"Sunshine" Vitamin D Reduces Breast Cancer Risk

Nidhi Sharma
Women who get an adequate amount of vitamin D through daily exposure to the Sun are less likely to develop breast cancer as compared to women who do not, new studies suggests.

The "sunshine vitamin," when taken in high doses may cut the risk of breast cancer by 70%. Vitamin D is synthesized naturally in human body after the skin is exposed to the ultraviolet (UV) rays and lack of UV exposure is linked to higher risk of breast cancer.

A new study led by Garland FC and colleagues from the University of California San Diego showed there is an association between low ultraviolet irradiance and higher breast cancer risk. The study, which is published in the March 17, 2008 issue of Breast Journal also found high levels of vitamin D translated to a 50% lower risk of breast cancer.

The researchers concluded that "there was a protective effect of UVB irradiance on risk of breast cancer that was independent of fertility rate, proportion of the population overweight, alcohol intake, animal energy intake, and other covariates."

A second study by Canadian researchers, found that women who spent time outdoors or got a lot of vitamin D from their diets or supplements. This holds true especially for teens who were 25% to 45% less likely to develop breast cancer than women with less vitamin D.

Approximately 1,150,000 cases and 410,000 deaths from breast cancer occur annually worldwide, including 215,000 new cases and 41,000 deaths in the United States.

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the effectiveness of computer-aided detection (CAD) for screening mammography

When it comes to reading mammogram results, two heads aren’t always better than one.

A new study found that so-called computer-aided detection (CAD) for screening mammography has rates of cancer detection similar to mammograms read by two different radiologists.

“Reading mammograms by a single reader (radiologist) using CAD has been shown to be as clinically effective as having films read by two expert readers,” said the study’s lead author, Dr. Fiona Gilbert, a professor of radiology at the University of Aberdeen in the United Kingdom.

“Women should be reassured that the final decision on recall is made by the human reader using their knowledge and experience to decide if any areas of the mammogram marked by CAD merit further investigations,” she said.

In the United Kingdom and many European countries, the recommendation is that every mammogram be read by two independent radiologists. This practice isn’t common in the United States, according to Dr. Thomas Hall, director of breast imaging for Providence Hospital in Southfield, Mich. “Most mammograms are single-read in America, though most places now, when they get digital mammography, also get CAD,” he said.

Gilbert said, “We know that two readers will detect approximately 10 percent more cancers than a single reader.” But two readers aren’t always available. Sometimes, there might be seasonal shortages, as might occur during the holidays. Or, it may be that there aren’t enough resources to have multiple radiologists available to read mammography results, she said.

So, Gilbert and her colleagues wanted to know if the computer plus one reader would be similarly effective to two readers.

To assess this question, the researchers randomly assigned more than 31,000 women undergoing routine screening mammography to have their films read by two radiologists, by CAD and one radiologist, or using both measures.

Double reading found 87.7 percent of the cancers, while CAD plus a single reading was able to detect 87.2 percent. Recall rates, that is the number of women called back for further testing due to suspicious findings, were 3.4 percent for double reading and 3.9 percent for single reading with CAD.

The study findings were expected to be published in the Oct. 16 issue of the New England Journal of Medicine, but were posted online Oct. 1.

“CAD could increase the cancer detection rate of a single reader in breast screening centers currently using single reading alone,” said Gilbert, who added that, “in countries where double reading is standard practice, CAD could be used if there is a shortage of readers without compromising cancer detection rates.”

Hall said it’s likely that, if this study had been done with a digital mammography system, the results would have been even better. He said for this study, the researchers took mammography films and scanned them into the computer before the computer reading. That means the computer was essentially checking a copy, and when you copy something, information may be lost, he said.

“There are definite advantages to digital mammography with CAD. Digital helps you visualize the anatomy better, and the CAD helps keep you on your toes,” Hall said.

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Adequate Intake of Vitamin D Reduces Breast and Colon Cancer Rates

Sufficient intake of Vitamin D3 might prevent 60,000 cases of colon and breast cancer every year across the globe, a new study has found.

Vitamin D3 is available through diet, supplements and exposure of the skin to sunlight.

The study was conducted by a team of researchers led by Cedric F. Garland at the Moores Cancer Center at the University of California, San Diego (UCSD).

As part of the study, researchers combined data from surveys of serum vitamin D levels during winter from 15 countries. The data was then applied to 177 countries to estimate the average serum level of a vitamin D metabolite of people living there.

The study found an inverse association of serum vitamin D with risk of colorectal and breast cancer and estimated that 250,000 colorectal cancer cases and 350,000 cases of breast cancer could be prevented worldwide by increasing intake of vitamin D3, particularly in countries north of the equator.

“For the first time, we are saying that 600,000 cases of breast and colorectal cancer could be prevented each year worldwide, including nearly 150,000 in the United States alone,” Garland said.

The researchers suggested that increasing vitamin D levels in populations, particularly those in northern climates, might both prevent and possibly serve as an adjunct to existing treatments for cancer.

“This could be best achieved with a combination of diet, supplements and short intervals – 10 or 15 minutes a day – in the sun. It could be less for very fair-skinned individuals. The appropriate dose of vitamin D in order to reach this level, could be very little in a lifeguard in Southern California… or quite a lot for someone in Northern Europe who tends to remain indoors most of the year,” Garland said.

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Recurrence of Stage III Colon Cancer Traced to High-Fat Diets

After curative surgery and adjuvant chemotherapy for stage III colon cancer, patients who ate a high-fat diet were more likely to have a recurrence than those who ate a so-called prudent diet, found researchers here.

Those with a higher recurrence risk ate more meat, fat, French fries, refined grains, and desserts. Jeffrey A. Meyerhardt, M.D., M.P.H., of the Dana-Farber Cancer Institute, and colleagues, reported in the Aug. 15 issue of the Journal of the American Medical Association.

By contrast, a "prudent diet," high in fruits, vegetables, poultry, and fish, had no effect on cancer recurrence or death.
The findings came from a prospective observational study of 1,009 patients with stage III disease enrolled in a randomized adjuvant chemotherapy trial from April 1999 through May 2001. The NCI-sponsored Cancer and Leukemia Group B (CALGB) trial compared with weekly fluorouracil and leucovorin with weekly irinotecan, fluorouracil, and leucovorin.
Previous epidemiological studies have indicated that dietary factors are associated with the risk of developing colon cancer, the researchers wrote. "However, the influence of diet and other lifestyle factors on the outcome of patients with established colon cancer is largely unknown," they added.
It is possible, they said, that after resection of stage III colon cancer, increasing intake of the high-fat and processed foods in the Western diet may facilitate a milieu that allows residual microscopic disease to proliferate and spread.
Also, they said, patients rated high for consumption of foods in the Western diet after diagnosis may have had a similar diet before diagnosis and consequently may have had more biologically aggressive tumors. Nonetheless, there was no significant association between dietary pattern and tumor-related characteristics, the researchers said.
Patients filled out a semiquantitative food frequency questionnaire during and six months after adjuvant chemotherapy. Using factor analysis, the researchers identified two major dietary patterns, the fat-heavy Western diet and the prudent diet. Patients were then followed up for cancer recurrence or death.
During a median follow-up of 5.3 years for the overall cohort, 324 patients had a cancer recurrence, 223 died as a result, and 28 died without documented cancer recurrence.
Compared with patients in the lowest quintile of the Western pattern, those in the highest quintile had a more than three-fold higher risk of cancer recurrence or death (adjusted hazard ratio hazard ratio for disease-free survival, 3.25, 95% confidence interval 2.04-5.19; P for trend <0.001).
Patients in the highest quintile were also 2.9 times more likely to have a recurrence than those in the lowest quintile (adjusted HR, 2.85; CI, 1.75-4.63, P for trend <0.001).
Similarly, a significantly higher overall risk of death was observed compared with the lowest quintile (adjusted HR, 2.32; CI, 1.36-3.96, P for trend <0.001).
The reduction in disease-free survival with the Western diet was not significantly modified by sex, age, nodal stage, body mass index, physical activity level, baseline performance status, or treatment group.
No relationship was seen for recurrence-free survival (P for trend =0.84) or overall survival (P for trend =0.54) across various intakes of the prudent dietary pattern.
The adjusted hazard ratio comparing the highest and lowest quintiles of the prudent diet was 1.20 (CI, 0.83 -1.75) for disease-free survival (P for trend 0.78).
Similarly, no relationship was seen for recurrence-free or overall survival across the various intakes for those who ate a prudent diet.
Higher prudent diet scores were found for patients who were physically active, had a lower BMI six months after adjuvant therapy, and were less likely to be smokers.
Higher undesirable Western scores were seen among men, whites, and past or current smokers.
In contrast, other characteristics, particularly tumor types known to predict prognosis, did not vary significantly among the quintiles of either dietary pattern, the researchers reported.
The researchers pointed out that they could not completely exclude the possibility that a higher intake of the Western pattern may have reflected other predictors of poor prognosis.
Nevertheless no significant association between diet and predictors associated with cancer recurrence (extent of invasion into bowel wall, number of positive lymph nodes) was observed.
Because the study was observational, causality cannot and should not be drawn from these data, Dr. Meyerhardt wrote. Nonetheless, the data suggest that eating more red and processed meat, sweets and desserts, French fries, and refined grains increases the risk of recurrence and decreases survival.
"Further analyses are under way to better delineate specific nutrients or food groupings that may have the strongest association," the authors concluded.
Eric Jacobs, Ph.D., a senior epidemiologist at the American Cancer Society, called the study by Dr. Meyerhardt and colleagues well-designed and addressing "an important question that has not been studied so far."
He pointed out that diet and the risk of colon cancer studies have not been consistent, but there has been almost nothing about the risk of recurrence. "The effect of diet on recurrence may be biologically different from the original risk," he noted. "Other studies will have to attempt to duplicate the results and then see where it leads."
As to why the prudent diet showed no benefit beyond not stimulating recurrence is an important question, he added. "Stay tuned," Dr. Jacobs said. "It's a really important question and needs more research."

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Femara Found To Reduce Spread Of Breast Cancer To The Lungs

Femara reduces the risk of breast cancer spreading to the lungs, the brain or the bone which has a worse prognosis than when the cancer is localised to the breast

Newly published data in the May issue of Annals of Oncology, Oxford University Press show that after two years of post-surgical therapy, postmenopausal women with hormone-sensitive early breast cancer treated with Femara experienced 30 percent fewer early breast cancer recurrences at sites away from the breast (distant metastases) compared with tamoxifen(1).

of breast cancer to other parts of the body means that it is extremely likely that a woman will die from the disease(2). Recurrences that occur locally, regionally, or in the opposite breast (contra-lateral) are more easily treated than those that spread far from the original tumour, and they are associated with better long-term outcomes(3,4).

In the retrospective analysis of more than 7,700 women at a median follow-up of two years, approximately 75 percent of early recurrences occurred at distant sites such as bone or vital organs. However, there were 30 percent fewer distant recurrences in the Femara group than in the tamoxifen group (87 vs. 125, respectively)(1).

Maria Leadbeater, Secondary Breast Cancer Nurse Specialist at Breast Cancer Care commented, "Breast Cancer Care speaks to women with breast cancer daily and knows that they welcome any treatment development that could help to reduce the likelihood of their cancer recurring. Having been treated for breast cancer the first time round, one of the greatest fears is that the disease might return. These findings confirm earlier results from this trial, and suggest that Femara may be a treatment option for postmenopausal women with early breast cancer that could help reduce the risk of this happening to them."

Compared with tamoxifen Femara also demonstrated a significant reduction in the risk of recurrence to the same breast (local recurrence), the other breast and to the lymph nodes (regional recurrence).

"Femara is the only aromatase inhibitor shown to significantly reduce the risk of distant metastases versus tamoxifen as initial adjuvant therapy in postmenopausal women with hormone-sensitive early breast cancer. This is particularly good news since we know that this type of recurrence significantly worsens the prognosis for these women," said Dr Andrew Wardley, study investigator and consultant medical oncologist at the Christie Hospital, Manchester, and the South Manchester University Hospitals NHS Trust.

The retrospective analysis also identified patients at higher risk of recurrence based on clinical and pathological disease characteristics. The results showed that patients with the highest risk of early recurrence had tumours larger than five centimetres, four or more positive nodes, positive oestrogen receptor status but negative progesterone status, grade three tumours and invasive disease. Notably, women with node positive disease, who are considered to be at a higher risk of recurrence, maintained this lower risk of relapse when treated with upfront Femara than with tamoxifen(1).

"These results provide the tip of the iceberg and for the bigger picture, physicians will be eagerly awaiting the results of the BIG 1-98 sequencing arms, which hope to indicate the optimal strategy for using Femara post surgery and are due to be ready for 2008. This is why Novartis has made a significant commitment to sponsor this important study", said Hugh O'Dowd, Business Unit Director, Novartis Oncology UK.

Notes to Editors About BIG 1-98

BIG 1-98 is the only clinical trial that incorporates both a head-to-head comparison and a sequencing of Femara and tamoxifen as adjuvant treatment for postmenopausal women with hormone receptor positive breast cancer. The results of the primary core analysis of the head-to-head comparison based on a median follow up of 26 months were published in the December 29, 2005, issue of the New England Journal of Medicine(5). The BIG 1-98 trial was conducted by the International Breast Cancer Study Group (IBCSG) with many independent centres and was supported by Novartis.

About Femara

Femara is the only AI with the widest range of licences - before surgery, directly post-surgery, after five years of standard tamoxifen treatment and in advanced cancer(6).

A once-a-day oral AI, Femara is currently indicated in the UK for:

- Adjuvant (post-surgery) treatment of postmenopausal women with hormone receptor-positive invasive early breast cancer

- The treatment of early invasive breast cancer in postmenopausal women who have completed prior standard adjuvant tamoxifen therapy (extended adjuvant)

- Newly diagnosed postmenopausal women with advanced breast cancer

- Postmenopausal women with advanced breast cancer in whom tamoxifen, or other anti-oestrogen therapy has failed

- Neoadjuvant (pre-operative) therapy in postmenopausal women with localised hormone receptor-positive breast cancer, to allow subsequent breast conserving surgery in women not originally considered candidates for breast-conserving therapy

About Novartis

Novartis AG is a world leader in offering medicines to protect health, cure disease and improve well-being. Our goal is to discover, develop and successfully market innovative products to treat patients, ease suffering and enhance the quality of life. We are strengthening our medicine-based portfolio, which is focused on strategic growth platforms in innovation-driven pharmaceuticals, high-quality and low-cost generics, human vaccines and leading self-medication OTC brands. Novartis is the only company with leadership positions in these areas. In 2006, the Group's businesses achieved net sales of USD 37.0 billion and net income of USD 7.2 billion. Approximately USD 5.4 billion was invested in R&D. Headquartered in Basel, Switzerland, Novartis Group companies employ approximately 101,000 associates and operate in over 140 countries around the world.

References

(1). Mauriac L, et al. Predictors of early relapse in postmenopausal women with hormone receptor-positive breast cancer in the BIG 1-98 trial. Annal of Oncology 2007. Feb 14 online edition

(2). American Cancer Society. Breast Cancer Detailed Guide. How is Breast Cancer Staged? http://www.cancer.org/docroot/CRI/content/CRI_2_4_7x_CRC_Breast_Cancer_PDF.as p. Accessed 23.04.07

(3). National Cancer Institute. Breast Cancer PDQ: Treatment, Health Professional version. http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional. Accessed 23.04.07

(4). Imaginis, the breast cancer resource. http://www.imaginis.com/breasthealth/metastatic.asp. Accessed 23.04.07

(5). Thurlimann B et al. Adjuvant letrozole reduces the risk of relapse in postmenopausal women with receptor positive early breast cancer compared with tamoxifen: first results of the BIG 1-98 trial. N Engl J Med, December 2005

(6). Femara Summary of Product Characteristics. December 2005 For more information contact: Press Office Novartis Oncology Tel: +44(0)1276-698691 Sabrina Gallon Ruder Finn Tel: +44(0)20-7462-8965 e-mail: sgallon@ruderfinn.co.uk Amy Lawrence Ruder Finn Tel: +44(0)20-7462-8906 e-mail: alawrence@ruderfinn.co.uk

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Diets That Fight Cancer

Susan Burke MS, RD, LD/N, CDE
eDiets.com Chief Nutritionist

Cancer. It’s the diagnosis everyone dreads. But this is not a story about fear, it’s about hope. There’s hope for those diagnosed with cancer, because new techniques, treatments and medicines help people live longer. And although there’s no guarantee that lifestyle will prevent cancer, how you live, what you eat, and your daily habits can lower your risk for getting many types of cancer, even breast cancer.

Cancer is a disease that may be managed, though not usually completely cured. Although heart disease kills more Americans, cancer is a close second. The National Cancer Institute (NCI) reports that although cancer research has improved the outlook for people already diagnosed with cancer, it remains one of our most “urgent health concerns and the disease many fear most.” More than 1.3 million new cases will be diagnosed this year, and more than a half million people will die from cancer.

Breast cancer follows lung cancer as the second most common cancer in women. The American Cancer Society (ACS) estimates that one in every seven American women will develop breast cancer in their lifetime. More than 220,000 American women will develop breast cancer this year, more commonly in older (greater than age 60) women. Risk increases with a family history (grandmother, mother, sister, daughter or two other close relatives).

Overweight Increases Risk for Cancer

Let’s get down to brass tacks. If you’re having a hard time finding motivation to lose weight, then think about cancer, because the risk for cancer increases along with overweight and obesity. Overweight women have a higher risk for breast cancer, especially if they gained weight after menopause. According to the NCI, obesity and physical activity may account for up to 30 percent of postmenopausal breast cancer, as well as colon, endometrial, kidney and esophageal cancer.

From 11,000 to 18,000 deaths per year from breast cancer in American women over age 50 might be avoided if women could maintain a BMI under 25 throughout their adult lives. For example, a 5-foot-6 woman who weighs 165 pounds has a BMI of 26.6; losing 15 pounds makes the BMI about 24.2.

A study in Cancer Detection and Prevention (June 2003) reported that approximately 41,000 new cases of cancer in the U.S. were linked to obesity, and 20 percent of cancer deaths in women were due to overweight and obesity. Obesity may increase estrogen levels, which supports rapid growth of breast tumors. Before menopause, the ovaries are the primary producer of estrogen, but after menopause fat tissue becomes the primary estrogen source.

Obesity is linked to type 2 diabetes, a risk factor for gallbladder, ovarian and pancreatic cancer. The online journal Diabetes Today (September 26, 2006) reported those with type 2 diabetes were more likely to develop cancer, especially of certain organs, such as the pancreas and liver. Researchers hypothesize that type 2 diabetes produces excess insulin that may promote cancer-cell growth in the liver or pancreas.

According to the ACS, obesity is known to increase cervical, endometrial, ovary and gallbladder cancer risk in women, and colorectal and prostate cancer risk in men.

Losing weight after menopause decreases risk for breast cancer. The best advice is to avoid gaining weight to begin with, and staying at a healthy weight.

Prevention

The ACS notes that there are some risk factors you can control, some you cannot. Your age (over 50 increases risk), gender (women are 100 times more likely to get breast cancer than men), and genes (certain gene mutations increases risk by 80 percent) cannot be controlled. But other risk factors, including excess alcohol and obesity, increase risk for cancer. Your weight and your diet are two factors that are absolutely controllable. Take control.

The Best Diet

Managing your weight with healthy diet and exercise not only lowers your risk for breast cancer, but also can help prevent cancer reoccurrence.

Jennifer K. Nelson, Mayo Clinic’s director of clinical nutrition, says research supports including more fruits and vegetables in your diet daily to lower the risk for many serious diseases, including cancer. Rather than taking supplements, getting the health-providing compounds from foods means more phytonutrients, minute chemicals that are immunity-boosting and protective against cancer-causing free radicals.

“Eating a variety of plant foods -- fruits, vegetables, whole grains, legumes, nuts, seeds -- helps ensure that we get a variety of what Mother Nature intended for us to get," she said.

Jennifer also notes that managing your weight through diet and physical activity can "play a role in preventing breast cancer and keeping it from returning."

A study in the Journal of Clinical Oncology (September 20, 2005) found that women who increase their intake of vegetables and fruits following early-stage breast cancer diagnosis had a greater rate of recurrence-free survival.

Lower your risk for cancer by managing your weight. The Mayo Clinic Plan gives you virtually unlimited vegetables and fruits, plus a variety of healthy choices from all of the food groups. More variety increases your intake of beneficial phytonutrients in different fruits and vegetables. Lose weight and improve high blood pressure and cholesterol, as well as reduce your risk for heart disease, Type 2 diabetes and certain types of cancer.

The Mayo Clinic experts have developed this plan to help you live a longer, healthier life. Join eDiets.com and get a personalized approach to weight management, support and reliable information.

Physical Activity Lowers Cancer Risk

Moderate to vigorous regular activity reduces risk of developing colon and breast cancer, and since physical activity is a key factor in maintaining or achieving a healthy body weight, make it your business to stay active. Physical activity has beneficial effects against heart disease and diabetes too, so find something you like to do and get moving.

Your eDiets Fitness Plan is also personalized to your current level of fitness, and is modified to be more challenging as your strength and fitness increases.

Early Diagnosis

Early diagnosis means early treatment, perhaps even a cure. Monthly breast self-exams can save your life. Depending upon your individual risk factors, women should have a mammogram every year beginning at age 40. Prostate cancer will affect almost all men at some point in their life and staying at a healthy weight and activity lowers risk. Prostate is usually a slow-growing cancer, not as easily detected, and men also need a digital exam starting at age 40. Early detection means a better chance of survival. Find out more about early detection at http://www.nbcam.org/aboutBC_earlyDetection.cfm.

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