CANCER RISK REDUCTION:

8. SPECIFIC CANCERS

J. A. Scharffenberg, M.D., M.P.H.

Adjunct Prof. Nutrition
Loma Linda University
CANCER INCIDENCE & DEATH
RATES

• “Cancer incidence and death rates in the

United States are continuing to decline. . .
Incidence declined 0.5% per year between
1991 and 2001. In men, cancer incidence
rates declined for seven of the top 15 cancers
(colon, larynx, leukemia, lung, oral cavity,
pancreas, and stomach) and increased for
only four (cancers of the esophagus, kidney,
and prostate and melanoma). In women
Continued

• the rate of lung cancer declined for the

first time. . . . Overall rates of cancer
death dropped 1.1% per year between
1993 and 2001.” J Natl Cancer Inst 2004;96:988.
The mortality rate for cancer of the
prostate and breast cancer in women
have declined in this period of time. Ibid.
p. 987.
THE FOUR MAJOR U.S.
CANCERS

• Over 50% of our cancer mortality is

from cancer of the lung, colon,
prostate, and breast.
Cancer Facts & Figures, 2005, ACS
MAJOR CANCERS IN THE US

MEN WOMEN
Lung Lung
Prostate Breast
Colon Colon
Pancreas Ovary
Leukemia Pancreas
Esophagus Leukemia
Liver Non-Hodgkin Lymphoma
Cancer Facts & Figures, 2005. ACS
SMOKING RATES

• Smoking rate among US adults is declining –

20.9% in 2004 were smoking, 21.6% in 2003,
22.5% in 2002. Morbidity and Mortality Weekly Report Nov. 11,
2005.

For California the rate was 16.2% in 2003.

California Cancer Facts & Figures, 2005.

• Overall smoking rates have declined for 12-17

year olds since 1994 in California but has
risen to 22.4% for the18-24 year old group in
2003. Ibid.
LUNG CANCER

• Mortality has been dropping for men and

leveling off for women. Adolescents smoking
rates are no longer increasing.
• Besides not smoking eat lots of fruits and
vegetables.
• Use of apples had a risk ratio of 0.42 after
adjusting for other fruits & vegetables. Am J
Epidemiol 1997;146:223-30.
LUNG CANCER

• “Lung cancer is the leading cause of

cancer death in US women and is
responsible for as many deaths as
breast cancer and all gynecological
cancers combined.” JAMA 2004;291:1763-8.
COLON CANCER

• Keep your weight down.

• Get on a good exercise program.
• Consume beans, cruciferous vegetables
and use whole grains.
• Avoid meat. Even white meats carry a
high risk.
• From age 50 on get your colonoscopic
exam.
COLON CANCER

• A review of 3 trials shows those with

higher plasma selenium levels had 34%
less risk of colon cancer. J Natl Cancer Inst
2004;96:1645, 1649. Eat Brazil nuts . Each one

contains 100 mcg if grown in area with

high selenium content soil.
COLON CANCER

• Those in the highest quintile of calcium

(>1767 mg/d) vs. the lowest (<731
mg/d) had a 12% lower colon adenoma
risk. This is due largely to calcium
supplement intake. Am J Clin Nutr 2004;80:1358-65.
COLON CANCER

• Colon and rectal cancer mortality data, mostly

around 1993-94 and egg consumption data in
nine time periods (1964-94) in 34 countries
were derived from WHO and FAO
respectively. Egg consumption was
significantly and positively correlated with
mortality from colon and rectal cancers in
both sexes. Nutr Cancer 2003;46:158-65.
• This also occurred in the Adventist Health
Study. J Natl Cancer Inst 1994;86:1409-15.
COLON

• Adenomas of the colon are precursors

to colorectal cancers and are inversely
related to plasma lycopene levels but
not to a-tocopherol or beta carotene
levels. Am J Clin Nutr 2003;78:1219-24.
FOLATE

• There is some evidence that a high

intake of folate from the diet or from
supplements may reduce the risk of
colon cancer. J Natl Cancer Inst 1995;87:265-73; Cancer
Causes Control 1996;7:214-223; Annals of Intern Med 1998;129:517-
24.

• Folate comes from lentils, beans,

asparagus, spinach, orange juice. It is
added to many dry breakfast cereals.
COLON

• Rectal cancer was inversely associated

with intakes of vegetables (odds ratio
0.72), fruit (0.73), and whole grain
products (0.69), whereas a high intake
of refined grain products was directly
associated with an increased risk
(1.42). A threshold effect at about 5
servings of vegetables/d was needed to
see a reduced risk. Am J Clin Nutr 2004;79:274-81.
PROSTATE CANCER

• Keep your weight down.

• Have a good exercise program.
• Avoid use of meat.
• Eggs and cheese should be minimized.
• Go easy on milk or high calcium intake.
• Get adequate selenium (Brazil nuts). Se
reduced this cancer 63%.Nutr Rev 1997;55:277-9.
• Get lycopene from tomatoes. Users 10X vs.
<1.5X/wk had RR 0.47. J Natl Cancer Inst
1995;87:1767-76.
SELENIUM

• In 5 of 6 trials selenium has been

effective in lowering risk of prostate
cancer. It appears selenium affects
tumor progression rather than
premalignancy. J Natl Cancer Inst 2004;96:645-7.
• Risk was lowered 64% using only 200
mcg Se/d equivalent of 2 Brazil nuts.
Biomed Environ Sci 1997;10:227-34; Nutr Rev 1997;55:277-9; Brit J
Urol 1998;81:730-4; Am J Epidemiol 1994;140:20-6.
SOY

• “Currently, although only limited

epidemiologic data indicate soy intake
reduces prostate cancer risk, results from a
pilot intervention trial suggest isoflavones
may be beneficial to prostate cancer patients.
For several reasons, men concerned about
their prostate health may consider
incorporating soy into their diet.” Messina, Nutr Rev
2003;61:117-31.
PSA TESTING

• Dr. Thomas Stamey, Stanford University

urologist, the original champion of the
PSA test lost faith in PSA as a marker
for prostate cancer after analyzing data
from 1300 radical prostatectomies
performed over the last 20 years. He
says today that PSA reflects only
prostate enlargement. J Natl Cancer Inst
2005;97:168.
PSA TESTING

• A low level is no guarantee that cancer

does not exist. In the Prostate Cancer
Prevention Trial 15% of men with levels
less than 4.0 ng/mL had prostate
cancer and 15% of those had high-
grade disease. J Natl Cancer Inst 2005;97:168.
PROSTATE CANCER PROGNOSIS

• The majority of patients diagnosed with

prostate cancer in the PSA screening era do
not have excess mortality compared to the
general population under our present medical
care system. J Clin Oncol 2005;23:407-9.
• In England they don’t do as much screening
as in the US with no difference in mortality
rates. BJU Int 2004;94;59-62.
PROSTATE CANCER PROGNOSIS

• A randomized trial of persons with

prostate cancer compared watchful
waiting to radical prostatectomy. The
surgery reduced the death rate from
prostate cancer but overall mortality
was no different between the groups.
Distant metastases were less frequent
in those having surgery. N Engl J Med
2002;347:781-9.
PROTON TREATMENT FOR
PROSTATE CANCER

• Report on 1225 patients treated from 1991

through 1997 showed overall survival rate of
73% but was 90% in those with initial PSA
<or=4.0, 87% in those with post-treatment
PSA nadirs <or=5.0, but rates dropped with
rises in initial and nadir PSA values. Survival
is comparable to other treatment methods
but with this there is minimal morbidity.
Int J Radiat Oncol Biol Phys 2004 59:3438-52.
BREAST CANCER

• Keep your weight down. Obesity increases risk only

in postmenoapusal women, not in premenopausal women.
• Get on a good exercise program.
• Avoid animal fat.
• Avoid regular use of meat. It increases
overweight risk 2-2.5X.
• Minimize use of eggs and cheese.
• Eat lots of fruits and vegetables, especially
cruciferous.
• Avoid alcohol.
BREAST CANCER

• The Nurses Health Study showed eating

beans or lentils at least twice a week
reduced risk of women (pre-
menopausal at the beginning of the
study) by 24% of getting breast cancer.
Int J Cancer Apr. 20, 2005.
INCIDENCE DIFFERS 4-FOLD IN
VARIOUS COUNTRIES

• The incidence rates 1993-1997 were

27/100,000 in Asian countries and
97/100,000 in US white women.
Int J Epidemiol 2005 Feb. 29 Epub ahead of print.
MAMMOGRAPHY

• Screening mammography reduces breast

cancer mortality by 20-35% in women aged
50-69 and slightly less in the 40-49 year age
group at 14 years follow-up. Breast self-
exam does not reduce mortality but increases
biopsies. JAMA 2005;293:1245-56.
•

• ACS announced Mar. 31, 2005 37% of these

deaths could be prevented if all those 50-79
had mammograms.
BREAST CANCER SURGERY

• Between 1973 and 1980 women with

breast cancer measuring no more than
2 cm in diameter were assigned to
undergo either a radical mastectomy or
breast-conserving surgery. Long-term
survival rate was the same with no
difference in rate of metastases. N Engl J
Med 2002;347:1227-32.
DID SOY PRIOR TO DIAGNOSIS
AFFECT SURVIVAL?

• The soy intake did not affect breast

cancer survival. Breast Cancer Res Treat 2005;92:11-7.
OVARY CANCER

• Keep your weight down.

• Avoid meat & eggs as they increased
the risk (the Adventist Health Study).
• Soy foods may be useful. A study
showed them to be inversely related
with 82 g vs. <20/d resulting in a 60%
lower risk. Br J Cancer 2002;86:712-7; Am J Epidemiol
1997;146:294-306.
MILK

• High intake of lactose and dairy products,

particularly milk, are associated with an
increased risk of serous ovarian cancer but
not of other subtypes of ovarian cancer. Am J Clin
Nutr 2004;80:1353-7.

• Dietary calcium and low fat, but not whole,

milk and lactose are inversely related to ovary
cancer risk. Reduces risk by half. Am J Epidemiol
2002;156:148-57.
• Milk does reduce the risk of many other cancers
(stomach, esophagus, colon, bladder). The Committee on Diet,
Nutrition, and Cancer, National Academy of Sciences, Diet, Nutrition, and Cancer,
National Academy Press, 1982, pp. 61, 139, 140, 396, 406.
NON-HODGKIN’S LYMPHOMA

• A population based case control study with

601 cases and 717 controls was conducted in
1995-2001 among women. When the highest
quartile of intake was compared with the
lowest the increased risk of NHL associated
with animal protein was 1.7 and saturated fat
1.9. An increased risk was noted for retinol,
eggs, and dairy products, but a reduced risk
for fiber and several fruit and vegetable
items. Am J Epidemiol 2004;159:454-66.
NON-HODGKIN’S LYMPHOMA

• A case-control study of 597 cases and

467 controls in Sweden of both men
and women showed risk increased with
high dairy use and fried red meat
intake. High consumption of fruits and
vegetables was associated with reduced
risk. Women in the highest quartile of
vegetable intake had a RR of 0.3. Cancer
Epidemiol Biomarkers Prev 2005;14:512-20.
MELANOMA

• Melanoma has increased after the

1970s but stabilized in the mid-1990s.
This has been postulated to be due to
the increased recreational exposure to
sunlight. Incidence increased 126%
between 1973 and 1995. J Natl Cancer Inst
2003;95:933.
PANCREAS

• Avoid tobacco
• Don’t get diabetes
• Avoid obesity
• Exercise Nutrition Action Healthletter Oct. 2002.
PANCREATIC CANCER

• A study showed a relative risk of

pancreatic cancer associated with any
current use of aspirin versus no use to
be 0.57. Aspirin may be a
chemopreventive for pancreatic cancer.
J Natl Cancer Inst 2002;94:1168-71.
ESOPHAGEAL CANCER

• A case-control study of 124 people with

esophageal cancer and 154 with stomach
cancer and 449 controls showed people
eating a high meat diet had nearly 4X the risk
of esophageal cancer and more than double
the risk of stomach cancer. This research was
sponsored by the National Cancer Institute.
Environmental Nutrition 2002;25, No. 2 taken from Am J Clin Nutr Jan. 2002.
ESOPHAGEAL CANCER

• Eat lots of fruits and vegetables

• Avoid obesity
• Avoid gastric reflux (heartburn
increases risk 50X) Nutr Action Healthletter Oct. 2002.
• Avoid tobacco
• Avoid alcohol
• Avoid very hot drinks
THE END