CMAJ. 2011 Feb 7. [Epub ahead of print]

Eisenberg MJ, Afilalo J, Lawler PR, Abrahamowicz M, Richard H, Pilote L.

Abstract
Background Patients exposed to low-dose ionizing radiation from cardiac imaging and therapeutic procedures after acute myocardial infarction may be at increased risk of cancer.

Methods Using an administrative database, we selected a cohort of patients who had an acute myocardial infarction between April 1996 and March 2006 and no history of cancer. We documented all cardiac imaging and therapeutic procedures involving low-dose ionizing radiation. The primary outcome was risk of cancer. Statistical analyses were performed using a time-dependent Cox model adjusted for age, sex and exposure to low-dose ionizing radiation from noncardiac imaging to account for work-up of cancer.

Results Of the 82 861 patients included in the cohort, 77% underwent at least one cardiac imaging or therapeutic procedure involving low-dose ionizing radiation in the first year after acute myocardial infarction. The cumulative exposure to radiation from cardiac procedures was 5.3 milli Sieverts (mSv) per patient-year, of which 84% occurred during the first year after acute myocardial infarction. A total of 12 020 incident cancers were diagnosed during the follow-up period. There was a dose-dependent relation between exposure to radiation from cardiac procedures and subsequent risk of cancer. For every 10 mSv of low-dose ionizing radiation, there was a 3% increase in the risk of age- and sex-adjusted cancer over a mean follow-up period of five years (hazard ratio 1.003 per milliSievert, 95% confidence interval 1.002-1.004).

Interpretation Exposure to low-dose ionizing radiation from cardiac imaging and therapeutic procedures after acute myocardial infarction is associated with an increased risk of cancer.

PMID: 21324846 [PubMed - as supplied by publisher]Free Article

Am J Clin Nutr. 2010 Nov;92(5):1189-96. Epub 2010 Sep 1.

Sofi F, Abbate R, Gensini GF, Casini A.

Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy. francescosofi@gmail.com

Abstract
BACKGROUND: The Mediterranean diet has long been reported to be protective against the occurrence of several different health outcomes.

OBJECTIVE: We aimed to update our previous meta-analysis of published cohort prospective studies that investigated the effects of adherence to the Mediterranean diet on health status.

DESIGN: We conducted a comprehensive literature search through electronic databases up to June 2010.

RESULTS: The updated review process showed 7 prospective studies published in the past 2 y that were not included in the previous meta-analysis (1 study for overall mortality, 3 studies for cardiovascular incidence or mortality, 1 study for cancer incidence or mortality, and 2 studies for neurodegenerative diseases). These recent studies included 2 health outcomes not previously investigated (ie, mild cognitive impairment and stroke). The meta-analysis for all studies with a random-effects model that was conducted after the inclusion of these recent studies showed that a 2-point increase in adherence to the Mediterranean diet was associated with a significant reduction of overall mortality [relative risk (RR) = 0.92; 95% CI: 0.90, 0.94], cardiovascular incidence or mortality (RR = 0.90; 95% CI: 0.87, 0.93), cancer incidence or mortality (RR = 0.94; 95% CI: 0.92, 0.96), and neurodegenerative diseases (RR = 0.87; 95% CI: 0.81, 0.94). The meta-regression analysis showed that sample size was the most significant contributor to the model because it significantly influenced the estimate of the association for overall mortality.

CONCLUSION: This updated meta-analysis confirms, in a larger number of subjects and studies, the significant and consistent protection provided by adherence to the Mediterranean diet in relation to the occurrence of major chronic degenerative diseases.

PMID: 20810976 [PubMed - indexed for MEDLINE]

Prostate cancer has become a major public health problem worldwide. Yet, the etiology of prostate cancer remains largely unknown. Dietary factors, dietary supplements, and physical activity might be important in the prevention of the disease. In the majority of studies, it was observed that high consumption of meat and dairy products has been linked to a greater risk. In contrast, frequent consumption of fatty fish and tomato products has been associated with a reduced risk. It has been shown consistently that high levels of circulating insulin-like growth factor 1 (IGF-1) are associated with an increased risk of prostate cancer. Dietary factors are also recognized as determinants of circulating IGF-1, thus changes in diet may influence IGF-1 concentrations in serum. Furthermore, increased intake of vitamin E and selenium (from supplements) has been shown in intervention studies to decrease the risk. Possibly, high level of physical activity is also associated with decreased risk of prostate cancer. The accumulated scientific evidence concerning the associations between diet, lifestyle, and risk of prostate cancer development suggests that there are some identified modifiable risk factors that it might be recommended to change in order to decrease the risk for this common cancer site.

Wolk A.

Division of Nutritional Epidemiology, the National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Alicja.Wolk@imm.ki.se

Acta Oncol. 2005;44(3):277-81.Links

The epidemiologic literature in the English language regarding intake of tomatoes and tomato-based products and blood lycopene (a compound derived predominantly from tomatoes) level in relation to the risk of various cancers was reviewed. Among 72 studies identified, 57 reported inverse associations between tomato intake or blood lycopene level and the risk of cancer at a defined anatomic site; 35 of these inverse associations were statistically significant. No study indicated that higher tomato consumption or blood lycopene level statistically significantly increased the risk of cancer at any of the investigated sites. About half of the relative risks for comparisons of high with low intakes or levels for tomatoes or lycopene were approximately 0.6 or lower. The evidence for a benefit was strongest for cancers of the prostate, lung, and stomach. Data were also suggestive of a benefit for cancers of the pancreas, colon and rectum, esophagus, oral cavity, breast, and cervix. Because the data are from observational studies, a cause-effect relationship cannot be established definitively. However, the consistency of the results across numerous studies in diverse populations, for case-control and prospective studies, and for dietary-based and blood-based investigations argues against bias or confounding as the explanation for these findings. Lycopene may account for or contribute to these benefits, but this possibility is not yet proven and requires further study. Numerous other potentially beneficial compounds are present in tomatoes, and, conceivably, complex interactions among multiple components may contribute to the anticancer properties of tomatoes. The consistently lower risk of cancer for a variety of anatomic sites that is associated with higher consumption of tomatoes and tomato-based products adds further support for current dietary recommendations to increase fruit and vegetable consumption.

Giovannucci E.

Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA. edward.giovannucci@channing.harvard.edu

J Natl Cancer Inst. 1999 Feb 17;91(4):317-31.

Background: Reports from several studies have suggested that carotenoids, and in particular lycopene, could be prostate cancer–preventive agents. This has stimulated extensive laboratory and clinical research, as well as much commercial and public enthusiasm. However, the epidemiologic evidence remains inconclusive.

Materials and Methods: We investigated the association between prediagnostic serum carotenoids (lycopene, {alpha}-carotene, ß-carotene, ß-cryptoxanthin, lutein, and zeaxanthin) and risk of prostate cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a multicenter study designed to examine methods of early detection and risk factors for cancer. The study included 692 incident prostate cancer cases, diagnosed 1 to 8 years after study entry, including 270 aggressive cases, with regional or distant stage (n = 90) or Gleason score ≥7 (n = 235), and 844 randomly selected, matched controls. As study participants were selected from those who were assigned to annual standardized screening for prostate cancer, results are unlikely to be biased by differential screening, a circumstance that is difficult to attain under non–trial conditions.

Results: No association was observed between serum lycopene and total prostate cancer [odds ratios (OR), 1.14; 95% confidence intervals (95% CI), 0.82-1.58 for highest versus lowest quintile; P for trend, 0.28] or aggressive prostate cancer (OR, 0.99; 95% CI, 0.62-1.57 for highest versus lowest quintile; P for trend, 0.433). ß-Carotene was associated with an increased risk of aggressive prostate cancer (OR, 1.67; 95% CI, 1.03-2.72 for highest versus lowest quintile; P for trend, 0.13); in particular, regional or distant stage disease (OR, 3.16; 95% CI, 1.37-7.31 for highest versus lowest quintile; P for trend, 0.02); other carotenoids were not associated with risk.

Conclusion: In this large prospective study, high serum ß-carotene concentrations were associated with increased risk for aggressive, clinically relevant prostate cancer. Lycopene and other carotenoids were unrelated to prostate cancer. Consistent with other recent publications, these results suggest that lycopene or tomato-based regimens will not be effective for prostate cancer prevention.

(Cancer Epidemiol Biomarkers Prev 2007;16(5):962–8)

Full Text

Ulrike Peters1,2,3, Michael F. Leitzmann3, Nilanjan Chatterjee3, Yinghui Wang1, Demetrius Albanes3, Edward P. Gelmann4, Marlin D. Friesen5, Elio Riboli6 and Richard B. Hayes3

1 Fred Hutchinson Cancer Research Center; 2 University of Washington, Seattle, Washington; 3 Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Department of Health and Human Services, Rockville, Maryland; 4 Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia; 5 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and 6 Nutrition and Cancer Unit, International Agency for Research on Cancer, Lyon, France

Requests for reprints: Ulrike Peters, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, P.O. Box 19024, 1100 Fairview Avenue North M4-B402, Seattle, WA 98109-1024. Phone: 206-667-2450; Fax: 206-667-7850. E-mail: upeters@fhcrc.org

The Canadian Cancer Society is recommending a specific amount of Vitamin D supplementation for Canadians to consider taking. This first-time recommendation is based on the growing body of evidence about the link between Vitamin D and reducing risk for colorectal, breast and prostate cancers.

“The evidence is still growing in this area, but we want to give guidance to Canadians about this emerging area of cancer prevention based on what we know now,” says Heather Logan, Director, Cancer Control Policy, Canadian Cancer Society. “As we find out more we will update our recommendation.”

In consultation with their healthcare provider, the Society is recommending that:

* Adults living in Canada should consider taking Vitamin D supplementation of 1,000 international units (IU) a day during the fall and winter.
* Adults at higher risk of having lower Vitamin D levels should consider taking Vitamin D supplementation of 1,000 IU/day all year round. This includes people:

* who are older;
* with dark skin;
* who don’t go outside often, and
* who wear clothing that covers most of their skin.

“We’re recommending 1,000 IUs daily because the current evidence suggests this amount will help reduce cancer risk with the least potential for harm,” says Logan. “More research is needed to clearly define the amount of Vitamin D that will maximize health benefits.”

Logan explains that Canada’s geographic location was a strong factor in the Society’s decision making about the recommendation.

“Where a person lives is one important factor in how much Vitamin D they can produce from the sun. Because of our country’s northern latitude, the sun’s rays are weaker in the fall and winter and Canadians don’t produce enough Vitamin D from sunlight during this time.”

Research findings announced today add to the mounting evidence in this area. A study published in The American Journal of Clinical Nutrition found that taking Vitamin D supplements and calcium substantially reduces all-cancer risk in post menopausal women. Specifically, the researchers found that the higher the levels of Vitamin D in the blood, the lower the relative risk of developing cancer. As well, another study released in May, suggests that women who consume more calcium and vitamin D may be less likely to develop breast cancer before menopause.

In addition to taking supplements, people can get Vitamin D by exposure to the sunlight and in their diets. However, Logan cautions Canadians about relying too much on getting Vitamin D through exposure to sunlight.

“It’s important to remember that a few minutes a day of unprotected sun exposure is usually all that is needed for some people to get enough Vitamin D,” says Logan. “It’s not a good idea to rely solely on the sun to obtain Vitamin D. For some people, it’s possible that just a few minutes of unprotected sun exposure every day could increase skin cancer risk.”

Logan says a large-scale clinical trial would help provide more answers about the amount of Vitamin D needed to maximize health benefits, and the long-term risks, if any, of taking large doses of the vitamin.

“The Canadian Cancer Society is looking seriously at what we can do to make this research happen. We will also be talking to our partners about this. We need to keep building on our knowledge about this important area of cancer prevention.”

More research is also needed about the amount of sunlight exposure needed to achieve the optimum Vitamin D level.

The Society is not changing its SunSense guidelines, as skin cancer is the most frequently diagnosed cancer in Canada. The Society recommends that people reduce their exposure to the sun, particularly between 11 a.m. and 4 p.m. when the sun’s rays are the strongest. Use a sunscreen with a sun protection factor (SPF) 15 or higher and SPF 30 if you work outdoors or if you will be outside for most of the day.

At this time, the Canadian Cancer Society does not have a recommendation for Vitamin D supplementation for children. The research to date about the role of Vitamin D and cancer prevention has focused on adults.

The Canadian Dermatology Association recently updated its recommendations about Vitamin D supplementation. The association’s website says: “In order to lessen the health risks associated with skin cancer yet still reap the known and possible benefits of Vitamin D levels take 1,000 international units of Vitamin D supplements a day.”

TORONTO, 08 June 2007

BACKGROUND: Previous studies, such as the Women’s Health Initiative, have shown that a low dose of vitamin D did not protect against colorectal cancer, yet a meta-analysis indicates that a higher dose may reduce its incidence. METHODS: Five studies of serum 25(OH)D in association with colorectal cancer risk were identified using PubMed. The results of all five serum studies were combined using standard methods for pooled analysis. The pooled results were divided into quintiles with median 25(OH)D values of 6, 16, 22, 27, and 37 ng/mL. Odds ratios were calculated by quintile of the pooled data using Peto’s Assumption-Free Method, with the lowest quintile of 25(OH)D as the reference group. A dose-response curve was plotted based on the odds for each quintile of the pooled data. Data were abstracted and analyzed in 2006. RESULTS: Odds ratios for the combined serum 25(OH)D studies, from lowest to highest quintile, were 1.00, 0.82, 0.66, 0.59, and 0.46 (p(trend)<0.0001) for colorectal cancer. According to the DerSimonian-Laird test for homogeneity of pooled data, the studies were homogeneous (chi(2)=1.09, df=4, p=0.90. The pooled odds ratio for the highest quintile versus the lowest was 0.49 (p<0.0001, 95% confidence interval, 0.35-0.68). A 50% lower risk of colorectal cancer was associated with a serum 25(OH)D level > or =33 ng/mL, compared to < or =12 ng/mL. CONCLUSIONS: The evidence to date suggests that daily intake of 1000-2000 IU/day of vitamin D(3) could reduce the incidence of colorectal with minimal risk.

 Am J Prev Med. 2007 Mar;32(3):210-6.

 

Gorham ED, Garland CF, Garland FC, Grant WB, Mohr SB, Lipkin M, Newmark HL, Giovannucci E, Wei M, Holick MF.

University of California San Diego, Department of Family and Preventive Medicine, School of Medicine, La Jolla, California, USA. gorham@nhrc.navy.mil

 

Vitamin D status differs by latitude and race, with residents of the northeastern United States and individuals with more skin pigmentation being at increased risk of deficiency. A PubMed database search yielded 63 observational studies of vitamin D status in relation to cancer risk, including 30 of colon, 13 of breast, 26 of prostate, and 7 of ovarian cancer, and several that assessed the association of vitamin D receptor genotype with cancer risk.The majority of studies found a protective relationship between sufficient vitamin D status and lower risk of cancer. The evidence suggests that efforts to improve vitamin D status, for example by vitamin D supplementation, could reduce cancer incidence and mortality at low cost, with few or no adverse effects.

Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, Holick MF.

Department of Family and Preventive Medicine, 0631C, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0631, USA. cgarland@ucsd.edu

Vitamin D status differs by latitude and race, with residents of the northeastern United States and individuals with more skin pigmentation being at increased risk of deficiency. A PubMed database search yielded 63 observational studies of vitamin D status in relation to cancer risk, including 30 of colon, 13 of breast, 26 of prostate, and 7 of ovarian cancer, and several that assessed the association of vitamin D receptor genotype with cancer risk. The majority of studies found a protective relationship between sufficient vitamin D status and lower risk of cancer. The evidence suggests that efforts to improve vitamin D status, for example by vitamin D supplementation, could reduce cancer incidence and mortality at low cost, with few or no adverse effects.

Department of Family and Preventive Medicine, 0631C, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0631, USA. cgarland@ucsd.edu

Am J Public Health. 2006 Feb;96(2):252-61. Epub 2005 Dec 27.

In February, 2007, 26 scientists from 15 countries met at IARC in Lyon, France, to reassess the carcinogenicity of alcoholic beverages. The Working Group reviewed the epidemiological publications on the possible association between alcohol consumption and cancer at 27 anatomical sites.

A relative risk increase for consumption of 50 g/day has been established for the following cancers:
- Oral Cavity, Pharynx, Larynx, Oesophagus: 2-3 x
- Liver: Difficult to quantify
- Breast: 1.5 x
- Colorectum: 1.4 x

Furthermore, in populations that are genetically deficient in the activity of an enzyme involved in the metabolism of ethanol, much higher risks for cancer, particularly oesophageal cancer, after alcohol consumption have been reported than in populations with a fully active enzyme. This enzyme deficiency, a condition that is particularly prevalent in certain eastern-Asian populations, causes a strong facial flushing response, physical discomfort, and severe toxic reactions.

As these associations were observed with different types of alcoholic beverages, and given the carcinogenicity of ethanol in animals, ethanol in alcoholic beverages was classified as “carcinogenic to humans (Group 1)”.

The adverse effects of drinking and smoking do not simply add up, but seem to be multiplicative.

Read the full press release from the IARC.