Cancer and Society
Quackery Nuts and cancer: where are we now? only in the female population. Such a differential benefit for women has not yet been met with a reasonable explanation. Several suggestions have been made regarding the role of phyto-oestrogens derived from nuts and expression of oestrogen receptors in normal and malignant colonic tissue; however, most of these data are speculative. Furthermore, a Canadian study of 1095 patients with colorectal cancer and 1890 healthy matched individuals reported a protective role of higher phyto-oestrogen consumption (lignan), which reduced the risk of colorectal cancer by 27%, with no differential benefit between the two sexes. Other large studies have shown no protective role of greater nut consumption in the battle to prevent development of colon cancer. Looking at other tumour types, a prospective trial of 14 000 Seventhday Adventist men showed an initial risk reduction of prostate cancer by 45% with higher nut consumption, which was not subsequently confirmed by multivariate statistical analysis. A retrospective study, obtaining information from UN databases of 59 countries showed that prostate cancer mortality decreased with higher consumption of nuts and oilseeds. Furthermore, combined data from three trials in Canada, including 617 patients with prostate cancer and 636 healthy individuals, reported that higher consumption of nuts, lentils, and beans had a protective role, reducing the risk of prostate cancer by 31%. Countering these persuasive data, a Chinese study comparing patients with stomach cancer and healthy individuals failed to show any association between stomach cancer and nut consumption and a trial of 35 000 women from Iowa failed to show any association between nut consumption and the subsequent
www.thelancet.com/oncology Vol 14 November 2013
development of non-Hodgkin lymphoma. However, an interesting study of nearly 30 000 women who completed a high-school diet questionnaire in 1998 in the USA retrospectively identified a reduction in risk of developing benign breast disease by 36% in those who consumed a high amount of nuts, thus suggesting a potentially protective role in breast disease. In recent years, there has been an extensive amount of preclinical evidence from in-vitro models in which several nut compounds (resveratrol, ellagic acid, anacardic acid, omega 3 and 9 fatty acids) have been found to induce cancer cell death, inhibit the proliferative capacity of cancer cells, and reduce their potential to spread to distant sites (metastasise) via the inhibition of critical cancer molecular pathways, such as NF-kB (which promotes tumorigenesis via the induction of inflammation), inactivation of genes that promote cancer cell survival (BCL2 and BIRC5, which encodes survivin), inhibition of enzymes that increase cancer cell invasiveness (matrix metalloproteinases), and inactivation of molecules that promote the formation of new tumour vessels through which cancer
For the EPIC study see Cancer Epidemiol Biomarkers Prev 2004; 13: 1595–6039 For the Taiwan colorectal cancer study see World J Gastroenterol 2006; 12: 222–27 For the Canadian colorectal cancer study see J Nutr 2006; 136: 3046–53 For evidence of no protective role see Am J Epidemiol 1998; 148: 761–74 For the study into prostate cancer in Seventh-day Adventists see Cancer 1989; 64: 598–604 For the UN prostate cancer data see J Natl Cancer Inst 1998; 90: 1637–47 For the Canadian prostate cancer data see Nutr Cancer 1999; 34: 173–84 For the Chinese stomach cancer study see J Am Coll Nutr 2012; 31: 375–84 For the Iowa non-Hodgkin lymphoma study see Int J Cancer 2010; 126: 992–1003 For the US breast cancer questionnaire study see Cancer Causes Control 2010; 21: 1033–46
Fir0002/Wikimedia Commons
There are many types of nuts that many of us enjoy eating. By definition, tree nuts consist of walnuts, almonds, hazelnuts, cashews, pistachios, macadamias, pecans, and brazil nuts (considered seeds in reality). Peanuts are, in botanical terms, legumes; however, they have similar nutritional properties to tree nuts, and are therefore often grouped together. Chestnuts contain a higher content of starch, and are therefore nutritionally different. Nuts are nutritionally precious because they are the source of a wide range of important nutrients, including proteins, unsaturated fatty acids, vitamins (B6, niacin, folic acid, tocopherol), dietary fibre, copper, magnesium, potassium, zinc, antioxidants (ie, resveratrol, ellagic acid, and several flavonoids), phyto-oestrogens, and many phytochemicals (ie, anacardic acid). In recent years there has been extensive research showing a reduction in the risk of coronary artery disease with increased consumption of nuts. Cancer and nut consumption has been investigated to a lesser extent, with some interesting results from clinical studies. The EPIC study (European Prospective Investigation into Cancer and Nutrition) is a large trial involving ten European countries, nearly 500 000 participants, 855 colon cancer cases, and 474 rectal cancer cases. Interestingly, higher consumption of nuts and seeds was associated with a 31% risk reduction of colorectal cancer development for women, but no benefit for men was observed. Similar results were obtained from a prospective study in Taiwan, including more than 12 000 men and 11 000 women, that showed that higher consumption of peanuts was associated with a reduction in the risk of colorectal cancer development by 58%, again
1161
Cancer and Society
cells receive nutrients, but also use as routes of escape (VEGF family). A similar protective role of walnut consumption against mammary gland tumorigenesis has been identified in mice that spontaneously develop breast cancer, and in models in which cancer cells were transplanted into mice. Although preclinical research is somewhat persuasive, there is no standout answer from epidemiological studies, although one has to keep in mind the technical difficulties in designing large prospective studies that aim to accurately measure nut consumption. Furthermore, some
of the studies group nuts, pulses, legumes, and seeds together, thus making it difficult to distinguish a true nut effect. Quite often recall bias by trial participants might be inevitable, inflating true nut consumption. Even in multinational studies, large variations in nut consumption from country to country, and the fact that several potentially protective nut compounds are also found in other foods under investigation in the same studies (eg, vegetables), might alleviate and obscure a true mild or moderate association. To obtain potentially stronger associations between nut consumption
and cancer prevention, if possible, similar studies could be done in previously radically treated cancer populations under follow-up, who are by default at increased risk of cancer recurrence or development of metastatic disease. Although a reasonable recommendation would be to simply follow a balanced diet, nuts don’t seem to be a bad thing when it comes to cancer, and larger studies on balance probably suggest benefits.
of young vigilante Hit-Girl (played in the films by Chloë Moretz) to an altogether more elusive villain: cancer. Millar worked with Canadian artist Curtis Tiegs to draw the cartoon, which depicts the costumed superhero in a series of scenes plotting her attack on a large, purple, monster-like character, representing cancer. In one, Hit-Girl is accompanied by several women wearing pink t-shirts and wielding baseball bats and sledgehammers. In another, she is seen standing defiant with a speech bubble declaring: “Hey cancer, I’m coming to mess you up”. For those familiar with the HitGirl character—particularly the film version—the decision to use a dangerous, profanity-spewing 11-year-old girl desensitised to violence, blood, and death to front
a fundraising campaign might seem like an unusual choice. But it fits with Race for Life’s more aggressive strategy of recent years, with defiant phrases such as “Cancer, we’re coming to get you” synonymous with this year’s drive to recruit participants. The message is clear: cancer should not be something to fear, ignore, or attack half-heartedly; it should be relentlessly pursued until it is brutally extinguished. The Hit-Girl character fits perfectly with the image of women coming together to fight a common evil that the Race for Life campaigns promote, and hopefully it will have inspired a younger generation, especially those that have read the comics or seen the films, to get involved in the race this year. Aside from getting people to sign up, Millar hoped his comic would remind them to submit their sponsorship money. The numbers are not yet out, but if CRUK’s target has been reached this year, they will have raised more than £50 million, helping them to kick cancer’s ass that little bit harder.
Panagiotis Papanastasopoulos, *Justin Stebbing Imperial College, London, UK [email protected]
Charity Hit-Girl races for life
Cancer Research UK/Mark Millar/Curtis Tiegs
For more on Cancer Research UK’s Race for Life see http:// raceforlife.cancerresearchuk.org/ index.html
The Cancer Research UK (CRUK) Race for Life campaign, in which women and girls of all abilities join together to walk or run 5 km to raise money for the charity, hosted more than 230 events around the UK from May to the end of September this year. The Race for Life is CRUK’s most lucrative fundraising campaign, so it is clear why they are keen to promote the event in the most novel and enticing ways possible, and the 2013 campaign was no exception. This year, CRUK enlisted the help of Mark Millar, the award-winning British writer and creator of the KickAss series of comics—since made into two feature films (Kick-Ass [2010] and Kick-Ass 2 [2013])—to produce a one-off special comic strip to promote Race for Life, changing the target
Helen Penny 1162
www.thelancet.com/oncology Vol 14 November 2013
Quackery Nuts and cancer: where are we now? only in the female population. Such a differential benefit for women has not yet been met with a reasonable explanation. Several suggestions have been made regarding the role of phyto-oestrogens derived from nuts and expression of oestrogen receptors in normal and malignant colonic tissue; however, most of these data are speculative. Furthermore, a Canadian study of 1095 patients with colorectal cancer and 1890 healthy matched individuals reported a protective role of higher phyto-oestrogen consumption (lignan), which reduced the risk of colorectal cancer by 27%, with no differential benefit between the two sexes. Other large studies have shown no protective role of greater nut consumption in the battle to prevent development of colon cancer. Looking at other tumour types, a prospective trial of 14 000 Seventhday Adventist men showed an initial risk reduction of prostate cancer by 45% with higher nut consumption, which was not subsequently confirmed by multivariate statistical analysis. A retrospective study, obtaining information from UN databases of 59 countries showed that prostate cancer mortality decreased with higher consumption of nuts and oilseeds. Furthermore, combined data from three trials in Canada, including 617 patients with prostate cancer and 636 healthy individuals, reported that higher consumption of nuts, lentils, and beans had a protective role, reducing the risk of prostate cancer by 31%. Countering these persuasive data, a Chinese study comparing patients with stomach cancer and healthy individuals failed to show any association between stomach cancer and nut consumption and a trial of 35 000 women from Iowa failed to show any association between nut consumption and the subsequent
www.thelancet.com/oncology Vol 14 November 2013
development of non-Hodgkin lymphoma. However, an interesting study of nearly 30 000 women who completed a high-school diet questionnaire in 1998 in the USA retrospectively identified a reduction in risk of developing benign breast disease by 36% in those who consumed a high amount of nuts, thus suggesting a potentially protective role in breast disease. In recent years, there has been an extensive amount of preclinical evidence from in-vitro models in which several nut compounds (resveratrol, ellagic acid, anacardic acid, omega 3 and 9 fatty acids) have been found to induce cancer cell death, inhibit the proliferative capacity of cancer cells, and reduce their potential to spread to distant sites (metastasise) via the inhibition of critical cancer molecular pathways, such as NF-kB (which promotes tumorigenesis via the induction of inflammation), inactivation of genes that promote cancer cell survival (BCL2 and BIRC5, which encodes survivin), inhibition of enzymes that increase cancer cell invasiveness (matrix metalloproteinases), and inactivation of molecules that promote the formation of new tumour vessels through which cancer
For the EPIC study see Cancer Epidemiol Biomarkers Prev 2004; 13: 1595–6039 For the Taiwan colorectal cancer study see World J Gastroenterol 2006; 12: 222–27 For the Canadian colorectal cancer study see J Nutr 2006; 136: 3046–53 For evidence of no protective role see Am J Epidemiol 1998; 148: 761–74 For the study into prostate cancer in Seventh-day Adventists see Cancer 1989; 64: 598–604 For the UN prostate cancer data see J Natl Cancer Inst 1998; 90: 1637–47 For the Canadian prostate cancer data see Nutr Cancer 1999; 34: 173–84 For the Chinese stomach cancer study see J Am Coll Nutr 2012; 31: 375–84 For the Iowa non-Hodgkin lymphoma study see Int J Cancer 2010; 126: 992–1003 For the US breast cancer questionnaire study see Cancer Causes Control 2010; 21: 1033–46
Fir0002/Wikimedia Commons
There are many types of nuts that many of us enjoy eating. By definition, tree nuts consist of walnuts, almonds, hazelnuts, cashews, pistachios, macadamias, pecans, and brazil nuts (considered seeds in reality). Peanuts are, in botanical terms, legumes; however, they have similar nutritional properties to tree nuts, and are therefore often grouped together. Chestnuts contain a higher content of starch, and are therefore nutritionally different. Nuts are nutritionally precious because they are the source of a wide range of important nutrients, including proteins, unsaturated fatty acids, vitamins (B6, niacin, folic acid, tocopherol), dietary fibre, copper, magnesium, potassium, zinc, antioxidants (ie, resveratrol, ellagic acid, and several flavonoids), phyto-oestrogens, and many phytochemicals (ie, anacardic acid). In recent years there has been extensive research showing a reduction in the risk of coronary artery disease with increased consumption of nuts. Cancer and nut consumption has been investigated to a lesser extent, with some interesting results from clinical studies. The EPIC study (European Prospective Investigation into Cancer and Nutrition) is a large trial involving ten European countries, nearly 500 000 participants, 855 colon cancer cases, and 474 rectal cancer cases. Interestingly, higher consumption of nuts and seeds was associated with a 31% risk reduction of colorectal cancer development for women, but no benefit for men was observed. Similar results were obtained from a prospective study in Taiwan, including more than 12 000 men and 11 000 women, that showed that higher consumption of peanuts was associated with a reduction in the risk of colorectal cancer development by 58%, again
1161
Cancer and Society
cells receive nutrients, but also use as routes of escape (VEGF family). A similar protective role of walnut consumption against mammary gland tumorigenesis has been identified in mice that spontaneously develop breast cancer, and in models in which cancer cells were transplanted into mice. Although preclinical research is somewhat persuasive, there is no standout answer from epidemiological studies, although one has to keep in mind the technical difficulties in designing large prospective studies that aim to accurately measure nut consumption. Furthermore, some
of the studies group nuts, pulses, legumes, and seeds together, thus making it difficult to distinguish a true nut effect. Quite often recall bias by trial participants might be inevitable, inflating true nut consumption. Even in multinational studies, large variations in nut consumption from country to country, and the fact that several potentially protective nut compounds are also found in other foods under investigation in the same studies (eg, vegetables), might alleviate and obscure a true mild or moderate association. To obtain potentially stronger associations between nut consumption
and cancer prevention, if possible, similar studies could be done in previously radically treated cancer populations under follow-up, who are by default at increased risk of cancer recurrence or development of metastatic disease. Although a reasonable recommendation would be to simply follow a balanced diet, nuts don’t seem to be a bad thing when it comes to cancer, and larger studies on balance probably suggest benefits.
of young vigilante Hit-Girl (played in the films by Chloë Moretz) to an altogether more elusive villain: cancer. Millar worked with Canadian artist Curtis Tiegs to draw the cartoon, which depicts the costumed superhero in a series of scenes plotting her attack on a large, purple, monster-like character, representing cancer. In one, Hit-Girl is accompanied by several women wearing pink t-shirts and wielding baseball bats and sledgehammers. In another, she is seen standing defiant with a speech bubble declaring: “Hey cancer, I’m coming to mess you up”. For those familiar with the HitGirl character—particularly the film version—the decision to use a dangerous, profanity-spewing 11-year-old girl desensitised to violence, blood, and death to front
a fundraising campaign might seem like an unusual choice. But it fits with Race for Life’s more aggressive strategy of recent years, with defiant phrases such as “Cancer, we’re coming to get you” synonymous with this year’s drive to recruit participants. The message is clear: cancer should not be something to fear, ignore, or attack half-heartedly; it should be relentlessly pursued until it is brutally extinguished. The Hit-Girl character fits perfectly with the image of women coming together to fight a common evil that the Race for Life campaigns promote, and hopefully it will have inspired a younger generation, especially those that have read the comics or seen the films, to get involved in the race this year. Aside from getting people to sign up, Millar hoped his comic would remind them to submit their sponsorship money. The numbers are not yet out, but if CRUK’s target has been reached this year, they will have raised more than £50 million, helping them to kick cancer’s ass that little bit harder.
Panagiotis Papanastasopoulos, *Justin Stebbing Imperial College, London, UK [email protected]
Charity Hit-Girl races for life
Cancer Research UK/Mark Millar/Curtis Tiegs
For more on Cancer Research UK’s Race for Life see http:// raceforlife.cancerresearchuk.org/ index.html
The Cancer Research UK (CRUK) Race for Life campaign, in which women and girls of all abilities join together to walk or run 5 km to raise money for the charity, hosted more than 230 events around the UK from May to the end of September this year. The Race for Life is CRUK’s most lucrative fundraising campaign, so it is clear why they are keen to promote the event in the most novel and enticing ways possible, and the 2013 campaign was no exception. This year, CRUK enlisted the help of Mark Millar, the award-winning British writer and creator of the KickAss series of comics—since made into two feature films (Kick-Ass [2010] and Kick-Ass 2 [2013])—to produce a one-off special comic strip to promote Race for Life, changing the target
Helen Penny 1162
www.thelancet.com/oncology Vol 14 November 2013
