Diet
The consensus on diet and cancer is that obesity increases the risk of developing cancer. Particular dietary practices often explain differences in cancer incidence in different countries (e.g. gastric cancer is more common in Japan, while colon cancer is more common in the United States. In this example the preceding consideration of Haplogroups are excluded). Studies have shown that immigrants develop the risk of their new country, often within one generation, suggesting a substantial link between diet and cancer.[35] Whether reducing obesity in a population also reduces cancer incidence is unknown.
Despite frequent reports of particular substances (including foods) having a beneficial or detrimental effect on cancer risk, few of these have an established link to cancer. These reports are often based on studies in cultured cell media or animals. Public health recommendations cannot be made on the basis of these studies until they have been validated in an observational (or occasionally a prospective interventional) trial in humans.
Proposed dietary interventions for primary cancer risk reduction generally gain support from epidemiological association studies. Examples of such studies include reports that reduced meat consumption is associated with decreased risk of colon cancer,[36] and reports that consumption of coffee is associated with a reduced risk of liver cancer.[37] Studies have linked consumption of grilled meat to an increased risk of stomach cancer,[38] colon cancer,[39] breast cancer,[40] and pancreatic cancer,[41] a phenomenon which could be due to the presence of carcinogens such as benzopyrene in foods cooked at high temperatures.
A 2005 secondary prevention study showed that consumption of a plant-based diet and lifestyle changes resulted in a reduction in cancer markers in a group of men with prostate cancer who were using no conventional treatments at the time.[42] These results were amplified by a 2006 study in which over 2,400 women were studied, half randomly assigned to a normal diet, the other half assigned to a diet containing less than 20% calories from fat. The women on the low fat diet were found to have a markedly lower risk of breast cancer recurrence, in the interim report of December, 2006.[43]
Recent studies have also demonstrated potential links between some forms of cancer and high consumption of refined sugars and other simple carbohydrates.[44][45][46][47][48] Although the degree of correlation and the degree of causality is still debated,[49][50][51] some organizations have in fact begun to recommend reducing intake of refined sugars and starches as part of their cancer prevention regimens.[52][53][54]
In November 2007, the American Institute for Cancer Research (AICR), in conjunction with the World Cancer Research Fund (WCRF), publishedFood, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective, "the most current and comprehensive analysis of the literature on diet, physical activity and cancer".[55] The WCRF/AICR Expert Report lists 10 recommendations that people can follow to help reduce their risk of developing cancer, including the following dietary guidelines: (1) reducing intake of foods and drinks that promote weight gain, namely energy-dense foods and sugary drinks, (2) eating mostly foods of plant origin, (3) limiting intake of red meat and avoiding processed meat, (4) limiting consumption of alcoholic beverages, and (5) reducing intake of salt and avoiding mouldy cereals (grains) or pulses (legumes).[56][57]
Some mushrooms offer an anti-cancer effect, which is thought to be linked to their ability to up-regulate the immune system. Some mushrooms known for this effect include, Reishi,[58][59] Agaricus blazei, [1], Maitake,[2] and Trametes versicolor[3]. Research suggests the compounds in medicinal mushrooms most responsible for up-regulating the immune system and providing an anti-cancer effect, are a diverse collection of polysaccharide compounds, particularly beta-glucans. Beta-glucans are known as "biological response modifiers", and their ability to activate the immune system is well documented. Specifically, beta-glucans stimulate the innate branch of the immune system. Research has shown beta-glucans have the ability to stimulate macrophage, NK cells, T cells, and immune system cytokines. The mechanisms in which beta-glucans stimulate the immune system is only partially understood. One mechanism in which beta-glucans are able to activate the immune system, is by interacting with the Macrophage-1 antigen (CD18) receptor on immune cells.[60]
Vitamins
Vitamin supplementation has not been proven effective in the prevention of cancer. The components of food are also proving to be more numerous and varied than previously understood, so patients are increasingly being advised to consume fruits and vegetables for maximal health benefits.[61]
- Vitamin D
Low levels of vitamin D is correlated with increased cancer risk.[62][63] Whether this relationship is causal is yet to be determined.[64]
- Beta carotene
Beta-carotene supplementation has been found to increase slightly, but not significantly risks of lung cancer.[65]
- Folic acid
Folic acid supplementation has not been found effective in preventing colon cancer and may increase colon polyps.[66]
Chemoprevention
The concept that medications could be used to prevent cancer is an attractive one, and many high-quality clinical trials support the use of such chemoprevention in defined circumstances.
Daily use of tamoxifen, a selective estrogen receptor modulator (SERM), typically for 5 years, has been demonstrated to reduce the risk of developing breast cancer in high-risk women by about 50%. A recent study reported that the selective estrogen receptor modulator raloxifenehas similar benefits to tamoxifen in preventing breast cancer in high-risk women, with a more favorable side effect profile.[67]
Raloxifene is a SERM like tamoxifen; it has been shown (in the STAR trial) to reduce the risk of breast cancer in high-risk women equally as well as tamoxifen. In this trial, which studied almost 20,000 women, raloxifene had fewer side effects than tamoxifen, though it did permit moreDCIS to form.[67]
Finasteride, a 5-alpha-reductase inhibitor, has been shown to lower the risk of prostate cancer, though it seems to mostly prevent low-grade tumors.[68] The effect of COX-2 inhibitors such as rofecoxib and celecoxib upon the risk of colon polyps have been studied in familial adenomatous polyposis patients[69] and in the general population.[70][71] In both groups, there were significant reductions in colon polypincidence, but this came at the price of increased cardiovascular toxicity.
Genetic testing
Genetic testing for high-risk individuals is already available for certain cancer-related genetic mutations. Carriers of genetic mutations that increase risk for cancer incidence can undergo enhanced surveillance, chemoprevention, or risk-reducing surgery. Early identification of inherited genetic risk for cancer, along with cancer-preventing interventions such as surgery or enhanced surveillance, can be lifesaving for high-risk individuals.
| Gene | Cancer types | Availability |
|---|---|---|
| BRCA1, BRCA2 | Breast, ovarian, pancreatic | Commercially available for clinical specimens |
| MLH1, MSH2, MSH6, PMS1, PMS2 | Colon, uterine, small bowel, stomach, urinary tract | Commercially available for clinical specimens |
Vaccination
Prophylactic vaccines have been developed to prevent infection by oncogenic infectious agents such as viruses, and therapeutic vaccines are in development to stimulate an immune response against cancer-specific epitopes.[72]
As reported above, a preventive human papillomavirus vaccine exists that targets certain sexually transmitted strains of human papillomavirusthat are associated with the development of cervical cancer and genital warts. The only two HPV vaccines on the market as of October 2007 areGardasil and Cervarix.[72] There is also a hepatitis B vaccine, which prevents infection with the hepatitis B virus, an infectious agent that can cause liver cancer.[72] A canine melanoma vaccine has also been developed.[73][74]
Tidak ada komentar:
Posting Komentar