Dennis Ramon M. Tudtud, MD, FPCP, FPSMO
Diplomate, Philippine Specialty Board of Internal Medicine
Diplomate , Philippine Specialty Board of Medical Oncology
President, Philippine Society of Medical Oncology

• 3 rd in incidence after communicable & cardiovascular diseases
•1 out of 1,800 Filipinos has cancer
•114:103 females: males
•Incidence increases with age

2005 Phil Cancer Facts & Estimates
Leading cancer sites of mortality:
Females breast cervix uteri lung
Males lung liver colon/rectum

OXIDANTS
Dead cell Lose many cells
Healthy cell
Cell regeneration
Cell damaged
Impaired cell
Regeneration

I. Smoking
Tobacco use is the most preventable cause of cancer
Cigarette smoke has enormous amount of oxidants
Most people know smoking causes lung cancer
Causes a higher risk of esophageal, stomach, kidney, bladder, pancreas, cervical, uterine, head and neck, tongue
Surgeon General of the USA showed that tobacco smoke contains more than 4,000 chemicals, and at least 43 of them cause cancer

2 . AGING
• Anyone of any age can get cancer
• Getting older is one of the biggest risk factors
• Aging is partly caused by oxidants that can damage DNA
• Antioxidants like vitamins A and C minimize damage from oxidants, but most humans don't get enough nutrients to ward off cancers

Aging From Lack of Physical Activity
Gain weight
Too little exercise, lack muscles mass, poor bone health
Being overweight increase the risk for Breast, Colon,
Kidney, Uterus ,Esophageal Cancers
Produce too many hormones that cause cancer to grow

• Aging isn't just the number of years since we were born
• It is How quickly the parts of our bodies wear out
• Our bodies age partly because it doesn’t get enough of the right nutrients
Too much fat and calories
Not eating foods that contain antioxidants which boost the immune system and fight disease--can lead to many forms of cancer.
• Poor diet is one of the main contributors to aging

• Knowing which ingredients are carcinogens or cancer promoters
• Proper handling and preparation of certain foods
• Reading food labels to permanently avoid consuming those ingredients

Common Cancer Causing Substances in Foods
• Acrylamides
• Omega 6 – vegetable oils
• Sodium Nitrite
• Hydrogenated Oils
• Spoiled corn & peanuts (aflatoxin)

• Used to prolong shelf life and preserve flavor and color
• Increases cancer risk and cardiovascular disease

• In 1958 US Congress established a GRAS list
• In 1960 the Color Additive Amendment was passed and includes a provision, the Delaney Clause , that prohibits any additives shown to cause cancer in humans or animals to be added to our food
This is not being strictly enforced!
Artificial colors proven to increase cancer risks, hyperactivity in children, and allergies, are still found in our food
• Some additives are listed as “natural” flavorings or colorings but can contain over 40 chemical compounds another misleading label

BHT (Butylated Hydroxytoluene)
• To help protect flavor, retards rancidity in oils
• Should be avoided by infants, young children, pregnant women and those sensitive to aspirin, may be toxic to the nervous system, (BHT – banned in England)
• BHT is common in potato chips, baked goods, cosmetics and other products
Ÿ A related substance known as butylated hydroxyanisole (BHA) may be used instead of BHT

• Some studies linked BHT with an increase in tumors and cancers
• Other studies suggested that it may protect the body from free radicals which cause other cancers
• BHT seems to have antimicrobial and antiviral activity, and it has in fact been used in medical research for treating conditions related to the herpes virus family
• FDA still considers BHT to be safe, although consumers who wish to avoid it may want to check their labels carefully

Refined Sugars
• Cancer develop, in part, by feeding on sugar in the bloodstream
• Solution to an Anti-Cancer Diet: eat a low glycemic diet eat less refined sugars consume more dietary fibers

Jung-whan Kim 1, and Chi V. Dang1 , 2
Cancer Res September 15, 2006 66; 8927

• Warburg reported a fundamental difference between normal and cancerous cells to be the ratio of glycolysis to respiration
• "healthy" cells mainly generate energy from oxidative breakdown of pyruvate which is an end-product of glycolysis, and is oxidized within the mitochondria
• In contrast, cancer cells show signs of glycolysis, (the process of sugar breakdown) with lactate secretion even in the presence of oxygen
• Hypothesized that cancer and tumor growth are caused by the fact that tumor cells mainly generate energy (as e.g. ATP) by non-oxidative breakdown of glucose (glycolysis)

These findings show that cancer cells can readily metabolize fructose to increase proliferation”
Journal of Cancer Research, Dec. 2010
“They have major significance for cancer patients given dietary refined fructose consumption, and indicate that efforts to reduce refined fructose intake or inhibit fructose-mediated actions may disrupt cancer growth.”
Dr. Anthony Heaney, UCLA’s Jonsson Cancer Center

WHITE
WHEAT
• high-fructose corn syrup
• sugar
• sucrose
• enriched bleached flour
• white rice
• white pastas
• white breads
• other "white" foods

Forms from sugars and an amino acid (asparagine) during certain types of high-temperature cooking
• Frying, roasting, and baking
• Mainly in foods made from plants, such as potato products, grain products, or coffee
• Does not form, or at lower levels, in dairy, meat, and fish products
• More likely to accumulate when cooking is done for longer periods or at higher temperatures

• Omega-6 fatty acids are one of two groups of essential fatty acids (EFAs) that are required in human nutrition
• Omega-6 fatty acids include linoleic acid and its derivatives
• Excessive levels of certain n −6 fatty acids, relative to certain n −3 (Omega-3) fatty acids, shifts the physiologic state of tissues to prothrombotic, proinflammatory and proconstrictive states
• The optimal ratio (n-6 FA: n-3 FA) : 4 to 1 or lower
• Modern Western diets typically have ratios in excess of
10 to 1, some as high as 30 to 1

A high consumption of omega-6 polyunsaturated fatty acids (PUFAs), found in most types of vegetable oil, may increase the likelihood that postmenopausal women will develop breast cancer. Similar effect was observed on prostate cancer.
E.Sonestedt et al, Article 1 st published online
17 July 2008, Int’l J Cancer
Chronic excessive production of n −6 eicosanoids is associated with heart attacks, thrombotic stroke, arrhythmia, arthritis, osteoporosis, inflammation, mood disorders, obesity, and cancer.
P. Calder, American Journal of Clinical Nutrition, Vol. 83, No. 6, S1505-1519S,
June 2006

• Four major food oils (palm, soybean, rapeseed, and sunflower)
• Poultry and meat
• Eggs
• Nuts
• Most vegetable oils

Solution is to balance omega 6 intakes with high omega 3 intakes

• Essential fatty acids
• Omega3 FA’s are thought to play an important role in reducing inflammation throughout the body -- in the blood vessels, the joints, and elsewhere.
• Rich sources of omega3 FA’s are from cold water oily fish, such as salmon, herring, mackerel, anchovies, and sardines
• Recommended Intake for n −3 :
1.6 gm/day for men and 1.1 gm/day for women

Omega 3 Fatty Acids
An increase in the consumption of fish and fish n-3 polyunsaturated fatty acids in industrialized countries may contribute to lower breast and colorectal cancer risks
It is concluded that fish consumption is associated with protection against the later promotional stages of colorectal carcinogenesis, but not with the early initiation stages.”
Caygill CP, Hill MJ, , Eur J Cancer Prev.
1995 Aug;4(4):329-32.
De Deckere, Eur J Cancer Prev. 1999 Jul,
8(3): 213-21

• Helps prolong shelf life but simultaneously creates trans fats (causes inflammation in the body)
• Besides being a cancer factor, trans fats promote heart disease, interrupt metabolic processes, and cause belly fat that crowd the organs and strain the heart
• To avoid listing trans fats, or to claim "trans free" on their label, food manufacturers simply adjust the serving size until the trans fat content falls under 0.5 grams per serving

European Prospective Investigation into Cancer and Nutrition (EPIC STUDY)
The American Medical Association supports any state and federal efforts to ban the use of artificial trans fats in U.S. restaurants and bakeries

FRENCH FRIES
• made with hydrogenated oil and fried at high temperatures
• they clog your arteries with saturated fat and trans fat, they also contain acrylamides
• should be called "cancer fries," not French fries.
CHIPS, CRACKERS, COOKIES
• contain white flour and sugar as well as trans-fats
• MSG in yeast extract

• Added to processed meats, hot dogs, bacon, and any other meat that needs a reddish color to look "fresh”
• Also found in food items that are pickled, fried, or smoked; in things such as beer, cheese, fish byproducts, and tobacco smoke
• Nitrosamines are extremely carcinogenic

HETEROCYCLIC AROMATIC AMINES (HAA)
• Charred foods, especially meats, cooked at high temperatures create carcinogens called heterocyclic aromatic amines
• When organic plant or animal products are burned, causing them to become blackened, toxins are released and mutagenic byproducts are formed
• The longer the meat is cooked at high temperature, the higher the production of these compounds will be.

• Ascorbic acid (vitamin C), an antioxidant, inhibits nitrosamine formation
• Addition of at least 550 ppm of ascorbic acid is required in meats
• Add antioxidants and spices when marinating meat eg. red bell peppers, curry powder, garlic, citrus fruits
è delays the formation of nitrosamines

Hot dogs
• The Cancer Prevention
Coalition recommends that children should not eat >12 hot dogs/month because of the risk of cancer.
• If you must have your hot dog, look for those without sodium nitrite
Processed Meats, Bacon
These meats almost always contain the same sodium nitrite found in hot dogs.
Bacon is also high in saturated fat, which contributes to the risk of cancers, including breast cancer.

• Have a diet rich in fruits and vegetables Minimum of 5 servings a day
• Eat healthy proteins: Beans, Fish, Tofu
• Eat healthy carbohydrates: brown rice, tubers, corn, wheat bread, pasta etc
• A serving for fruits and vegetables, carbohydrates is approximately your fist size
• A serving of your protein is approximately your palm size

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1. Green tea
2. Curcumin
3. Cruciferous Vegetables
4. Folate Rich Foods
5. Tomatoes
6. Ginger
7. Vitamin D (2,000 IU/day)

• Antioxidant activity : two cups of green tea = four apples, seven glasses of orange juice or 20 glasses of apple juice
(Paganga, 1999)
• Green tea (GT) contains many polyphenol compounds, with epigallocatechin gallate (EGCG) being the most prominent

Green Tea and Prostate Cancer
• EGCG in Green tea have been shown to exhibit a chemopreventive effect against prostate cancer, with studies showing that it inhibits prostate cancer cell growth, induce apoptosis, arrest cell cycle progression, decrease
PSA production and inhibit the development and metastasis
(
Siddiqui, 2006; Adhami, 2003; Sartor, 2004; Ren, 2000)
Green Tea and Breast Cancer
• GT decreased BCA tumor size injected to mice(66%) and weight (68%)
• Green tea inhibits VEGF growth, and cell proliferation and migration
( Experimental Biology 2008 conference. Wei-Gu. )

• Recent studies have shown curcumin to interfere with cell-signaling pathways, thus suppressing the transformation, proliferation, and invasion of cancerous cells
• In prostate cancer cell lines, curcumin inhibits cell growth and induces apoptosis, which is programmed cell death (Nakamura, 2002)
• These observations have been extended to in vivo animal models (Dorai, 2001)

• Sources :
arugula, broccoli, brussels sprouts, bok choy, cabbage, canola, cauliflower, collard greens, daikon, horseradish, kale, kohlrabi, mustard, radish, rutabaga, wasabi and watercress
• Cancer fighting compound :
Indole-3-Carbinol ( 13c)
• Recommendation:
1 serving per day reduces risk for breast cancer

Cruciferous Vegetables and Breast Cancer
• Findings from a large cohort analysis of more than
3000 survivors suggest that higher intake of vegetables in women taking TAMOXIFEN reduced new or recurrent breast cancer events by as much as 52%
• This effect was not present for non-tamoxifen users
Thomson, 2010

• Sources: Wheat bread, Pasta, breakfast Cereals
• In a large-scale study, researchers evaluated the effects of folate on more than
27,000 male smokers between ages 50 and 69
• Men who consumed at least the recommended daily allowance of folate -- about 400 micrograms -- cut by half their risk of developing pancreatic cancer

)
Men who consumed 2 or > servings of tomato sauce a week over the course of the 12-year study :
28% lower risk of developing organ-confined prostate cancer,
35% lower risk of developing locally advanced disease, 36% lower risk of developing metastatic disease
( Giovannucci, 2002, Health Professionals Follow-Up)
Another study found that pre-prostatectomy patients who consumed tomato sauce pasta dishes for 3 weeks (containing 30 mg of lycopene per day) demonstrated decreased PSA counts and lower oxidative DNA damage
(CHEN, 2001)
A similar study showed increased apoptosis in prostatectomy specimens after consuming 3 weeks of tomato sauce pasta dishes
(Kim, 2003)

Researchers discovered ginger's ability to kill cancer cells in two ways:
1.In apoptosis, the cancer cells essentially commit suicide without harming surrounding cells
2. In autophagy, "the cells are tricked into digesting themselves"
J
. Rebecca Liu, the University of Michigan in Ann Arbor

• Link between increased vitamin D intake & reduced breast cancer risk by 50% (AACR)
• Improved survival rates among lung cancer patients
(Harvard study,2005)
Lung Cancer surgery survival rate :
Surgery during summer = 56% 5yr SR
Surgery during winter = 23% 5yr SR
• Recommended dose is 2000 IU per day
• Good sources: Fish ( tuna, mackerel, herring)
• Eel, egg, fortified dairy foods
• Sunlight exposure before 10 am and after 4pm for 10 minutes a day

-
• Drink green tea
2-3 cups per day green tea is protective against breast and prostate cancer risk
• Drink red wine instead of beer daily allowance : 1 glass/day for women, 2 glasses/daymen
• Exercise 30 minutes a day
• Sleep 7-8 hours a day
• Manage your stress levels