Saturday, April 18, 2015

CNiC's Colditz Honored for Contributions to Prevention - Highlights Importance of Early Life in Breast Cancer Risk

Cancer News in Context's Graham Colditz is being honored tonight at the American Association for Cancer Research Annual Meeting in Philadelphia, Pennsylvania as an AACR 2014-2015 Scientific Awardee.

In the announcement of his 2014 Award for Outstanding Achievement in Cancer Prevention, AACR describes the honor and Colditz's contributions to the field:
The award is given annually to a scientist residing in any country in the world for his or her seminal contributions to the field of cancer prevention. Such investigations must have been conducted in basic, translational, clinical, epidemiological, or behavioral science in cancer prevention research. Further, these studies must have had not only a major impact on the field, but must also have stimulated new directions in this important area.

Colditz is an internationally recognized leader in cancer prevention. Colditz’s research includes developing statistical models to more accurately classify levels of risk for several cancers, and to clarify the importance of adolescent lifestyle in the prevention of breast cancer.
In his related blog post on the ACCR site -- A Youthful Approach: Expanding the Reach of Breast Cancer Prevention -- Colditz detailed the growing evidence showing that early life behaviors play a key role in later adult breast cancer risk.  The post was the site's number three most popular post of 2014.

Building on this evidence, Colditz has co-authored a forthcoming ebook on breast cancer that highlights a generational approach to preventing the disease.  Titled Together: Every Woman's Guide to Preventing Breast Cancer, the book is filled with engaging messages for mothers, daughters, grandmothers and women at all stages of life.  It is written for a general audience and is expected to be released late spring of this year.

More on early life and breast cancer.

Friday, April 3, 2015

New Dietary Recommendations Take Innovative Approach - and Not Everyone's Happy About It

By Yikyung Park, ScD
Editor's note: Not surprisingly, the recently released report from the Dietary Guidelines for Americans Advisory Committee was met with both praise and scorn.  Many in the medical and health fields lauded the report for its innovative approach to considering both the food environment and sustainability, as well as for its healthy eating recommendations, which focussed largely on consuming more plant-based foods. The food industry, however, took issue with many aspects of the report, with the meat industry seeming particularly up-in-arms to fight the report's recommendation to cut back on both red meat and processed meat.  A recent Op-Ed in New York Times highlights the hot-button issue red meat and health has become since the report's release.  CNiC's Yikyung Park explains these new recommendations, the process behind them, and some details about the new red meat guidelines.   
A recent report from the 2015 Dietary Guidelines Advisory Committee (DGAC) is gathering much attention from the public as well as from the food industries. Why and what is in this report?

Since 1980, the Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) jointly published the Dietary Guidelines for Americans every 5 years. To update the Guidelines, the Dietary Guidelines Advisory Committee (DGAC) is assembled and
reviews scientific and medical literature. The Committee submits a report that includes recommendations (not the actual guidelines) for a new set of dietary guidelines to the Secretaries of the USDA and DHHS. The USDA and DHHS write the actual guidelines after reviewing the report and comments submitted by the public. A new 2015 Dietary Guidelines for Americans is scheduled for release at the end of this year.

The recommendations for healthy eating that make up the Guidelines have been largely consistent through the years, but new scientific evidence results in some changes from edition to edition. Of note, the 2015 Guidelines Committee makes a recommendation that emphasizes dietary patterns and foods over nutrients and in doing so considers the importance of food environments and sustainability. The committee recognizes “the significant impact of food and beverages on environmental outcomes, from farm to plate to waste disposal, and, therefore, the need for dietary guidance to include the wider issue of sustainability.” The committee also highlights the importance of the food environment– those external factors that influence our food choices, from advertising to cafeteria menus – in making healthy choices.

In the report, the Committee recommends a healthy diet which is higher in vegetables, fruits, whole grains, low-fat (or non-fat) dairy, seafood, legumes, and nuts; moderate in alcohol; lower in red meat and processed meats; and low in sugar-sweetened foods and drinks and refined grains. The report also recommends actions for not only individuals and families, but also for communities, industry, and government to achieve and maintain healthy dietary patterns and the levels of physical activity needed to promote a healthy U.S. population. Among those are:
  • Aim to make healthy lifestyles and prevention a national and local priority and reality.
  • Establish healthy food environments.
  • Seek a paradigm shift in health care and public health toward a greater focus on prevention and integration with food systems.
  • Establish healthy food environments.
  • Support and expand access to healthy built environments and advocate wide community use.
  • Maintain strong support for federal food and nutrition programs.
  • Recognize and place priority on moving toward a more sustainable diet consistent with the healthy dietary pattern options described in this DGAC report. Access to sufficient, nutritious, and safe food is an essential element of food security for the U.S. population. A sustainable diet helps ensure this access for both the current population and future generations.

The Committee’s recommendation for eating less red meat and processed meat is strongly supported by a large body of scientific evidence on its adverse effects. Diets high in red meat and processed meat have been found to increase the risk of cardiovascular disease, diabetes, and cancer, especially colorectal cancer, as well as an increased risk of premature death. In addition, accumulating evidence as summarized in the report indicates that “in general, a dietary pattern that is higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in animal based foods is more health promoting and is associated with lesser environmental impact (GHG emissions and energy, land, and water use) than is the current average U.S. diet.”

This new report, however, is being heavily criticized by the meat industry, especially for taking environmental sustainability into consideration in making recommendations. But food industry’s attack on the dietary guidelines is not new. Whenever the DGA is updated, the food industry actively lobbies to influence the recommendation. Why? Because the Guidelines inform a host of governmental nutrition programs, including National School Lunch Program and meals in the military, and also influences food-related policies and laws. A new guideline emphasizing a healthy diet pattern which is mostly plant based and low in red and processed meat may cause the meat industry a huge business loss.

The Committee’s recommendations are based on convincing scientific evidence on diet and health as well as food environments and sustainability. At the same time, the Committee’s report is purely advisory. Whether the final guideline released at the end of this year by the USDA and DHHS will include these exact recommendations remains to be seen. Although historically USDA policies have been heavily influenced by the food industry, public comments can make a difference. The Committee report is currently available on the dietary guidelines website for public comments until May 8, 2015.

Wednesday, February 18, 2015

John Oliver Skewers Big Tobacco's Heavy-Handed Global Efforts (Video)

We're not prone to posting video clips from satirical news programs, but this weekend's piece from Last Week Tonight with John Oliver really captured why it is so important to keep up the fight against Big Tobacco.  While we still have a great deal of work to do to get tobacco under control in the United States, the situation is even more pressing across the globe, where tobacco companies use heavy-handed tactics to squelch anti-tobacco efforts.  Mr. Oliver deconstructs these tactics in great - and humorous - detail, finishing with his own campaign idea to subvert their efforts.

Warning: video contain [EXPLICIT] language.

Wednesday, February 11, 2015

Study Finds Tobacco is Even Deadlier Than Typically Estimated. Fighting It Should Remain "Our Highest Priority"

Photo (Creattive Commons): Flickr/jeffjose
It can be easy to think that we've won the fight against tobacco.  Rates of smoking have plummeted since the 1960s.  Most restaurants, bars, and workplaces across the country are now largely smoke-free.  And many of us may have trouble coming up with a single family member or close friend who smokes.

Yet, the reality is that tobacco remains a persistent and insidious problem.   Over 40 million adult Americans still smoke.  That's 18 percent of the population, and rates can vary wildly, with some groups of people in the single digits and others closer to 50 percent.  Smoking rates in adults with  advanced college degrees hovers around 6 percent, while rates in those with GEDs is over 40 percent.  Smoking rates break across income as well, with those making more money smoking at significantly lower rates than those making less.

Now, a new paper published today in the New England Journal of Medicine finds that the ill-effects of tobacco likely reach well beyond what we've typically understood.  It's estimated that in the United States there are approximately 480,000 deaths per year from the 21 broad diseases said to be caused by smoking.  This new study by Carter et al pulls together data from five large cohort studies and reveals that a number of additional categories of diseases should likely be included in the smoking mortality estimates - things like breast cancer, prostate cancer, infections, and kidney failure.  When these diseases are taken into account, the number of deaths each year in the United States from smoking balloon by an additional 60,000 to 120,000 deaths.

Cancer News in Context's Graham Colditz, MD, DrPh writes in an accompanying editorial that:
A total of 60,000 excess deaths is a number that by itself would have an important public health impact, since it is in line with annual deaths in the United States from excessive alcohol intake or low fruit and vegetable intake.

When combined with the existing estimates of smoking-related deaths it becomes abundantly clear that while there have been great successes in tobacco control there is still a great deal of work to accomplish.  Colditz continues in the editorial to highlight the complexities of tobacco use in society and that successful efforts to curb use and aid smoking cessation will take wide-ranging efforts that cut across issues of policy and healthcare, among others.

He concludes by reaffirming the need to keep up the vigorous fight against tobacco - not only for society and for the United States, but for individuals and for other countries as well:
Tobacco control must be our highest priority here and globally to advance population health, to reduce economic burden, and to extend years of health and productive life for all citizens.

More CNiC posts on tobacco, included the latest evidence on smoking and breast cancer.


Smoking and Mortality — Beyond Established Causes
Brian D. Carter, M.P.H., Christian C. Abnet, Ph.D., Diane Feskanich, Sc.D., Neal D. Freedman, Ph.D., Patricia Hartge, Sc.D., Cora E. Lewis, M.D., Judith K. Ockene, Ph.D., Ross L. Prentice, Ph.D., Frank E. Speizer, M.D., Michael J. Thun, M.D., and Eric J. Jacobs, Ph.D.
N Engl J Med 2015; 372:631-640

Smoke Alarm — Tobacco Control Remains Paramount
Graham A. Colditz, M.D.
N Engl J Med 2015; 372:665-666

Friday, February 6, 2015

Current Evidence on Smoking and Breast Cancer

Photo: flickr/saneboy (Creative Commons lic; cropped)
Though the most recent Surgeon General’s report on the health effects of tobacco stops just short of classifying smoking as a cause of breast cancer, current evidence seems compelling enough to finally push tobacco smoke from simple risk factor to full-fledged “cause.”

While research into the tobacco/breast cancer link can be confounded by certain differences in the habits of smokers and non-smokers - such as cancer screening frequency and alcohol consumption - studies that take such factors into account have found a fairly consistent impact of smoking on breast cancer risk.

Meta-analyses from the Surgeon General’s report, which combined the results from numerous case-control and cohort studies, are remarkably similar in their findings, showing around a 10 – 15 percent increase in risk in women who actively smoke (or smoked) compared to non smokers (1).

Looking at more recent analyses, the large Cancer Prevention Study II, which followed over 73,000 women for up to 14 years, found that current smokers had a 25 percent higher risk of breast cancer compared to never smokers, while past smokers had a 10 percent higher risk (2). A related meta-analysis, which included data from 14 others studies, found that both current and former smokers had a 10 percent higher breast cancer risk compared to never smokers.

These broad numbers, though, likely don’t paint the full picture of the tobacco/breast cancer link. As with other risk factors, such as alcohol consumption, studies are showing that smoking early in life – between the first period (menarche) and first full-term pregnancy – may have the greatest impact on cancer risk. A recently released long-term Norwegian study of over 300,000 women found that those women who smoked for at least 10 years before their first pregnancy had a 60 percent increased risk of breast cancer compared to those who never smoked (3). Results from the Cancer Prevention Study II found similar risk with smoking starting early in life.

While smoking doesn’t increase breast cancer risk on the order that it increases the risk of lung cancer, it nevertheless has a real and measurable impact. Healthy behaviors can prevent 50 percent or more of all breast cancers. On top of its many other health benefits, avoiding smoking - or stopping smoking -  should be included as a key way for women to take control and help lower their breast cancer risk.

--  --  --  --  

Evidence Summaries from 2014’s 
Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General (1)

Smoking and Breast Cancer Incidence (New Cases)
“Based on 22 cohort reports published prior to 2012 and 27 case-control reports published from 2000– 2011, evidence suggests that a history of ever smoking is associated with an increase in the RR for breast cancer by an average of 10%; long duration of smoking (20 or more years), greater number of cigarettes smoked per day (20 or more), and more pack-years of smoking (20 or more) significantly increase risk for breast cancer by 13–16%, depending on study design and the exclusion of studies with design or analysis issues.”

Smoking and Breast Cancer Mortality
“To date, the evidence is insufficient to conclude that either active or passive smoking influences breast cancer mortality. Studies have been complicated by prob­lems with misclassifying exposure and a lack of specific­ity because smoking increases risk for several noncancer, comorbid conditions that contribute to mortality in survi­vors of breast cancer.”
Potential Causal Mechanisms
"The available evidence supports biologically plausible mechanisms, particularly for DNA adduct formation and unrepaired DNA mutations, by which exposure to tobacco smoke could cause breast cancer. However, data are limited and a detailed mechanistic model of how exposure to tobacco smoke may affect risk for breast cancer cannot yet be assembled. "

  1. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. In: U.S. Department of Health and Human Services CfDCaP, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, ed. Atlanta, GA2014.
  2. Gaudet MM, Gapstur SM, Sun J, Diver WR, Hannan LM, Thun MJ. Active smoking and breast cancer risk: original cohort data and meta-analysis. J Natl Cancer Inst 2013;105:515-25.
  3. Bjerkaas E, Parajuli R, Weiderpass E, et al. Smoking duration before first childbirth: an emerging risk factor for breast cancer? Results from 302,865 Norwegian women. Cancer Causes Control 2013;24:1347-56.

Tuesday, February 3, 2015

Study Finds Periods Start Earlier in Girls Who Drink a Lot of Sugary Drinks. What Does This Mean for Breast Cancer Risk?

Creative Commons photo (cropped): Flickr/zingersbs
A new study released last week in the journal Human Reproduction has found that regularly drinking sugar-sweetened beverages - like sodas and fruit drinks - may cause girls to start their menstrual periods at earlier ages.  

The study, a spin off of the long-running Nurses' Health Study at Harvard University, followed around 5,000 9 - 14 year old girls for up to five years - tracking their food, beverage intake, and menstrual status along the way.  Researchers found a distinct link between regularly drinking sugary beverages and the age periods started (technically called, menarche).  Those girls who drank more than 1.5 servings of soda or fruit drink each day started their period on average at 12.8 years, about three months earlier than girls drinking 2 or fewer servings each week. Even after taking body mass index (BMI) into account, which is linked to age at menarche,  the same general association remained.

So, what does this have to do with cancer?

There's increasingly good data that early life plays a particularly important role in later adult breast cancer risk, something we've certainly written about here on CNiC.  This new study provides further evidence that the choices our children make - and that we help them make - can have implications later in life.  The earlier menarche begins, the greater the lifetime exposure to estrogen and other reproductive hormones, which is a key risk factor for breast cancer.

And while the age differences at menarche weren't huge in this new study - meaning the impact of sugary drinks on overall breast cancer risk would likely be modest - cutting back on sodas and fruit drinks still provides an easy way to help lower risk, which when combined with other healthy choices in youth - like choosing plant-based foods and getting regular exercise - can have an important overall impact on later breast health.

A healthy lifestyle started in mid-life - when most women are likely to actually start thinking in earnest about their breast health - can cut the risk of breast cancer by 50 percent.  Starting healthy behaviors in childhood and continuing them throughout adulthood can cut risk by close to 70 percent (see figure). And the steps are surprisingly simple, with one of the easiest being substituting water for sugary sodas and fruit drinks.

[Small text edit, Feb 5, 2015]