Diet and environmental carcinogenesis in breast/gynaecological cancers

Common misconceptions and myths about ovarian cancer causation: a national cross-sectional study from palestine

BACKGROUND

Women's inability to recognize ovarian cancer (OC) causation myths to be incorrect may lead to behavioral changes that could distract them from actual risk factors and impact their treatment decision making. This study examined Palestinian women's recognition of OC mythical causes, and explored factors associated with good recognition.

METHODS

A national cross-sectional study was conducted. Adult Palestinian women were recruited from hospitals, primary healthcare facilities, and public areas in 11 governorates. The Cancer Awareness Measure-Mythical Causes Scale was modified and utilized for data collection. Awareness level was determined based on the number of myths around OC causation recognized to be incorrect: poor (0-4), fair (5-9), and good (10-13).

RESULTS

A total of 5618 participants agreed and completed the questionnaire out of 6095 approached (response rate = 92.1%), and 5411 questionnaires were included in the final analysis. The most recognized food-related myth was 'drinking from plastic bottles' (n = 1370, 25.3%) followed by 'eating burnt food' (n = 1298, 24.0%). The least recognized food-related myth was 'eating food containing additives' (n = 611, 11.3%). The most recognized food-unrelated myth was 'having a physical trauma' (n = 2899, 53.6%), whereas the least recognized was 'using mobile phones' (n = 1347, 24.9%). Only 273 participants (5.1%) had good awareness of OC causation myths as incorrect. Earning higher monthly incomes as well as visiting governmental healthcare facilities were associated with a decrease in the likelihood of exhibiting good awareness.

CONCLUSION

The overall recognition of OC causation myths was low. Addressing mythical beliefs should be included in OC prevention strategies and public health interventions to improve women's understanding of OC risk factors versus mythical causes.

Awareness about Gynecologic Cancers and Related Factors among Healthy Women: A Cross-Sectional Study

The risk of cancer-related mortality and morbidity decreases when women are aware of the risk factors for gynecologic cancers and implement strategies such as attending relevant early screening programs. This cross-sectional study conducted between August 2017 and August 2018 at a public hospital in Turkey aimed to determine the awareness about gynecologic cancers among healthy women by utilized the Krieger's ecosocial theory as a framework for the study. The study included 554 Turkish women aged 18-65 years. Data were collected using the Gynecological Cancer Awareness Scale (GCAS) and a questionnaire designed in this study. Significant differences were noted between the average GCAS score and variables such as the amount of menstrual bleeding, entering menopause, a history of reproductive system disease, regular gynecological examination (including Pap test), regular vaginal self-examination, sexually transmitted infections (STIs), genital hygiene behavior, the fear of having cancer, having knowledge about cancer, and requiring information about cancer (p < .05). Despite the high level of awareness about gynecologic cancer among these women, the lack of proper knowledge and preventive measures was high. Having knowledge about gynecologic cancers results in increased awareness; however, the level of knowledge is not sufficient to prevent gynecologic cancers, which shows the need for sufficient and effective cancer screening and education programs.

Diet and The Risk of Endometriosis in Iranian Women: A Case-Control Study

Background

Endometriosis is one of the most common pelvic diseases associated with dyspareunia, pelvic pain, and infertility. The primary aim of this study is to evaluate the role of diet on the risk of endometriosis among Iranian women.

Materials and Methods

This case-control study was conducted in two health research centres between 2015 and 2016. There were 207 women with endometriosis (case) and 206 women without endometriosis (control) who were evaluated by laparoscopy. The women were asked about their frequency of consumption per week of portions of se- lected dietary items in the Iranian diet in the year before the interview.

Results

The results indicated that intake of green vegetables (odds ratio [OR]=0.39, 95% confidence interval [CI]=0.21–0.74, Ptrend=0.004), red meat (OR=0.61, 95% CI=0.41–0.91, Ptrend=0.015) and dairy products (milk [OR=0.65, 95% CI=0.47–0.92, Ptrend=0.014], cheese [OR=0.53, 95% CI=0.37–0.76, Ptrend<0.001]), fresh fruit (OR=0.68, 95% CI=0.50–0.93, Ptrend=0.015) and grain legumes (OR=0.59, 95% CI=0.47–0.77; Ptrend<0.001) had a significant association with lower risk of endometriosis. Consumption of carrots, green tea, fish, eggs and oil was not significantly related to the risk of endometriosis.

Conclusion

This study suggests that certain types of dietary components may be related to the risk of endometriosis.

The effect of the type of dietary protein on the development of ovarian cancer

We evaluated whether different dietary protein qualities (isocaloric diets involving animal (casein) or plant protein (soy protein) could inhibit the ovarian cancer growth in mice and improve their prognosis and whether chemotherapy had different tumor reducing effects on these mice. In the mice of the 20% plant protein group, the ovarian cancer growth at 5 weeks after tumor implantation was clearly reduced in comparison to the mice in the 20% animal protein group (p< 0.001). The serum levels of insulin and IGF-1 levels were both lower in the mice of the 20% plant protein group than in the mice of the 20% animal protein group (p<0.001 and p<0.01, respectively). Immunohistochemistry revealed that the level of eukaryotic initiation factor 4E-binding protein 1 (p-4EBP1) activity―one of the major downstream effectors of the mTOR pathway ―of the plant protein group was significantly weaker than that of the animal protein group (p<0.001). The prognosis of the 20% plant protein group was better than that of the 20% animal protein group (log-rank test, p=0.0062). The ovarian cancer growth in the 20% plant protein plus cisplatin treatment group was not significantly reduced in comparison to the 20% animal protein plus cisplatin treatment group. Our findings suggest that a diet high in plant protein reduces the growth of human ovarian cancer cells in mice compared to a diet high in animal protein, ―possibly through the lack of activation of the IGF/Akt/mTOR pathway, and leads to a better prognosis with or without cisplatin treatment.

Circulating adropin levels in patients with endometrium cancer

AIM

Adropin is a recently identified protein in liver, brain and many peripheral tissues, which is important in energy homeostasis. The purpose of this study is to determine adropin levels in patients with endometrium cancer (EC).

MATERIAL AND METHODS

A total of 74 patients (47 EC patients and 27 healthy controls) were included in the study. Fasting venous blood samples were collected from all patients. Serum adropin levels were measured by an enzyme-linked immunosorbent assay (ELISA). The correlations between serum adropin levels and clinicopathologic variables were determined.

RESULTS

In body mass index and age-matched groups of patients, adropin levels were determined lower in patients with EC than control group (p < 0.01). Adropin levels were negatively correlated with age (r = -0.265, p = 0.023), homeostasis model-resistance index (HOMA-IR) (r = -0.294, p = 0.005) and fasting insulin levels (r = -0.292, p = 0.001). It was shown that in receiver operator characteristic (ROC) analysis, at cut-off value ≤ 1.055 (ng/ml), adropin had 92.7% sensitivity, 91.5% specificity and had AUC = 0.948, CI; 0.894-1.000 for diagnosis of EC (p < 0.001).

CONCLUSION

Adropin seems to be an important protein in pathogenesis of EC. Clearly, there are largely unknown aspects of adropin in EC pathophysiology and require further multi-centered, molecular and genetic studies including high number of cases.

New drugs from ancient natural foods. Oleocanthal, the natural occurring spicy compound of olive oil: a brief history

Extra-virgin olive oil (EVOO), a principal component of the Mediterranean diet (Med diet), is one of the most ancient known foods and has long been associated with health benefits. Many phenolic compounds extracted from Olea europea L. have attracted attention since their discovery. Among these phenolic constituents, oleocanthal has recently emerged as a potential therapeutic molecule for different diseases, showing relevant pharmacological properties in various pathogenic processes, including inflammation, cancers and neurodegenerative diseases. Here, we discuss and summarize the most recent pharmacological evidence for the medical relevance of oleocanthal, focusing our attention on its anti-inflammatory and chemotherapeutic roles.

Diet quality and survival after ovarian cancer: results from the Women's Health Initiative

BACKGROUND

Survival after an ovarian cancer diagnosis is poor. Given the high mortality in these patients, efforts to identify modifiable lifestyle behaviors that could influence survival are needed. Earlier evidence suggests a protective role for vegetables, but no prior studies have evaluated overall dietary quality and ovarian cancer survival. The purpose of this analysis was to evaluate the role of prediagnosis diet quality in ovarian cancer survival.

METHODS

We identified 636 centrally adjudicated cases of ovarian cancer within the Women's Health Initiative Observational Study or Clinical Trials of 161808 postmenopausal women followed from 1995 to 2012. Dietary quality was assessed for the Healthy Eating Index (2005) using a food frequency questionnaire, covariables were obtained from standardized questionnaires, and adiposity was measured by clinic-based measurements of height, weight, and waist circumference. The association between diet quality and mortality was analyzed using Cox proportional hazards regression, adjusted for potential confounders, and stratified by waist circumference, physical activity level, and diabetes status. Tests of statistical significance were two-sided.

RESULTS

Overall, higher diet quality was associated with lower all-cause mortality after ovarian cancer (hazard ratio [HR] for highest vs lowest tertile = 0.73; 95% confidence interval [CI] = 0.55 to 0.97, P(trend) = .03). The effect was strongest among women with waist circumference of 88 cm or less and with no history of diabetes (HR = 0.73, 95% CI = 0.54 to 0.98). Physical activity level did not modify the association between diet quality and survival.

CONCLUSION

Our results suggest that overall higher prediagnosis diet quality may protect against mortality after ovarian cancer.

Dietary intake and ovarian cancer risk: a systematic review

Ovarian cancer is a leading cause of gynecological cancer death. There is a need to identify modifiable dietary risk factors for this disease. To evaluate the role of diet in ovarian cancer risk, we performed a PRISMA-directed systematic review that included prospective cohort studies with >200 cases (n = 24). Higher risk for ovarian cancer was shown for total, animal, and dairy fat (five of nine studies), as well as total nitrate and possibly total vitamin C. No associations were demonstrated for red meat, fiber, vitamin A, vitamin E, β-carotene, or folate. Vegetables were associated with lower risk in one of three studies; fruit showed no association, although risk estimates were all greater than 1.0. Isoflavones and flavonoids were associated with modestly lower risk in two studies and tea intake was associated with lower risk in one of two studies. This review suggests that no specific dietary factors are consistently associated with ovarian cancer risk. Data by tumor subtypes are limited, but suggest that differential associations by tumor subtype may exist and should be evaluated. Studies of ample sample size, varied exposure, which can better control for dietary measurement error, are needed to fully define dietary recommendations for ovarian cancer prevention.

Alcohol consumption and risk of all-cause and cardiovascular disease mortality in men

This study examined the association between consumption of alcoholic beverages and all-cause and cardiovascular disease (CVD) mortality in a cohort of men (n = 31,367). In the Cox proportional hazards model adjusted for age, year of examination, body mass index (BMI), smoking, family history of CVD, and aerobic fitness, there were no significant differences in risk of all-cause mortality across alcohol intake groups. Risk of CVD mortality was reduced 29% in quartile 1 (HR = 0.71, 95% confidence interval (CI): 0.53, 0.95) and 25% in quartile 2 (HR = 0.75, 95% CI: 0.58, 0.98). The amount of alcohol consumed to achieve this risk reduction was <6 drinks/week; less than the amount currently recommended. The addition of other potential confounders and effect modifiers including blood pressure, insulin sensitivity, lipid levels, and psychological variables did not affect the magnitude of association. Future research is needed to validate the current public health recommendations for alcohol consumption.

The role of antioxidants and vitamin A in ovarian cancer: results from the Women's Health Initiative

Antioxidant nutrients and carotenoids have been inconsistently associated with ovarian cancer risk. We examined the relationship between intake of dietary and supplemental antioxidant nutrients including vitamins C, E, and selenium as well as carotenoids and vitamin A and ovarian cancer in 133,614 postmenopausal women enrolled in the Women's Health Initiative (WHI) study. Dietary intake was assessed using a food frequency questionnaire, and ovarian cancer endpoints were centrally adjudicated. Cox regression models were used to estimate the risk for invasive ovarian cancer in relation to each of the antioxidant nutrients and carotenoids under consideration using models stratified for a WHI study component. A total of 451 cases of invasive ovarian cancer were diagnosed over 8.3 yr of follow-up. Dietary intake at baseline was not significantly different for cases vs. controls. Cases reported greater intake of supplemental vitamin C (358.0 mg/day vs. 291.6 mg/day, respectively; P = 0.024). Multivariate modeling (P for trend) of the risk for developing ovarian cancer did not suggest any significant relationships among dietary factors and ovarian cancer risk. The results from this prospective study of well-nourished, postmenopausal women suggest that intake of dietary antioxidants, carotenoids, and vitamin A are not associated with a reduction in ovarian cancer risk.

Macronutrients, fatty acids and cholesterol intake and endometrial cancer

BACKGROUND

There is some evidence that dietary habits may influence the risk of endometrial cancer independently of body mass, although the role of diet on endometrial carcinogenesis is unclear.

PATIENTS AND METHODS

We carried out a multicenter case-control study from 1992 to 2006 in Italy on 454 women with incident, histologically confirmed endometrial cancer (age range 18-79 years) and 908 controls (age range 19-79 years) admitted to hospitals for acute, non-neoplastic diseases. A validated food-frequency questionnaire was used to estimate macronutrients, fatty acids and cholesterol intake. Logistic regression models, conditioned on age and study centre, and adjusted for major known risk factor of endometrial cancer and residual of energy intake were used to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Significant direct associations were observed with intake of energy (OR = 1.7 for the highest versus the lowest quintile, 95% CI = 1.1-2.5), and cholesterol (OR = 2.1, 95% CI = 1.4-3.2), while a direct borderline association emerged with saturated fatty acids (OR = 1.3, 95% CI = 0.9-2.0). There was no association with proteins, sugars, starch, total fat and other selected fatty acids.

CONCLUSION

Energy and cholesterol intake were associated with endometrial cancer.

Flavonoids and Breast Cancer Risk in Italy

Few epidemiologic studies have investigated the potential relation between flavonoids and breast cancer risk. We have applied recently published data on the composition of foods and beverages in terms of six principal classes of flavonoids (i.e., flavanones, flavan-3-ols, flavonols, flavones, anthocyanidines, and isoflavones) on dietary information collected in a large-case control study of breast cancer conducted in Italy between 1991 and 1994. The study included 2,569 women with incident, histologically confirmed breast cancer, and 2,588 hospital controls. Odds ratios (OR) and 95% confidence intervals were estimated by multiple logistic regression models. After allowance for major confounding factors and energy intake, a reduced risk of breast cancer was found for increasing intake of flavones (OR, 0.81, for the highest versus the lowest quintile; P-trend, 0.02), and flavonols (OR, 0.80; P-trend, 0.06). No significant association was found for other flavonoids, including flavanones (OR, 0.95), flavan-3-ols (OR, 0.86), anthocyanidins (OR, 1.09), as well as for isoflavones (OR, 1.05). The findings of this large study of an inverse association between flavones and breast cancer risk confirm the results of a Greek study.

Endometrial adenocarcinoma: beliefs and scepticism

The incidence of endometrial adenocarcinoma is high in North America and northern Europe, and low in Asia and Africa. This variance in frequency rates occurred in the late 1970s and its real cause has remained in question since. There is a widespread belief that endometrial adenocarcinomas associated with endometrial hyperplasia have a much better prognosis than those related to endometrial atrophy. This view is, in general terms, true but only because a high proportion of tumors arising from an atrophic endometrium are of serous/papillary, clear cell, or Grade 2-3 endometrioid carcinomas, in contrast to those developing from a hyperplastic endometrium, which are nearly all G1 endometrioid adenocarcinomas. These adenocarcinomas have, however, an excellent prognosis, no matter whether they are related to hyperplasia or atrophy, and taxonomically they form a single tumor group. In this regard, it is most reasonable to separate endometrial carcinomas into low- and high-grade tumors. The first are formed solely of G1 or "authentic" endometrioid adenocarcinomas, i.e., endometrioid neoplasms composed in their entirety of glandular elements without having traces of nonsquamous solid components. The high-grade tumors are formed of both endometrioid Grade 2-3 adenocarcinomas and nonendometrioid carcinomas-all of particularly aggressive behavior. The question of grading endometrioid adenocarcinomas in a precise and reproducible way becomes obvious. It is also believed that endometrial adenocarcinomas associated with endometrial hyperplasia are estrogen-primed, while those related to endometrial atrophy are deprived of hormonal stimulation. However, as we have shown in this laboratory recently, estrogen stimulation may be very common in endometrial neoplasms developing in an atrophic endometrium. For indeed most, if not all, postmenopausal atrophic endometria harboring adenocarcinomas contain actively proliferating glands, with high Ki-67 proliferation index, high epidermal growth factor receptor (EGFR) activity, high microvessel density (MVD), and rich in estrogen and progesterone receptors (ER and PR), indicative of a continuous low-level estrogenic stimulation. That there is a number of endometrial carcinomas that tend to develop in a milieu of antiestrogenic domination, following treatment for breast carcinoma, this may well represent a form of breast-endometrial hereditary disease and, certainly, merits further investigation.

Dietary Determinants of Epithelial Ovarian Cancer: A Review of the Epidemiologic Literature

Ovarian cancer is commonly a fatal disease and, despite advances in screening and treatment, the lack of understanding of the underlying etiology has limited prevention strategies. This article reviews the epidemiologic literature on the relationship between consumption of major food groups and the risk of epithelial ovarian cancer (EOC). We identified 7 cohort studies and 27 case-control studies of consumption of major food groups (fruits and vegetables, meats, eggs, fish, dairy products, grains, fats and oils) and EOC risk. Vegetable but not fruit consumption was found to possibly exhibit beneficial effects on the risk of EOC, whereas high meat consumption may be associated with an increased risk. A protective effect on risk of EOC for whole-grain food consumption as well as for consumption of low-fat milk is suggested by the results of the studies. However, evidence for associations of foods such as fish, grains, milk products, and fats and oils with EOC risk is limited and inconsistent, and further examination of these dietary determinants of EOC are warranted. In conclusion, a typical Western diet, which is high in meats and low in vegetables, may be positively associated with ovarian cancer incidence. However, the association between specific dietary factors and EOC risk remains unclear and merits further examination. In particular, future studies need to address the effect of milk products according to fat content and possible biological mechanisms to explain observed effects.

Glycemic index and glycemic load in endometrial cancer

Glycemic index (GI) and glycemic load (GL) are measures of the metabolic effects of dietary carbohydrates. The higher their value, the greater the glucose and insulin responses. Raised insulin levels are associated with endometrial cancer and with its risk factors including obesity, diabetes and hypertension. To study the role of the GI and GL we analyzed the data of two hospital-based case-control studies on endometrial cancer conducted between 1988-98 in Italy and Switzerland, including a total of 410 women with incident, histologically confirmed endometrial cancer and 753 controls admitted for acute, non-neoplastic diseases. A food frequency questionnaire was used to assess the subjects usual diet and to derive estimates of dietary GI and GL. The odds ratios (OR) of endometrial cancer, after adjustment for major risk factors, for the highest versus the lowest quintile of dietary GI and GL were 2.1 (95% confidence interval [CI] = 1.4-3.2) and 2.7 (95% CI = 1.8-4.2), respectively. The associations were stronger in older women, in those with higher body mass index and in hormone replacement therapy users. Our study supports the hypothesis of a direct association between GI and endometrial cancer risk.