The Cancer Chronicles (30 page)

1.
two-thirds of cancer cases are preventable:
See, for example, World Cancer Research Fund/American Institute for Cancer Research,
Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective
(Washington, DC: AICR, 2007), xxv. [
http://www.dietandcancerreport.org
]

2.
the argument is weak at best:
Miguel A. Sanjoaquin et al., “Folate Intake and Colorectal Cancer Risk: A Meta-analytical Approach,”
International Journal of Cancer
113, no. 5 (February 20, 2005): 825–28 [
http://www.ncbi.nlm.nih.gov/pubmed/15499620
]; Susanna C. Larsson, Edward Giovannucci, and Alicja Wolk, “Folate and Risk of Breast Cancer: A Meta-analysis,”
Journal of the National Cancer Institute
99, no. 1 (January 3, 2007): 64–76 [
http://jnci.oxfordjournals.org/content/99/1/64.abstract
]; and Jane C. Figueiredo et al., “Folic Acid and Risk of Prostate Cancer: Results from a Randomized Clinical Trial,”
Journal of the National Cancer Institute
101, no. 6 (March 18, 2009): 432–35. [
http://jnci.oxfordjournals.org/content/101/6/432.short
]

3.
folic acid … can increase cancer risk:
See, for example, Figueiredo et al., “Folic Acid and Risk of Prostate Cancer”; and Marta Ebbing et al., “Cancer Incidence and Mortality After Treatment with Folic Acid and Vitamin B12,”
JAMA: The Journal of the American Medical Association
302, no. 19 (November 18, 2009): 2119–26. [
http://www.ncbi.nlm.nih.gov/pubmed/19920236
]

4.
administering antifolates:
John J. McGuire, “Anticancer Antifolates: Current Status and Future Directions,”
Current Pharmaceutical Design
9, no. 31 (2003): 2593–613. [
http://www.ncbi.nlm.nih.gov/pubmed/14529544
]

5.
among the oldest chemotherapeutic drugs:
The pioneer in this research was Sidney Farber. See S. Farber et al., “Temporary Remissions in Acute Leukemia in Children Produced by Folic Acid Antagonist, 4-Aminopteroyl-Glutamic Acid,”
New England Journal of Medicine
238, no. 23 (June 3, 1948): 787–93. [
http://www.nejm.org/doi/full/10.1056/NEJM194806032382301
] The story is told in Siddhartha Mukherjee’s fine book
The Emperor of All Maladies: A Biography of Cancer
(New York: Scribner, 2010), 27–36.

6.
the mythology surrounding antioxidants:
Rudolf I. Salganik, “The
Benefits and Hazards of Antioxidants,”
Journal of the American College of Nutrition
20 (2001): 464S–72S. [
http://www.ncbi.nlm.nih.gov/pubmed/11603657
]

7.
a clinical trial in Finland:
“The Effect of Vitamin E and Beta Carotene on the Incidence of Lung Cancer and Other Cancers in Male Smokers,”
New England Journal of Medicine
330, no. 15 (April 14, 1994): 1029–35. [
http://www.ncbi.nlm.nih.gov/pubmed/8127329
]

8.
A similar trial in the United States:
Gary E. Goodman et al., “The Beta-Carotene and Retinol Efficacy Trial,”
Journal of the National Cancer Institute
96, no. 23 (December 1, 2004): 1743–50. [
http://www.ncbi.nlm.nih.gov/pubmed/15572756
]

9.
phytochemicals:
Lee W. Wattenberg, “Chemoprophylaxis of Carcinogenesis: A Review,” part 1,
Cancer Research
26, no. 7 (July 1, 1966): 1520–26. [
http://cancerres.aacrjournals.org/content/26/7_Part_1/1520.abstract
]

10.
the evidence here is also meager:
A randomized controlled study of male doctors recently reported an annual cancer incidence of 1.7 percent among the multivitamin takers compared with 1.8 percent for the placebo group: J. Gaziano et al., “Multivitamins in the Prevention of Cancer in Men,”
JAMA: The Journal of the American Medical Association
(published online October 17, 2012): 1–10. See the comment section of the paper for references to other studies finding neutral and even negative effects.

11.
5 A Day program:
“5 A Day for Better Health Program Evaluation Report: Executive Summary,” National Cancer Institute website, last updated March 1, 2006. [
http://dccps.nci.nih.gov/5ad_exec.html
]

12.
The evidence, alas:
Walter C. Willett, “Fruits, Vegetables, and Cancer Prevention: Turmoil in the Produce Section,”
Journal of the National Cancer Institute
102, no. 8 (April 21, 2010): 510–11. [
http://jnci.oxfordjournals.org/content/102/8/510.short
]

13.
those most likely to volunteer:
Willett, “Fruits, Vegetables, and Cancer Prevention.”

14.
The largest prospective study on diet and health:
The European Prospective Investigation into Cancer and Nutrition, or EPIC, is described on the website of the International Agency for Research on Cancer. [
http://epic.iarc.fr
] For a summary with citations of key EPIC findings, see “Diet and Cancer: the Evidence,” Cancer Research UK website, [
http://info.cancerresearchuk.org/healthyliving/dietandhealthyeating/howdoweknow
] updated September 25, 2009.

15.
a very weak effect:
Willett, “Fruits, Vegetables, and Cancer Prevention”; and Paolo Boffetta et al., “Fruit and Vegetable Intake and Overall Cancer Risk in the European Prospective Investigation into Cancer and Nutrition,”
Journal of
the National Cancer Institute
102, no. 8 (April 21, 2010): 529–37. [
http://www.ncbi.nlm.nih.gov/pubmed/20371762
,
http://jnci.oxfordjournals.org/content/early/2010/04/06/jnci.djq072
] No evidence was found that fruits and vegetables help ward off cancer of the breast (Carla H. van Gils et al., “Consumption of Vegetables and Fruits and Risk of Breast Cancer,”
JAMA: The Journal of the American Medical Association
293, no. 2 [January 12, 2005]: 183–93) [
http://jama.ama-assn.org/content/293/2/183.abstract
] or cancer of the prostate (Timothy J. Key et al., “Fruits and Vegetables and Prostate Cancer,”
International Journal of Cancer
109, no. 1 [March 2004]: 119–24). [
http://www.ncbi.nlm.nih.gov/pubmed/14735477
]

16.
possible benefits with a few cancers:
See, for example, Anthony B. Miller et al., “Fruits and Vegetables and Lung Cancer,”
International Journal of Cancer
108, no. 2 (January 10, 2004): 269–76 [
http://www.ncbi.nlm.nih.gov/pubmed/14639614
]; and Heiner Boeing et al., “Intake of Fruits and Vegetables and Risk of Cancer of the Upper Aero-digestive Tract,”
Cancer Causes & Control
17, no. 7 (September 2006): 957–69. [
http://www.ncbi.nlm.nih.gov/pubmed/16841263
]

17.
said to nurture a mix of bacteria:
Constantine Iosif Fotiadis et al., “Role of Probiotics, Prebiotics and Synbiotics in Chemoprevention for Colorectal Cancer,”
World Journal of Gastroenterology
14, no. 42 (November 14, 2008): 6453–57 [
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773329
]; and Janelle C. Arthur and Christian Jobin, “The Struggle Within: Microbial Influences on Colorectal Cancer,”
Inflammatory Bowel Diseases
17, no. 1 (January 2011): 396–409. [
http://www.ncbi.nlm.nih.gov/pubmed/20848537
]

18.
The case for fiber may be a little stronger:
See Teresa Norat et al., “The Associations Between Food, Nutrition and Physical Activity and the Risk of Colorectal Cancer,” which is available along with other recent EPIC findings on the World Cancer Research Fund’s Diet and Cancer Report website. [
http://www.dietandcancerreport.org/cancer_resource_center/continuous_update_project.php
] See “Continuous Update Project Report Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer” (2011).

19.
the evidence has been controversial:
EPIC’s positive findings were published as Sheila A. Bingham et al., “Dietary Fibre in Food and Protection Against Colorectal Cancer in the European Prospective Investigation into Cancer and Nutrition,”
Lancet
361, no. 9368 (May 3, 2003): 1496–1501. [
http://www.ncbi.nlm.nih.gov/pubmed/12737858
] For conflicting results from the Nurses’ Health Study, see Scott Gottlieb, “Fibre Does Not Protect Against Colon Cancer,”
BMJ: British Medical Journal
318, no. 7179 (January 30, 1999): 281; and C. S. Fuchs, W. C. Willett, et al., “Dietary Fiber and the Risk of Colorectal Cancer and Adenoma in Women,”
New England Journal of Medicine
340, no. 3 (January 21, 1999): 169–76. [
http://www.ncbi.nlm.nih.gov/pubmed/9895396
]

20.
no evidence of a reduction in colorectal polyps:
Arthur Schatzkin et al., “Lack of Effect of a Low-Fat, High-Fiber Diet on the Recurrence of Colorectal Adenomas,”
New England Journal of Medicine
342, no. 16 (April 20, 2000): 1149–55. [
http://www.nejm.org/doi/full/10.1056/nejm200004203421601#t=abstract
] Similar controlled studies have also found no relationship. See, for example, D. S. Alberts et al., “Lack of Effect of a High-fiber Cereal Supplement on the Recurrence of Colorectal Adenomas,”
New England Journal of Medicine
342, no. 16 (April 20, 2000): 1156–62; and Shirley A. Beresford et
al., “Low-fat Dietary Pattern and Risk of Colorectal Cancer,”
JAMA: The Journal of the American Medical Association
295, no. 6 (February 8, 2006): 643–54.

21.
no effect on the recurrence of breast cancer:
John P. Pierce et al., “Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer,”
JAMA: The Journal of the American Medical Association
298, no. 3 (July 18, 2007): 289–98.
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083253]

22.
brussels sprouts, cabbage:
B. N. Ames, M. Profet, and L. S. Gold, “Nature’s Chemicals and Synthetic Chemicals: Comparative Toxicology,”
Proceedings of the National Academy of Sciences
87, no. 19 (October 1990): 7782–86 [
http://www.pnas.org/content/87/19/7782.abstract
] and Bruce N. Ames, “Dietary Carcinogens and Anticarcinogens,”
Science
221, no. 4617 (September 23, 1983): 1256–64.
[http://www.ncbi.nlm.nih.gov/pubmed/6351251]

23.
eating a lot of red meat:
The calculation is for a fifty-year-old. See Teresa Norat et al., “Meat, Fish, and Colorectal Cancer Risk,”
Journal of the National Cancer Institute
97, no. 12 (June 15, 2005): 906–16;
[http://www.ncbi.nlm.nih.gov/pubmed/15956652]
and Doris S. M. Chan et al., “Red and Processed Meat and Colorectal Cancer Incidence: Meta-Analysis of Prospective Studies,”
PLOS ONE
6, no. 6 (June 6, 2011).
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108955]

24.
from 1.28 percent to 1.7 percent:
Norat et al., “Meat, Fish, and Colorectal Cancer Risk.”

25.
fish, fish oils, and colon cancer prevention:
For evidence that eating fish discourages cancer by encouraging apoptosis and impeding cellular proliferation, see Youngmi Cho et al., “A Chemoprotective Fish Oil- and Pectin-Containing Diet Temporally Alters Gene Expression Profiles in Exfoliated Rat Colonocytes Throughout Oncogenesis,”
Journal of Nutrition
141, no. 6 (June 1, 2011): 1029–35.
[http://jn.nutrition.org/content/141/6/1029.abstract]
For another perspective, see Catherine H. MacLean et al., “Effects of Omega-3 Fatty Acids on Cancer Risk,”
JAMA: The Journal of the American Medical Association
295, no. 4 (January 25, 2006): 403–15.
[http://www.ncbi.nlm.nih.gov/pubmed/16434631]

26.
mammalian fat … has come under challenge:
Ross L. Prentice et al., “Low-Fat Dietary Pattern and Risk of Invasive Breast Cancer: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial,”
JAMA: The Journal of the American Medical Association
295, no. 6 (February 8, 2006): 629–42;
[http://jama.ama-assn.org/content/295/6/629]
and Shirley A. Beresford et al., “Low-Fat Dietary Pattern and Risk of Colorectal Cancer.” For a summary, see “The Nutrition Source: Low-Fat Diet Not a Cure-All,” Harvard School of Public Health website. [
http://www.hsph.harvard.edu/nutritionsource/nutrition-news/low-fat
]

27.
sugar may pose a greater danger:
Gary Taubes,
Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health
(New York: Vintage, 2008); and Gary Taubes,
Why We Get Fat: And What to Do About It
(New York: Knopf, 2010).

28.
Obesity … has joined the short list:
See, for example, “AACR Cancer Progress Report,” 2012, American Association for Cancer Research website.
[http://cancerprogressreport.org]

29.
caloric restriction:
The mechanisms are complex, involving insulin regulation and other cellular processes. See Stephen D. Hursting et al., “Calorie Restriction, Aging, and Cancer Prevention,”
Annual Review of Medicine
54 (February 2003): 131–52
[http://www.annualreviews.org/doi/abs/10.1146/annurev.med.54.101601.152156]
; D. Kritchevsky, “Caloric Restriction and Cancer,”
Journal of Nutritional Science and Vitaminology
47, no. 1 (February 2001): 13–19
[http://www.ncbi.nlm.nih.gov/pubmed/11349885]
; Sjoerd G. Elias et al., “Transient Caloric Restriction and Cancer Risk (The Netherlands),”
Cancer Causes & Control
18, no. 1 (February 2007): 1–5
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764866]
; and David M. Klurfeld et al., “Reduction of Enhanced Mammary Carcinogenesis in LA/N-cp (Corpulent) Rats by Energy Restriction,”
Proceedings of the Society for Experimental Biology and Medicine
196, no. 4 (April 1, 1991): 381–84.
[http://ebm.rsmjournals.com/content/196/4/381.abstract]
In
Good Calories, Bad Calories
Taubes argues that the anticarcinogenic effects seen in the animal experiments come not from an overall reduction in calories but from limiting sugars and carbohydrates.