8 replies to this topic

[doug123]

Here's the news release from UCSD:

UCSD Medical Center: News Source

News Release 

Date:  July 17, 2007

Increasing Vegetables and Fruits Beyond Current National Guidelines Not Necessary for Breast Cancer Survivors

Eating a diet very high in vegetables, fruit and fiber and low in fat did not reduce breast cancer recurrence or death in early stage breast cancer survivors, according to a new study. Researchers from the Rebecca and John Moores Cancer Center at the University of California, San Diego found that this intensive diet provided no additional benefit to following the generally recommended dietary guidelines. 

The study is published in the July 18 issue of the Journal of the American Medical Association.

The results are from the multi-center Women’s Healthy Eating and Living (WHEL) Study, based at UC San Diego, the largest randomized clinical trial to assess the influence of diet on additional breast cancer events.  Participating institutions included the University of California, Davis; Stanford University; Kaiser Permanente in Oakland and Portland; University of Arizona at Tucson, and the University of Texas M.D. Anderson Cancer Center in Houston.

“This is a definitive study,” said principal investigator John Pierce, Ph.D., director of the University’s Cancer Prevention and Control Program.  "The WHEL Study provides strong evidence that, for the typical woman diagnosed with early stage breast cancer, there is no additional health benefit over 7 years from dramatically increasing the diet's amount of nutrient-rich plant-based foods, compared to following the recommended healthy diet."

The study followed 3,088 breast cancer survivors, aged 18 to 70, for between 6 and 11 years.  Participants were randomly assigned to one of two diet groups. The comparison group followed the guidelines promoted by the U.S. Department of Agriculture (USDA).  The intensive intervention group was asked to follow a daily dietary pattern that included  5 vegetable servings, 16 ounces of vegetable juice, 3 fruit servings, 30 grams of fiber, and 15-20% from fat.

At the start of the study, both groups consumed similar amounts of vegetables and fruits (7 servings a day on average), fiber, and calories from fat.  Telephone counseling helped women assigned to the intensive dietary group to change their diets substantially: at the end of the first year of observation, women in the intervention group had increased their average vegetable and fruit intake by 5 servings per day (to an average of 12 servings per day).  They also increased their fiber intake substantially and decreased fat intake.

These large changes in self-reported dietary pattern were validated by large changes in plasma carotenoid concentrations.  By the fourth year of the trial, relative to the comparison group, the intensive dietary group was still consuming more vegetable servings (+65%), more fruit servings (+25%), more fiber (+30%), and less fat (-13%). The difference in diets between the two groups was maintained throughout the trial.

“The dietary changes achieved and maintained by the women in the intervention group resulted in some of  the biggest differences in dietary pattern ever reported in a large randomized clinical trial,” said Vicky Newman, M.S., R.D., Director of Nutrition Services for the Cancer Prevention Program at the Moores UCSD Cancer Center.  “It provides further evidence of the effectiveness of telephone counseling in helping people to change behaviors.”

After a median of 7 years of follow-up, the study observed no difference in recurrence or survival between groups: about 17% of women in both diet groups developed a breast cancer recurrence or new breast cancer, and 10 % of women in both groups died. 

“These results do not mean that women should stop paying attention to what they eat,” said study investigator Bette Caan, Dr.P.H., senior epidemiologist at the Kaiser Permanente Division of Research in Oakland, California. “In addition to exercising regularly, eating a diet that has plenty of fruits and vegetables and is moderate in fat is still one of the best ways we know to maintain health.”

“We want to keep in mind that this study relates only to breast cancer survivors,” said co-investigator Cheryl Rock, Ph.D., R.D., of the Moores UCSD Cancer Prevention and Control Program.  “We recognize that several other very well-designed, controlled studies have shown clearly that eating more than five fruits and vegetables a day can make major differences in disease risk, such as in lowering blood pressure and reducing risk of stroke and heart disease.”

The study results refer to the typical woman on the study.  The research team emphasizes that there may be subgroups that benefited from the intensive dietary pattern and further research will investigate this.  The 7 year follow-up time is also short for young and middle aged women diagnosed with breast cancer.  It is possible that there will be longer term benefits particularly from reduction in heart disease risk with this intensive dietary pattern.

# # #

In addition to Pierce and Rock, who are both faculty members of the Department of Family and Preventive Medicine at the UCSD School of Medicine, co-authors are: Kathyrn Hollenbach, Susan Faerber, Shirley W. Flatt, Jennifer Emond, Loki Natarajan, Lisa Madlensky, Wael K. Al-Delaimy, Sheila Kealey, Barbara A. Parker, Wayne Bardwell, Vicky A. Newman, and Linda Wasserman, Moores Cancer Center, University of California, San Diego, La Jolla, California; Marcia L. Stefanick and Robert Carlson, Stanford Prevention Research Center, Stanford University, Palo Alto, California; Ellen Gold, University of California Davis, Davis, California; Bette Caan, Division of Research, Kaiser Permanente Northern California, Oakland, California; Cynthia A. Thompson and Cheryl Ritenbaugh, Arizona Cancer Center, University of Arizona, Tucson, Arizona;  Njeri Karanja, Kaiser Permanente, Portland, Oregon;  Lovell Jones and Richard Hajek, M.D. Anderson Cancer Center, The University of Texas, Houston, Texas; E. Robert Greenberg, Dartmouth Medical School, Hanover, New Hampshire; and James Marshall, Roswell Park Cancer Institute, Buffalo, New York.

This work was initiated with support by the Walton Family Foundation, with the major part of the study supported from grants from the National Cancer Institute. 

Founded in 1979, the Moores UCSD Cancer Center is one of just 40 centers in the United States to hold a National Cancer Institute (NCI) designation as a Comprehensive Cancer Center.  As such, it ranks among the top centers in the nation conducting basic, translational and clinical cancer research, providing advanced patient care and serving the community through innovative outreach and education programs.

A broadcast quality video news report is available through www.thejamareport.org  Media outlets are invited to view and download this video as early as 9a.m. Eastern Time on Tuesday July 17th, 2007, but must not air the EMBARGOED video until 4p.m. Eastern Time. 

Broadcast stations may also obtain the video via satellite:

Tuesday, July 17, 2007 -- Embargoed until 4p.m. Eastern Time

Satellite Feed Times:
9:00 - 9:30 AM (ET) and 2:00 - 2:30 PM (ET)
Galaxy 26, (C band) Transponder 09
Downlink Frequency:  3880 Vertical ~ Audio: 6.2/6.8
Trouble #: 312-455-1275

Media Contact: Kimberly Edwards, 619-543-6163, kedwards@ucsd.edu

Some introductory information regarding The Journal of the American Medical Association:

JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world.[1]

Founded in 1883 by the American Medical Association and published continuously since then, JAMA publishes original research, reviews, commentaries, editorials, essays, medical news, correspondence, and ancillary content (such as abstracts of the Morbidity and Mortality Weekly Report). In 2005, JAMAs impact factor was 23.5[1] placing it among the leading general medical journals.[2] JAMAs acceptance rate is approximately 8% of the nearly 6000 solicited and unsolicited manuscripts it receives annually.[1] The first editor was Nathan Smith Davis, the founder of the American Medical Association and present editor of JAMA is Catherine DeAngelis, MD

Some information on the AMA from Answers.com, provided by US History Encyclopedia:

American Medical Association

American Medical Association (AMA) was founded on 7 May 1847 as a response to the growing demands for reforms in medical education and practice. Dr. Nathan S. Davis (1817–1904), a delegate from the New York State Medical Society who later came to be known as the "founding father of the AMA," convened a national conference of physicians to address reforms in medical education, medical ethics, and public health. On 7 May 1847 more than 250 physicians from more than forty medical societies and twenty-eight medical colleges assembled in the Great Hall of the Academy of Natural Sciences in Philadelphia and established the American Medical Association. A Committee on Medical Education was appointed, and minimum standards of medical education were established. The first national code of American medical ethics, the cornerstone of professional self-regulation, was adopted. Written by Dr. John Bell (1796–1872) and Dr. Isaac Hays (1796–1879) and published in 1847, the Code of Medical Ethics of the American Medical Association provided guidelines for the behavior of physicians with respect to patients, society, and other medical professionals.

Throughout the nineteenth century the AMA worked to expose fraudulent and unethical practitioners and to limit licensure to allopathic physicians. In 1883 the Journal of the American Medical Association (JAMA) was established with Nathan Davis as the first editor. By 1901, JAMA was reporting a circulation of 22,049 copies per week, the largest of all medical journals in the world.

Membership, however, remained small, including only 10,000 of the 100,000 orthodox physicians. In 1901 the AMA underwent a major reorganization to become a more effective national body by providing proportional representation among state medical societies. The House of Delegates was established as the legislative body of the AMA. Each state society was allowed a specific number of delegates with voting rights. By 1906, membership in the AMA exceeded 50,000 physicians, and educational and licensing reforms began to take hold.

The newly established Council on Medical Education inspected 160 medical schools (1906–1907), and in 1910 the Flexner Report, Medical Education in the United States and Canada, was published. Funded by the Carnegie Foundation and supported by the AMA, the report exposed the poor conditions of many schools and recommended implementing rigorous standards of medical training. By 1923 the AMA had adopted standards for medical specialty training, and in 1927 the association published a list of hospitals approved for residency training.

By World War I, the AMA had become a powerful political lobby. Wary of governmental control, it fought proposals for national health insurance. The 1935 Social Security Act passed without compulsory health insurance due to AMA influence. Physician membership grew steadily to over 100,000 physicians by 1936. The AMA continued to fight government involvement in health care with a campaign against President Truman's initiatives in 1948. In 1961 the American Medical Political Action Committee (AMPAC) was formed to represent physicians' and patients' interests in health care legislation.

The AMA continued to work on numerous public health initiatives, including declaring alcoholism to be an illness (1956), recommending nationwide polio vaccinations (1960), and adopting a report on the hazards of cigarette smoking (1964). AMA membership exceeded 200,000 physicians by 1965. From 1966 to 1973, the AMA coordinated the Volunteer Physicians in Vietnam program and in 1978 supported state legislation mandating use of seat belts for infants and children.

In 1983, membership included 250,000 physicians. As AIDS became an epidemic in the 1980s, the AMA passed a resolution opposing acts of discrimination against AIDS patients (1986) and established the office of HIV/AIDS (1988).

By 1990, health maintenance organizations (HMOs) and other third-party payers were involved extensively in health care delivery. Health care reform had become a political priority. In 1994 and 1995 the AMA drafted two Patient Protection Acts, and in 1998 the AMA supported the Patient's Bill of Rights.

In 2001, AMA membership included 300,000 physicians. As new threats to the nation's health, such as bioterrorism, began to emerge in the twenty-first century, the AMA continued to rely on the principles in the AMA Code of Medical Ethics (revised 2001) and the democratic process of the AMA House of Delegates to guide its actions and policies to fulfill its mission as "physicians dedicated to the health of America."

Bibliography

Baker, Robert B., et al. The American Medical Ethics Revolution: How the AMA's Code of Ethics Has Transformed Physicians' Relationships to Patients, Professionals, and Society. Baltimore: Johns Hopkins University Press, 1999.

Duffy, John. From Humors to Medical Science: A History of American Medicine. Chicago: University of Illinois Press, 1993.

Starr, Paul. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry. New York: Basic Books, 1982.

Stevens, Rosemary. American Medicine and the Public Interest: A History of Specialization. Berkeley, Calif.: University of California Press, 1998.

This full text is available free: click here to access the full text of: "Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer -- The Women's Healthy Eating and Living (WHEL) Randomized Trial."

Here's the abstract + a couple charts I liked (there are more), and some other parts of the paper I thought others might enjoy viewing:

Vol. 298 No. 3, July 18, 2007
Original Contribution

Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer
The Women's Healthy Eating and Living (WHEL) Randomized Trial

John P. Pierce, PhD; Loki Natarajan, PhD; Bette J. Caan, DrPh; Barbara A. Parker, MD; E. Robert Greenberg, MD; Shirley W. Flatt, MS; Cheryl L. Rock, PhD, RD; Sheila Kealey, MPH; Wael K. Al-Delaimy, MD, PhD; Wayne A. Bardwell, PhD; Robert W. Carlson, MD; Jennifer A. Emond, MS; Susan Faerber, BA; Ellen B. Gold, PhD; Richard A. Hajek, PhD; Kathryn Hollenbach, PhD; Lovell A. Jones, PhD; Njeri Karanja, PhD; Lisa Madlensky, PhD; James Marshall, PhD; Vicky A. Newman, MS, RD; Cheryl Ritenbaugh, PhD, MPH; Cynthia A. Thomson, PhD; Linda Wasserman, MD, PhD; Marcia L. Stefanick, PhD

JAMA. 2007;298:289-298.

ABSTRACT 

Context  Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival.

Objective  To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer.

Design, Setting, and Participants  Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006.

Intervention  The intervention group (n = 1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n = 1551) was provided with print materials describing the "5-A-Day" dietary guidelines.

Main Outcome Measures  Invasive breast cancer event (recurrence or new primary) or death from any cause.

Results  From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, +65%; fruit, +25%; fiber, +30%, and energy intake from fat, –13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P = .63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P = .43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment.

Conclusion  Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period.

Trial Registration  clinicaltrials.gov Identifier: NCT00003787

INTRODUCTION

Considerable evidence from preclinical studies indicates that plant-derived foods contain anticarcinogens.1 A comprehensive review of the literature found that a diet high in vegetables and fruit probably decreases breast cancer risk and that a diet high in total fat possibly increases risk.2 However, evidence of an association between a diet high in vegetables and fruit and low in total fat and prevention of cancer progression has been mixed in epidemiological studies.3-17 An interim analysis of data from the Women's Intervention Nutrition Study (WINS), which assessed the effect of a dietary intervention designed to reduce fat intake on relapse-free survival in breast cancer patients,18 found that the intervention was associated with a marginally statistically significant improvement in relapse-free survival. To our knowledge, no other clinical trials investigating dietary change and breast cancer survival have been reported.

The Women's Healthy Eating and Living (WHEL) Study was a randomized trial assessing whether a dietary pattern very high in vegetables, fruit, and fiber and low in fat reduces the risks of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer. The study was based on the recommendations of a national committee of experts called to respond to a 1993 challenge grant from a private philanthropist who believed that the role of diet in preventing cancer progression deserved scientific study to enable cancer survivors to make decisions without having "to rely on folklore, rumor and hearsay."19


Figure 1. Participant Flow

* Not included in analysis


Table 1. Baseline Characteristics of WHEL Study Participants by Study Groupa

...

Although the WHEL Study's intervention diet focused mainly on increasing vegetable, fruit, and fiber intake, there was a significant between-group difference in fat intake. However, this difference may not have been sufficient to test the dietary fat hypothesis adequately. Unlike the changes observed for intakes of vegetables, fruit and fiber, the smallest dietary fat change was made by participants in the quartile that was furthest from the study target at baseline. Nonetheless, our analyses did not suggest an effect across quartiles of fat intake at baseline, nor did our results indicate an intervention effect in subgroups defined by hormone receptor status, as was seen in WINS.

The absence of an observed effect on breast cancer events or all-cause mortality over a 7.3-year follow-up period in this study does not rule out the possibility of improved longer-term survivorship within this cohort. We did not explore the possibility that increased exercise and weight loss might benefit breast cancer survivors. Finally, our study did not address whether consuming the high–vegetable/fruit/fiber and low-fat diet of our study intervention early in life would alter risk of primary breast cancer.

In conclusion, during a mean 7.3-year follow-up, we found no evidence that adoption of a dietary pattern very high in vegetables, fruit, and fiber and low in fat vs a 5-a-day fruit and vegetable diet prevents breast cancer recurrence or death among women with previously treated early stage breast cancer.

...

AUTHOR INFORMATION

Corresponding Author: John P. Pierce, PhD, Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901 (jppierce@ucsd.edu).

Author Contributions: Dr Pierce had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Pierce, Natarajan, Parker, Greenberg, Carlson, Faerber, Hajek, Jones, Ritenbaugh, Wasserman.

Acquisition of data: Caan, Parker, Kealey, Carlson, Gold, Hollenbach, Karanja, Marshall, Newman, Ritenbaugh, Thomson, Stefanick.

Analysis and interpretation of data: Pierce, Natarajan, Greenberg, Flatt, Rock, Al-Delaimy, Bardwell, Emond, Faerber, Gold, Madlensky, Stefanick.

Drafting of the manuscript: Pierce, Natarajan, Greenberg, Flatt.

Critical revision of the manuscript for important intellectual content: Pierce, Natarajan, Caan, Parker, Greenberg, Flatt, Rock, Kealey, Al-Delaimy, Bardwell, Carlson, Emond, Faerber, Gold, Hajek, Hollenbach, Jones, Karanja, Madlensky, Marshall, Newman, Ritenbaugh, Thomson, Wasserman, Stefanick.

Statistical analysis: Natarajan, Flatt, Emond, Marshall.

Obtained funding: Pierce, Caan, Greenberg, Bardwell, Gold, Hollenbach, Jones, Marshall, Newman, Ritenbaugh, Wasserman, Stefanick.

Administrative, technical, or material support: Flatt, Rock, Kealey, Al-Delaimy, Carlson, Faerber, Hajek, Karanja, Madlensky, Newman.

Study supervision: Pierce, Natarajan, Caan, Parker, Gold, Hollenbach, Jones, Karanja, Newman, Thomson, Stefanick.

Financial Disclosures: None reported.

WHEL Study Investigators: Research Team by Clinical Site: WHEL Study Coordinating Center: University of California, San Diego (UCSD), Cancer Prevention and Control Program, Moores UCSD Cancer Center, San Diego (John P. Pierce, PhD, Susan Faerber, BA, Barbara A. Parker, MD, Loki Natarajan, PhD, Cheryl L. Rock, PhD, RD, Vicky A. Newman, MS, RD, Shirley W. Flatt, MS, Sheila Kealey, MPH, Linda Wasserman, MD, PhD, Wayne A. Bardwell, PhD, Lisa Madlensky, PhD); WHEL Study Dietary Counselors: Sheila K. Fisher, Joyce Bertaux, Leslie Barbier, Sharon Bonner, Prudy Galagan, Carrie Gonzales, Kaylene Grove, Pam Herskovitz, Susie Newmiller, Lita Simmons, Susan Wancewicz; WHEL Study Dietary Assessors: Andrea Jackson, Lita Simmons, Denice Murillo, Sophie Levy, Nichole Brumley; Laboratory Analysis: Dennis Heath, MS, Mila Pruitt; Clinical Sites: Center for Health Research–Portland, Portland, Oregon (Njeri Karanja, PhD, Mark U. Rarick, MD, Lucy Fulton, DTR, RD); Kaiser Permanente Northern California, Oakland (Bette J. Caan, DrPH, Lou Fehrenbacher, MD, Sarah Josef, RD); Stanford Prevention Research Center, Stanford University, Stanford, California (Marcia L. Stefanick, PhD, Robert Carlson, MD, Charlene Kranz, RD, Gwen D’Antoni, RD, Natalie Ledesma, MS, RD, Monique Schloetter, MS, RD); University of Arizona, Tucson and Phoenix (Cynthia Thomson, PhD, RD, James Warneke, MD, Cheryl Ritenbaugh, PhD, MPH, Tina Green, MS, RD, Emily Nardi, MPH, RD); University of California, Davis (Ellen B. Gold, PhD, Sidney Scudder, MD, Stephanie Burns, Linda Bresnick); University of California, San Diego, Moores UCSD Cancer Center, San Diego (Kathryn A. Hollenbach, PhD, Vicky Jones, MD, Michelle McKinney, Diana Wiggins, RD); University of Texas M. D. Anderson Cancer Center, Houston (Lovell A. Jones, PhD, Richard Hajek, PhD, Richard Theriault, DO, Taylor Tran, RD, LD).

Funding/Support: The WHEL Study was initiated with the support of the Walton Family Foundation and continued with funding from National Cancer Institute grant CA 69375. Some of the data were collected from general clinical research centers (National Institutes of Health grants M01-RR00070, M01-RR00079, and M01-RR00827).

Role of the Sponsor: The funding sponsors had no role in the design, protocol development, or conduct of the trial or in data collection, data analysis, or manuscript preparation.

Additional Contributions: We thank the WHEL Study's data and safety monitoring committee (Brian Henderson, MD, Ross Prentice, PhD, Marion Nestle, MPH, PhD, and Charles Loprinzi, MD) and Sharon Ross, PhD (National Cancer Institute project officer) for their assistance with review of the article. We also acknowledge Kaylene Grove, BS, BA, Christine Hayes, MA, and Hollie Ward, BA, Cancer Prevention and Control Program, UCSD, for their administrative support and assistance with manuscript preparation. Finally, we are especially grateful to our dietary counseling team and WHEL Study participants for their sustained commitment and dedication to this long-term trial.

Author Affiliations: Moores UCSD Cancer Center, University of California, San Diego, La Jolla (Drs Pierce, Natarajan, Parker, Rock, Al-Delaimy, Bardwell, Hollenbach, Madlensky, and Wasserman and Mss Flatt, Kealey, Faerber, and Newman); Kaiser Permanente Northern California, Division of Research, Oakland (Dr Caan); Fred Hutchinson Cancer Research Center, Seattle, Washington (Dr Greenberg); Stanford Comprehensive Cancer Center (Dr Carlson) and Stanford Prevention Research Center (Dr Stefanick), Stanford University, Stanford, California; Department of Family and Preventive Medicine, Division of Biostatistics, University of California, San Diego (Ms Emond); Department of Public Health Sciences, University of California, Davis (Dr Gold); M. D. Anderson Cancer Center, University of Texas, Houston (Drs Hajek and Jones); Center for Health Research, Portland, Oregon (Dr Karanja); Roswell Park Cancer Institute, Buffalo, NY (Dr Marshall); and Department of Family and Community Medicine (Dr Ritenbaugh) and Arizona Cancer Center, Department of Nutritional Sciences (Dr Thomson), University of Arizona, Tucson.

For another mainstream take on this story, clickhere to read: Reuters: "Diet does not improve breast cancer survival."

A directly related story is Diet plus exercise up survival after breast cancer -- also UCSD research.

Thoughts or comments?

Take care.

[Matt]

Lots of mixed messages from science lately, and it will only add to the current obesity problems. There have been studies showing that breast cancer is reduced with diets that are high in vegetables. However, one of the best methods of probably calorie restriction. There is some evidence in humans, and very good in rodents. Rodents that have been genetically susceptible to getting breast cancers have their incidence rate slashed from 60% to 0 - 5%

The younger one adopts a healthy life style, the better the chances are of NOT getting cancer.

[niner]

Yeah, this is a study that is ripe for misinterpretation. They compared a good diet (7 servings fruit/veg) to an arguably great diet (12 servings). What if they compared a good diet to a really lousy one- lots of fried junk food and no vegies at all? That's the sort of diet that a lot of people eat, and the message people will take home from the headline is that they might as well go to McDonalds because it just doesn't matter. Further, the study looks at recurrence only, while most people are interested in prevention of the initial cancer. The effect of diet on those two endpoints might well be very different. This was not a bad study; the damage will be done later by bad medical reporters.

[health_nutty]

Disappointing. Very disappointing. :(

[acto]

I have read the paper and I have a few comments.

1. About 2/3 of them had BMIs of 25 or greater. There have been a number of studies showing that f+v protect only in people with BMIs under 25.

2. The avg weight was about 166 lbs but they average kcal intake was reported as between 1538 and 1619 kcal per day. On a diet of about 30 g/fiber per day there is reduced metabolizable energy (about 100 kcal or so) which would make their net even lower. So say they net about 1480 kcal/day. Which for me, at 104 lbs, would mean a weight LOSS of about 10 lbs per year. Yet these women, who started out at weights averaging 62 lbs more than me, actually gained 0.6 lb during the intervention. It was a six year trial.

Do the math, it's impossible, they did not actually do what they reported.

Just another worthless study.

[Liquidus]

The fact is, at this moment, the best method of survival is early detection. My grandmother got breast-cancer and they found it early enough, granted she had to get one removed, but she's alive, healthy, and cancer-free now.

If I were a little older and could personally afford it, I would get myself checked out as often as possible as to identify any issues as soon as possible.l

[doug123]

The fact is, at this moment, the best method of survival is early detection. My grandmother got breast-cancer and they found it early enough, granted she had to get one removed, but she's alive, healthy, and cancer-free now.

If I were a little older and could personally afford it, I would get myself checked out as often as possible as to identify any issues as soon as possible.l

Dear G Snake,

Thank you so much for sharing your thoughts.

Do you mind if I share my thoughts on your thoughts as they may correspond with the evidence?

It appears that the study cited above that was published in The Journal of the American Medical Associaton: "Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast Cancer -- The Women's Healthy Eating and Living (WHEL) Randomized Trial" -- seems to be likely the strongest evidence ever published to support the hypothesis that diet may have no significant effect on long cancer prognosis for women that have already been diagnosed with breast cancer.

To be one-hundred percent honest with you, I wasn't under the impression that diet alone is powerful enough to fight cancer. These days, chemotherapy doesn't appear to be enough -- for many patients. And if you've ever had a friend or family member who had to undergo chemo, you'd probably note that in many cases, Chemotherapy is not lots of fun. In fact, from what I've heard, it's no fun at all.

You may have noted -- that another high quality study was published as recently as June 10, 2007 in JCO (The Journal of Clinical Oncology) that investigated the additive effect of exercise with a healthy diet -- and this combination appeared to be effective; in other words, when it comes to cancer, diet alone and exercise alone don't seem to be effective -- but together they may appear to be a winning team!

Let me please present some of the relevant evidence as published in The Journal of Clinical Oncology -- but first -- may I please present some introductory information regarding the primary source of evidence, in this case -- JCO (a publication of the American Society of Clinical Oncology)?

Here ya go:

This data appears to be accurate regarding American Society of Clinical Oncology as of July 27, 2007 (I can't always vouch for data on all Wikipedia pages):

American Society of Clinical Oncology, or ASCO, is an organization that represents all clinical oncologists. Every year, ASCO holds a large symposium where physicians and researchers meet to convey and discuss research and ideas. This year's next oncology symposium will occur September 19-20 in Dallas, Texas. It will be on the topic of breast cancer.[1][2]

Founded in 1964, ASCO's stated goal is "improving cancer care and prevention and ensuring that all patients with cancer receive care of the highest quality."[3] It is occupied by almost 25,000 oncology practitioners.

1. ^ http://www.asco.org/portal/site/ASCO
2. ^ www.tripathimaging.com/wh_glossary.htm
3. ^ http://www.asco.org/...nextfmt=default

Here is the study abstract:

Journal of Clinical Oncology, Vol 25, No 17 (June 10), 2007: pp. 2345-2351
© 2007 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2006.08.6819

Greater Survival After Breast Cancer in Physically Active Women With High Vegetable-Fruit Intake Regardless of Obesity

John P. Pierce, Marcia L. Stefanick, Shirley W. Flatt, Loki Natarajan, Barbara Sternfeld, Lisa Madlensky, Wael K. Al-Delaimy, Cynthia A. Thomson, Sheila Kealey, Richard Hajek, Barbara A. Parker, Vicky A. Newman, Bette Caan, Cheryl L. Rock

From the Moores University of California, San Diego Cancer Center, La Jolla; Stanford Prevention Research Center, Stanford University, Palo Alto; Division of Research, Kaiser Permanente Medical Group Inc, Oakland, CA; Arizona Cancer Center, Tucson, AZ; and The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to John P. Pierce, PhD, Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, La Jolla, CA 92093-0901; e-mail: jppierce@ucsd.edu

Purpose: Single-variable analyses have associated physical activity, diet, and obesity with survival after breast cancer. This report investigates interactions among these variables.

Patients and Methods: A prospective study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000. Enrollment was an average of 2 years postdiagnosis. Only seven women were lost to follow-up through December 2005.

Results: In univariate analysis, reduced mortality was weakly associated with higher vegetable-fruit consumption, increased physical activity, and a body mass index that was neither low weight nor obese. In a multivariate Cox model, only the combination of consuming five or more daily servings of vegetables-fruits, and accumulating 540+ metabolic equivalent tasks-min/wk (equivalent to walking 30 minutes 6 d/wk), was associated with a significant survival advantage (hazard ratio, 0.56; 95% CI, 0.31 to 0.98). The approximate 50% reduction in risk associated with these healthy lifestyle behaviors was observed in both obese and nonobese women, although fewer obese women were physically active with a healthy dietary pattern (16% v 30%). Among those who adhered to this healthy lifestyle, there was no apparent effect of obesity on survival. The effect was stronger in women who had hormone receptor–positive cancers.

Conclusion: A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables-fruits and moderate levels of physical activity. The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival.

Supported by the Walton Family Foundation, and support continued with funding from National Cancer Institute Grant No. CA 69375 for The Women's Healthy Eating and Living (WHEL) Study. Some of the data were collected from General Clinical Research Centers, National Institutes of Health Grants No. M01-RR00070, M01-RR00079, and M01-RR00827.

The National Cancer Institute played no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Oh, and because many here appear to be aware of the potential bias effect due to conflict of interest, I accessed the full text so I can provide you with this important information -- I've attached it as a Screen Capture and quoted the full text for your enjoyment:

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

Also, you can view a "mainstream" news report on this study by clicking: here to view: "Reuters Health: Diet plus exercise up survival after breast cancer."

Here's a relevant excerpt:

Diet plus exercise up survival after breast cancer
Thu Jun 21, 2007 12:06PM EDT
By Charnicia Huggins

NEW YORK (Reuters Health) - Among women who have been treated for breast cancer, those who stick to a healthy diet and are moderately active seem to live longer, results of a new study indicate. A good diet alone or exercise alone doesn't have the same benefit.

"It looks like if you get your physical activity going and get your fruits and vegetables in you can reduce your risk (of dying) significantly," study co-author Dr. John Pierce told Reuters Health.
...


"Doing each one alone didn't do it," Pierce said. "There was no benefit from each one alone, but there was a benefit from both together."

Further thoughts or comments?

Take care.

Attached Files

•  Screen_Capture.JPG   106.6KB   0 downloads

[doug123]

Here's a study that suggests diet does have an effect -- on prostate cancer -- however, I don't think this data suggests that diet can get rid of cancer once you've been diagnosed with it...this data seems to suggest it can help prevent one from getting prostate cancer.

Here's some information regarding the primary source provided by the National Institutes of Health (NIH) -- U.S. Department of Health and Human Services:

The Journal of the National Cancer Institute:

Mission

The National Cancer Institute is the world’s largest organization solely dedicated to cancer research.

NCI supports researchers at universities and hospitals across the United States and at NCI-Designated Cancer Centers, a network of facilities that not only study cancer in laboratories, but conduct research on the best ways to rapidly bring the fruits of scientific discovery to cancer patients.

In NCI’s own laboratories, almost 5,000 principal investigators, from basic scientists to clinical researchers, conduct earliest phase cancer clinical investigations of new agents and drugs. Recent advances in bioinformatics and the related explosion of technology for genomics and proteomics research are dramatically accelerating the rate for processing large amounts of information for cancer screening and diagnosis. The largest collaborative research activity is the Clinical Trials Program for testing interventions for preventing cancer, diagnostic tools, and cancer treatments, allowing access as early as possible to all who can benefit. NCI supports over 1,300 clinical trials a year, assisting more than 200,000 patients.

NCI’s scientists also work collaboratively with extramural researchers in order to accelerate the development of state-of-the-art techniques and technologies. In addition to direct research funding, NCI offers the Nation's cancer scientists a variety of useful research tools and services, including tissue samples, statistics on cancer incidence and mortality, bioinformatic tools for analyzing data, databases of genetic information, and resources through NCI-supported Cancer Centers, Centers of Research Excellence, and the Mouse Models of Human Cancer Consortium. NCI researchers are also seeking the causes of disparities among underserved groups and gaps in quality cancer care, helping to translate research results into better health for groups at high risk for cancer, including cancer survivors and the aging population.

As the leader of the National Cancer Program, NCI provides vision and leadership to the global cancer community, conducting and supporting international research, training, health information dissemination, and other programs. Timely communication of NCI scientific findings help people make better health choices and advise physicians about treatment options that are more targeted and less toxic.

Information about the National Cancer Institute's research and activities is available through its Web site, http://cancer.gov.

Here's the study abstract:

Journal of the National Cancer Institute Advance Access published online on July 24, 2007
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djm065

Published by Oxford University Press 2007.

--------------------------------------------------------------------------------

ARTICLES

Prospective Study of Fruit and Vegetable Intake and Risk of Prostate Cancer
Victoria A. Kirsh, Ulrike Peters, Susan T. Mayne, Amy F. Subar, Nilanjan Chatterjee, Christine C. Johnson, Richard B. Hayes on behalf of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial

Affiliations for authors: Research Unit, Division of Preventive Oncology, Cancer Care Ontario, Toronto, ON, Canada (VAK); Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT (VAK, STM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (UP); Department of Epidemiology, University of Washington, Seattle, WA (UP); Divisions of Cancer Epidemiology and Genetics (NC, RBH) and Cancer Control and Population Sciences (AFS), National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD; Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI (CCJ)

Correspondence to: Richard B. Hayes, PhD, EPN 8114, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892 (e-mail: hayesr@mail.nih.gov).

Background: Several epidemiologic studies have reported associations between fruit and vegetable intake and reduced risk of prostate cancer, but the findings are inconsistent and data on clinically relevant advanced prostate cancer are limited.

Methods: We evaluated the association between prostate cancer risk and intake of fruits and vegetables in 1338 patients with prostate cancer among 29361 men (average follow-up = 4.2 years) in the screening arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Participants completed both a general risk factor and a 137-item food-frequency questionnaire at baseline. Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided.

Results: Vegetable and fruit consumption was not related to prostate cancer risk overall; however, risk of extraprostatic prostate cancer (stage III or IV tumors) decreased with increasing vegetable intake (RR = 0.41, 95% CI = 0.22 to 0.74, for high versus low intake; Ptrend = .01). This association was mainly explained by intake of cruciferous vegetables (RR = 0.60, 95% CI = 0.36 to 0.98, for high versus low intake; Ptrend = .02), in particular, broccoli (RR = 0.55, 95% CI = 0.34 to 0.89, for >1 serving per week versus <1 serving per month; Ptrend = .02) and cauliflower (RR = 0.48, 95% CI = 0.25 to 0.89 for >1 serving per week versus <1 serving per month; Ptrend = .03). We found some evidence that risk of aggressive prostate cancer decreased with increasing spinach consumption, but the findings were not consistently statistically significant when restricted to extraprostatic disease.

Conclusion: High intake of cruciferous vegetables, including broccoli and cauliflower, may be associated with reduced risk of aggressive prostate cancer, particularly extraprostatic disease.

--------------------------------------------------------------------------------

CONTEXT AND CAVEATS
Prior knowledge

Several epidemiologic studies have found that fruit and vegetable intake are associated with reduced risk of prostate cancer, but the findings have been inconsistent and data on advanced prostate cancer are limited.

Study design

Prospective study of men in the screening arm of a long-term randomized screening trial.

Contribution

Fruit and vegetable intake was not related to the overall risk of prostate cancer. A decreased risk of extraprostatic prostate cancer (stage III or IV tumors) was associated with increased intake of vegetables, mainly cruciferous vegetables, including broccoli and cauliflower.

Implications

High intake of cruciferous vegetables, especially broccoli and cauliflower, may be associated with a reduced risk of aggressive prostate cancer.

Limitations

Individuals with high intakes of fruits and vegetables generally have lower rates of smoking, higher levels of physical activity, and a more healthy lifestyle than those with low intakes. These associations could confound the prostate cancer association.

Manuscript received February 15, 2007; revised May 31, 2007; accepted June 19, 2007.

Thoughts or comments?

Take care.

[doug123]

A potentially related study was just published; here is the abstract:

Vol. 298 No. 7, August 15, 2007
Original Contribution

Association of Dietary Patterns With Cancer Recurrence and Survival in Patients With Stage III Colon Cancer
Jeffrey A. Meyerhardt, MD, MPH; Donna Niedzwiecki, PhD; Donna Hollis, MS; Leonard B. Saltz, MD; Frank B. Hu, MD, PhD; Robert J. Mayer, MD; Heidi Nelson, MD; Renaud Whittom, MD, FRCPC; Alexander Hantel, MD; James Thomas, MD; Charles S. Fuchs, MD, MPH

JAMA. 2007;298:754-764.

Context  Dietary factors have been associated with the risk of developing colon cancer but the influence of diet on patients with established disease is unknown.

Objective  To determine the association of dietary patterns with cancer recurrences and mortality of colon cancer survivors.

Design, Setting, and Patients  Prospective observational study of 1009 patients with stage III colon cancer who were enrolled in a randomized adjuvant chemotherapy trial (CALGB 89803) between April 1999 and May 2001. Patients reported on dietary intake using a semiquantitative food frequency questionnaire during and 6 months after adjuvant chemotherapy. We identified 2 major dietary patterns, prudent and Western, by factor analysis. The prudent pattern was characterized by high intakes of fruits and vegetables, poultry, and fish; the Western pattern was characterized by high intakes of meat, fat, refined grains, and dessert. Patients were followed up for cancer recurrence or death.

Main Outcome Measures  Disease-free survival, recurrence-free survival, and overall survival by dietary pattern.

Results  During a median follow-up of 5.3 years for the overall cohort, 324 patients had cancer recurrence, 223 patients died with cancer recurrence, and 28 died without documented cancer recurrence. A higher intake of a Western dietary pattern after cancer diagnosis was associated with a significantly worse disease-free survival (colon cancer recurrences or death). Compared with patients in the lowest quintile of Western dietary pattern, those in the highest quintile experienced an adjusted hazard ratio (AHR) for disease-free survival of 3.25 (95% confidence interval [CI], 2.04-5.19; P for trend <.001). The Western dietary pattern was associated with a similar detriment in recurrence-free survival (AHR, 2.85; 95% CI, 1.75-4.63) and overall survival (AHR, 2.32; 95% CI, 1.36-3.96]), comparing highest to lowest quintiles (both with P for trend <.001). The reduction in disease-free survival with a Western dietary pattern was not significantly modified by sex, age, nodal stage, body mass index, physical activity level, baseline performance status, or treatment group. In contrast, the prudent dietary pattern was not significantly associated with cancer recurrence or mortality.

Conclusions  Higher intake of a Western dietary pattern may be associated with a higher risk of recurrence and mortality among patients with stage III colon cancer treated with surgery and adjuvant chemotherapy. Further studies are needed to delineate which components of such a diet show the strongest association.

Author Affiliations: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (Drs Meyerhardt, Mayer, and Fuchs); CALGB Statistical Center, Duke University Medical Center, Durham, North Carolina (Dr Niedzwiecki and Ms Hollis); Memorial Sloan-Kettering Cancer Center, New York, New York (Dr Saltz); Harvard School of Public Health and Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts (Dr Hu); Mayo Clinic Foundation, Rochester, Minnesota (Dr Nelson); Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada (Dr Whittom); Division of Hematology and Oncology, Loyola University Stritch School of Medicine, Maywood, Illinois (Dr Hantel); and Division of Hematology and Oncology, Ohio State University, Columbus (Dr Thomas).

So, it seems for patients already diagnosed with stage III colon cancer that are already underwent surgery and undergo chemotherapy, it appears a western diet may play a role in increasing cancer incidence.

A mainstream story was issued that reports on the findings of this study -- you can view it by clicking here; that's Health Day News: "Healthy Diet Guards Against Return of Colon Cancer: Patients who ate high-fat foods were three times more likely to see recurrence of disease, study finds."

Thoughts/comments?

Take care.