Full Report - Food, Nutrition, and the Prevention of Cancer

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CHAPTER 7 • CANCERS height in both men and women may indicate a potential influence of some growth factor or hormone during childhood or adolescence, but the potential role of growth factors on thyroid carcinogenesis is still poorly defined. 7.18.1.2 Conclusions Thyroid cancer was reviewed in the previous report. It judged that both iodine deficiency (probably) and iodine excess (possibly) were causes of this cancer, and also that vegetables and fruits were possibly protective. The Panel concludes that the associations identified warrant more investigation into food, nutrition, and thyroid cancer. 7.18.2 Testis Cancer of the testis is the 19th most common type in men. An estimated 49 000 cases occurred in 2002, accounting for around 0.5 per cent overall. This cancer is increasing worldwide, with rapid rises in many high-income countries and some transition countries. 124 Rates are more than five times higher than in middle- to low-income countries. Cancer of the testis is usually not fatal where chemotherapy is available, with a 5-year survival rate of more than 90 per cent in high-income countries, but less than 60 per cent in middle- to low-income countries. 2 6 Also see box 7.1.1. Most (95 per cent) testicular cancers are germ cell cancers, with seminomas being the other main subtype. 4 The most well established risk factor for testicular cancer is the failure of one testis or both to descend into the normal position during fetal development. 4 Rates peak in young adulthood. 7.18.2.1 Evidence The evidence from the narrative review is summarised below. 7.18.2.1.1 Milk and dairy products Five case-control studies, one twin study, and four ecological studies investigated milk and dairy consumption. All ecological studies and two of the case-control studies showed statistically significant relationships between increased milk and dairy consumption and increased testicular cancer incidence. None of the other studies reported statistically significant associations, although non-significant associations were heterogeneous. There are no well established mechanisms through which milk could influence testicular cancer development. Milk and dairy products contain fat, protein, and calcium, all of which may have an effect on testicular cancer risk. 7.18.2.2 Conclusions Cancer of the testis was not reviewed in the previous report. The Panel concludes that the evidence does not warrant significant investigation into food, nutrition, and testicular cancer. 7.18.3 Lymphoid and haemopoietic system Cancers of the lympho-haemopoietic system are predominantly lymphomas (Hodgkin’s or non-Hodgkin’s), leukaemias, and multiple myelomas. These cancers have different non-dietary causes and there is no reason to believe that they might be affected by food, nutrition, and physical activity in the same ways. If taken together, this group of cancers would be the sixth most common type worldwide. An estimated 749 000 cases occurred in 2002, accounting for around 7 per cent overall. Approximately 48 per cent of these cancers were lymphomas (83 per cent non-Hodgkin’s; 17 per cent Hodgkin’s), and 40 per cent were leukaemias, with multiple myelomas accounting for the remaining 12 per cent. 2 Non-Hodgkin’s lymphoma is the 11th most common cause of cancer incidence. It is increasing in incidence worldwide. 124 Non-Hodgkin’s lymphoma is most frequent in highincome countries, with rates more than twice those of middle- to low-income countries. It is usually fatal, with a 5-year survival rate of less than 35 per cent. 4 This is not a single cancer, but a wide group of cancers (such as Burkitt’s lymphoma and diffuse large B-cell lymphoma), each with a distinct geographical distribution, development path, age profile, and prognosis. Hodgkin’s lymphoma is the 25th most common type. It is most frequent in high-income countries, where rates are more than twice those of middle- to low-income countries. It is not usually fatal, with a 5-year survival rate of approximately 75 per cent in high-income countries and less than 60 per cent in middle- to low-income countries. 2 4 This cancer occurs mainly in children, young adults, and the elderly (tending to occur at a younger age or in old age in middleto low-income countries). 124 Leukaemias are the 12th most common type and the 10th most common cause of cancer death. They are gradually increasing in incidence worldwide. They are most frequent in high-income countries, with rates more than twice those of middle- to low-income countries. Leukaemias are usually fatal, with a 5-year survival rate of approximately 40 per cent in high-income countries, and less than 20 per cent in middle- to low-income countries. 124 However, childhood leukaemias have a very high survival rate. This is not a single cancer, but a wide group of both acute and chronic leukaemias. Multiple myeloma is the 24th most common type and the 19th most common cause of cancer death. It is gradually increasing in incidence worldwide, and is most frequent in high-income countries with rates more than three times higher than in middle- to low-income countries. It is usually fatal, with a 5-year survival rate of less than 50 per cent in highincome countries and less than 30 per cent in middle- to lowincome countries. 2 Infection with Epstein-Barr virus (see box 7.2.1) is a risk factor for developing Hodgkin’s lymphoma. 329 HIV-1 infection, immune suppression (whatever the cause), and infection with Epstein-Barr and human T-cell leukaemia virus all increase the risk of developing non-Hodgkin’s lymphoma. 330 319
Tobacco use, infection with human T-cell leukaemia virus, radiation, and benzene are established causes of leukaemia. 10 67 328 331 Exposure to ionising radiation is a cause of multiple myeloma. Also see chapter 2.4. 7.18.3.1 Evidence The evidence from the narrative review is summarised below. 7.18.3.1.1 Vegetables and fruits One cohort study and six case-control studies investigated vegetables and fruits. The cohort study and five of the casecontrol studies showed statistically significant associations with increased vegetable and fruit intake and reduced incidence of lymphoid and haemopoietic cancers. However, the cohort study and two of the case-control studies reported on non-Hodgkin’s lymphoma only. The sixth case-control study reported increased incidence with consumption of ‘vegetables other than cruciferous, leafy, or yellow/orange’. Vegetables and fruits contain many potentially protective substances, including several antioxidants, as well as phytochemicals with antiproliferative capabilities. They are also a rich source of folate, which plays an important role in the synthesis, repair, and methylation of DNA. 7.18.3.1.2 Milk and dairy products One cohort study, nine case-control studies, and one ecological study investigated milk and dairy products, with most reporting on non-Hodgkin’s lymphoma. The cohort study, the ecological study, and most of the case-control studies reported statistically significant associations between increased milk and dairy consumption and increased incidence. There are no well established mechanisms by which milk could increase lymphoma incidence. Hypotheses include calcium restricting the bioavailability of vitamin D (this vitamin promotes differentiation and apoptosis and inhibits cancer cell growth in the laboratory). Alternatively, organochlorines (which are potential carcinogens) may accumulate in dairy fat. A final hypothesis is that bovine leukaemia virus might transmit through milk to humans, although there is no direct evidence for this. 7.18.3.1.3 Meat One cohort study, seven case-control studies, and one ecological study investigated meat or red meat. The cohort study, the ecological study, and most of the case-control studies showed an association with increased incidence, with several reaching statistical significance. A review article came to the same conclusion. There are no postulated mechanisms by which meat could increase the incidence of lymphoid and haemopoietic cancers. 7.18.3.1.4 Fish Two cohort studies and seven case-control studies investigated fish and lymphoid and haematopoietic cancers. Most studies showed a non-significant relationship with reduced incidence. This reached statistical significance in two casecontrol studies that reported results separately for non- Hodgkin’s lymphoma. 320 P ART 2 • EVIDENCE AND JUDGEMENTS One animal study has shown that fish oils can inhibit the formation of lymphoid and haemopoietic cancers. 7.18.3.1.5 Fat Two cohort studies and four case-control studies investigated fat consumption. All showed statistically significant relationships with increased incidence. One case-control study that reported separately on PUFAs described a significantly reduced incidence for that fatty acid type, while confirming a significant increased incidence for saturated fatty acids. There are no postulated mechanisms by which fat could increase lymphoid and haemopoietic cancers. 7.18.3.1.6 Alcoholic drinks One pooled analysis of case-control studies representing 15 175 participants, with 6492 non-Hodgkin’s lymphoma cases, showed a statistically significant reduced incidence for this type, particularly Burkitt’s lymphoma. There are no postulated mechanisms by which alcohol could decrease the incidence of lymphoid and haemopoietic cancers. 7.18.3.1.7 Body fatness Nine cohort studies and 11 case-control studies investigated BMI or obesity and non-Hodgkin’s lymphoma, leukaemia, or multiple myeloma. In each case, most studies reported an association with increased incidence, with several reporting statistically significant relationships. Obesity results in pathological states of inflammation and altered immune responses, both of which are factors that can influence lymphoid and haemopoietic cell function. 7.18.3.2 Conclusions These cancers were not reviewed in the previous report. The Panel concludes that more work into mechanisms that might underlie the associations identified is warranted. A more comprehensive and systematic review might also clarify the epidemiology. The different cancer types should be investigated separately unless there is reason to believe that they have common causes. 7.18.4 Musculoskeletal system Cancers of the musculoskeletal system are a diverse group, including those of the bones, muscles, and related tissues, all around the body. These include liposarcomas, fibrosarcomas, osteosarcomas, and myosarcomas. These cancers are all uncommon or rare, each accounting for less than 1 per cent — usually much less — of all cancers. There is no reason to think that they have causes in common. The narrative review did not produce any findings. Because these cancers are uncommon, any study investigating their possible links with food, nutrition, and physical activity would be unlikely to be fruitful. Because they are diverse, any investigation that grouped all of them together would also be unlikely to show consistent results.
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World Cancer Research Fund Food, Nu
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Please cite the Report as follows:
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Preface I am very grateful to the s
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Contents Preface i v Contents v i A
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Panel viii FOOD, NUTRITION, PHYSICA
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x FOOD, NUTRITION, PHYSICAL ACTIVIT
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xii FOOD, NUTRITION, PHYSICAL ACTIV
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xiv FOOD, NUTRITION, PHYSICAL ACTIV
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xvi FOOD, NUTRITION, PHYSICAL ACTIV
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xviii FOOD, NUTRITION, PHYSICAL ACT
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xx FOOD, NUTRITION, PHYSICAL ACTIVI
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xxii FOOD, NUTRITION, PHYSICAL ACTI
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xxiv FOOD, NUTRITION, PHYSICAL ACTI
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important and can be modified. Thes
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CHAPTER 1 • INTERNATIONAL VARIATI
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Data from World Health Organization
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C HAPTER 2 • THE CANCER PROCESS T
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C HAPTER 2 • THE CANCER PROCESS s
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C HAPTER 2 • THE CANCER PROCESS 2
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C HAPTER 2 • THE CANCER PROCESS B
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C HAPTER 2 • THE CANCER PROCESS B
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C HAPTER 2 • THE CANCER PROCESS o
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C HAPTER 2 • THE CANCER PROCESS N
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C HAPTER 2 • THE CANCER PROCESS 4
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C H A P T E R 3 Judging the evidenc
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Box 3.1 Issues concerning interpret
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Box 3.2 Dose response ‘Dose respo
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Box 3.4 Systematic literature revie
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harvesting conditions, animal feed,
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3.4.2 The ‘portfolio’ approach
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Box 3.8 Criteria for grading eviden
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excluded. Usually this evidence cam
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EVIDENCE AND JUDGEMENTS PART 2 64 I
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C H A P T E R 4 Foods and drinks Th
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countries with hot, damp climates a
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70 Box 4.1.4 Aflatoxins Mycotoxins
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72 Figure 4.1.1 Dietary fibre and c
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4.2). All of these are highest in d
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VEGETABLES, 1 FRUITS, 1 PULSES (LEG
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content, and the oils produced from
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80 Box 4.2.4 Foods containing dieta
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4.2.4.2 Specific Considerations spe
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assessed carrots, but some looked a
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Non-starchy root vegetables and tub
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cohort and case-control data on gre
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Non-starchy vegetables and fruits A
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Green, leafy vegetables All three c
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94 Figure 4.2.16 Garlic consumption
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studies, 33 85 86 88 90 97 105 111
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cancer cases) showed a statisticall
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504 508 511 506 and in men but not
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Figure 4.2.29 Carotenoids and lung
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Figure 4.2.31 Lycopene and prostate
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somal breakage and rearrangement ca
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Figure 4.2.35 Vitamin C and oesopha
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Dietary selenium One cohort study s
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Selenoproteins appear to reach thei
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tected against cancers of the liver
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These animal foods are sources of p
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those of birds; because they are ge
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Box 4.3.5 Cantonese-style salted fi
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The single cohort study showed incr
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124 There is limited evidence, most
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Figure 4.3.11 Salted fish and nasop
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128 There is limited, inconsistent
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From the late 19th century, consump
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Seven case-control studies showed i
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on three and two cohort studies, re
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heart disease, and cancers of some
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4.5.4.2 Specific Some consideration
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cause of lung cancer or postmenopau
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taste preference promotes energy co
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Box 4.6.4 Refrigeration Freezing an
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preserved foods may be eaten more b
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Water is essential. Without water,
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specifically the infusion of the dr
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4.7.4.2 Specific Classification. Di
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cant decreased risk in men. 74 Meta
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Figure 4.7.4 Maté and oesophageal
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since the effects on mood of the fe
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Figure 4.8.1 Alcoholic drinks and m
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showed increased risk, which was st
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94 106 184 198 studies were in the
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control studies, 280 282 317 318 33
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influencing hormone levels and oest
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Spirits Two cohort studies6 486 425
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Practically all food and drink is c
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Box 4.9.2 ‘Organic’ farming So-
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Box 4.9.4 Water fluoridation In the
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and in these cases, the Panel’s j
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corresponding to judgements of ‘c
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Box 4.10.1 Food fortification Food
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4.10.6.4.1 Retinol Skin Two RCTs in
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Table 4.10.4 Beta-carotene suppleme
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analysis was possible on two of the
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4.11 Dietary patterns The nature, q
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elatively costly. In some tradition
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meat, fish, and olive oil) was asso
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meals. But none of these studies de
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CHAPTER 5 • PHYSICAL ACTIVITY PHY
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CHAPTER 5 • PHYSICAL ACTIVITY Box
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CHAPTER 5 • PHYSICAL ACTIVITY Fig
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CHAPTER 5 • PHYSICAL ACTIVITY Fou
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CHAPTER 5 • PHYSICAL ACTIVITY the
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CHAPTER 5 • PHYSICAL ACTIVITY cer
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CHAPTER 6 • BODY COMPOSITION, GRO
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C H A P T E R 7 Cancers Every year
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7.1.1 Trends, incidence, and surviv
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Studies that reported on combined i
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7.2 Nasopharynx Cancer of the nasop
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Six case-control studies investigat
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epithelial cells, from which adenoc
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7.3.5.4 Foods containing folate (Al
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oesophageal cancer. High body fatne
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7.4.1 Trends, incidence, and surviv
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plasma or serum selenium; and 3 coh
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The Panel is aware that since the c
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— increased, notably in high-inco
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Page 299 and 300: mation caused by other factors (suc
Page 301 and 302: Box 7.8.1 Hepatitis viruses Hepatit
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Page 305 and 306: include mucinous carcinomas and ade
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Page 309 and 310: 7.9.5.13 Cheese (Also see chapter 4
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Page 313 and 314: The Panel judges as follows: The ev
Page 315 and 316: 7.10.5.2 Lactation (Also see chapte
Page 317 and 318: The Panel is aware that since the c
Page 319 and 320: 7.11 Ovary Ovarian cancer is the se
Page 321 and 322: nutrition, altered hormone profiles
Page 323 and 324: 7.12.2 Pathogenesis Type 1 endometr
Page 325 and 326: case-control studies, and the mecha
Page 327 and 328: 7.13.3 Other established causes (Al
Page 329 and 330: y environmental factors. Although s
Page 331 and 332: The evidence from cohort and case-c
Page 333 and 334: 7.15 Kidney Cancer of the kidney is
Page 335 and 336: per 5 kg/m2 ; meta-analysis of case
Page 337 and 338: 7.16.5 Evidence and judgements In t
Page 339 and 340: Despite the considerably higher inc
Page 341: 7.18 Other cancers The Panel also c
Page 345 and 346: C H A P T E R 8 This chapter examin
Page 347 and 348: Box 8.1 Energy density A concept ce
Page 349 and 350: 326 Table 8.2 Approximate relative
Page 351 and 352: food, using up oxygen in the proces
Page 353 and 354: Figure 8.4 Relationship between BMI
Page 355 and 356: density (box 8.1). Therefore, the P
Page 357 and 358: Table 8.5 Physical activity interve
Page 359 and 360: were 0.70 (95% CI 0.54-0.91; minima
Page 361 and 362: iours examined, including physical
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Page 365 and 366: C H A P T E R 9 Cancer survivors Ca
Page 367 and 368: After recovery • People who are a
Page 369 and 370: Box 9.2 Use of supplements by cance
Page 371 and 372: C H A P T E R 1 0 348 P ART 2 • E
Page 373 and 374: other interested parties were exclu
Page 375 and 376: Milk and dairy products. One report
Page 377 and 378: adults, 16 30 35 36 40 41 44 46 56
Page 379 and 380: Table 10.1 Recommendations to preve
Page 381 and 382: 10.6.3 Foods and drinks Cereals (gr
Page 383 and 384: CHAPTER 11 • RESEARCH ISSUES 11.1
Page 385 and 386: CHAPTER 11 • RESEARCH ISSUES Crit
Page 387 and 388: RECOMMENDATIONS PART 3 366 Introduc
Page 389 and 390: C H A P T E R 1 2 This Report is co
Page 391 and 392: 12.1.4 Cancer in general This Repor
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12.1.7 Challenging The Panel emphas
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to enable them to increase their av
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Personal recommendations The points
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Guidance Most people can readily bu
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380 RECOMMENDATION 4 PLANT FOODS Ea
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382 RECOMMENDATION 5 ANIMAL FOODS L
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depending on the type of drink. Thi
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for a relatively long time in warm,
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388 SPECIAL RECOMMENDATION 1 BREAST
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ecommendations in this Report would
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ishing, and only the evidence on re
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�� Appe
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APPENDIX A • PROJECT PROCESS canc
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APPENDIX B • THE FIRST WCRF/AICR
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APPENDIX C• THE WORLD CANCER RESE
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GLOSSARY Cantonese-style salted fis
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GLOSSARY Exposure A factor to which
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GLOSSARY Mineral An inorganic compo
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GLOSSARY Smoking (foods) Smoking is
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REFERENCES 41. Joint United Nations
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REFERENCES 18. Romney SL, Ho GY, Pa
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REFERENCES from postmenopausal wome
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REFERENCES 50. Black RJ, Bray F, Fe
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REFERENCES possible factor in the e
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REFERENCES 1992;69:860-5. 93. Su W,
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REFERENCES Causes Control 2004;15:6
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REFERENCES 292. Miller AB, Altenbur
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REFERENCES 386. Bosetti C, Negri E,
Page 449 and 450:
REFERENCES [Correlation between nut
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REFERENCES cancer patients and heal
Page 453 and 454:
REFERENCES Serum beta-carotene and
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REFERENCES Epidemiol 1991;1:385-93.
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REFERENCES and potential risk modif
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REFERENCES 1982;68:401-5. 134. Llop
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REFERENCES [Alcoholism, smoking and
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REFERENCES diseases. Hepatogastroen
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REFERENCES National Academy Press,
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REFERENCES 413. Potischman N, Hoove
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REFERENCES The Netherlands. Eur J C
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REFERENCES 598. Leon DA, Lithell HO
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REFERENCES amenorrhoea: studies amo
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REFERENCES oropharyngeal squamous c
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REFERENCES 2005;16:839-50. 207. Eng
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INDEX classification, 214 colorecta
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INDEX weight gain determinants, 337
Page 531 and 532:
INDEX Interleukin 6 (IL-6), 39 Inte
Page 533 and 534:
INDEX adipose tissue-derived, 221 O
Page 535 and 536:
INDEX stomach cancer, 146, 269-70 S
Page 537:
INDEX trends, 324-7 Western diets,
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