The Annual Report to the Nation, issued jointly by the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR), reports that cancer incidence and mortality have continued on a decline that started in the early 1990s. Overall, cancer incidence declined by 0.5% per year from 1999 to 2008, with most of the decline occurring from 1999 to 2005. The report also states that cancer mortality declined from 1999 to 2008 overall and among men, women, children, and all racial and ethnic groups, with cancer mortality decreasing by 1.3% annually during the period 2004 through 2008.
Despite these encouraging statistical trends, we must not be complacent in the battle against cancer. In the US, much of the cancer burden could be reduced by lifestyle. The American Cancer Society's 2012 Cancer Prevention & Early Detection Facts & Figures calls for improved collaboration between various entities interested in public health -- including government agencies, private companies, nonprofit groups, health-care providers, policymakers, and the general population – to reduce the risk of cancer and other chronic diseases. Reporting that an estimated 577,000 people will die from cancer this year, about one-third caused by tobacco use and about one-third caused by poor nutrition, physical inactivity, and overweight and obesity, the American Cancer Society reports that much of the cancer burden in the US could be reduced with increased attention to preventing disease through lifestyle change – namely, by reducing tobacco use, improving diet, exercising, losing weight, and an expanded use of established screening tests. The society urges, "Public policy and legislation at the federal, state, and local levels can increase access to preventive health services, including cancer screening."
To that end, this column reviews recent breakthroughs in natural approaches to cancer prevention.
Eheman C, Henley SJ, Ballard-Barbash R, et al. Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer. 2012;118:2338–2366.
American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2012. Atlanta: American Cancer Society; 2012.
How Broccoli Beats Cancer
Sulforaphane, a compound found in broccoli and other cruciferous vegetables, helps to restore a balance in intracellular processes, beneficially affecting the genetics behind cancer. Sulforaphane inhibits histone deacetylases, (HDACs), thereby interfering with the cellular triggers for cancer. Scientists from Oregon State University (Oregon, US) studied the effect of sulforaphane on prostate cancer cells, and revealed that DNA methylation appears to also contribute to the cancer process. Whereas DNA methylation is a normal process of turning off genes, helping to control what DNA material is utilized in intracellular communications, the process is disrupted in cancer cells. Showing that sulforaphane helps to restore a balance in DNA methylation, the study authors conclude: "dietary phytochemicals that affect the epigenome also can trigger DNA damage and repair mechanisms."
Rajendran P, Ho E, Williams DE, Dashwood RH. Dietary phytochemicals, HDAC inhibition, and DNA damage/repair defects in cancer cells. Clin Epigenetics. 2011;3:4.
Anticancer Mechanism of Tomatoes Revealed
Tomatoes are rich in lycopene, a carotenoid compound with potent antioxidant properties. In that cancer cells employ the mechanism known as angiogenesis to connect to the body's blood supply, Mridula Chopra and colleagues from the University of Portsmouth (UK) observed that lycopene disabled the angiogenic ability of cancer cells. Writing, "The anti-angiogenic effects of lycopene in the present study were shown at a concentration that should be achievable by dietary means," the study authors conclude, "These results extend our knowledge of one of the putative anti-cancer actions of lycopene."
Elgass S, Cooper A, Chopra M. Lycopene inhibits angiogenesis in human umbilical vein endothelial cells and rat aortic rings. Br J Nutr. 2011 Dec 6:1–9.
Fiber May Reduce Breast Cancer Risk
Numerous studies established the wide-ranging health benefits of fiber. Most notably, increased dietary intake of fiber associates with lower risks of dying from cardiovascular, infectious, and respiratory diseases. D. Aune and colleagues from Imperial College London (UK) completed a meta-analysis in which they observed that soluble fiber exerted an effect on the risk of breast cancer. Specifically, the researchers observed that for every 10 g per day increase in soluble fiber intake, a woman may reduce her risk of breast cancer by up to 26%. No such effect was observed for insoluble fiber. Good sources of soluble fiber include oatmeal, oat cereal, lentils, apples, oranges, pears, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots. The study authors conclude, "In this meta-analysis of prospective studies, there was an inverse association between dietary fiber intake and breast cancer risk."
Aune D, Chan DSM, Greenwood DC, et al. Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol. January 10, 2012.
Moderate Red Wine Consumption May Lower Breast Cancer Risk
Red wine apparently mimics the effects of aromatase inhibitors, which play a key role in managing estrogen levels. Chrisandra Shufelt and colleagues from Cedars-Sinai Heart Institute (California, US) studied 36 women who were randomized to drink either cabernet sauvignon or chardonnay daily for almost a month, then switched to the other type of wine. Blood was collected twice each month to measure hormone levels. Researchers sought to determine whether red wine mimics the effects of aromatase inhibitors, which play a key role in managing estrogen levels. Aromatase inhibitors are currently used to treat breast cancer. The team found that chemicals in the skins and seeds of red grapes slightly lowered estrogen levels while elevating testosterone among premenopausal women who drank 8 ounces of red wine nightly for about a month. Concluding, "These data suggest that red wine is a nutritional [aromatase inhibitor] and may explain the observation that red wine does not appear to increase breast cancer risk," the study authors submit that these data challenge the widely held belief that all types of alcohol consumption heighten the risk of developing breast cancer.
Shufelt C, Merz CNB, Yang Y, et al. Red versus white wine as a nutritional aromatase inhibitor in premenopausal women. J Womens Health. December 2011.
Vitamin E Protects Against Many Cancers
Gamma- and delta-tocopherols, the forms of vitamin E found in soybean, canola, and corn oils as well as nuts, help prevent cancer formation and growth in animal models. Chung S. Yang and colleagues from Rutgers University (New Jersey, US) completed animal studies for colon, lung, breast, and prostate cancer. Reporting, "When animals are exposed to cancer-causing substances, the group that was fed these tocopherols in their diet had fewer and smaller tumors," the study authors observed, "When cancer cells were injected into mice these tocopherols also slowed down the development of tumors," leading them to conclude, "we suggest that vitamin E, as ingested in the diet or in supplements that are rich in [gamma and delta-tocopherols], is cancer preventive."
Yang CS, Suh N, Kong A-NT. Does vitamin E prevent or promote cancer? Cancer Prev Res. April 3, 2012.
Lifestyle Plays Clear Role in Cancer
The study findings that we share in this column reiterate the role of lifestyle in cancer. A team of researchers from the UK recently identified the proportions of cancer in the population that associate with lifestyle and environmental factors. D. M. Parkin and colleagues from Queen Mary University of London found that smoking exerts by far the largest effect on the risk of cancer, with 19.4% of cancer cases in the UK attributable to tobacco use. A poor diet (less intake of fruits and vegetables and fiber and greater intake of meat and salt), obesity, and alcohol are the next most important factors that relate to cancer, with alcohol being calculated to relate to 4.0% of cancer cases in the UK. The study authors observe, "Population-attributable fractions provide a valuable quantitative appraisal of the impact of different factors in cancer causation, and are thus helpful in prioritizing cancer control strategies."
Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br J Cancer. 105:S77–S81.
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