: 72,608 women followed for five years; results showed that those women who were most physically active had 29% lower incidence of breast cancer.  Patel AV, et al. Cancer Causes Control. 2003 Aug;14(6):519-29. Recreational physical activity and risk of postmenopausal breast cancer in a large cohort of US women. Exercise Lowers Colon Cancer Risk  Increasing hours of exercise directly lowered colon cancer risk.  Exercise decreases inflammation by lowering prostaglandin E2 levels in colorectal mucosa.  Chao A, et al. Cancer Epidemiol Biomarkers Prev. 2004 Dec;13(12):2187-95. Amount, type, and timing of recreational physical activity in relation to colon and rectal cancer in older adults: the Cancer Prevention Study II Nutrition Cohort.  Martinez ME, et al. J Natl Cancer Inst. 1999 Jun 2;91(11):950-3. Physical activity, body mass index, and prostaglandin E2 levels in rectal mucosa. Non-strenuous Exercise is Best  Exercise need not be strenuous in order to see the anti-cancer benefit.   McTiernan A, et al. JAMA. 2003 Sep 10;290(10):1331-6. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study. Knight JA , et al. Am J Epidemiol. 2005 Dec 1;162(11):1114-22. Epub 2005 Oct 5. Light and exercise and melatonin production in women. Take-home Point:  Exercise prevents cancer. It should be regular but need not be strenuous.  Regular, brisk walking is ideal. Sunshine Sunshine Vitamin D and Sunshine  Sunlight is necessary for the conversion of 7dehydrocholesterol in the dermis to 25hydroxycholecalciferol which is, in turn, converted to 1,25-dihydroxycholecalciferol by the kidneys. Vitamin D Prevents Cancer  High levels of Vitamin D are associated with increased apoptosis in rectal epithelium.  Take Home Point: Vitamin D helps the body rid itself of old or damaged cells so that they do not live on to become cancer.  Miller EA, et al. Cancer Epidemiol Biomarkers Prev. 2005 Feb;14(2):525-8. Calcium, vitamin d, and apoptosis in the rectal epithelium. Sunshine Helps the Body Fight Cancer  Vitamin D inhibits angiogenesis and adjacent tissue invasion.  Lower rates of lung cancer metastasis. Nakagawa K, et al. Carcinogenesis. 2005 Feb 17;22-oxa-1α,25-dihydroxyvitamin D3 inhibits metastasis and angiogenesis in lung cancer. Sunshine Lowers Breast Cancer Risk  Women with a Vitamin D gene mutation have 2X the risk of developing breast and other cancers.  BBC News. http://news.bbc.co.uk/1/hi/health/3542344.stm Vitamin D and Breast Cancer Survival Norwegian Study  Premenopausal women diagnosed with breast cancer in the summer had a 1525% lower relative risk of dying from their disease compared with those diagnosed during the winter.  Porojnicu AC, et al. Breast Cancer Res Treat. 2006 Sep 21; Changes in risk of death from breast cancer with season and latitude : Sun exposure and breast cancer survival in Norway. Vitamin D and Breast Cancer Survival Norwegian Study  Those living in the southeast region of the country with its 1.5X higher annual UV exposure also had a 25% lower RR of death.  No benefit from Vitamin D food supplement during winter for northerners.  Porojnicu AC, et al. Breast Cancer Res Treat. 2006 Sep 21; Changes in risk of death from breast cancer with season and latitude : Sun exposure and breast cancer survival in Norway. Sunshine and Prostate Cancer  Vitamin D has been shown to reduce cytokine-related inflammation associated with prostate cancer carcinogenesis.  Nonn L, et al. Cancer Res. 2006 Apr 15;66(8):4516-24. Inhibition of p38 by vitamin D reduces interleukin-6 production in normal prostate cells via mitogen-activated protein kinase phosphatase 5: implications for prostate cancer prevention by vitamin D. Melatonin and Breast Cancer  Melatonin has been found not only to neutralize the effects of estrogens on the breast, but also to block the local biosynthesis of estrogens from androgens  Similar effect to estrogen blocking medications  Cos S, et al. Cancer Detect Prev. 2006 Apr 26. Estrogen-signaling pathway: A link between breast cancer and melatonin oncostatic actions. Melatonin and Cancer  Melatonin helps fight breast and colon cancer, and possibly cancers of the prostate, stomach, rectum, skin and lung.  Early morning sunlight is particularly important for increased secretion of melatonin secretion at night. Sunshine Prescription: Medline Plus. http://www.nlm.nih.gov/medlineplus/ency/article/0 02405.htm. Acquired 3/8/05. Trust in Divine Power Mental and Physical Health Interact 1. Mental stress raises inflammation: ―To balance the immune system, one must balance the mind and emotions.‖ 2. Inflammation increases cancer Take Home Point: Mental imbalane can increase the risk of cancer. TAKE HOME POINT: ―A merry heart doeth good like a medicine, but a broken spirit drieth the bones. Veldhuijzen. Ann Rheum Dis. 2005 Feb 11. Increased C reactive protein in response to acute stress in patients with rheumatoid arthritis. Spiritual Health (Faith) Helps the Body Fight Cancer Self-reported or perceived 'religiousness', as defined in the study was associated with a 30% improvement in cancer survival. Take Home Point: Improved spiritual health (trust) helps the body fight cancer. Kune GA, et al. J R Soc Med. 1993 Nov;86(11):645-7. Perceived religiousness is protective for colorectal cancer: data from the Melbourne Colorectal Cancer Study. The Perfect Triangle  Physical, Mental and Spiritual Health work together to create ―WHOLE PERSON HEALTH‖  When one aspect is defective or missing, then the other parts are affected. “Faith cometh by hearing and hearing by the word of God.” Romans 10:17 In summary: 1. Healthy choices in lifestyle can exhibit a great influence to decrease cancer incidence. 2. Cancer survival can even be affected by healthy changes in diet and lifestyle. 3. These principles can be remembered with the acronym, ‗W A N T R E S Ttm‘. And Remember: Health Change is Progressive NOTE:  CAUTION: These talks are for your information only and do not serve to create a doctor-patient relationship, if you are ill or on medication and wish to significantly change your lifestyle you should do so under the direction of your regular physician.  Copyright 2006. 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