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START.

A.Hanna
Epidemiological Evidence

Willett's Review of Nutritional Studies:

 Reviewed studies on dietary intake and cancer risk over the past decade.
 Analysis in nutrition studies is challenging, as individuals are exposed to varying dietary
levels.
Criteria for Study Quality (Boyle):
1. Validated methods for estimating dietary and energy intakes.
2. Adjustments for nutrient intake based on total energy intake.
3. Study size sufficient to detect risks.
4. Sufficient dietary intake range to observe graded effects.
Ayurvedic Cancer Treatments (Kulkami):
 Ayurvedic herbal drugs were used to treat advanced-stage cancers, showing positive,
though not curative, effects.
 Herbal ingredients: Mesuaferrea, Asparagus racemosus, Withania somnifera, etc.
Aloe Vera for Cancer and HIV (Hoffman):
 Aloe vera stimulated T-4 lymphocyte production, boosting the immune system and
reducing Kaposi's sarcoma in HIV patients.
 Aloe vera and cesium chloride are considered low-toxicity alternatives for cancer and
AIDS treatments.
Diet and Lifestyle in Cancer Treatment (Kulkami):
  Dietary changes, herbal supplements, and lifestyle adjustments, such as meditation, help
cancer patients gain confidence and strength.

Fiber's Role in Cancer Prevention (Burkitt):

 High-fiber diets are linked to lower colon cancer rates, as observed in African
populations.
 Willett's Study: Increased fruit fiber intake showed a dose-response decrease in colon
cancer risk, but total crude and vegetable fiber showed no clear link.
Protective Role of Nutrients:
 Micronutrients like beta-carotene and vitamin E may contribute to cancer prevention in
high-fiber diets.
Mechanisms for Fiber's Protective Effects:
 Insoluble fiber increases fecal bulk, dilutes carcinogens, and reduces intestinal transit
time.
 Fiber binds mutagenic agents and enhances their excretion.
 High fiber may reduce estrogen, possibly lowering breast cancer risk, though evidence is
inconclusive.
Inconclusive Fiber-Cancer Link:
 While fiber has protective potential, studies show mixed results regarding its impact on
colon and breast cancers.
Trans Fatty Acids:
 No evidence supports the link between trans fatty acids and increased cancer risk (Ip &
Marshall).
 Animal studies show trans fats do not increase tumor development compared to cis fats.
Breast Cancer:
 Diet's impact on breast cancer risk is minimal based on epidemiological evidence.
 No strong link between trans fatty acids and increased breast cancer risk.
Colon and Rectal Cancer:
 Diet, particularly saturated fats and animal fats, increases the risk of colon and rectal
cancers.
 Fiber and vegetable intake decrease the risk.
  Ongoing clinical trials are assessing the impact of dietary fat restriction and increased
fiber/vegetable intake.
Prostate Cancer:
 Evidence suggests a link between saturated fat intake and prostate cancer risk, but no
link has been found with trans fats.
Obesity and Cancer Risk:
 Obesity is associated with certain cancers, though the causal relationship isn't fully
established.
 Moderate exercise can reduce the risk of some cancers.
 A fat-rich diet often lacks fruits and vegetables, making it difficult to isolate the impact
of fat alone.
Caloric Restriction:
 Caloric restriction has been shown to inhibit cancer development in both spontaneous
and chemically induced cancers (Kritchevsky).
 Caloric restriction reduces tumor incidence and tumor burden, even in high-fat diets.
Saturated Fat vs. Fiber and Vegetables:
 High saturated fat intake is linked to breast and colorectal cancers.
 Up to 40% of breast cancer cases may be preventable through dietary changes.
 Fiber and vegetable intake potentially offer protective effects, but their exact role is still
under investigation.

Link Between Diet and Disease:

  Human diseases, including cancer, are closely tied to dietary habits (Krishnaswamy).
 Recent scientific focus is on how diets prevent chronic diseases like cancer and
cardiovascular disease.
Functional Foods:
 Functional foods are gaining recognition for their role in disease prevention and health
promotion (WHO, NRC).
 These foods may include both nutrients and non-nutrients that influence chronic
disorders.
Micronutrient Deficiency and Cancer Risk:
 Low intakes of nutrients like beta-carotene, vitamins A, C, E, folate, iron, and zinc
increase the risk of cancers in the upper digestive tract.
 Vegetables and fruits are critical in preventing epithelial cancers, such as those affecting
the alimentary and respiratory tracts.
Antioxidants and Cancer Prevention:
 Antioxidant vitamins (e.g., vitamin C, beta-carotene) may reduce cancer risk by
protecting against environmental damage.
 Nutrient intervention studies suggest antioxidants like vitamin A, zinc, and selenium play
therapeutic roles in preventing precancerous lesions.
Role of Spices and Non-Nutrients:
 Spices like turmeric, mustard, and Allium vegetables (e.g., onions) contain non-nutrient
compounds (e.g., phenols, flavonoids, isothiocyanates) that act as antioxidants,
antimutagens, and anticarcinogens.
 These compounds help neutralize free radicals, inhibit carcinogens, and prevent tumor
formation.
Turmeric’s Anticancer Properties:
 Turmeric and its active component, curcumin, inhibit carcinogen-DNA binding and
reduce tumor formation in animal models.
 It is being studied for its potential to prevent skin, breast, oral, and stomach cancers.
Vitamin A and Cancer:
 Vitamin A intake shows a modest inverse association with breast cancer, but its effect on
colon and prostate cancer is unclear.
 Ongoing studies will further assess vitamin A's impact on cancer risk.
Dietary Recommendations:
 Increasing intake of fruits and vegetables rich in carotenoids is encouraged for cancer
prevention, with expected benefits beyond cancer, including lower risk of cardiovascular
diseases and cataracts.
Beta-Carotene Supplementation:
 Large-scale intervention studies show no chemopreventive effect of beta-carotene in
humans, with few exceptions (Astrog).
 Carotenoids act on cellular mechanisms (e.g., reducing cell proliferation and enhancing
immunity) but their antioxidant effects may not be the primary cause of their cancer-
preventive properties.
tannins:
 Tannins, found in plant foods, can have carcinogenic or antinutritional effects in large
quantities, but small amounts may be beneficial (Chung et al.).
Garlic:
 Garlic has shown positive results in reducing cancer risk. One study found a 35% lower
risk of colon cancer with garlic consumption, but garlic supplements (pills) showed no
consistent benefit (Steinmetz, Reuter).
Antinutrients:
 Compounds like phytic acid, tannins, saponins, and phytoestrogens found in plant
foods may reduce cancer risk at appropriate intake levels. These substances could protect
against reproductive and pancreatic cancers, among others (Thompson).
Lycopene:
 Lycopene, found in tomatoes, may lower the risk of several cancers. However, more
research is needed to determine the effects of lycopene supplements (Clinton).
 A diet rich in fruits and vegetables, especially tomatoes, may reduce cancer risk more
effectively than isolated carotenoid supplements.
Carotenoid and Cancer Risk:
 Epidemiological studies suggest a link between higher carotenoid levels (like beta-
carotene) and lower cancer risk, particularly for tobacco-related cancers.
 Randomized trials show mixed results: beta-carotene supplements increased lung cancer
risk in high-risk populations but showed protective effects against oral leukoplakia and
cervical lesions.
Complex Interactions:
 The protective effects of fruits and vegetables are likely due to a combination of nutrients
and non-nutrients, not just carotenoids. Lycopene and other components may modulate
cancer by influencing hormone levels, carcinogen metabolism, and immune response.
iii. EFFECTS OF DIET AND LIFESTYLE ON SPECIFIC CANCERS
Louise from A to B
a. Cancers of the Digestive Tract
1. Tongue, Mouth, and Pharyngeal Cancer
Risk Factors:
o Cigarette smoking and alcohol consumption are independent risk factors; their
combined effects are geometrically additive.
o Ex-smokers' risk decreases to levels similar to lifelong nonsmokers after 10 years
of cessation.
o Use of oral snuff and fine tobacco powder increases risk.
o Betel nut chewing is a significant cause in regions like India.
o Poor dental hygiene is an independent risk factor, mitigated by fruit and vegetable
consumption.

2. Nasopharyngeal Cancer
Risk Factors:
o Involves Epstein-Barr virus (EBV) infections.
o High risk associated with consumption of salted fish and preserved/fermented
foods, especially in Chinese infants.
o Such foods are sources of volatile nitrosamines (carcinogens) that can induce
tumors.

3. Esophageal Cancer
Risk Factors:
o Cigarette smoking and alcohol intake are primary risk factors in developed
countries, particularly in France.
o High rates linked to combined effects of smoking and alcohol.
o Increased risk observed in nonsmokers who drink alcohol and nondrinkers who
smoke.
o In developing countries (e.g., Iran, China), factors like very hot drinks and
contaminated foods are implicated.
o Dietary deficiencies (e.g., vitamins A and C) are major contributing factors in
high-risk areas.
o Northern Italy study: 90% of male esophageal cancer attributed to smoking, high
alcohol use, and low beta-carotene intake.

4. Stomach Cancer
Epidemiology:
o Previously the leading cancer cause of mortality; now surpassed by lung cancer.
 o High incidence in China, Japan, eastern Europe, and northern Italy; declining
rates in the West.
o Improved diets and food processing (e.g., refrigeration) linked to lower rates.
Risk and Protective Factors:
o Diets high in fresh fruits, vegetables, and garlic are protective.
o Traditional starchy foods are positively associated with risk.
o Potential links to dietary salt, nitrates/nitrites, and specific nutrients (antioxidants,
beta-carotene, ascorbic acid) require further research.
Common Factors with Stroke:
o Dietary salt is a linking factor between stomach cancer and stroke.
o High carbohydrate intake may promote both conditions, particularly in lower
socioeconomic classes where diets are high in salt.
5. Colorectal Cancer Overview
Incidence:
o Third most common cancer worldwide.
o Highest rates in Western Europe and North America, intermediate in Eastern
Europe, and lowest in sub-Saharan Africa.
o Approximately 166,000 new cases annually in the European Community.
Risk Factors
Non-Dietary Factors:
o Few specific non-dietary risk factors established.
Energy Intake:
o Complex relationship; physically active individuals consume more energy but
have lower colorectal cancer risk.
o Obesity's association with colorectal cancer is inconsistent.
Fat Intake:
o Epidemiological evidence suggests a positive relationship between fat intake and
colorectal cancer risk.
o Increased colon cancer risk associated with animal fat consumption, especially in
women.
o High meat consumption identified as a risk factor, potentially due to carcinogenic
compounds formed during cooking (e.g., amino imidazoazarenes, or AIAs).
Saturated Fat:
o Increased risk linked to high saturated fat intake, particularly in sedentary
individuals.
o Among Chinese-Americans, risk increases significantly with higher saturated fat
consumption.
Dietary Fiber:
o Protective effect of dietary fiber against colorectal cancer is debated.
o Different effects of soluble and insoluble fibers; fruits and vegetables may have
more beneficial effects than cereal fiber alone.
 Alcohol Consumption:
o Positive association with colorectal cancer, though the specific causative factor is
unclear.
Vitamins and Nutrients:
o Some evidence suggests vitamin E, selenium, and beta-carotene may offer
protective effects against colon tumors.
o Coffee consumption may be inversely related to colorectal cancer risk.
Conclusion
Dietary factors are significant determinants of colorectal cancer risk, particularly:
o Saturated fat: Likely a risk factor independent of total energy intake.
o Meat intake: Potentially increases risk due to mutagenic products formed during
cooking.
o Vegetable fiber and coffee: Possible protective effects, while the role of other
factors (like calcium and cereal fiber) remains to be fully understood.

b. Liver Cancer and Pancreatic Cancer

Liver Cancer
Risk Factors:
 High alcohol intake correlates with increased liver cancer risk; alcoholics have a 50%
higher risk.
 Risk may be underestimated due to liver damage leading to reduced alcohol consumption
before cancer diagnosis.
 Dietary deficiencies, especially in vitamin A and other micronutrients, may increase
hepatocellular carcinoma risk.
 Significant risk factors include hepatitis B virus infection, alcohol consumption, and
aflatoxin exposure, particularly in tropical regions of Africa and Asia.
Pancreatic Cancer
Demographics:
 More prevalent in men, blacks, and urban populations.
 Risk Factors:
 Cigarette smoking is a well-established risk factor.
 No significant relationship found with coffee or alcohol consumption.
 Positive associations with carbohydrate and cholesterol intake, and inverse relationships
with dietary fiber and

NINA FROM C TO E
C. Lung and Laryngeal Cancers
Lung and Laryngeal Cancers
Lung Cancer:
 Cigarette smoking is the primary cause.
 Regular consumption of fruits and vegetables is associated with lower lung cancer
risk, particularly those high in beta-carotene.
Laryngeal Cancer:
o Major risk factors include tobacco smoking (especially pipe and cigar smoking)
and alcohol consumption.
o Poor diet, particularly low intake of fruits and vegetables, is linked to higher risk.

D. Breast Cancer
Epidemiology:
 Over half a million new cases diagnosed annually.
 The relationship between body mass index and breast cancer risk is complex;
it may increase risk in postmenopausal women but reduce it in premenopausal
women.
Dietary Factors:
o The association between dietary fat and breast cancer remains controversial; some
studies suggest increased risk with high saturated fat intake, especially in
postmenopausal women.
o Green vegetable consumption is linked to lower breast cancer rates, though
evidence is weak.
o Alcohol consumption has been associated with a modest increase in breast cancer
risk.
E. Cervical and Endometrial Cancers
  Cervical Cancer:
 Higher risk in lower socioeconomic classes, long-term oral contraceptive users,
and cigarette smokers.
 Protective factors may include dietary carotenoids and vitamin E, though these
associations could reflect a healthier lifestyle.
 Risk factors include early age at first intercourse and number of sexual partners.
 Endometrial Cancer:
o Strongly associated with hormonal factors, particularly increased estrogen levels.
o Risk is elevated in women using hormone replacement therapy (HRT) and those
with obesity.
o Dietary associations include positive correlations with meat, eggs, milk, and total
energy intake, while protective effects may be linked to green leafy vegetables.

F – H AUBREY

F. Ovarian and Prostatic Cancers

Ovarian Cancer
Epidemiology:
 Most common gynecological malignancy; obesity is associated with an
elevated risk.
 Evidence from case-control studies is largely inconclusive, possibly due to
weight loss caused by the cancer itself.
Dietary Factors:
o Some studies suggest associations with total fat intake and possible protective
effects from green leafy vegetables.
o The role of milk fat and lactose in increasing risk is debated, with some proposing
galactose is toxic to oocytes.
Prostatic Cancer
Epidemiology:
 One of the most frequent cancers in men, with unclear etiology.
  Androgens are believed to play a role in its development, but support for this
theory is limited.

Dietary Factors:
 Linked to per capita fat intake; animal fat intake may increase risk.
 Milk consumption's effect on prostate cancer is uncertain but might relate to
fat intake.

G. Kidney and Bladder Cancers

Kidney Cancer
Epidemiology:
 More common in men (2:1 ratio).
 Renal cell adenocarcinoma accounts for about 85% of kidney cancers.
Risk Factors:
 Cigarette smoking is a significant risk factor.
 Some associations with obesity and animal protein/fat intake; however,
evidence is inconsistent.
 Kidney stones are also linked to increased risk.
Bladder Cancer
Epidemiology:
 Strongly associated with cigarette smoking.
 Coffee consumption may increase risk; saccharin's potential as a risk factor is
largely considered reassuring.
Dietary Factors:
 A diet rich in fresh fruits and vegetables, and possibly vitamin A, may be
protective.
H. Thyroid Cancer
Epidemiology:
 More common in women, with a wide range of malignancy severity.
 Iodine deficiency's role in development is still under investigation.
Dietary Factors:
  A poor diet, particularly one containing natural goitrogens, is linked to an increased risk
of thyroid cancer.

iv. DIET AND CANCER: CAUSATIVE AND PREVENTIVE MECHANISMS

HANNA’S PART

Mechanisms of Diet's Influence on Carcinogenesis

1. Provision of Carcinogens:
 Diet can provide carcinogens or their immediate precursors, directly contributing
to cancer risk.
2. Facilitation or Inhibition of Carcinogen Production:
 Certain dietary components may promote or inhibit the body's endogenous
production of carcinogens.
3. Modification of Carcinogenesis:
 Dietary elements can modify the metabolic activation or inactivation of
carcinogens, affecting their potential to cause cancer.
4. Delivery of Carcinogens:
 Changes in diet can alter how carcinogens are delivered to their sites of action
within the body.
5. Tissue Susceptibility:
 Diet may influence the susceptibility of tissues to cancer induction, potentially
increasing or decreasing risk.
6. Elimination of Transformed Cells:
 Dietary factors can affect the body's ability to eliminate transformed (cancer)
cells, impacting cancer progression.