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prevention of cancer

Etiology: - modifiable risk factors: [19] - cigarette smoking: 19% of cancer cases; 29% of deaths - overweight & obesity: 8% of cancer cases; 7% of deaths - alcohol abuse: 6% of cancer cases; 4% of deaths - ultraviolet radiation exposure: 5% of cancer cases; 2% of deaths - sleep - sleep duration of 6-8 hours/night for men & 6-9 hours for women may be optimal for reducing cancer incidence & mortality [22] - sleeping 10+ hours/night may increase a woman's risk of cancer & both men & women's risk of dying from cancer [22] Management: 1) Mediterranean diet may provide a framework for orchestrating guidelines 2) eat plenty of fruits & vegetables, especially cruciferous vegetables, deeply pigmented fruits* vegetables containing carotenoids & fruits & vegetable rich in vitamin C - aim for at least 5 servings of fruits & vegetable per day - 2 servings of fruit & 3 servings of vegetables associated with the lowest mortality [21] - increased consumption of fruits and vegetables is associated with ~4% reduction in overall cancer risk [7,8] - no decrease in cancer-specific mortality [10] - cruciferous vegetables reduce risk of colorectal cancer [8] - > 85% of adults in the U.S. do not eat the recommended amounts of fruits & vegetables [9] 3) eat plenty of high-fiber foods such as whole grains, fruits & vegetables - aim for a daily fiber intake of 20-30 grams. - limit consumption of processed foods [20] 4) decrease fat intake to < 30% of total calories consumed 5) minimize consumption of salt-cured, smoked & nitrite-cured foods such as bacon, ham & hot dogs [6,8,15] to reduce risk of - colorectal cancer - association of red meat with colorectal cancer is weak with no clear dose-response pattern [16] - breast cancer - prostate cancer - kidney cancer - pancreatic cancer [2] 6) limit or avoid alcohol to reduce the risk of - head & neck cancer - esophageal cancer - colorectal cancer - breast cancer [3] 7) limit or avoid dairy products to reduce the risk of prostate cancer [3] 8) consumption of soy products during adolescence reduces risk of breast cancer in adulthood & risk of recurrence & mortality for women previously treated for breast cancer [3] 9) Do NOT smoke. 10) a healthy body mass index (BMI < 25) reduces risk of 13 cancers b) gastric cancer (cardia), liver cancer, gallbladder cancer, pancreatic cancer, ovarian cancer, thyroid cancer, multiple myeloma, meningioma, breast cancer (postmenopausal), uterine cancer (corpus), esophageal adenocarcinoma, renal cell cardinoma, & colorectal cancer [18] c) aim for weight control through exercise & lower calorie intake. [4] 11) healthy life-style can reduce risk of cancer-related death 44-48% - not smoking, alcohol in moderation or not at all, regular exercise, BMI of 18.5-27.4 12) there is little evidence that vitamin/mineral supplements decrease risk of cancer or preinvasive neoplasia [3] - combined folic acid (2.5 mg), vitamin B6 (50 mg), & vitamin B12 (1 mg) may reduce risk of invasive cancer in women > 65 years of age [5] - no benefit in younger women - folic acid increases risk of cancer - overall (RR=1.07) - prostate cancer (RR=1.24) - colorectal cancer (RR=1.28) [11] - beta-carotene may increase the risk for lung cancer (RR=1.20) & stomach cancer (RR=1.54) [12] - selenium increases risk for non-melanoma skin cancer (RR=1.44) [13,14] - vitamin E increases the risk for prostate cancer (RR=1.17) [14] 13) higher cardiorespiratory fitness (maximal oxygen consumption) is associated with lower risks of colon, prostate & lung cancer among Swedish men [23] - moderate-high colon cancer, low-high prostate cancer, high lung cancer

Related

malignant neoplasm (cancer) risk factors for cancer

General

prophylaxis (prevention, ppx)

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 467
  2. Department of Health & Human Sevices, publication #95-3862, Bethesda, MD, National Cancer Institute, 1995
  3. Davies AA, Davey Smith G, Harbord R, Bekkering GE, Sterne JA, Beynon R, Thomas S. Nutritional interventions and outcome in patients with cancer or preinvasive lesions: systematic review. J Natl Cancer Inst. 2006 Jul 19;98(14):961-73. Review. PMID: 16849679
  4. Reeves GK et al, Cancer incidence and mortality in relation to body mass index in the Million Women Study: Cohort Study. BMJ 2007, 335:1134 PMID: 17986716
  5. Zhang SM et al. Effect of combined folic acid, vitamin B6, and vitamin B12 on cancer risk in women: A randomized trial. JAMA 2008 Nov 5; 300:2012. PMID: 18984888
  6. Sinha R et al Meat Intake and Mortality: A Prospective Study of Over Half a Million People Arch Intern Med. 2009;169(6):562-571 PMID: 19307518 http://archinte.ama-assn.org/cgi/content/full/169/6/562
  7. Bofetta P et al Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC) JNCI Journal of the National Cancer Institute Advance Access published online on April 6, 2010 PMID: 19924549 doi:10.1093/jnci/djq072 http://jnci.oxfordjournals.org/cgi/content/abstract/djq072 - Willet WC Fruits, Vegetables, and Cancer Prevention: Turmoil in the Produce Section Journal of the National Cancer Institute Advance Access published online on April 6, 2010 PMID: 20371763 doi:10.1093/jnci/djq098 http://jnci.oxfordjournals.org/cgi/content/full/djq098
  8. Gonzales JF, Barnard ND, Jenkins DJ et al Applying the Precautionary Principle to Nutrition and Cancer. J Am Coll Nutr. 2014 May 28:1-8. PMID: 24870117
  9. Moore LV, Thompson FE Adults Meeting Fruit and Vegetable Intake Recommendations - United States, 2013 MMWR Weekly. July 10, 2015 / 64(26);709-713 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6426a1.htm - USDA: How Many Vegetables Are Needed Daily or Weekly? http://www.choosemyplate.gov/printpages/MyPlateFoodGroups/Vegetables/food-groups.vegetables-amount.pdf - USDA: How Much Fruit Is Needed Daily? http://www.choosemyplate.gov/printpages/MyPlateFoodGroups/Fruits/food-groups.fruits-amount.pdf
  10. Wang X, Ouyang Y, Liu J et al Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014;349:g4490 PMID: 25073782
  11. Wien TN, Pike E, Wisloff T, Staff A, Smeland S, Klemp M. Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open. 2012;2:e000653. PMID: 22240654
  12. Druesne-Pecollo N, Latino-Martel P, Norat T, et al. Beta-carotene supplementation and cancer risk: a systematic review and meta-analysis of randomized controlled trials. Int J Cancer. 2010;127:172-184 PMID: 19876916
  13. Vinceti M, Dennert G, Crespi CM, et al. Selenium for preventing cancer. Cochrane Database Syst Rev. 2014 Mar 30;3:CD005195. PMID: 24683040
  14. Klein EA, Thompson IM Jr, Tangen CM, et al. Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT). JAMA. 2011;306:1549-1556 PMID: 21990298
  15. Rohrmann S, Overvad K, Bueno-de-Mesquita HB, et al. Meat consumption and mortality -- results from the European Prospective Investigation into Cancer and Nutrition. BMC Med. 2013;11:63. PMID: 23497300
  16. Alexander DD, Weed DL, Miller PE, Mohamed MA. Red meat and colorectal cancer: a quantitative update on the state of the epidemiologic science. J Am Coll Nutr. 2015:1-23. PMID: 25941850
  17. Song M, Giovannucci E Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States. JAMA Oncol. Published online May 19, 2016 PMID: 27196525 http://oncology.jamanetwork.com/article.aspx?articleid=2522371
  18. Lauby-Secretan B, Scoccianti C, Loomis D et al Body Fatness and Cancer - Viewpoint of the IARC Working Group. N Engl J Med 2016; 375:794-798. August 25, 2016 PMID: 27557308 http://www.nejm.org/doi/full/10.1056/NEJMsr1606602
  19. Islami F, Goding Sauer A, Miller KD et al Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin. 2017 Nov 21 PMID: 29160902 Free Article http://onlinelibrary.wiley.com/doi/10.3322/caac.21440/full
  20. Fiolet T, Srour B, Sellem L et al Consumption of ultra-processed foods and cancer risk: results from NutriNet-Sante prospective cohort. BMJ 2018;360:k322 PMID: 29444771 http://www.bmj.com/content/360/bmj.k322 - Monge A, Lajous M Ultra-processed foods and cancer. BMJ 2018;360:k599 PMID: 29444772 http://www.bmj.com/content/360/bmj.k599
  21. Wang DD, Li Y, Bhupathiraju SN et al Fruit and Vegetable Intake and Mortality. Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021;143:00-00 PMID: 33641343 https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.048996
  22. Brooks M Can Too Much Sleep Raise the Risk of Cancer? Medscape. June 14, 2022 https://www.medscape.com/viewarticle/975553 - Wilunda C,Abe SK, Svensson T et al Sleep duration and risk of cancer incidence and mortality: A pooled analysis of six population-based cohorts in Japan. Int J Cancer. 2022;1-13 PMID: 35616624 https://onlinelibrary.wiley.com/doi/epdf/10.1002/ijc.34133
  23. Ekblom-Bak E, Bojsen-Moller E, Wallin P et al Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men. JAMA Netw Open. 2023;6(6):e2321102. PMID: 37382952 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2806585