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Foods and Cancer
Neal D. Barnard, MDAdjunct Associate Professor of Medicine George Washington University School of Medicine
President, Physicians Committee for Responsible Medicine Washington, DC
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Association of Dietary Fat & Breast Cancer
USA
SwitzerlandCanada
Denmark
Germany
Norway
New Zealand
FranceUK
SwedenAustralia
ItalyIsrael
Finland
Spain
Poland Hungary
Hong Kong
Yugoslavia
Romania
Japan
0
50
100
150
200
250
600 900 1200 1500
r=0.76
Bre
ast
Can
cer
Inci
den
ce(p
er 1
00,0
00 w
om
en, 4
5-69
yrs
)
Per Capita Fat Availability (kcal)from Prentice, et al. JNCI 1988
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Western Diets and Breast Cancer in China
The Shanghai Breast Cancer Study
The “meat-sweet” pattern: meat dessertfish breadcandy milk
30% percent increased breast cancer risk
Cui X. Dietary Patterns and Breast Cancer Risk in the Shanghai Breast Cancer Study. Cancer Epidemiol Biomarkers Prev. 2007;16(7):1443-1448.
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Excess body fat
Increasedestrogen activity
Cancer promotion
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High-fat / low-fiber dietExcess body fat
Increasedestrogen activity
Cancer promotion
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Women’s Health Initiative
48,835 participants, aged 50-79
Diet: 20% fat, ↑ vegetables, fruits, and grains
Fat intake fell from 38% at baseline… to 24% at 1 year, and to 29% at 6 years.
Prentice RI. JAMA. 2006;295:629-642.
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Women’s Health Initiative
After 8.1 years:
Overall breast cancer risk ↓9% (not significant).Progesterone-receptor-negative tumor risk ↓24%.
Prentice RI. JAMA. 2006;295:629-642.
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Fat Content(Percentage of Calories from Fat)
Leanest beef 29%
Skinless chicken breast 23%
Sea trout 32%
White tuna 16%
Broccoli 8%
Beans 4%
Rice 1–5%
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Diet and Breast Cancer Survival
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Women in Japan
Less likely to develop breast cancer, compared with women in U.S.
More likely to survive cancer, if it develops.
Wynder EL, et al. A comparison of survival rates between American and Japanese patients with breast cancer. Surg Gynecol Obstet 1963;117:196-200.
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Body Weight and Breast Cancer Survival
Risk of recurrence or decreased survival:
26 studies: higher weight increases risk
8 studies: no increased risk
Overall, a high BMI increased 5-year mortality by 91%.
Included studies published 1990 – 2001.
Chlebowski RT. J Clin Oncol 2002;20:1128-43.
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Body Weight and Breast Cancer SurvivalShanghai, China, 2006
1,455 women with breast cancer, aged 25-64
BMI 5-year survival< 23.00 86.5%23.00-24.99 83.8%≥ 25.00 80.1% (P = 0.02)
Tao MH. Association of overweight with breast cancer survival. Am J Epidemiol 2006;163:101-107.
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Women’s Intervention Nutrition Study (WINS)
2,437 women with breast cancer
Ages: 48-79, all postmenopausal
Reduced fat (15% of energy) diet vs control
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WINSDiet and Cancer Recurrence
All cancers ↓ 24%
Estrogen receptor - ↓ 42%
Estrogen receptor + ↓ 15%
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WINS Study
Body Mass Index and Relapse (%)
<25 25-30 >300
5
10
15
20
25
30
35
8.9%9.8% 10.2%
Body Mass Index
Chlebowski RT, et al. JNCI 2006;98:1767-76.
Women previously treated for breast cancer,N = 957 intervention, 1424 control
12.8%
11.1%
16.2%
InterventionControl
% relapse
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Women’s Healthy Eating and Living Study
3,109 pre- and postmenopausal women previously treated for breast cancer
7 clinical sites, enrollment 1995-2000
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Women’s Healthy Eating and Living Study
Comparison diet (“5-a-day”): 5 servings of vegetables and fruits (<30% fat, 20 g fiber)
Intervention diet (“8-a-day”): 5 vegetable servings, 3 fruit servings
16 oz. vegetable juice (15-20% fat, 30 g fiber)
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Vegetables and Fruits: “8-a-day” vs “5-a-day”
Mean follow-up: 7.3 years
Mortality
Intervention group (“8-a-day+”) 10.1%
Comparison group (5-a-day) 10.3%
Pierce JP. JAMA 2007;858:289-98.
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“A diet high in vegetables and fruits apparently does nothing to prevent breast cancer from returning, according to a seven-year U.S. government study of more than 3,000 women.”
USAToday.com, accessed July 19, 2007
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WHEL Study Vegetables-Fruits and Regular Walking
1490 women in comparison group Followed for 5-11 years
Mortality
↑ veg/fruit (7.6 servings) + ↑ activity 4.8%
↓ veg/fruit (3.4 servings) + ↑ activity 10.4%
↑ veg/fruit (7.2 servings) + ↓ activity 10.7%
↓ veg/fruit (3.1 servings) + ↓ activity 11.5%
Pierce JP. J Clin Oncol 2007;25:2345-51.
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What about Soy Products?
Source: Wood CE. Biology of Reproduction. 2006;75:477-86.
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Soy and Breast Cancer
Meta-analysis of 8 studies in Asians and Asian Americans:
High soy intake: 29% ↓ risk of breast cancer.
High: 20 mg isoflavones
Low: 5 mg isoflavones
Wu AH. Br J Cancer. 2004;98:9-14.
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Soy and Cancer Recurrence or Mortality in WHEL
<0.0
7
0.07
-1.0
1
1.01
-16.
33
>16.
330
1
P for trend = 0.02
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
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Soy and Survival
High soy intake:
54% ↓ risk.
16.3 mg isoflavones = ½ cup soymilk or
2 oz. tofu
Soy and Cancer Recurrence or Mortality
<0.0
7
0.07
-1.0
1
1.01
-16.
33
>16.
330
1
P for trend = 0.02
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Caan BJ. Cancer Epidemiology, Biomarkers, & Prevention. 2011;20:854-8.
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Shanghai Breast Cancer Survival Study
Shu XO. JAMA. 2009;302:2437-43
Soy and Cancer Mortality
<20.
01
20.0
1-36
.50
36.5
1-62
.68
>62.
680
1
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
16.3 mg isoflavones = ½ cup soymilk or 2 oz. tofu
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Soy and Breast Cancer Recurrence
<4.0
4.0
- 9.9
910
.0
0.0
0.5
1.0
Isoflavone Intake (mg/d)
Haz
ard
Rat
io
Nechuta SJ. Am J Clin Nutr. 2012;96:123-32.
After Breast Cancer Pooling Project
1. Women’s Healthy Eating & Living Study
2. Shanghai Breast Cancer Survival Study
3. Life After Cancer Epidemiology Study
9,514 breast cancer survivors
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Kaiser Permanente Life After Cancer Epidemiology Study
Guha N. Breast Cancer Research & Treatment. 2009;118:395-405.
Daidzein
0
0.10
-7.7
7
7.78
-149
.59
149.
60-1
,453
.00
1,45
3.10
-9,5
96.5
4
>9,5
96.5
40
1
Daidzein Intake (mcg/d)
Haz
ard
Rat
io
Genistein
0
0.10
-6.9
9
7.00
-220
.61
220.
62-2
,184
.8
2,19
9.82
-13,
025.
87
>13,
025.
870
1
Genistein Intake (mcg/d)
Haz
ard
Rat
io
Glycetein
0-3.
61
3.62
-8.1
6
8.17
-14.
99
15.0
0-78
.53
78.5
4-79
5.39
>796
.39
0
1
Glycetin Intake (mcg/d)
Haz
ard
Rat
io
Soy Intake and Breast Cancer Recurrence
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Nutrition & Breast Cancer Survival Summary
Reduced body fat → ↑ survival
Reduced dietary fat → ↑ survival
Vegetables & fruits + exercise → ↑ survival
Soy (~2 servings/day) → ↑ survival
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Prostate Cancer
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Milk and Prostate Cancer
Ganmaa D, Li X, Wang J, Qin L, Wang P, Sato A. Int J Cancer 2002:98,262-267.
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Physicians’ Health Study (Harvard)
≥ 2.5 servings/day of dairy products
20,885 physicians
34% increased risk
of prostate cancer
Relative risk: 1.34 (1.04-1.71)Chan JM. Am J Clin Nutr 2001;74:549-54.
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Health Professionals Follow-up Study (Harvard)
83% of milk consumed was skim or lowfat
Giovannucci E. Cancer Res 1998;58:442-7.
> 2 servings/day of milk
47,781 health professionals
60% increased risk
of prostate cancer
Relative risk for advanced cancer: 1.6 (95% CI, 1.2-2.1)
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Milk Affects Hormones
Milk
↑ IGF-I
↓ Vitamin D
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“Insulin-like” = moves sugar into cells
“Growth factor” = encourages cell proliferation
Insulin-Like Growth Factor IInsulin-Like Growth Factor I
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Men and women aged 55 to 85 years
Three 8-oz servings of milk for 12 weeks
Serum IGF-I levels: ↑ 10%
P<.001 Heaney RP. J Am Dietetic Asso 1999;99:1228-33.
Milk Drinking Raises Human IGF-IMilk Drinking Raises Human IGF-I
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Vitamin DVitamin D
skin
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Vitamin DVitamin D
skin
liver
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Vitamin DVitamin D
skin
liverkidney
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Vitamin DVitamin D
skin
liverkidney
intestine
Calcium
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Vitamin DVitamin D
skin
liverkidney
prostate
intestine
Calcium
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Vitamin DVitamin D
skin
liverkidney
prostate
intestine
Calcium
X X
X
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Vegan Diet and Prostate Cancer
Preventive Medicine Research Institute
84 men with untreated prostate cancer, 1-year study
Control group:
PSA ↑ 6%
6 of the 43 participants required cancer treatment
Vegan group:
PSA ↓4%
No one required treatmentOrnish D, Weidner G, Fair WR, et al. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005;174:1065-1069.
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PhIP Structure*
* 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine)
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Processed meats: Bacon Sausage Ham Hot dogs Deli meats
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Nutrition and Cancer: Mechanisms• Low-fat diets reduce body weight
• Fiber increases hormone elimination
• Low-fat, high-fiber diets reduce hormone effects
• Isoflavones may reduce risk.
• Avoiding meat reduces carcinogen exposure
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Complete Nutrition
Protein
Calcium
Vitamin B12
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Acceptability
• No artificial calorie limits.
• No portion sizes.
• No carbohydrate-counting.
• Benefits encourage adherence.
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Acceptability Acceptability is similar to that of other therapeutic diets.
• Men and women with heart disease (1992) • Young women with dysmenorrhea (2000) • Postmenopausal overweight women (2004)• Men and women with diabetes (2008)
Barnard ND, Scherwitz L, Ornish D. J Cardiopulmonary Rehab 1992;12:423-31.Barnard ND, Scialli AR, Bertron P, et al. J Nutr Educ 2000;32:314-9. Barnard ND, Scialli AR, Turner-McGrievy GM, et al. J Cardiopulm Rehab 2004;24:229-35.Barnard ND, et al. J Am Diet Assoc 2009;109:263-72.
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Body Weight
P-value < 0.0001
Am J Health Promotion, In press
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Waist Circumference
Am J Health Promotion, In pressP-value < 0.001
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