Current and Future Approaches to Nutrition and Cancer Prevention

Starving Cancer
Current and Future Approaches to
Nutrition and Cancer Prevention
SeAnne Safaii, PhD, RD
University of Idaho
University of Idaho- Lunch & Lead
3-15-12
US Mortality, 2006
Rank Cause of Death
No. of
deaths
% of all
deaths
•
•
•
1.
Heart Diseases
631,636
26.0
2.
Cancer
559,888
23.1
•
•
•
•
•
•
•
•
•
•
•
•
9.
3.
Cerebrovascular diseases
137,119
5.7
4.
Chronic lower respiratory diseases
124,583
5.1
5.
Accidents (unintentional injuries)
121,599
5.0
6.
Diabetes mellitus
72,449
3.0
7.
Alzheimer disease
72,432
3.0
8.
Influenza & pneumonia
56,326
2.3
Nephritis*
45,344
1.9
•
10. Septicemia
34,234
1.4
*Includes nephrotic syndrome and nephrosis.
Source: US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention,
2009.
Trends in the Number of Cancer Deaths Among Men and Women,
US, 1930-2006
300,000
295,000
290,000
Men
285,000
250,000
280,000
Women
275,000
200,000
270,000
Women
265,000
150,000
20
00
20
01
20
02
20
03
20
04
20
05
20
06
Number of Cancer Deaths
Men
100,000
50,000
0
1930
1940
1950
1960
1970
1980
1990
2000
Source: US Mortality Data, 1930-2006, National Center for Health Statistics, Centers for Disease
Control and Prevention, 2009.
2009 Estimated US Cancer Cases*
Men
766,130
Women
713,220
Prostate
25%
27%
Breast
Lung & bronchus
15%
14%
Lung & bronchus
Colon & rectum
10%
10%
Colon & rectum
Urinary bladder
7%
6%
Uterine corpus
Melanoma of skin
5%
4%
Non-Hodgkin
lymphoma
5%
Non-Hodgkin
lymphoma
4%
Melanoma of skin
Kidney & renal pelvis
5%
4%
Thyroid
Leukemia
3%
3%
Kidney & renal pelvis
Oral cavity
3%
3%
Ovary
Pancreas
3%
3%
Pancreas
19%
22%
All Other Sites
All Other Sites
*Excludes basal and squamous cell skin cancers and in situ carcinomas except urinary bladder.
Source: American Cancer Society, 2009.
Lifetime Probability of Developing Cancer, Men, 2003-2005*
Site
Risk
All sites†
Prostate
1 in 2
1 in 6
Lung and bronchus
1 in 13
Colon and rectum
1 in 18
Urinary bladder‡
1 in 27
Melanoma§
1 in 39
Non-Hodgkin lymphoma
1 in 45
Kidney
1 in 57
Leukemia
1 in 67
Oral Cavity
1 in 72
Stomach
1 in 90
* For those free of cancer at beginning of age interval.
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
‡ Includes invasive and in situ cancer cases
§ Statistic for white men.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and
Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan
Lifetime Probability of Developing Cancer, Women, US, 2003-2005*
Site
Risk
All sites†
Breast
1 in 3
1 in 8
Lung & bronchus
1 in 16
Colon & rectum
1 in 20
Uterine corpus
1 in 40
Non-Hodgkin lymphoma
1 in 53
Urinary bladder‡
1 in 84
Melanoma§
1 in 58
Ovary
1 in 72
Pancreas
1 in 75
Uterine cervix
1 in 145
* For those free of cancer at beginning of age interval.
† All Sites exclude basal and squamous cell skin cancers and in situ cancers except urinary bladder.
‡ Includes invasive and in situ cancer cases
§ Statistic for white women.
Source: DevCan: Probability of Developing or Dying of Cancer Software, Version 6.3.0 Statistical Research and
Applications Branch, NCI, 2008. http://srab.cancer.gov/devcan
One in three cancer cases can be
prevented
Let’s Talk Prevention
What Is Metastasis?
1. Cancer cells invade
surrounding tissues
and vessels
Blood
vessel
2. Cancer cells
are transported
by the circulatory
system to distant sites
3. Cancer cells
reinvade and grow at
new location
Metastasis Requires Angiogenesis
Angiogenesis
What Is Tumor Angiogenesis?
Small localized tumor
Tumor that can grow and spread
Angiogenesis
Blood vessel
Signaling
molecule
Normal Angiogenesis in Adults
Angiogenesis in
uterine lining
Angiogenesis in tissue during
wound healing
Without Angiogenesis,
Tumor Growth Stops
Infuse nutrient solution
Isolated organ
(e.g., thyroid gland)
Injected cancer cells
stop growing as mass
reaches
1–2 mm in diameter
Drugs That Block
Extracellular Matrix Breakdown
Cancer
cell
VEGF (or bFGF)
Receptor
protein
Endothelial
cell
MMPs
Matrix
Marimistat
AG3340
COL-3
Neovastat
BMS-275291
No endothelial
cell migration
Can we then eat to starve cancer??
Trends in Consumption of Five or More Recommended Vegetable
and Fruit Servings for Cancer Prevention, Adults 18 and Older, US,
1994-2007
35
Prevalence (%)
30
25
24.2
24.4
24.1
24.4
23.6
24.3
24.7
1994
1996
1998
2000
2003
2005
2007
20
15
10
5
0
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000, 2003, 2005, 2007), National Center for Chronic Disease Prevention and Health Promotion, Centers for
Disease Control and Prevention, 1997, 1999, 2000, 2001, 2004, 2006, 2008.
60
55
50
45
40
35
30
25
20
15
10
5
0
Adults with less than a high school education
2007
2006
2005
2004
2003
2002
2000
1998
1996
1994
All adults
1992
Prevalence (%)
Trends in Prevalence (%) of No Leisure-Time Physical Activity, by
Educational Attainment, Adults 18 and Older, US, 1992-2007
Year
Note: Data from participating states and the District of Columbia were aggregated to represent the United
States. Educational attainment is for adults 25 and older.
Source: Behavioral Risk Factor Surveillance System CD-ROM (1984-1995, 1996, 1998) and Public Use Data Tape
(2000, 2002, 2004, 2005, 2006, 2007), National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, 1997, 1999, 2000, 2001, 2003, 2005, 2006, 2007, 2008.
Trends in Prevalence (%) of High School Students
Attending PE Class Daily, by Grade, US, 1991-2007
70
60
Prevalence (%)
50
9th
40
10th
30
11th
20
12th
10
0
1991
1993
1995
1997
1999
2001
2003
2005
2007
Year
Source: Source: Youth Risk Behavior Surveillance System, 1991, 1995, 1997, 1999, 2001, 2003, 2005, 2007
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, 2008.
Trends in Overweight* Prevalence (%), Adults 18 and
Older, US, 1992-2007
1992
1995
1998
Less than 50%
2007
50 to 55%
More than 55%
State did not participate in survey
*Body mass index of 25.0 kg/m2or greater. Source: Behavioral Risk Factor Surveillance System, CD-ROM (1984-1995,
1998) and Public Use Data Tape (2004-2007), National Center for Chronic Disease Prevention and Health Promotion,
Centers for Disease Control and Prevention, 1997, 2000, 2005, 2007, 2008.
Chronic Inflamation
• Can damage DNA
• Mutated DNA repair enzymes are the
biomarkers for cancer
• Foods and food components influence on
biomarkers of cancer risk
Weight, Exercise & Cancer
• Compared to people at a healthy weight,
those who are overweight or obese have an
increased risk for cancer
Weight and Cancer
•
•
•
•
•
Breast Cancer (post menapausal)
Endometrial Cancer
Colon
Kidney
Esophagus.
Breast Cancer
• Estrogen is produced in fat tissue
• Estrogen levels in postmenopausal women
are 50 to 100 X higher among heavy women
• Increased growth of estrogen-responsive
breast tumors
Exercise
30-60 minutes every day
“Fitness can not be bestowed or bought
Like honor, it must be earned”
Cruciferous Vegetables
•
•
•
•
•
•
•
•
Cabbage
Broccoli
Cauliflower
Brussels sprouts
Kale
Watercress
Radish
Wasabi
Bioactive Food Components in
Cruciferous Vegetables
•
•
•
•
Glucosinolates: Sulfur-rich products
Flavonoids: Quercetin, Kaemferol
Vitamins: Vitamin C, E, and K
Carotenoids: B-Carotene, Lutein,
Aeaxanthine
• Minerals: Selenium
Glucosinolate--Sulforaphane
Effects the process of carcinogenesis at the
biochemical level for:
– Lung Cancer
– Mammary Gland
– Prostate
– Colon
– Cervical
Summary
• The anticarcinogenic activities of cruciferous
vegetables are mainly attributed to their
glucosinolates that generate sulforaphane
• Individual response to cruciferous vegetables
may depend upon genetic polymorphisms.
• Sulforaphane modulate cancer processes by
influencing gene expression, enzyme activity,
and cell cycle progression.
Grapes
• Resveratrol (antioxidant) affects the three
stages of carcinogenesis in rats—initiation,
promotion and progression)
• Several clinical trials are in progress in
healthy and cancer patients to investigate
the effects of resveratrol alone or in
combination with drugs and grape products
and on markers for cancer.
Probiotics
• Live microorganisms that when administered
in adequate amounts confer a health benefit
on the host.
• Probiotic supplements have grown by 16% since
2008
–
–
–
–
–
Bifidus digestivum
Bifidus regularis
Bifidobacterium lactis
Lactobacillus casei immunitass
Lactobacillus casei defensis
Conclusions
•
•
•
•
Disconnect between market and science
Science of probiotics still in infancy
Probiotic effects are strain specifc
In vitro tests are not fully adequate to predict
functionality
• Evidence from in vitro studies support
evidence of an anti-carcinogenic effect in
animals
• There is no direct experimental evidence for
cancer suppression in humans
Tea and Tea Polyphenols
• Green, white, oolong and black teas
originate fro the leaves of the evergreen
plant Camellia sinesis and are differentiated
by various processing techniques.
Summary
• Green, black and oolong teas are differentiated
by tea manufacturing processes
• Teas are rich in polyphenols—catechins
• Epidemiological studies show inconsistent
evidence for the association between tea
consumption and reduced risk of cancer
• Preclinically, tea frequently inhibits colon,
esophageal, liver, lung and skin tumorigensis
• Biomarkers of intake and affect are needed
Soy and Breast
Cancer
Traditional soy foods
•
•
•
•
Edamame
Soymilk
Tofu
Whole soy
Western soy products
• Made mainly of soy protein isolate and
concentrate, not whole soybeans
• Burgers, soy nuts, energy bars, breakfast
cereals, etc
Why is soy linked to breast cancer
risk?
• Asian women have high intakes and low
incidence of breast cancer
• Isoflavone
USA: < 2 mg per day
Asia: 10-15 mg per day
Meta-analysis 2006 & 2007
• Decrease in risk was in pre-menapausal
women
• Asian and Asian-Americans—soy intake
reduces risk
• Western women—soy intake does not
reduce the risk
(JNCI 2006 and BJC 2008)
From cell culture to animal models
and human studies
• Adult soy intake does not effect mammary
tumorigenesis in animal models
(cohen et al, 2000) (Kim et al. J nutr 2004)
What do we need to know before
determining whether soy is safe for breast
cancer survivors?
• Asian women consume soy throughout life:
is a beneficial effect seen in Caucasian
women who start consuming soy foods
after diagnosis??
• Do Asian soy foods, Western soy products
and isoflavone supplements cause similar or
different biological effects?
Summary
• Soy isoflaones MIGHT reduce menopausal
symptoms and prevent bone loss, but is lifetime exposure required?
• Childhood and adolescent soy intake MIGHT
provide life-long protection against breast
cancer, and sensitize for the protective effects
of adult soy intake
• More studies are needed to determine
whether starting soy food consumption after
breast cancer diagnosis is safe/reduces risk of
occurrence
Omega 3 Fatty Acids (EPA & DHA)
•
•
•
•
•
•
May inhibit cancer cachexia
May inhibit Progression
May inhibit Metastasis
Increasing tumor radiosensitivity
Increases sensitivity to chemotherapy
Genetic polymorphisms may determine
who would benefit.
Food (1 gm per day)
• Salmon
• Halibut
• Supplements
Vitamin D
• Sources: dairy, fresh salmon, multivitamins
and sunbathing
• As little as 10 minutes of exposure, 3 times
per week can give us what we need—4006oo IU per day.
• It is actually a hormone
• A serum level lower than 37 nanomoles per
liter of blood is considered to be
inadequate.
The Institute of Medicine
Recommends:
(if vitamin D3 is not being made in the skin
through sun exposure)
Age Recommended Minimum Vitamin D Intake
(μg/day and IU/day)
• Birth to 50 years
5 μg (=200 IU)
• 51–70 years 10 μg (=400 IU)
• 71+ years
15 μg (=600 IU)
• Pregnancy
5 μg (=200 IU)
• Lactation
5 μg (=200 IU)
Geographic Role in Cancer
Colorectal Cancer
• Higher levels of Vit D intake are associated
with reduced risk
• Other cancers less conclusive
• Currently under study at NIH
Recommendation
• Get Vitamin D from sunshine when at all
possible
The Future: Nutrigenomics
• Disease prevention
and healthy aging
through the
manipulation of genediet interactions
• Bio-individual
personalized medicine
Recommendations to Live By
• Be as lean as possible and exercise every
day—60 minutes every day moderate
• Eat plant-based foods—grapes, tomatoes,
cruciferous vegetables—5 servings per day
• Eat fish
• Drink tea
• Be careful with soy
• Get enough sunshine
• Use alcohol in moderation
• Know your genes
Questions??