February 3-5, 2016 | Lansdowne Resort, Leesburg, VA

Diet and Cancer Survivorship: Where have we been - where should we be going:

and how can AACR help get us there?

Ruth E. Patterson, PhD Professor, Department of Family Medicine and Public Health

Associate Director, Population Sciences Program Leader, Cancer Prevention

Moores UC San Diego Cancer Center

Diet & Cancer Risk: 2015 Observational Studies

Foods and Nutrients that Reduce Cancer Risk

Foods and Nutrients that Increase Cancer Risk

Tomatoes, fish, soy/genistein, green tea, nuts, β-carotene, fiber, cabbages,

allium vegetables, legumes/beans, mushrooms, citrus fruits, spinach,

selenium, vitamins A, E, C, D, zinc, folate, olive oil, dairy foods, ω-3 Fatty

Acids, turmeric/curcumin, garlic, ginger, lycopene, anise, total fruits &

vegetables, chocolate, monosaturated fat, Mediterranean Diet, flavonoids,

resveratrol/grapes, berries, olives, phytochemicals, red chili/capsaicin,

cadmium, apples, antioxidants, green leafy vegetables, cranberries, kale,

cabbage, black tea, flaxseed, probiotics supplements

Diet & Cancer Risk: Clinical Trials

Null and Negative Findings

β-carotene & lung cancer (ATBC & CARET)

Folate, B12 & all cancers (Norwegian Vitamin Trials)

Vitamin E, selenium & prostate cancer (SELECT)

Fat & breast cancer (WHI & WINS)

Fruits, veges & breast CA recurrence (WHEL) Fruits, vegetables, fiber and polyps (PPT)

Calcium, vitamin D & colon cancer (WHI)

Tantilizing:

Mediterranean Diet (olive oil) & Breast Cancer (PREVIMED)

8 cases/7031 person years

The Experts: ACS (CA: A Cancer J for Clinicians 2012;62:242)

Eat a healthy diet, with an emphasis on fruits, vegetables,

and whole grains.

The most health benefits are associated with a diet high in

fruits, vegetables, whole grains, poultry, and fish, and low in

refined grains, red meat and processed meat, desserts, high-

fat dairy products and French fries.

Taking vitamins, herbs and other nutritional supplements

often does not help cancer patients live longer, and may

even shorten life.

Diet and Cancer Survivorship

YES:

Research on Energetics and Cancer Risk (e.g., BWel study of

weight loss in breast cancer survivors).

D&I research on current guidelines (translation)

Disparities

YES:

PROBABLY/MAYBE:

Focus on dietary patterns (e.g., Mediterranean diet, time-

restricted feeding)

Diet-genotype interactions (with some lessening of enthusiasm

for big wins)

New technologies (e.g., wearable glucose monitors)

New (tangential) fields continue to emerge (e.g., microbiome)

PROBABLY NOT:

Large-scale trials of individual nutrients or foods

Trials of dietary supplements

Cracking the code for simple and accurate dietary assessment

Will diet be left out of the Precision Medicine Initiative?

SCOTT AACR FEATURE

Example: Precision Medicine and Diet in the context of

Breast Cancer Prognosis (265 breast cancer survivors)

Breast Tissue

IGF-IR Status

Carbohydrate Intake after

Diagnosis

Recurrence

OR (95% CI)

Negative Increased/no Δ 1

Negative Decreased 0.7 (0.2-1.8)

Positive Decreased 0.6 (0.2-1.4)

Positive Increased/no Δ 5.5 (1.8-16.3) Adjusted for race/ethnicity, number of positive nodes, progesterone receptor status of primary cancer, and chemotherapy treatment.

Emond JA, Pierce JP, Natarajan L, Gapuz LR, Nguyen J, Parker BA, Varki NM,

Patterson RE. CEBP. 2014;23:1273

OUR CHARGE: Advise how AACR can support the Cancer

Prevention (and Survivorship) Community?

GOALS & OBJECTIVES QUESTIONS

Identify top priorities & research directions. How do we prioritize future research in diet

and survivorship?

Messaging through communications, meetings,

journals, education, and training.

Which message and why?

Advancing policy changes. What policies would we target and why?

Serve the public through public education and services. What niche could AACR play in this crowded

field?

Collaborations with national/international agencies. To accomplish which of the above aims?