Breast Cancer: Do Non-Starchy Vegetables Lower Risk?

Limited evidence suggests that non-starchy vegetables may lower the risk for estrogen-receptor (ER) negative breast cancer, a less common but more challenging to treat type of tumor. Limited evidence also links dairy, diets high in calcium and foods containing carotenoids to lowering the risk of some breast cancers. Carrots, apricots, spinach and kale are all foods high in carotenoids, a group of phytonutrients studied for their health benefits.

The Study: Diet, Nutrition, Physical Activity and Breast Cancer evaluated the research worldwide on how diet, weight and exercise affect breast cancer risk in the first such review since 2010. The report analyzed 119 studies, including data on 12 million women and 260,000 cases of breast cancer.

Results: The report points to links between diet and breast cancer risk. There was some evidence — although limited — that non-starchy vegetables lowers risk for estrogen-receptor (ER) negative breast cancers, a less common but more challenging to treat type of tumor.

Limited evidence also links dairy, diets high in calcium and foods containing carotenoids to lowering risk of some breast cancers. Carrots, apricots, spinach and kale are all foods high in carotenoids, a group of phytonutrients studied for their health benefits.

These links are intriguing but more research is needed, says McTiernan. “The findings indicate that women may get some benefit from including more non-starchy vegetables with high variety, including foods that contain carotenoids,” she said. “That can also help avoid the common 1 to 2 pounds women are gaining every year, which is key for lowering cancer risk.”

Steps Women Can Take: Aside from these lifestyle risk factors, other established causes of breast cancer include being older, early menstrual period and having a family history of breast cancer.

While there are many factors that women cannot control, says Alice Bender, MS, RDN, AICR’s Head of Nutrition Programs, the good news from this report is that all women can take steps to lower their breast cancer risk.

“Wherever you are with physical activity, try to nudge it up a bit, either a little longer or a little harder. Make simple food shifts to boost protection — substitute veggies like carrots, bell peppers or green salad for chips and crackers and if you drink alcohol, stick to a single drink or less,” said Bender.

There are no guarantees when it comes to cancer, but it’s empowering to know you can do something to lower your risk.

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

And, one more thing: NEW free apps for Android and iOS (Apple): In apps, search My Breast Cancer by Michael Hunter.

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Reference: S. J. Lowry, K. Kapphahn, R. Chlebowski, C. I. Li. Alcohol Use and Breast Cancer Survival among Participants in the Women’s Health Initiative. Cancer Epidemiology Biomarkers & Prevention, 2016; 25 (8): 1268 DOI: 10.1158/1055-9965.EPI-16-0151

Could This Diet Raise your Risk of Colon Cancer?

A pro-inflammatory diet replete in red, processed, and organ meat, among other foods, increases the risk for colorectal cancer (CRC) in both men and women. It is especially risky in overweight and obese men, and, paradoxically, also in lean women.

Today, we turn again to ways you can use your diet to reduce your risk of cancer; more specifically, we will focus on the harm of a so-called pro-inflammatory diet. Researchers at the Harvard T.H. Chan School of Public Health (USA) reported two provocative findings this week in the online issue of JAMA Oncology. Let’s cut to the chase and tell you what you need to know. There were two major findings from this study: 1) Higher dietary inflammatory potential was associated with an increased risk of developing colon or rectal cancer among both men and women; and 2) the risk of colon or rectal cancer appeared even higher amongst overweight and obsessive men and in lean women and among men and women not consuming alcohol.

The team rated 18 food groups for their inflammatory potential, using a score based on three inflammatory biomarkers (interleukin-6, C-reactive protein, and tumor necrosis factor-alpha receptor 2. They then rated diets on a continuum from a maximally anti-inflammatory diet to a maximally pro-inflammatory one. Foods that raised the concentrations of these inflammatory markers included tomatoes; high- and low-energy carbonated beverages; vegetables other than green leafy and dark yellow vegetables, and processed or red meat, organ meat, and fish other than dark-meat fish. On the other hand, beer, wine, tea, coffee, dark yellow and dark yellow vegetables, snacks, fruit juice, and pizza were inversely related to concentrations of these same inflammatory markers.

The bottom line? Colorectal cancer risk was nearly 1.5-times higher among overweight or obese men with the most pro-inflammatory diets, as compared to those with the least inflammatory diets. Even lean women had a higher risk with the pro-inflammatory diet, with the chances for getting colorectal cancer rising by a factor of 1.31.

The alcohol finding is puzzling, as it is in contrast to many previous studies in which alcohol raised cancer risk. It may be that alcohol increases that risk through mechanisms unrelated to inflammation.

So, you may be able to reduce your own chances of getting colorectal cancer. Multiple studies have shown a baby aspirin reduces the risk, perhaps partly through inhibition of inflammation. Now, we know that diet can similarly affect your state of inflammation, perhaps independently of the aspirin effect. Finally, if you are at higher risk of colorectal cancer (say, a family member had the disease, or through some personal risk factors), please discuss other potential interventions (e.g. more frequent colonoscopy; consideration of a baby aspirin daily). And all of us should check in with our healthcare provider to see when we are due for a colonoscopy. And yes, I am personally overdue! I’m Dr. Michael Hunter.

Wanna learn more? Click here to explore my new site, devoted to wellness: Wellness!

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JAMA Oncol. Published online January 18, 2018.

Medscape Oncology 2018

Can Mediterranean Diet Reduce Your Chances of Becoming Blind?

Better adherence to a Mediterranean diet reduces the risk of developing age-related macular degeneration, according to a study reported in 2016 in Ophthalmology.

 

Background: Macular degeneration is the leading cause of vision loss, affecting more than 10 million Americans – more than cataracts and glaucoma combined. At present, it is considered incurable. One can compared the human eye to a camera, with the macula the central and most sensitive area of the so-called film. When it is working properly the macula collects highly detailed images at the center of your field of vision and sends the information up the optic nerve to the brain, where we interpret the signals as sight. When the cells of the macula deteriorate, images are not received correctly. While early macular degeneration may not affect your vision, as the disease progresses, you may experience wavy or blurred vision. If the condition continues to worsen, central vision may be completely lost (although peripheral vision may be retained). A Mediterranean diet has been inversely associated with heart attack, stroke, cancer, and mortality. But what about eye health, including macular degeneration?

The Study: Researchers evaluated 5060 patients aged 65 years or older, chosen randomly from centers in Norway, Estonia, the United Kingdom, France, Italy, Greece, and Spain between 2001 and 2002. Dietary intake during the previous 12 months was evaluated, which captured information about consumption of items such as olive oil, fish, wine, fruit, legumes, and meat/meat products. All patients had eye exams, including digital retinal photographs, and blood samples were collected to evaluate antioxidant levels (including lutein, zeaxanthin, carotene, and lycopene). In addition, information was collected regarding smoking and alcohol use and environmental exposure. The mean age among participants was 73.6 years, and 55% were women.

Results: The researchers found that, among the 4753 participants with full dietary data, individuals with a high adherence to a Mediterranean diet had the lowest odds of neovascular advanced macular degeneration, dropping their risk by about half.

My Take:  We cannot establish causality between consuming a Mediterranean diet and the risk of macular degeneration. In addition, self-reporting of dietary information may lead to bias. Still, given the good effects of the diet on the risk of heart attack stroke, and cancer, I am gonna go have some Italian food! I’m Dr. Michael Hunter.

New: Free apps for Android and iOS (Apple): Search My Breast Cancer by Michael Hunter. Please let me know what you think!

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

References: Ophthalmology. Published online November 5, 2016; https://www.macular.org/what-macular-degeneration

Poor adolescent diet associated with premenopausal breast cancer

“During adolescence and early adulthood, when the mammary gland is rapidly developing and is therefore particularly susceptible to lifestyle factors, it is important to consume a diet rich in vegetables, fruit, whole grains, nuts, seeds, and legumes and to avoid soda consumption and a high intake of sugar, refined carbohydrates, and red and processed meats.”

– lead author Karin B. Michels, ScD, PhD, professor and chair of the Department of Epidemiology at the UCLA Fielding School of Public Health, Los Angeles

Key points: Women who consumed a diet associated with chronic inflammation  as adolescents or young adults appear to have a higher risk of developing premenopausal breast cancer, as compared with those who had a diet not linked to inflammation.

Background: Researchers used data from 45,204 women in the Nurses’ Health Study II who had completed a food frequency questionnaire in 1998, when they were ages 33 to 52, about their diet during high School. The investigators then assed adult diet by first using a food frequency questionnaire in 1991, when participants were ages 27 to 44, and then every 4 years thereafter. They gave each woman’s diet an inflammatory score using a previously method that links diet with inflammatory markers in the blood.

During 22 years of follow-up, 870 of the women who completed the high school food frequency questionnaire were diagnosed with premenopausal breast cancer and 490 were diagnosed with postmenopausal breast cancer. When women were divided into five groups based on the inflammatory score of their adolescent diet, those in the highest score group had a 35 percent higher risk for premenopausal breast cancer relative to those in the lowest score group. When the same analysis was done based on early adulthood diet, those in the highest inflammatory score group had a 41 percent higher risk for premenopausal breast cancer relative to those in the lowest score group.

I’m Michael Hunter, the Breast Cancer Doctor.

Should doctors prescribe exercise?

“Although the data vary by different cancer types, there is a consistent trend suggesting that moderate daily exercise has a beneficial effect on preventing certain cancers. If you are a reasonably healthy adult, your should exercise regularly.” 

Let’s look at the relationship of exercise and selected cancers. The American Society of Clinical Oncology (ASCO) has done a nice job of summarizing:

Breast Cancer

While the amount of risk reduction varies among studies (20-80%), most suggest that 30 to 60 minutes of moderate to high-intensity exercise per day lowers breast cancer risk. Women who are physically active throughout their life appear to benefit the most, but those who increase physical activity after menopause also fare better than inactive women.1

Colon Cancer

Research suggests that people who increase their physical activity can lower the chance of developing colon cancer by 30 to 40% relative to sedentary adults.1,2 A decrease in colon cancer risk can be achieved regardless of body mass index (BMI) and people who are most active benefit the most. There is insufficient evidence of a protective effect of physical activity on the risk of rectal cancer (a protective effect was seen in some case-control studies, but not in cohort studies).3

Endometrial, Lung and Ovarian Cancer

A handful of studies have suggested that women who are physically active have a 20-40% reduced risk of endometrial cancer compared to those who don’t exercise.1 Higher levels of physical activity seem to also protect against lung cancer (up to 20% reduction in risk), particularly among men.1Although less consistent, research suggests that physical activity possibly reduces the risk of ovarian and prostate cancer.

What about Other Cancers?

While observational data on the benefits of exercise for prevention of the types of cancers listed above are fairly consistent, evidence of the effects of exercise on prevention of any other type of cancer either is either insufficient or inconsistent.2,4

Prostate Cancer

Prostate cancer is one disease in which the data are not consistent, however prostate cancer is a heterogeneous disease and risk factor associations for total non-aggressive disease are different from aggressive / lethal disease. Most population based studies show similar findings, with little effect of exercise on overall incidence of prostate cancer but lower risk of aggressive prostate cancers for those with the highest levels of VIGOROUS activity (rather than any type of activity). In the Health Professionals Follow-up Study men 65 years or older who engaged in vigorous physical activity, such as running, jogging, biking, swimming or tennis at least three hours per week  had a 67% lower risk of advanced prostate cancer and 74% lower risk of fatal prostate cancer.5

Conflicting data for other malignancies

For example, one recent study found no association between physical activity and risk of developing gastric, rectal, pancreatic, bladder, testicular, kidney and hematological cancers.4 In contrast, a pooled analysis of data from prospective trials with 1.4 million participants found that physical activity was linked to lower risk of 13 cancers: esophageal, lung, kidney, gastric, endometrial, myeloid leukemia, myeloma, colon, head and neck, rectal, bladder, and breast.6Interestingly, leisure-time physical activity was associated with a higher risk of melanoma (presumably due to time spent outdoors) and prostate cancer, although it is not clear from these data whether that association was with nonaggressive or aggressive prostate cancer.

While we wait for confirmation and clarity on the role of exercise in preventing all the 200+ types of cancer – should doctors prescribe exercise? The answer is simple: yes, because evidence of the protective role of exercise is already strong for some of the most common cancers.

References

  1. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006.
  2. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239–252.
  3. Pham NM, et al. Physical activity and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2012 Jan;42(1):2-13.
  4. Friedenreich CM, Neilson HK, Lynch BM. Eur J Cancer. State of the epidemiological evidence on physical activity and cancer prevention. 2010 Sep;46(14):2593-604.
  5. Giovannucci E, Liu Y, Leitzmann MF, et al. A prospective study of physical activity and incident and fatal prostate cancer. Arch Intern Med. 2005; 165(9):1005-1010.
  6. Moore SC, Lee IM, Weiderpass E, et al. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25.
  7. http://www.asco.org/about-asco/press-center/asco-resources-media/cancer-perspectives/should-cancer-doctors-prescribe?et_cid=38723632&et_rid=463715101&linkid=Read+more

I’m Dr. Michael Hunter. Of course, the disclaimer: Do not begin an exercise program without input from an appropriate medical professional. Many can simply start with a brisk walk for 30 minutes daily, 5 days per week. Have a wonderful day!

Too High levels of Vitamin D May Increasing Mortality

What You Need to Know: The level of vitamin D in our blood should neither be too high nor too low. Scientists from the University of Copenhagen are the first in the world to show that there is a connection between high levels of vitamin D and cardiovascular deaths.

The Study: Several studies have shown that too low vitamin D levels can prove detrimental to our health. However, new research from the University of Copenhagen reveals, for the first time, that too much vitamin D in our blood is connected to an increased risk of dying from a stroke or a heart attack.

“We have studied the level of vitamin D in 247,574 Danes, and so far, it constitutes the world’s largest basis for this type of study. We have also analysed their mortality rate over a seven-year period after taking the initial blood sample, and in that time 16,645 patients had died. Furthermore, we have looked at the connection between their deaths and their levels of vitamin D,” Professor at the Department of Clinical Medicine, Peter Schwarz explains.

Conclusion: Dr. Schwartz concludes: “If your vitamin D blood level is below 50 or over 100 nanomol per litre, there is an greater connection to deaths. We have looked at what caused the death of patients, and when numbers are above 100, it appears that there is an increased risk of dying from a stroke or a coronary. In other words, levels of vitamin D should not be too low, but neither should they be too high. Levels should be somewhere in between 50 and 100 nanomol per litre, and our study indicates that 70 is the most preferable level,” Peter Schwartz states.

My Take: There is a correlation between mortality rates and too low levels of vitamin D, but the new findingis that the levels of vitamin D that are too high may be linked to cardiovascular risk. As is the case with so many things, moderation may be the key. I’m Dr. Michael Hunter.


The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

References:

  • D. Durup, H. L. Jørgensen, J. Christensen, P. Schwarz, A. M. Heegaard, B. Lind. A Reverse J-Shaped Association of All-Cause Mortality with Serum 25-Hydroxyvitamin D in General Practice: The CopD Study. The Journal of Clinical Endocrinology & Metabolism, 2012; 97 (8): 2644 DOI: 10.1210/jc.2012-1176
  • University of Copenhagen – The Faculty of Health and Medical Sciences. “High levels of vitamin D is suspected of increasing mortality rates.” ScienceDaily. ScienceDaily, 10 March 2015. <www.sciencedaily.com/releases/2015/03/150310105222.htm>.

How Can You Reduce Your Risk of Getting Cancer?

Recent reports suggest that about 2 out of 3 cancers may be due to “bad luck.” Today, we focus on the other third: What can you do to reduce your risk of cancer?

What You Need to Know:

  • Maintaining a healthy body weight and being physically active had the greatest impact on overall risk of a cancer-related death. 
  • Restricting alcohol consumption to one drink per day for women and two drinks per day for men was associated with 29% reduced risk for obesity-related cancers. Additionally, the risk was up to 71% lower for the most common site-specific cancers in the United States (breast, prostate, and colorectal).

Background

  • As people make their resolutions for 2015, two new studies — which show that curbing alcohol consumption, adding more plant foods to the diet, and losing excess weight can help reduce the risk of developing cancer — serve as a reminder that a healthy lifestyle is important.
  • In 1997, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) issued cancer prevention guidelines for weight management, diet, and physical activity. These were updated in 2007 and are considered to be the most comprehensive scientific analysis of cancer prevention and causation ever undertaken. Specifically, the guidelines reported that excess body fat is associated with an increased cancer risk and that there is convincing evidence that the consumption of alcohol, red meat, and processed meat elevates cancer risk. Since that time, numerous studies have reported links between colorectal cancer risk and alcohol, between breast cancer mortality and obesity, between breast cancer relapse and obesity, and between breast cancer risk and red meat.

The Evidence: The first study, published online January 6 in Cancer Causes & Control, showed that eating a plant-based diet and limiting alcohol intake, both already included in various cancer prevention guidelines, could help cut the risk for obesity-related cancers (about a third of all of cancers). In a cohort of nearly 3000 adults, the researchers found that restricting alcohol consumption to one drink per day for women and two drinks per day for men was associated with 29% reduced risk for obesity-related cancers. Additionally, the risk was up to 71% lower for the most common site-specific cancers in the United States (breast, prostate, and colorectal). For individuals who consume starchy vegetables, such as corn, potatoes, and yams, sufficient consumption of nonstarchy legumes, fruits, and vegetables was associated with a reduction in the risk for colorectal cancer.

Pronounced Effect on Cancer Risk

In their study, Makarem and colleagues investigated whether the healthful behaviors outlined in the WCRF/AICR guidelines were associated with the risk for obesity-related cancers, in particular, breast, prostate, and colorectal cancer. Of the 2983 adults enrolled in the Framingham Offspring cohort from 1991 to 2008, the researchers identified 480 incident obesity-related cancers.

Data from food frequency questionnaires, anthropometric measures, and self-reported physical activity were used to develop a 7-component score based on recommendations for body fatness; physical activity; foods that promote weight gain; plant foods; animal foods; alcohol; and food preservation, processing, and preparation. The cohort was, on average, middle aged to older and overweight, but had a relatively high level of physical activity. The mean duration of follow-up was 11.5 years.

The overall score was not associated with obesity-related cancer risk after adjustment for confounders such as age, sex, smoking, energy, and pre-existing conditions (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.86 – 1.02). However, when the score components were considered separately, the researchers found that for every unit increment in the alcohol score (representing an improvement and more closely meeting the guideline recommendations), there was 29% lower risk for obesity-related cancers (HR, 0.71; 95 % CI, 0.51 – 0.99) and a 49% to 71% reduced risk for breast, prostate, and colorectal cancers.

Similarly, each unit increment in the subcomponent score for nonstarchy plant foods (fruits, vegetables, and legumes) for those who eat starchy vegetables was associated with a 66% lower risk for colorectal cancer (HR, 0.44; 95% CI, 0.22 – 0.88).

Healthy Body Weight and Exercise Reduce Mortality

The second study, published online January 7 in the American Journal of Clinical Nutrition, reported similar results. Researchers found that greater adherence to the cancer prevention guidelines of the American Cancer Society (ACS) was associated with a reduction not only in cancer incidence, but also in cancer mortality and total mortality.

The ACS guidelines recommend that individuals avoid smoking, achieve and maintain a healthy weight, be physically active, and eat a healthy diet that emphasizes plant foods. In their study, Geoffrey Kabat, PhD, senior epidemiologist in the Department of Epidemiology & Population Health at the Albert Einstein College of Medicine in Bronx, New York, and colleagues report that maintaining a healthy body weight and being physically active had the greatest impact on overall mortality for both men and women.

The researchers used data from the NIH-AARP Diet and Health Study, a prospective cohort study of 566,401 adults who were 50 to 71 years of age in 1995 and 1996, when they enrolled in the study. They were followed for a median of 10.5 years for cancer incidence, 12.6 years for cancer mortality, and 13.6 years for total mortality.

During the study period, there were 73,784 cases of cancer, 16,193 cancer deaths, and 81,433 deaths from any cause. The patients were stratified by how closely they adhered to ACS guidelines, and adherence to the guidelines was associated with a reduced risk for all cancers combined. When the highest level of adherence was compared with the lowest level, the hazard ratio was 0.90 for men and 0.81 for women.

In addition, increased adherence was associated with a reduction in risk for 14 of 25 specific cancers. Reduction in the risk for gallbladder cancer was 65% in men and women combined, for endometrial cancer was 60%, for liver cancer was 48% in men, for colon cancer was 48% in men and 35% in women, and for rectal cancer was 40% in men and 36% in women.

My Take: These results add to the existing evidence on the potential role of limiting alcohol intake and increasing the intake of plant foods in influencing cancer risk. Dietary advice on cancer should focus on encouraging the consumption of a plant-based diet providing abundant non-starchy fruits, vegetables, and legumes, and restricting alcohol, if consumed at all, to the recommended levels. Try to stick to the ACS Guidelines, as the closer you follow them, the greater the benefit in cancer risk-reduction. Finally, exercise and don’t use tobacco. I’m Dr. Michael Hunter.

References: Cancer Causes Control. Published online January 6, 2015. Abstract; Am J Clin Nutr. Published online January 7, 2015. Abstract; http://www.medscape.com/viewarticle/837976#vp_2