Joel Evans, MD discusses various studies focused on cancer, pregnancy and the Mediterranean Diet.

by Joel M. Evans, MD 

Serum 25-hydroxyvitamin D and Risk of Post-Menopausal Breast Cancer—Results of a Large Case-Control Study.

Carcinogenesis. 2008 Jan;29(1):93-9. 

Abbas S, Linseisen J, Slanger T, Kropp S, Mutschelknauss EJ, Flesch-Janys D, Chang-Claude J.

Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany.

Various studies suggest that vitamin D may reduce breast cancer risk. Most studies assessed the effects of dietary intake only, although endogenous production is an important source of vitamin D. Therefore, the measurement of serum 25-hydroxyvitamin D [25(OH)D] better indicates overall vitamin D status. To assess the association of 25(OH)D serum concentrations with post-menopausal breast cancer risk, we used a population-based case-control study in Germany, which recruited incident breast cancer patients aged 50-74 between 2002 and 2005. Information on sociodemographic and breast cancer risk factors was collected by personal interview. For this analysis, we included 1394 cases and 1365 controls, matched on year of birth and time of blood collection. Conditional logistic regression was used to calculate odds ratios (ORs) for breast cancer adjusted for potential confounders. Serum 25(OH)D concentration was significantly inversely associated with post-menopausal breast cancer risk. Compared with the lowest category (<30 nM), OR [95% confidence intervals (CI)] for the higher categories of 25(OH)D (30-45, 45-60, 60-75 and >/=75 nM) were 0.57 (0.45-0.73), 0.49 (0.38-0.64), 0.43 (0.32-0.57) and 0.31 (0.24-0.42), respectively (P(trend) < 0.0001). Analysis using fractional polynomials indicated a non-linear association. The association was stronger in women never using menopausal hormone therapy (HT) compared with past and current users (P(interaction) < 0.0001). Our findings strongly suggest a protective effect for post-menopausal breast cancer through a better vitamin D supply as characterized by serum 25(OH)D measurement, with a stronger inverse association in women with low serum 25(OH)D concentrations (<50 nM).

Comment: This is the latest in a number of recent articles showing a protective effect of Vitamin D and breast cancer. The authors clearly show that breast cancer incidence is reduced in women with high vitamin D levels and increased in women with low levels. The clinical takeaway here is that women interested in breast cancer prevention should have their vitamin D levels checked and be offered supplementation to achieve adequate levels. In my practice I try to achieve levels of 60-70 nM for these women as well as those that already have a breast cancer diagnosis.

The Management of Cancer-Related Fatigue After Chemotherapy with Acupuncture and Acupressure: a Randomised Controlled Trial.

Complement Ther Med. 2007 Dec;15(4):228-37.

Molassiotis A, Sylt P, Diggins H.

University of Manchester, School of Nursing, Midwifery & Social Work, Coupland III, Coupland Street, Manchester M13 9PL, UK.

Background: Cancer-related fatigue after chemotherapy is a difficult symptom to manage in practice and the most disruptive symptom in patients’ lives. Acupuncture is a popular complementary therapy among cancer patients and some evidence exists that it could potentially alleviate fatigue by stimulating ‘energy’ points in the body. Hence, this study was carried out to assess the effects of acupuncture and acupressure in managing cancer-related fatigue and the feasibility of running a randomised trial with these two complementary therapies in preparation for a large trial. Methods: This study was a randomised controlled trial. Forty-seven patients with cancer who experienced moderate to severe fatigue were randomised either to an acupuncture group (n=15), an acupressure group (n=16) or a sham acupressure group (n=16). The acupuncture group received six 20-min sessions over 2 weeks, while the patients in the two acupressure groups were taught to massage/press the points and did so daily thereafter for 2 weeks on their own. Patients completed the Multidimensional Fatigue Inventory before randomisation, at the end of the 2-week intervention and again about 2 weeks after the end of the intervention. Results: Significant improvements were found with regards to General fatigue (P<0.001), Physical fatigue (P=0.016), Activity (p=0.004) and Motivation (P=0.024). At the end of the intervention, there was a 36% improvement in fatigue levels in the acupuncture group, while the acupressure group improved by 19% and the sham acupressure by 0.6%. Improvements were observed even 2 weeks after treatments, although they were lower (22%, 15%, 7%, respectively). Acupuncture was a more effective method than acupressure or sham acupressure. Subjects needed a longer treatment period to have more sustained results. The trial was methodologically feasible. Conclusion: Acupuncture shows great potential in the management of cancer-related fatigue. As a randomised trial with acupuncture is feasible and preliminary data shows significant improvements, it should be tested further using a large sample and a multicentre design.

Comment: This article comes ten years after the National Institute of Health stated that acupuncture showed promising results for the treatment of chemotherapy associated nausea and vomiting (National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Conference Statement).  As all practitioners who care for patients undergoing cancer treatment are aware, fatigue is a common side effect. I have had great results referring these patients for acupuncture, and here is a research paper that demonstrates impressive results. I offer acupuncture to all patients undergoing cancer treatment to both prevent and treat side effects, and this paper provides additional support for this practice.

Consequences of Exposure to Carcinogens Beginning During Developmental Life.

Basic Clin Pharmacol Toxicol. 2008 Feb;102(2):118-24

Soffritti M, Belpoggi F, Esposti DD, Falcioni L, Bua L.

Cesare Maltoni Cancer Research Center, European Ramazzini Foundation of Oncology and Environmental Sciences, Bologna, Italy.

The increased incidence of cancer over the last 50-60 years may be largely attributed to two factors: the ageing of the population and the diffusion of agents and situations presenting carcinogenic risks. Today, we have entered into a new era in which populations are ever-increasingly exposed to diffuse carcinogenic risks, present not only in the occupational, but also in the general environment. We must now also consider an additional factor in the carcinogenic process, that is, the age in which exposure to carcinogenic risks begins. Apart from the paradigmatic cases of diethylstilboestrol and ionizing radiation, the available epidemiological data concerning the adult consequences of developmental exposure to carcinogens is very limited. However, important data have been provided by long-term experimental carcinogenicity bioassays conducted using rodents. This paper reports a selection of studies conducted in the laboratories of the Cesare Maltoni Cancer Research Center of the European Ramazzini Foundation in which exposure to the chemical agents vinyl acetate monomer, ethyl alcohol and aspartame was started during developmental life and continued into adulthood. The results of these studies provide supporting evidence that lifespan exposure to carcinogenic agents beginning during developmental life produces an overall increase in the carcinogenic effects observed. Moreover, when comparing prenatal and postnatal exposure, the data demonstrate that the development of cancers may appear earlier in life.

Comment: This article is part of an exciting and increasingly important field of medicine: the fetal origins of adult disease. The authors state that carcinogenesis may have some of its roots in the toxins a fetus is exposed to in the intrauterine environment. This is an important concept that causes me to recommend all patients planning pregnancy to strongly consider a detoxification program prior to conception and to be keenly aware of reducing toxic exposures during preconception, coception and pregnancy.

Mediterranean Diet in Pregnancy Protective for Wheeze and Atopy in Childhood.

Thorax. 2008 Jan 15 [Epub ahead of print]

Chatzi L, Torrent M, Romieu I, Garcia-Esteban R, Ferrer C, Vioque J, Kogevinas M, Sunyer J.

Department of Social Medicine, Faculty of Medicine, University of Crete, Greece.

Introduction: Dietary intake of specific nutrients or food groups during pregnancy could play a role in the risk of asthma and atopy in offspring, but specific dietary patterns have not been implicated. We evaluated the impact of maternal (during pregnancy) and child adherence to the Mediterranean Diet on asthma and atopy in childhood. Methods: Women presenting for antenatal care at all general practices in Menorca, a Mediterranean island in Spain, over a 12-month period starting in mid-1997 were recruited. Four hundred and sixty children were included in the analysis after 6.5 years of follow-up. Maternal dietary intake during pregnancy and children’s dietary intake at age of 6.5 years were assessed by food frequency questionnaires and adherence to a Mediterranean Diet was evaluated through a priori defined scores. During follow-up, parents completed questionnaires on the child’s respiratory and allergic symptoms. Children underwent skin prick tests with 6 common aeroallergens. Results: The prevalence of persistent wheeze, atopic wheeze, and atopy at age 6.5 years were 13.2%, 5.8%, and 17.0% respectively. One third (36.1%) of the mothers had low quality of Mediterranean Diet during pregnancy according to the Mediterranean Diet Score, while the rest had a high score. A high Mediterranean Diet Score during pregnancy (in two levels, using “low” score as reference) was found to be protective for persistent wheeze (OR, 0.22; 95% CI, 0.08-0.58), atopic wheeze (OR, 0.30; 95% CI, 0.10-0.90), and atopy (OR, 0.55; 95% CI, 0.31-0.97) at age 6.5 years after adjusting for potential confounders. Childhood adherence to the Mediterranean Diet was negatively associated with persistent wheeze and atopy though the associations did not reach statistical significance. Conclusion: Our results support a protective effect of a high level of adherence to the Mediterranean Diet during pregnancy against asthma-like symptoms and atopy in childhood.

Comment: As so many studies are published about the effects of the Mediterranean Diet it should come as no surprise that the beneficial effects extend to pregnancy. Conceptually this article relates to the Soffritti paper above as both show the dramatic impact of the intrauterine environment, both positive and negative, years after the baby is born. Here the authors make a great case for the Mediterranean Diet as being one of the healthiest diets during pregnancy, especially for mothers at risk of having children that are atopic.

Joel Evans, MD, is the author of The Whole Pregnancy Handbook published in 2005.