1. CANCER QUESTIONS AND CONTROVERSIES A Seminar by Robert Buist PhD Copyright © 2012 International Academy of Nutrition

2. Current cost of cancer research in US: US $110 billion/year ($1 trillion spent since 1971)

3. 25% breast cancers diagnosed are slow-to-develop (ductal or lobar carcinomas 2% become malignant CISS 24(3)11 (2004) 80% of all DCIS’s (ductile carcinoma-in-situ) never become invasive even if left untreated 80% of all DCIS’s (ductile carcinoma-in-situ) never become invasive even if left untreated Townsend p124 June 2004

4. More than half of women diagnosed with breast cancer at Roswell Park Memorial Centre Hospital had benign lesions that were unable to spread 80% of all DCIS’s (ductile carcinoma-in-situ) never become invasive even if left untreated 80% of all DCIS’s (ductile carcinoma-in-situ) never become invasive even if left untreated Townsend p124 June 2004

5. Fibrocystic Breast Disease Fibrocystic Breast Disease PREVENTION No caffeine, coffee, choc No dairy products Low fat diet Omega-3 Fish Oil 3g/day Fresh fruit and veg 7serve No alcohol

6. Only one in six biopsies revealed cancer after a positive mammogram CISS 24(3)11 (2004)

7. Cochrane Review of Mammography 1. No reliable evidence that screening for breast cancer reduces mortality. Olsen & Gotzsche 2000 Olsen & Gotzsche 2000 2. Cochrane Review confirmed these findings that mammography did not reduce all cause mortality Olsen & Gotzsche Lancet 358, 1340-42 (2002)

8. SCREENING CAUSES INCREASED MASTECTOMY AND LUMPECTOMY SCREENING CAUSES INCREASED MASTECTOMY AND LUMPECTOMY Screening identified slow-growing tumours that would never develop into tumours Even cancerous pathology tests may not mean development of life-threatening tumours Olsen & Gotzsche Lancet 358, 1340-42 (2001)

9. Mammogram End Points should be OVERALL Mortality Treatment of early cancers by tumourectomy and radiotherapy might increase the likelihood that deaths among screen-detected breast cancer cases will be misclassified as deaths from other causes, especially other cancers Lancet 358, 1340 (2001)

10. Seven Randomised Trials for Screening Mammography Seven Randomised Trials for Screening Mammography There is NO survival benefit of mass screening for breast cancer There is NO survival benefit of mass screening for breast cancer Gotzsche et al, Lancet 355, 129-34 (2000)

11. NIH 1997 consensus conference recommend against routine screening mammography for 40- 49year olds N Engl J Nutr 336,1180-3 (1997) Subjects between 40-50 years who had a yearly mammogram showed a 36 to 52% INCREASE in breast cancer mortality Subjects between 40-50 years who had a yearly mammogram showed a 36 to 52% INCREASE in breast cancer mortality Lancet 1992

12. The number one enemy of the cancer patient is: the cancer patient is: metastasis Townsend p125 June 2004

13. Needle Biopsies Needle Biopsies There is a clear danger of seeding needle tracks with malignant cells which may enter vascular channels or even be transported to lymph nodes. Danish Med Bulletin 25(2) 82-87 (1978)

14. Problems with Surgery Problems with Surgery Cell debris stimulates tumour growth Inflammation promotes tumour cells Post op bacterial infections (endotoxin) Cauterisation is tissue damage (inflammation) General anaesthesia potentiates tumour growth Int Clin Nutr Rev 8(2) 62-68 (1988)

15. Cancer cells were found in 59% of samples of blood lost by patients during surgery for lung, ovarian, colon, oesophageal and other cancers Dr Fedorine, Sydney Morning Herald, June 13, 2001

16. Pelvic Radiation Therapy for Rectal Cancer Pelvic Radiation Therapy for Rectal Cancer 8000 patients enrolled in 14 preoperative and 8 postop randomised trials. 5 year survival was marginally better in those who received radiotherapy (62.2% vs 63.3% dead (p=0.06) Reduced local recurrence not overall survival. Lancet 358, 1285 (2001)

17. Randomised controlled trials compare one chemotherapeutic agent with another We need to compare agents with doing nothing (or with a placebo) or with approaches using alternative therapies We need to compare agents with doing nothing (or with a placebo) or with approaches using alternative therapies Townsend Letter for Doctors Feb-Mar (2004) pp 99-108

18. Approx 20 chemotherapeutic agents have been shown to cause cancer (50 more are suspect) (50 more are suspect) Survivors of ovarian cancer treated with chemo have 100 times higher incidence of leukaemia. This is worsened when combined with radiation Survivors of ovarian cancer treated with chemo have 100 times higher incidence of leukaemia. This is worsened when combined with radiation

19. Chemotherapy may produce good initial results but frequently poorer long-term prognosis Chemotherapy may produce good initial results but frequently poorer long-term prognosis Tumour regression by itself is a bad predictor for progression of disease Regression is not likely to improve survival Regression is not likely to improve survival Townsend p33 2004

20. Breast cancer tissue samples were co-cultured with patients’ lymphocytes: After 12 years- After 12 years- A. Lymphocytes that had no reaction A. Lymphocytes that had no reaction - 47% women had died - 47% women had died B. Lymphocytes that were stimulated and proliferated - 95% women still alive B. Lymphocytes that were stimulated and proliferated - 95% women still alive Dr James McCoy Annals NY Acad Sci 1993

21. Cancer Prevention is not Cancer Diagnosis Mammograpy, breast palpation, PSA, scans,endoscopy, X-rays, PAP smear, biopsy, tumour markers - AFP, HCG, PSA, [CEA for colorectal], paraprotein [myeloma] These are not Preventive Medicine These are not Preventive Medicine

22. Prostate Cancer Incidence and PSA Prostate Cancer Incidence and PSA Since introduction of PSA screening in US, incidence has doubled between 1983- 87 and 1993-95 (55 to 110 per 100,000) In UK: less PSA screening - less incidence Lancet 359, 1341-1342 (2002)

23. Prostate Cancer Survival after 10 Years Prostate Cancer Survival after 10 Years Watchful waiting - 91.5% (223 men) Radiation therapy - 77% (682 men) Radical Prostatectomy - 90% (1143 men) (but depends on tumour size and differentiation)

24. Seven times as many cancer tumours are discovered during autopsy than are discovered during a person’s lifetime Townsend p124 June 2004

25. Strength of recommendation: A. PAP Smear High costs, data unreliable A. Mammography>50yrs Better evidence C. Mammography 50yrs Better evidence C. Mammography <49yrs No evidence screening reduces mortality B. FOBT,Colonoscopy & Sigmoidoscopy No reduction in overall mortality D. PSA An unproven intervention not specific D. Lung CT scan No evidence of reduced mortality Thomas G Gates (Am Fam Physician 2001;63:513-22)

26. Cancer delay by decrease in mutation rate Cancer delay by decrease in mutation rate Type Type of Age (year) Average age Age of death Cancer of cancer of death if mutation rate is halved Hepatoma 10 50 90 Lung 35 55 75 Prostate 40 85 130 The Handbook of Preventive Medicine Florence & Setright Kingsclear 1994

27. Blueberries rich in Anthocyanins Greater firepower against cancer- causing free radicals than 40 other fresh fruits and vegetables Research by the Human Nutrition Research Centre on Aging

28. DO NOT USE SINGLE PHYTONUTRIENT SUPPLEMENTS DO NOT USE SINGLE PHYTONUTRIENT SUPPLEMENTS Beta carotene 30mg (Scand. Study) Lycopene (tomato paste) Lutein (egg yolk) Quercetin (onions) Genistein (carcinogenic) Carotenoids, flavonoids & polyphenolics are involved in competitive inhibition. HerbalGram 62, 54-55 (2004)

29. Effects of single flavonoids Effects of single flavonoids Single flavonoids (quercitin, fisetin, flavone, luteolin and genistein) cross the placenta and induce DNA cleavage and infant leukemia. These same chromosomal translocations involving the MLL gene are present in 80% of infants (<1yr) with Acute myelogenous and acute lymphoblastic leukemia. NOTE: Glycosylated/methylated bioflavonoids and flavanones/flavanols do not cause these problems Proc Natl Acad Sci (USA) 97 (9) 4790 - 4795 (2000)

30. Antioxidants in Cancer Therapy; Their Actions and Interactions With Oncologic Therapies Antioxidants in Cancer Therapy; Their Actions and Interactions With Oncologic Therapies Davis W. Lamson, MS, ND and Matthew S. Brignall, ND ….exogenous antioxidants alone produce beneficial effects in various cancers... animal and human studies demonstrate no reduction of efficacy of chemotherapy or radiation when given with antioxidants. In fact, considerable data exists showing increased effectiveness of many cancer therapeutic agents, as well as a decrease in adverse effects, when given concurrently with antioxidants. Altern Med Rev 1999;4(5):304-329

31. Food oils which promote CANCERS Food oils which promote CANCERS High linoleic acid-containing oils and trans fatty acids (TFA) (corn, soya, safflower, sunflower, margarine) Oils which prevent cancer: High lauric acid containing oils (coconut and palm), omega-3 oils (fish, flax seeds, nuts) Townsend 102-194, June 2002

32. Monounsaturated fats cut breast cancer risk Monounsaturated fats cut breast cancer risk Every 5 gram increase in dietary polyunsaturated fat INCREASED by 69% the the relative risk for invasive breast cancer. Conversely, for each 10g increment of monounsaturated fat, the relative risk for invasive cancer DECREASED by 45% Archives of Internal Medicine 158,41-45 (1998)

33. ANTICANCER EFFECTS OF OMEGA-3 OILS Low breast and prostate cancer in Japan Reduction in colonic adenomas Inhibition of promotion and progression Reduction in inflammatory eicosanoids (PGE2, leukotriene B4, 12 OH eicosaetraenoic acid) Decreases oestrogen production (PGE2 stimulates aromatase P450 which converts 19-carbon steroids to oestrogens)

34. Alpha-linolenic acid Alpha-linolenic acid RISK FACTOR for breast cancer when: low dietary linoleic acid (GLAor EPA) oxidised diet high in alcohol, saturated fats stress levels high Better to add ground whole linseeds to diet - less oxidation and high lignan content (enterolactone and enterodiol) blocks oestrogen and oestrogen dependent tumours.

35. Results of 47,866 Men Study …”High alpha-linolenic acid (ALA) intake is associated with an increased risk of advanced prostate cancer.” In contrast EPA and DHA intakes may be associated with a decreased risk of total and advanced prostate cancer. Am J Clin Nutr 80, 204-16 (2004)

36. ALA Function Different to EPA ALA less effective in displacing AA from cell membrane phospholipids and inhibiting prostaglandin synthesis. ALA has little conversion to EPA and almost zero conversion to DHA (may decrease DHA levels) ALA has little influence on immune function and inflammatory cytokine production.

37. Genistein and Daidzein block TAMOXIFEN (at low not high concentrations) 1. Better to tell women on Tamoxifen to avoid low levels of soy 2. High soy eaters (70g/day) not on Tamoxifen have lower levels of breast cancer and genistein acts as an agonist in oestrogen-dependent target cells promoting breast cancer cell proliferation at low concentrations

38. Black Cohosh (40mg extr/day) safely and effectively treats hot flashes in women with a history of ER-positive breast cancer taking tamoxifen HerbalGram 62,20-21 (2004)

39. Psychoneuroimmunology & Cancer Psychoneuroimmunology & Cancer Factors affecting outcome: Practitioner attitude Social Isolation/Group support Fighting spirit/helplessness Optimistic/pessimistic attitude Will to live/faith Lancet 1(8431) 750 (1985) Clin Oncol 21(3) 543-8 (2003)

40. COLORECTAL CANCER & STRESS Of 569 colorectal cancer patients those who experience on-the-job aggravation were 5.5 times as likely to develop cancer (compared with 510 matched health controls). Epidemiol 495) 407-14 (1993)

41. Factors Predisposing to Gastric Cancer Factors Predisposing to Gastric Cancer 242 Japanese gastric cancer patients (484 controls) *Eating quickly *Irregular sleeping *Overeating *Grey hair in males *Stress *Having dentures *Long working hours *Lack of teeth Oncol Rep 5(5) 1191-4 (1998)

42. #Psychological factors positively associated with lung cancer (preclinical) Uncontrollable bursts of emotion (OR 1.8) Poor working circumstances - including bad relationships with colleagues and superiors (OR 1.4) Long term depression (OR 4.1) #Study involved 750,000 including 309 lung cancer cases. Chung Hua Liu Ksing Ping Hsueh Tsa Chih 18(5) 289-92 (1997)

43. Breast Cancer and Social Isolation Breast Cancer and Social Isolation A population based sample of 525 black and 486 white women with newly diagnosed breast cancer Fewer close friends and relatives (RR 2.1) Fewer sources of emotional support (RR1.8) Cancer Epidemiol Biomarkers Prev 3(3), 253-9 (1994)

44. Chronically elevated levels of cortisone accompany the perception of loneliness which in turn reduces the immune defences of the body against malignant progression.

45. CANCER CELLS CAN REMAIN DORMANT - WHY? WHAT FACTORS RETARD CANCER GROWTH? CANCER CELLS CAN REMAIN DORMANT - WHY? WHAT FACTORS RETARD CANCER GROWTH?

46. SOYA MILK & PROSTATE CANCER SOYA MILK & PROSTATE CANCER Men who consumed soya milk more than once daily had a 70% REDUCTION in risk of prostate cancer Cancer Causes and Control 9, 553-557 (1998)

47. LOW BLOOD LEVELS OF CoQ10 in LOW BLOOD LEVELS OF CoQ10 in Cancer of breast, lung, prostate, pancreas, colon, kidney, head and neck Also in myeloma and lymphoma Folkers K. Biochem Biophys Res Comm 224(2) 358-61 (1996)

48. CoQ10 improves survival CoQ10 improves survival 32 Breast cancer patients,18 months on CoQ10 90mg daily (plus other antioxidants, vitamins and minerals plus surgery, radiation and chemotherapy) Survival rate - 100% over 24 months (Expected - 6 deaths) Remission - 6 patients. Decreased use of pain killers, improved quality of life, no weight loss. Molecular Aspects of Medicine 15S, S231-S240 (1994)

49. Incomplete Removal of Breast Tumour in 2 Patients Incomplete Removal of Breast Tumour in 2 Patients 3-4 months of high dose CoQ10 (390 and 300mg/day) resulted in complete regression of both residual breast tumours. Biochem Biophy Res Comm 199(3) 1504-1508 (1994)

50. High Dose CoQ10 and Tumour Remission 3 Breast cancer patients on 390mg CoQ10/day for 3-5 years. Patient 1 - complete remission of liver metastases Patient 2 - remission of tumour spread to chest wall Patient 3 - no microscopic evidence of remaining tumour after mastectomy Biochem Biophy Res Comm 212(1) 172-177 (1995)

51. VITAMIN D NONCALCAEMIC FUNCTIONS VITAMIN D NONCALCAEMIC FUNCTIONS Most cells in the body have nuclear receptors for 1,25(OH) 2 D e.g. heart, stomach, panceas, brain, gonads and activated T and B lymphocytes. Vitamin D (1,25) can down regulate hyperproliferative cell growth.

53. ANTI CANCER EFFECT OF 1,25OH 2 D ANTI CANCER EFFECT OF 1,25OH 2 D Sunlight or dietary vitamin D leads to increased 25-OH 2 Vitamin D which acts as a substrate for 25OH 2 D-1-hydroxylase in colon, breast, lung, prostate, etc. to produce 1,25OH 2 D which acts to regulate cell growth and decrease proliferative activity. Am J Clin Nutr 79, 362-71 (2004)

54. Normal cells can convert 25(OH)D to 1,25(OH) 2 D Am J Clin Nutr 79, 368 (2004)

55. Colon Cancer Diet Worst - high fat, low fibre, high refined carbs (increase beta- glucuronidase) Best - high protein, higher in unrefined carbs, lower in fat and rich in fibre (lowers beta-glucuronidase) Nutr Cancer 27(3),250-255(1997)