Its Not Easy Being Green How to Improve Your Chances for a Long

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Its Not Easy Being GreenHow to Improve Your
Chances for a Long Healthy Life

• 2006 Tulsa Oklahoma Prevention Health Summit
• Anna Giocondo, M.D.
• The University of Texas
• MD Anderson Cancer Center

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Remember, an ounce of prevention is worth a pound
of cure.
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Our journey starts here
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Consider this

• The time is now. There is no better time for you
  to make a change. Although you may think that
  things will stay the same, they may not

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Luckily

• Many of the behaviors that help reduce your
  risk for cancer are the same as those which help
  reduce your risk of heart disease, diabetes, and
  many other chronic diseases.

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Overview

• Definition, concepts statistics of cancer
• Modifiable risk factors for cancer
• Tobacco, caloric intake, excess body weight,
  diet, exercise, alcohol, solar ultraviolet
  radiation
• Vitamin D other vitamins, antioxidants
  supplements
• Gardasil cervical cancer
• STAR trial breast cancer
• Select pearls about other prevalent cancers

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What is Cancer?

• Diseases characterized by uncontrolled growth and
  spread of abnormal cells. If spread is not
  controlled, death may ensue (via destruction of
  other tissues, production of deleterious
  hormones, catabolic effects, etc.)
• Caused by external factors (tobacco, chemicals,
  radiation and infectious organisms) internal
  factors (inherited mutations, hormones, immune
  conditions and mutations resulting from
  metabolism)
• These factors can act together or in sequence to
  intiate or promote carcinogenesis.

Cancer Facts and Figures, American Cancer
Society, 2006
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What is Cancer?

• most, if not all, cancer cells seem to share a
  common set of biologic attributes essentially,
  changes in cell physiology termed acquired
  capabilitites. These attributes include the
  ability of cancer cells to generate their own
  mitogenic signals, to resist exogenous
  growth-inhibitory signals, to evade apoptosis, to
  proliferate without limits (i.e. to undergo
  immortalization), to acquire vasculature (i.e. to
  undergo angiogenesis) and in more advanced
  cancers, to invade and metastatize.

Hahn and Weinberg, NEJM, 2002
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Cancer Statistics

• Cancer is the second most common cause of death
  in the US, exceeded only by heart disease (1/4
  deaths)
• At least 80 of cancers in Americans are caused
  by habits (smoking, alcohol consumption, and
  diet)
• Approximately one-third of the anticipated
  564,830 cancer deaths in 2006 relate to
  nutrition, physical inactivity and overweight or
  obesity
• 170,000 cancer deaths expected to be caused by
  tobacco use (approximately 1/3)

Cancer Facts and Figures, American Cancer
Society, 2006
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Cancer Statistics

• Many of the more than 1 million cases of skin
  cancer diagnosed in 2006 could be preventable by
  sun protection.
• Cancers related to heavy alcohol use are also
  preventable.
• Certain cancers are related to infectious agents
  are preventable via behavioral changes,
  vaccines antibiotics
• Hepatitis B, HPV, HIV, H. pylori

Cancer Facts and Figures, American Cancer
Society, 2006
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Cancer Statistics

• Often 10 or more years pass between exposure to
  external factors and detectable cancer
• Risk increases with age
• 76 of cancers are diagnosed in persons who are
  55 years or older

Cancer Facts and Figures, American Cancer
Society, 2006 Manual of
Clinical Oncology, Fourth Edition, Lippincott
Williams Wilkins
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Modifiable Risk Factors for Cancer

Of the natural catastrophes that befall us, the
most distressing are those caused by our own
behavior. BL
Manual of Clinical Oncology, Fourth Edition,
Lippincott Williams Wilkins
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Tobacco

• The most preventable cause of death in our
  society.

ACS Cancer Facts Figures Tobacco Use
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Health Consequences of Tobacco Use

• The most important modifiable risk factor for the
  development of cancer AND heart disease
• Half of all Americans who smoke will die from
  their cigarette smoking addiction.
• Importance of targeting youth
• By age 13, 18 of students had smoked a whole
  cigarette and 58 of high school students have
  tried smoking

ACS Cancer Facts Figures Tobacco Use
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Health Consequences of Tobacco Use

• Smoking is associated with increased risk for
  more than 15 types of cancers
• Nasopharynx, nasal cavity paranasal sinuses,
  lip, oral cavity, pharynx, larynx, lung,
  esophagus, kidney, bladder, stomach, pancreas,
  uterine cervix acute leukemia
• Accounts for at least 30 all cancer deaths and
  87 of lung cancer deaths
• Low-tar and light brands are just as harmful
• Second-hand smoke can be harmful and even lethal

ACS Cancer Facts Figures 2005 Tobacco Use
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Health Consequences of Tobacco Use and Beyond

• Shortens lifespan
• In US on average, adult male and female smokers
  lost 13.2 14.5 y of life, respectively, due to
  smoking
• Reduced exercise tolerance quality of life
• Causes heart disease, stroke, chronic bronchitis
  emphysema, and is associated with stomach ulcers

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Health Consequences of Tobacco Use and Beyond

• Second-hand smoke
• increases cancer risk and risk for multiple other
  illnesses e.g. asthma in children
• Expensive (individually and socioeconomically)
• Smoking-related medical costs totaled 75.5
  billion in 1998
• Wrinkles, bad-breath, odor, fire-hazard, etc.

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Chewing Tobacco, Cigars Pipe-smoking

• Main culprits in head neck cancers
• Cigar smoking causes cancer of lung, oral cavity,
  larynx, esophagus, and pancreas 4 to 10 times
  risk of dying from laryngeal, oral or esophageal
  cancers compared with non-cigar smokers
• 11 of US male high school students were
  currently using chewing tobacco, snuff or dip in
  2003

ACS Cancer Facts Figures 2005 Tobacco Use
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Lung Cancer

• Largest cancer killer in both men and women
• Cancers due to tobacco use are totally
  preventable (most cases occur in smokers)
• Lung cancer mortality rates 22 times higher for
  current male smokers and 12 times higher for
  current female smokers, compared with lifelong
  non-smokers

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Lung Cancer Other Risk Factors

• Second-hand smoke
• Occupational environmental exposures
• radon, asbestos (particularly among smokers),
  certain metals (chromium, cadmium, arsenic), some
  organic chemicals, radiation
• Air pollution
• Tuberculosis
• Genetic susceptibility

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Excess Body Weight Obesity

• US epidemic major public health crisis
  (including youth)
• 66.3 US adults overweight or obese (BMI 25)
• 32.2 US adults obese (BMI 30)
• 4.8 US adults extremely obese (BMI 40)
• Increased prevalence of overweight obesity in
  preadolescents adolescents may increase
  incidence of cancer in the future

ACS Cancer Fact Figures 2005 Nutrition
Physical Activity Ogden et al, JAMA 2006
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Adami Trichopoulos. Obesity and Mortality from
Cancer. N Engl J Med 2003 3481623-1624
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Excess Body Weight Obesity

• Incidence of many chronic diseases are reduced by
  caloric restriction, including cancer
• Animal data show that beneficial effects of
  weight loss are present even when started later
  in life, or even by fasting one day weekly (one
  day fast almost as protective as 20-30 caloric
  reduction)

Stephen D. Hursting, PhD, MPH. Obesity and
Cancer from Bench to Bedside. November 3, 2006,
Cancer Prevention Grand Rounds, MD Anderson
Cancer Center
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Excess Body Weight Obesity

• One third of all cancer deaths are related to
  diet activity factors.
• Associated with increased death rates for all
  cancers combined and for cancers at multiple
  specific sites (breast in post-menopausal women,
  colon, endometrial, esophagus, kidney, etc.)
• Important modifiable risk factor in non-smokers

Calle et al. N Engl J Med 2003 348 1625-38
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Excess Body Weight Obesity

• Proposed biologic mechanisms
• Production circulation of steroid hormones,
  insulin insulin-like growth factor, which can
  stimulate cancer growth
• mechanical processes such as abdominal obesity
  and gastroesophageal reflux and esophageal
  adenocarcinoma

ACS Cancer Facts Figures 2005 Nutrition
Physical Activity
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Excess Body Weight Obesity

• Role of availability of energy in modulation of
  cellular replication processes has been
  demonstrated in laboratory animals
• Endocannabinoid system (adipocytes produce
  regulate many hormones)
• plays important role in regulating energy
  balance, feeding behavior, hepatic lipogenesis
  and glucose homeostasis
• Over-activated in human obesity

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Exercise

• 45 minutes or more of moderate to vigorous
  activity 5 or more days a week may help reduce
  risk of breast colon cancers
• Target heart rate (220 age) x 85

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Exercise

• Breast cancer
• Vigorous physical activity may decrease the
  exposure of breast tissue to circulating estrogen
• Colon cancer
• physical activity accelerates movement of food
  through intestine, reducing time of exposure of
  bowel lining to potential carcinogens
• Physical activity helps reduce risk for type 2
  diabetes which is associated with increased risk
  for cancers of colon, pancreas and possibly other
  sites
• Benefits of exercise go far beyond cancer risk
  reduction, including reduced risk for heart
  disease, high blood pressure, falls,
  osteoporosis, stress depression

ACS Cancer Facts Figures 2005 Nutrition
Physical Activity
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Alcohol

• Increases risk of multiple cancers
• Mouth, pharynx, larynx, esophagus, liver, breast
  probably colon rectum
• Risk ? substantially with intake of more than 2
  drinks/day
• Acts synergistically with tobacco to ? risk of
  HN cancers
• Mechanism of action
• Solvent to carcinogens
• Increases free radicals
• Immunosuppressive
• Frequently associated with malnutrition

Nutrition and Cancer Risk Reduction, Sally
Scroggs, M.S., R.D., L.D., Cancer Prevention
Clinic, MD Anderson Cancer Center ACS Common
Questions About Diet Cancer
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Alcohol

• Limit alcohol intake (1/day for women 2/day for
  men)
• 1 drink 12 oz beer, 5 oz wine or 1.5 oz
  80-proof distilled spirits
• Regular consumption of even a few drinks a week
  is associated with an increased risk of breast
  cancer in women
• women at high risk for breast cancer may consider
  alcohol avoidance

ACS Common Questions About Diet and Cancer
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Diet Nutrition

• At least 5 servings daily of fruits vegetables
  (variety is best)
• Dark-colored vegetables are BEST (green leafy,
  cruciferous (indole), dark orange e.g. squash,
  carrots, etc.)
• Full of vitamins, minerals, antioxidants other
  substances that help lower risk of certain
  cancers (lung, mouth, esophagus, stomach colon)
• Fresh or frozen are the most nutritious
• Canned vegetables are often high-sodium many
  canned fruits are packed in heavy syrups
• Steaming or microwaving best for vegetables,
  since boiling tends to leach out water-soluble B
  C vitamins

ACS Common Questions About Diet and Cancer
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Diet Nutrition

• Omega-3 fatty acids (fish is a rich source)
• Animal studies ?cancer suppression slowed
  progression
• Limited evidence for protection against cancer in
  humans, but protective against heart disease
• Large predatory fish (swordfish, tilefish, shark,
  king mackerel) may have high mercury levels
  other toxins ? vary types of fish eaten to reduce
  likelihood of exposure to toxins
• Unsaturated fats
• Monounsaturated canola, olive peanut oils,
  avocados
• Polyunsaturated safflower, sesame sunflower
  seeds, corn soybeans, many nuts seeds their
  oils (walnuts, almonds)

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Diet Nutrition

• Saturated fats may increase cancer risk
• Processed red meats (hot dogs, luncheon meat)
• Decreasing intake may reduce risk of prostate
  colon cancer
• Saturated fat, trans-fatty acids dietary
  cholesterol
• Animal fat (beef, beef fat, veal, lamb, pork,
  poultry fat, butter, cream, milk, cheese other
  dairy products made from whole milk)
• Tropical oils (coconut, palm, palm-kernel oil,
  cocoa butter)
• Partially-hydrogenated fats fast food,
  deep-fried foods, margarine
• Moreover, high-fat diets are associated with
  obesity, which is a risk factor for cancer

ACS Commonly Asked Questions About Diet and
Cancer
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Diet Nutrition

• Cholesterol
• From animal sources only (meat, dairy, eggs,
  animal fats such as butter lard)
• No evidence that lowering blood cholesterol
  levels affects cancer risk (but it does reduce
  risk for heart disease)
• However, many foods rich in cholesterol are
  linked with increased cancer risk (e.g. processed
  red meats)

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Dietary Fiber

• A variety of plant carbohydrates not digestible
  by humans (sources beans, grains, vegetables
  fruit)
• Link between fiber cancer risk not
  well-established, but still recommended to eat
  fiber-rich foods due to the many other nutrients
  and health benefits
• Choose whole grains instead of processed
  (refined) grains and sugars
• 3 servings daily (rolled oats, whole wheat bread,
  brown rice)
• Soluble (e.g. oat bran)
• Helps reduce blood cholesterol, which reduces
  risk of heart disease
• Insoluble (e.g. wheat bran and cellulose)

ACS Cancer Facts Figures 2005 Nutrition
Physical Activity
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Dietary Fiber

• Proposed mechanism of protective action
• Colon cancer
• ? fecal bulk dilutes carcinogens
• ? colonic pH bile acid levels
• Produces protective short chain fatty acids to
  help slow cell proliferation
• ? transit time through the gut, reducing exposure
  time of potentially harmful substances
• Breast cancer ? absorption of unconjugated
  estrogen
• Dietary fiber- soluble insoluble both
  protective

Nutrition and Cancer Risk Reduction, Sally
Scroggs, M.S., R.D., L.D., Cancer Prevention
Clinic, MD Anderson Cancer Center
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Folate

• B vitamin in many fruits, vegetables, beans
  whole grains
• Deficiency linked to increased risk of colon,
  rectal and breast cancer
• Current recommendation is to obtain folate
  through food sources
• However, folate supplementation may help
  counteract increased risk for breast cancer in
  women who consume excess alcohol (i.e. 1 drink
  daily or 3 drinks/week)

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Calcium

• Several studies suggest that foods high in
  calcium may help reduce risk for colorectal
  cancer supplementing diet with calcium modestly
  reduces formation of colorectal adenomas (polyps)
• Other evidence linked high-calcium diets
  (primarily through supplements) with increased
  risk for prostate cancer (esp. more aggressive
  types)

ACS Commonly Asked Questions About Diet and
Cancer
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Calcium

• Therefore, consume recommended levels primarily
  through food sources
• 1000 mg daily for people 19-50y and 1200 mg daily
  for those 50
• Excellent sources include dairy products (low-fat
  or non-fat best) and some leafy green vegetables

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Antioxidants

• Special nutrients in vegetables fruits that
  protect against damage to tissues occurring
  constantly as a result of normal metabolism
  (oxidation, which is linked to increased cancer
  risk)
• Clinical studies of antioxidant supplements are
  currently underway but have not yet shown a
  reduction in cancer risk from vitamin or mineral
  supplements
• Best advice to reduce cancer risk is to consume
  antioxidants through food sources, rather than
  supplements

ACS Common Questions About Diet and Cancer
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Antioxidants

• Beta Carotene supplementation was linked to
  increased risk for lung cancer in randomized
  trials in the US and Finland
• Vitamin E has not been shown to reduce cancer
  risk in randomized controlled trials

ATBC Study Group. The effect of vitamin E and
beta carotene on the incidence of lung cancer and
other cancers in male smokers. N Engl J Med
19943301029-35 Omenn GS, Goodman GE,
Thornquist MD, Balmes J, Cullen MR, Glass A, et
al. Effects of a combination of beta carotene and
vitamin A on lung cancer and cardiovascular
disease. N Engl J Med 19963341150-5 Lee IM,
Cook NR, Gaziano JM, Gordon D, Ridker D, Manson
JE, et al. Vitamin E in the primary prevention of
cardiovascular disease cancer in the Womens
Health Study. JAMA 200529456-61
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Dietary Carcinogens

• Salt/nitrite-cured foods
• Alter GI tract permeability to carcinogens
• Nitrite nitrate form nitrosamines in the
  stomach (gastric cancer, esp. Asians)
• Smoked charcoaled foods
• Carcinogens form during cooking deposit on meat
  as charring

Nutrition and Cancer Risk Reduction, Sally
Scroggs, M.S., R.D., L.D., Cancer Prevention
Clinic, MD Anderson Cancer Center
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Vitamin D

• Vitamin D deficiency has been linked to the
  development of several cancers (colon, prostate,
  breast others)
• Many common cancers such as colon prostate
  display north-south gradients
• Rates increase systematically with increasing
  geographic latitude and show an increased risk in
  African Americans
• Vitamin D supplementation recommended (800 IU
  probably more) in the absence of adequate sun
  exposure (elderly, etc.) or in persons with
  darkly-pigmented skin (melanin impairs formation
  of Vitamin D precursor when skin is exposed to
  UVB light)

Schwartz, GG Blot WJ. Vitamin D Status and
Cancer Incidence and Mortality Something New
Under the Sun. Journal of the National Cancer
Institute, Vol. 98, No. 7, April 5, 2006
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Solar Ultraviolet Radiation

• Limit exposure - some is good too much is bad
• 15 minutes daily (vitamin D)
• Avoid exposure during peak hours (10a-4p)
• Apply sunscreen liberally, at least 30 min prior
  to exposure (compounds with titanium dioxide)
• Use 30 SPF or greater and re-apply every 2h or
  sooner if perspiring or engaging in water
  activities

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Solar Ultraviolet Radiation

• Physical barriers important (hats, clothing)
• Regular check-ups, esp. if history of skin cancer
  or genetically prone to skin cancer
• Remember other effects of too much sun (wrinkles,
  photo aging)

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Solar Ultraviolet Radiation

• Practice self-skin exams every 3 months and
  report any warning signs to your physician
• Tanning beds are DANGEROUS !!
• Relative risk of malignant melanoma 3.6 with
  4-10x use of sunbeds/year
• Protect your children from the sun and teach them
  sun protection

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Skin Cancer Risk Factors

• Exposure to UV radiation
• Genetics (fair complexion, red-heads)
• Previous skin cancer
• Family history
• Dysplastic nevi

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Basal Cell Carcinoma
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Squamous Cell Carcinoma
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Melanoma
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Melanoma
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HPV Vaccine- Gardasil Cervical Cancer

• Protects against HPV types 16 18 (responsible
  for 70 cases of cervical cancer) and HPV types 6
  11
• Potential to eradicate cervical cancer (close to
  100 efficacy)
• Screening with Pap smear still essential, since
  30 of cervical cancers are caused by HPV types
  not contained in the vaccines
• Mandated now in some countries (where cervical
  cancer is no. 1 cause of cancer-related death in
  women)
• Currently recommended for pre-adolescent females
  (controversial)

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Breast Cancer

• Leading cause of death in women ages 35-55
• A leading cause of death due to cancer for women
  of all ages (second only to lung cancer)
• Modifiable risk factors diet, hormones,
  exercise, body weight
• Participate in regular aerobic exercise (moderate
  or vigorous physical activity every day)
• Limit alcohol intake to no more than one
  drink/day
• Folic acid 800 mcg daily
• Target maintain ideal body weight

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Breast Cancer Risk Factors

• Age and reproductive factors
• Inherited genetic mutations (BRCA1 BRCA2 gen. pop.- prophylactic bilateral mastectomy
  ooporectomy lowers risk, but counseling very
  important)
• Personal or family history of breast cancer
• High breast tissue density biopsy-confirmed
  hyperplasia
• High-dose radiation to the chest (e.g. lymphoma
  patients)

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Breast Cancer Hormonal Reproductive Factors

• Age of first full-term pregnancy (
• Tissue milieu rendered protective via
  upregulation of certain genes when breast tissue
  allowed to terminally differentiate (into a
  milk-producing organ)
• Protection persists, despite further changes in
  breast tissue following pregnancy
• Breastfeeding lowers risk
• Post-menopausal hormone therapy (esp. combined
  estrogen progestin therapy)

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Breast Cancer- STAR Trial

• NSABP P-1 Prevention Trial
• Tamoxifen reduced new breast cancers by 70 in
  women
• Increased risk for endometrial (uterine) cancer
  (? less impact from an epidemiological
  standpoint)

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Prostate Cancer

• Risk factors age, ethnicity, family history
  geographic latitude (Vitamin D deficiency)
• International studies suggest diet high in
  saturated fat may also increase risk
• Some evidence suggests that risk of dying from
  prostate cancer increases with obesity

Gary G. Schwartz Vitamin D and the Epidemiology
of Prostate Cancer. Seminars in Dialysis 18
276-289, 2005
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Prostate Cancer

• Finasteride
• Reduced rates overall for prostate CA but assoc.
  with increased risk for more aggressive types of
  cancer (harder to treat)
• SELECT trial (Selenium)- ongoing

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Colon Cancer

• Modifiable risk factors include excess body
  weight, physical inactivity, smoking, heavy
  alcohol consumption, diet high in red or
  processed meat, inadequate intake of fruits
  vegetables
• Risk increases with age
• Inherited genetic mutations (FAP HNPCC)
• Personal or family history of colorectal cancer
  and/or polyps

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Colon Cancer

• Calcium via food sources in recommended levels
• 1,000 mg (19-50 y) 1,200 mg (50 y)
• ? ASA daily (vs. NSAIDS ?), curcumin, HMG-CoA
  reductase inhibitors, estrogen progestin
  hormone therapy (WHI showed benefits not greater
  than risk overall)

ACS Common Questions About Diet and Cancer
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Liver Cancer

• Viral hepatitis alcoholic hepatitis associated
  with the development of cirrhosis progression
  to hepatocellular carcinoma
• Vaccination important for Hepatitis B in persons
  at risk (healthcare workers, etc.)
• Limit alcohol intake

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Leukemia

• Cigarette smoking
• Chemical exposures (benzene, a chemical in
  gasoline cigarette smoke)
• Exposure to ionizing radiation
• Side-effect of cancer treatment
• HTLV-1 (certain leukemias lymphomas)

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H. pylori Infection Cancer

• H. pylori is associated with gastric
  adenocarcinoma MALT lymphoma
• Important to screen for disease if reflux
  symptoms persist or if other symptoms present in
  someone older than 45 yrs, i.e. chest or upper
  abdominal pain, involutary weight loss, trouble
  swallowing, etc.
• H. pylori is a treatable infection which when
  treated can lead to regression of cancer in
  certain cases

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Ovarian Cancer

• BRCA1 and BRCA2 mutations (prophylactic surgery
  reduces risk as with breast cancer risk in
  persons with this mutations)
• Hereditary nonpolyposis colon cancer
• ? Higher body weight increases risk
• Use of estrogen alone as postmenopausal hormone
  therapy increases risk

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Pancreatic Cancer

• Cigarette cigar smoking (incidence rates more
  than twice as high for smokers than for
  nonsmokers)
• Risk increases with obesity, physical inactivity,
  chronic pancreatitis (heavy alcohol use),
  diabetes cirrhosis
• Pancreatic cancer rates higher in countries whose
  diet is high in fat

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Take-Home Pearls

• Prevention trials are underway
• http//clinicaltrials.gov ? cancer prevention
  (547 studies found)
• Make behavioral changes now, which can powerfully
  reduce your risk for cancer

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Take-Home Pearls

• STOP smoking.
• PROTECT your skin.
• Be mindful of your caloric intake (BMI
• Eat smaller portions choose healthy snacks
• Eliminate soft-drinks, saturated fat, trans-fatty
  acids dietary cholesterol
• Eat a variety of fruits, vegetables whole
  grains legumes (foods are the best sources for
  vitamins antioxidants)

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Take-Home Pearls

• Exercise. Build up to 30-45 minutes of moderate
  aerobic activity DAILY (make it habit like
  brushing your teeth do it no matter what)
• Limit alcohol intake (2 drinks/day in men and 1
  drink/day in women) take folate daily if you do
  consume more
• Supplement your diet with Vitamin D
• Ensure adequate calcium and folate in your diet

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Take-Home Pearls

• It is rarely, if ever, advisable to change diet
  or activity levels based on a single study or
  news report
• Be wary of over-the-counter preparations which
  can be harmful since they are not FDA-regulated,
  may interact with each other as well as
  prescribed medications(e.g. fish oil
  supplementation OTC vs. prescription formulation)

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Take-Home Pearls

• Pay attention to important screening
  recommendations (breast, prostate, colon,
  cervical)
• Become familiar with your family history, as this
  can affect your risk for the development of
  certain cancers may require you to seek further
  medical advice about prevention

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Take-Home Pearls

• When you make a wrong choice get back on the
  horse remember these lifestyle changes are FOR
  LIFE
• Look forward to positive feedback through
  discipline self-empowerment
• Remember the power of teaching others by example
  (together, we can inspire eachother)

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I am green, and itll do fineAnd I think its
what I want to be. -Kermit
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But, youve heard enough. Now, its time for
you to listen. Go and find your songs. -
Cantus Fraggle
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Quitting tobacco Where to find help

• American Cancer Society
• AHA American Stroke Association
• American Lung Association
• Centers for Disease Control Prevention
• National Cancer Institute
• Nicotine Anonymous
• Smokefree.gov
• Smoking Cessation Leadership Center

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Select NCI Resources

• Breast Cancer Prevention Studies
• Chemoprevention
• The Study of Tamoxifen and Raloxifene (STAR)
• Selenium and Vitamin E Cancer Prevention Trial
  (SELECT)
• Taking Part in Clinical Trials Cancer Prevention
  Studies
• www.cancer.gov/cancertopics/factsheet/Sites-Types

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More Diet Nutrition Pearls

• Bioengineered foods
• added genes from plants or other organisms (to
  increase a plants resistance to pests, retard
  spoilage, or inprove transportability, flavor,
  nutrient composition or other desired qualities)
• no evidence that they affect cancer risk
• Coffee
• no evidence that it increases risk for cancer
  (although it may increase symptoms related to
  fibrocystic breast lumps, a benign condition)

ACS Common Questions About Diet and Cancer
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More Diet Nutrition Pearls

• Beta-carotene
• Antioxidant related to Vitamin A
• Supplements should be avoided (high-dose
  supplements increased risk of lung cancer in
  smokers in two studies)
• Food sources best
• Aspartame
• a low calorie artificial sweetener about 200
  times sweeter than sugar
• current evidence does not show a link between
  aspartame ingestion increased cancer risk

ACS Commonly Asked Questions About Diet and
Cancer
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I am grateful for all who helped me prepare for
this talk

• Theresa Bevers, MD
• Gary Schwartz, MD
• Shine Chang, MD
• Sally Scroggs, MS, RD, LD
• Stephen Hursting, PhD, MPH
• Michael Giocondo, MD
• And many more