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CANCER PREVENTION, GENETICS, AND EPIDEMIOLOGY Integrative Cancer Prevention: Nutrition, Supplements, and Lifestyle CHAIR Donald I. Abrams, MD San Francisco General Hospital San Francisco, CA SPEAKERS Michelle Harvie, PhD University Hospital of South Manchester NHS Foundation Trust Manchester, United Kingdom Heather Greenlee, ND, PhD Columbia University Medical Center New York, NY
HARVIE, HOWELL, AND EVANS Can Diet and Lifestyle Prevent Breast Cancer: What Is the Evidence? Michelle Harvie, PhD, Anthony Howell, MSc, and D. Gareth Evans, MD, FCRP OVERVIEW Breast cancer is the most common cancer among women in both developed and less-developed countries. Rates of breast cancer are increasing worldwide, with a particular increase in postmenopausal and estrogen receptor-positive cases. The World Cancer Research Fund (WCRF) and American Cancer Society (ACS) cancer prevention guidelines recommend maintaining a healthy weight, undertaking at least 150 minutes of moderate intensity exercise per week, limiting alcohol consumption, and eating a plant-based diet. Observational data link adherence to physical activity and alcohol guidelines throughout life to a reduced risk of developing pre- and postmenopausal breast cancer. Weight control throughout life appears to prevent cases after menopause. Adherence to a healthy dietary pattern does not have specific effects on breast cancer risk but remains important as it reduces the risk for other common diseases, such as cardiovascular disease (CVD), diabetes, and dementia. Emerging data suggest that smoking during adolescence or early adulthood increases later risk of breast cancer. Lifestyle factors appear to modify risk among high-risk women with a family history and those with typical risk of the general population, although their effects among carriers of BRCA mutations are not well defined. Recent expert reports estimate that successful lifestyle changes could prevent 25% to 30% of cases of breast cancer. These reductions will only be achieved if we can implement targeted prevention programs for high-risk women and women in population-based breast screening programs during childhood, adolescence, and early adulthood when the rapidly developing breast is particularly susceptible to carcinogenesis. Breast cancer is the most common cancer among women in both developed and less-developed countries, with an estimated 1.67 million new cases diagnosed worldwide in 2012 (25% of all cancers). 1 Breast cancer is a major cause of mortality in both developed (198,000 deaths, 15.4% of total; ranking second after lung cancer) and less-developed (324,000 deaths, 14.3% of total; ranking fırst) countries. Incidence rates vary nearly fourfold among different regions of the world, with age-standardized rates of 29 to 36 per 100,000 in Asia and Africa compared with 91 to 96 per 100,000 in North America and Western Europe. These rates reflect differences in reproductive factors (late age of fırst pregnancy, fewer pregnancies, short or no breast-feeding, early menarche, late menopause) and lifestyle risk factors (obesity, inactivity, alcohol, Western-style diet, and use of hormone replacement therapy [HRT]). More developed countries typically have fıvefold higher rates of postmenopausal cancer than less developed countries (approximately 308 vs. 65 per 100,000), and twofold higher rates of premenopausal cases (29 vs. 13 per 100,000). 2 Global trends for the accumulation of risk factors are particularly associated with postmenopausal breast cancer. In the West, rates of estrogen receptor (ER)-positive cancers are increasing whereas those of ER-negative cancers are decreasing in all age, racial, and ethnic groups, and it is likely that global rates will follow these trends. 3,4 Prevention of breast cancer must target both ER-positive and ER-negative subgroups and will be best achieved through preventive therapies for high-risk groups and lifestyle changes across all risk strata. Trends for an association between ER-positive breast cancer and a Western lifestyle suggest that this subtype may be particularly amenable to lifestyle prevention. Selective estrogen receptor modulators (SERMs) and aromatase inhibitors can prevent 50% to 80% of ER-positive breast cancers 5 ; however, availability and uptake of these prevention therapies is currently low (1 to 40%, reviewed in Donnelley et al 6 ). Despite apparent reductions in the rate of ER-negative cancer, its poor prognosis and high burden of breast cancer mortality make this subtype a priority for prevention. There are several promising, but as yet unproven, preventative agents for ERnegative cancer, including inhibitors of ErbB receptor, COX-2, or poly (ADP-ribose) polymerase, metformin, retinoids, and statins. 7 This article summarizes current cancer prevention guidelines and current evidence for the links between diet and life- From the Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom. Disclosures of potential conflicts of interest are found at the end of this article. Corresponding author: Michelle Harvie, PhD, Genesis Prevention Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Rd., Manchester, M23 9LT, United Kingdom; email: michelle.harvie@manchester.ac.,uk. © 2015 by American Society of Clinical Oncology. e66 2015 ASCO EDUCATIONAL BOOK | asco.org/edbook
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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American Society of Clinical Oncolo
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Controversies in Neoadjuvant Therap
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Managing Ovarian Cancer in the Olde
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2015 ASCO Annual Meeting Disclosure
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2015 Educational Book Expert Panel
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James Marshall, PhD Roswell Park Ca
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2015 Annual Meeting Supporters* MIS
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David Yurman Corporate Allies Conqu
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PARTRIDGE, JACOBSEN, AND ANDERSEN C
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PARTRIDGE, JACOBSEN, AND ANDERSEN c
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PARTRIDGE, JACOBSEN, AND ANDERSEN w
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PARTRIDGE, JACOBSEN, AND ANDERSEN v
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LESLIE R. SCHOVER Sexual Healing in
Page 782 and 783:
LESLIE R. SCHOVER tinuous ADT in pr
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LESLIE R. SCHOVER 12. Potosky AL, H
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CATHERINE H. VAN POZNAK TABLE 1. Wo
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CATHERINE H. VAN POZNAK (tamoxifen,
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CATHERINE H. VAN POZNAK TABLE 3. FD
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CATHERINE H. VAN POZNAK premenopaus
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SHARI GOLDFARB KEY POINTS Brea
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SHARI GOLDFARB and friction with va
Page 798 and 799:
SHARI GOLDFARB importance both duri
Page 800 and 801:
PATIENT AND SURVIVOR CARE Moving Su
Page 802 and 803:
MAYER ET AL TABLE 1. Quality Metric
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MAYER ET AL to enhance the quality
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MAYER ET AL FIGURE 2. (A) Infertili
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MAYER ET AL efıcial suggests that
Page 810 and 811:
PATIENT AND SURVIVOR CARE The Chall
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BRUERA AND PAICE Choice of Opioid a
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BRUERA AND PAICE toxicity and proce
Page 816 and 817:
BRUERA AND PAICE effective. Basic s
Page 818 and 819:
PEDIATRIC ONCOLOGY Real-Time Molecu
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CARROLL, RAETZ, AND MEYER KEY POINT
Page 822 and 823:
CARROLL, RAETZ, AND MEYER most are
Page 824 and 825:
CARROLL, RAETZ, AND MEYER markers a
Page 826 and 827:
PEDIATRIC ONCOLOGY Translating Surv
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REDUCING THE BURDEN OF LATE EFFECTS
Page 830 and 831:
Page 832 and 833:
Page 834 and 835:
Page 836 and 837:
PROFESSIONAL DEVELOPMENT The Challe
Page 838 and 839:
ADVANCES IN WEBSITE INFORMATION RES
Page 840 and 841:
Page 842 and 843:
Page 844 and 845:
Page 846 and 847:
COMMUNICATION AND TECHNOLOGY: IT’
Page 848 and 849:
Page 850 and 851:
Page 852 and 853:
PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 854 and 855:
PATIENT-REPORTED OUTCOMES IN ONCOLO
Page 856 and 857:
PROFESSIONAL DEVELOPMENT Trends, An
Page 858 and 859:
CLINICAL ONCOLOGY PRACTICE 2015 FIG
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CLINICAL ONCOLOGY PRACTICE 2015 (6.
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CLINICAL ONCOLOGY PRACTICE 2015 Pro
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ADJUVANT/NEOADJUVANT MEDICAL THERAP
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Page 868 and 869:
Page 870 and 871:
INDICATIONS FOR ADJUVANT RADIATION
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Page 874 and 875:
Page 876 and 877:
Page 878 and 879:
SARCOMA Latest Advances in Systemic
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SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 882 and 883:
SYSTEMIC THERAPY FOR OSTEOSARCOMA A
Page 884 and 885:
RETHINKING TREATMENT FOR CHONDROSAR
Page 886 and 887:
Page 888 and 889:
Page 890 and 891:
Page 892 and 893:
BONE SARCOMAS IN ADULTS local disea
Page 894 and 895:
BONE SARCOMAS IN ADULTS structure a
Page 896 and 897:
SARCOMA Well-Differentiated and Ded
Page 898 and 899:
ABBAS MANJI ET AL ticular region. 7
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ABBAS MANJI ET AL MYXOID (ROUND CEL
Page 902 and 903:
ABBAS MANJI ET AL versus doxorubici
Page 904 and 905:
SHLUSH AND HERSHKOVITZ Clonal Evolu
Page 906 and 907:
SHLUSH AND HERSHKOVITZ FIGURE 1. Ti
Page 908 and 909:
TUMOR BIOLOGY New Strategies to Und
Page 910 and 911:
KNAPP, DHAWAN, AND OSTRANDER in dog
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KNAPP, DHAWAN, AND OSTRANDER TABLE
Page 914 and 915:
KNAPP, DHAWAN, AND OSTRANDER 14. Fe
Page 916 and 917:
SOURBIER, SRINIVASAN, AND LINEHAN M
Page 918 and 919:
SOURBIER, SRINIVASAN, AND LINEHAN F
Page 920 and 921:
SOURBIER, SRINIVASAN, AND LINEHAN T
Page 922:
Author Index Abbas Manji, Gulam ...
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