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Evidence in favour of lifestyle intervention for cancer prevention with special reference to colorectal cancer

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Environmental Health and Preventive Medicine Aims and scope

Abstract

Randomized controlled trials are recognized as having the strongest type of study design for generating evidence on prevention of disease. They are, however, the most labor- and time-intensive and costly to conduct. Intervention studies on the recurrence of colorectal adenomas might serve as a model with relevance to the etiology of not only large bowel cancer but also other sites of neoplastic development. The results of intervention studies assessing the effect of calcium, antioxidants and fiber on the recurrence of colorectal adenomas have been conflicting, showing a beneficial effect in some cases but not others. There are methodological issues in intervention trials for colorectal cancer, regarding study subjects, end point, dose, interaction, duration and timing, and compliance, for example. Although relatively few trials have been conducted to investigate the effects of an explicit dietary change on the recurrence of adenoma, results obtained so far have demonstrated that modifying the lifestyle may reduce the risk of chronic diseases including cancer. Furthermore, recent progress in molecular epidemiology has allowed clarification of many of the molecular mechanisms underlying susceptibility. Eventually, it may be possible to target intervention programs to genetically susceptible individuals, including molecular targeting, for the prevention of cancer.

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References

  1. Cook JW, Hazelwood GA. Conversion of a bile acid into a hydrocarbon derived from 1,2-benzanthracene. Chem. Ind. Rev. 1933; 11: 758–759.

    Article  Google Scholar 

  2. Newmark HL, Wargovich MJ, Bruce WR. Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J. Natl. Cancer Inst. 1984; 72: 1323–1325.

    PubMed  CAS  Google Scholar 

  3. Appleton GV, Davies PW, Bristol JB, Williamson RC. Inhibition of intestinal carcinogenesis by dietary supplementaion with calcium. Br. J. Surg. 1987; 74: 523–525.

    Article  PubMed  CAS  Google Scholar 

  4. Pence BC, Budding F. Inhibition of dietary fat-promoted colon carcinogenesis in rats by supplemental calcium or vitamin D3. Carcinogenesis 1988; 9: 187–190.

    Article  PubMed  CAS  Google Scholar 

  5. Behling AR, Kaup SM, Choquette LL, Greger JL. Lipid absorption and intestinal tumor incidence in rats fed varying levels of calcium and butterfat. Br. J. Nutr. 1990; 64: 505–513.

    Article  PubMed  CAS  Google Scholar 

  6. Wargovich MJ, Allnutt D, Palmer C, Anaya P, Stephens LC. Inhibition of the promotional phase of azoxymethane-induced colon carcinogenesis in the F344 rat by calcium lactate: effect of simulating two human nutrient density levels. Cancer Lett. 1990; 53: 17–25.

    Article  PubMed  CAS  Google Scholar 

  7. McSherry CK, Cohen BI, Bokkenheuser VD, Mosbach EH, Winter J, Matoba N, Scholes J. Effects of calcium and bile acid feeding on colon tumors in the rat. Cancer Res. 1989; 49: 6039–6043.

    PubMed  CAS  Google Scholar 

  8. Sitrin MD, Halline AG, Abrahams C, Brasitus TA. Dietary calcium and vitamin D modulate 1,2-dimethylhydrazine-induced colonic carcinogenesis in the rat. Cancer Res. 1991; 51: 5608–5613.

    PubMed  CAS  Google Scholar 

  9. Karkare MR, Clark TD, Glauert HP. Effect of dietary calcium on colon carcinogenesis induced by a single injection of 1,2-dimethylhydrazine in rats. J. Nutr. 1991; 121: 68–577.

    Google Scholar 

  10. Bostick RM, Potter JD, Selelrs TA, McKenzie DR, Kushi LH, Folsom AR. Relation of calcium, vitamin D, and dairy food intake to incidence of colon cancer among older women. The Iowa Women's Health Study. Am. J. Epidemiol. 1993; 137: 1302–1317.

    PubMed  CAS  Google Scholar 

  11. Bergsma-Kadijk JA, Van't Veer P, Kampman E, Burema J. Calcium does not protect against colorectal neoplasia. Epidemiology 1996; 7: 590–597.

    Article  PubMed  CAS  Google Scholar 

  12. Alder RJ, McKeown-Eyssen G, Bright-See E. Randomized trial of the effect of calcium supplementation on fecal risk factors for colorectal cancer. Am. J. Epidemiol. 1993; 138: 804–814.

    PubMed  CAS  Google Scholar 

  13. Alberts DS, Ritenbaugh C, Story JA, Aickin M, Rees-McGee S, Buller MK, Atwood J, Phelps J, Ramanujam PS, Bellapravalu S, Patel J, Bettinger L, Clark L. Randomized, double-blinded, placebo-controlled study of effect of wheat bran fiber and calcium on fecal bile acids in patients with resected adenomatous colon polyps. J. Natl. Cancer Inst. 1996; 88: 81–92.

    Article  PubMed  CAS  Google Scholar 

  14. Bostick RM, Fosdick L, Wood JR, Grambsch P, Grandits GA, Lillemoe TJ, Louis TA, Potter JD. Calcium and colorectal epithelial cell proliferation in sporadic adenoma patients: a randomized, double-blinded, placebo-controlled clinical trial. J. Natl. Cancer Inst. 1995; 87: 1307–1315.

    Article  PubMed  CAS  Google Scholar 

  15. Bostick RM. Human studies of calcium supplementation and colorectal epithelial cell proliferation. Cancer Epidemiol Biomark Prev. 1997; 6: 971–980.

    CAS  Google Scholar 

  16. Hofstad B, Almendingen K, Vatn M, Andersen SN, Owen RW, Larsen S, Osnes M. Growth and recurrence of colorectal polyps: a double-blind 3-year intervention with calcium and antioxidants. Digestion 1998; 59: 148–156.

    Article  PubMed  CAS  Google Scholar 

  17. Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, Rothstein R, Summers RW, Snover DC Beck GJ, Bond JH, Greenberg ER. Calcium supplements for the prevention of colorectal adenomas. N. Engl. J. Med. 1999; 340: 101–107.

    Article  PubMed  CAS  Google Scholar 

  18. Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, Faivre J, for the European Cancer Prevention Organisation Study Group. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomized intervention trial. Lancet 2000; 356: 1300–1306.

    Article  PubMed  CAS  Google Scholar 

  19. McKeown-Eyssen G, Holloway C, Jazmaji V, Bright-See E, Dion P, Bruce WR. A randomized trial of vitamins C and E in the prevention of recurrence of colorectal polyps. Cancer Res. 1988; 48: 4701–4705.

    PubMed  CAS  Google Scholar 

  20. Roncucci L, Di Donato P, Carati L, Ferrari A, Perini M, Bertoni G, Bedogni G, Paris B, Svanoni F, Girola M, et al. Antioxidant vitamins or lactulose for the prevention of the recurrence of colorectal adenomas. Dis. Colon. Rectum. 1993; 36: 227–234.

    Article  PubMed  CAS  Google Scholar 

  21. Greenberg ER, Baron JA, Tosteson TD, Freeman DH, Beck GJ, Bond JH, Colacchio TA, Coller JA, Franki HD, Haile RW, Mandel JS, Nierenberg DW, Rothstein R, Snover DC, Stevens MM, Summers RW, van Stolk RU, for the Polyp Prevention Study group. A clinical trial of antioxidant vitamins to prevent colorectal adenoma. N. Engl. J. Med. 1994; 331: 141–147.

    Article  PubMed  CAS  Google Scholar 

  22. Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int. J. Cancer 1975; 15: 617–631.

    Article  PubMed  CAS  Google Scholar 

  23. Burkitt DP Epidmiology of cancer of the colon and rectum. Cancer 1971; 28: 3–13.

    Article  PubMed  CAS  Google Scholar 

  24. Trock B, Lanza E, Greenwald P. Dietary fiber, vegetables and colon cancer: critical review and meta-analyses of the epidemiologic evidence. J. Natl. Cancer Inst. 1990; 82: 650–661.

    Article  PubMed  CAS  Google Scholar 

  25. Howe GR, Benito E, Castelleto R, Cornee J, Esteve J, Gallagher RP, Iseovich JM, Deng-ao J, Kaaks R, Kune GA, et al. Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies. J. Natl. Cancer Inst. 1992; 84: 1887–1896.

    Article  PubMed  CAS  Google Scholar 

  26. Platz EA, Giovannucci E, Rimm E, Rockett HR, Stamper MJ, Colditz GA, Willett WC. Dietary fiber and distal colorectal adenoma in men. Cancer Epidmiol. Biomarkers Prev. 1997; 6: 661–670.

    CAS  Google Scholar 

  27. Alberts DS, Martinez ME, Roe DJ, Guillen-Rodriguez JM, Marshall JR, van Leeuwen JB, Reid ME, Ritenbaugh C, Vargas PA, Bhattacharyya AB, Earnest DL, Sampliner RE, the Phoenix Colon Cancer Prevention Physicians' Network. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N. Engl. J. Med. 2000; 342: 1156–1162.

    Article  PubMed  CAS  Google Scholar 

  28. McKoewn-Eyssen GE, Bright-See E, Bruce R, Jazmaji V and the Toronto Polyp Prevention Group. A randomized trial of a low fat high fibre diet in the recurrence of colorectal polyps. J. Clin. Epidemiol. 1994; 47: 525–536.

    Article  Google Scholar 

  29. MacLennan R, Macrae F, Bain C, Battistutta D, Chapuis P, Gratten H, Lambert J, Newland RC, Ngu M, Russell A, Ward M, Wahlqvist ML, the Australian Polyp Prevention Project. Randomized trial of intake of fat, fiber, and beta carotene to prevent colorectal adenomas. J. Natl. Cancer Inst. 1995; 87: 1760–1766.

    Article  PubMed  CAS  Google Scholar 

  30. Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, Shike M, Weissfeld J, Burt R, Cooper MR, Kikendall W, Cahill J, and the Polyp Prevention Trial Study Group. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N. Engl. J. Med. 2000; 342: 1149–1155.

    Article  PubMed  CAS  Google Scholar 

  31. Tokudome S, Yokoyama Y, Kamiya T, Seno K, Okuyama H, Kuriki K, Cheng J, Nakamura T, Fujii T, Ichikawa H, Itoh M. Rationale and study design of dietary intervention in patients polypectomized for tumors of the colorectum. Jpn. J. Clin. Oncol. 2002; 32: 550–553.

    Article  PubMed  Google Scholar 

  32. de Deckere EAM. Possible beneficial effects of fish and fish n-3 polyunsaturated fatty acids in breast and colorectal cancer. Eur. J. Cancer Prev. 1999; 8: 213–221.

    Article  PubMed  Google Scholar 

  33. Rose DP, Connolly JM. Omega-3 fatty acids as cancer chemopreventive agents. Pharmacol. Ther. 1999; 83: 217–244.

    Article  PubMed  CAS  Google Scholar 

  34. Takahashi M, Minamoto T, Yamashita N, Kato T, Yazawa K, Esumi H. Effect of docosahexaenoic acid on azoxymethane-induced colon carcinogenesis in rats. Cancer Lett. 1994; 83: 177–184.

    Article  PubMed  CAS  Google Scholar 

  35. Chen Zy, Istfan NW. Docosahexaenoic acid is a potent inducer of apoptosis in HT-29 colon cancer cells. Prostaglandins Leukotr Essent Fatty Acids 2000; 63: 301–308.

    Article  CAS  Google Scholar 

  36. Zhang J, Temme EHM, Kesteloot H. Fish consumption is inversely associated with male lung cancer mortality in countries with high levels of cigarette smoking or animal fat consumption. Int. J. Epidemiol. 2000; 29: 615–621.

    Article  PubMed  CAS  Google Scholar 

  37. Blot WJ, Li J-Y, Taylor PR, Guo W, Dawsey S, Wang GQ, Yang CS, Zheng SF, Gail M, Li GY, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J. Natl. Cancer Inst. 1993; 85: 1483–1492.

    Article  PubMed  CAS  Google Scholar 

  38. The alpha-tocopherol, beta carotene cancer prevention study group: The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N. Engl. J. Med. 1994; 330: 1029–1035.

    Article  Google Scholar 

  39. Hirose K, Tajima K, Hamajima N, Takezaki T, Inoue M, Kuroishi T, Miura S, Tokudome S. Effect of body size on breast-cancer risk among Japanese women. Int. J. Cancer 1999; 80: 349–355.

    Article  PubMed  CAS  Google Scholar 

  40. Hirose K, Tajima K, Hamajima N, Kuroishi T, Kuzuya K, Miura S, Tokudome S. Comparative case-referent study of risk factors among hormone-related female cancers in Japan. Jpn. J. Cancer Res. 1999; 90: 255–261.

    PubMed  CAS  Google Scholar 

  41. Hirose K, Tajima K, Miura S. A model obesity control program focusing on a healthy diet and gentle exercise in Aichi Cancer Center Hospital. Asian Pacific J. Cancer Prev. 2002; 3: 149–154.

    Google Scholar 

  42. Kuriki K, Tajima K, Tokudome S. Correlation analysis of colorectal cancer and type II diabetes among Japanese according to change in food intakes. Asian Pacific J. Cancer Prev. 2004; 5: 28–35.

    Google Scholar 

  43. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Hanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med. 2001; 344: 1343–1350.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Kaoru Hirose.

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Hirose, K., Tajima, K. Evidence in favour of lifestyle intervention for cancer prevention with special reference to colorectal cancer. Environ Health Prev Med 9, 130–136 (2004). https://doi.org/10.1007/BF02898091

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