Diet and Cancer Survivorship: Where have we been - where should...
Transcript of Diet and Cancer Survivorship: Where have we been - where should...
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?