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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses dietary prevention strategies, the role of hormones in cancer prevention, and the interception approach of cancer prevention.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EGastrointestinal Cancers\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ENo randomized controlled trials have evaluated the effect of diet in the prevention of cancer or during cancer treatment. Therefore, there is confusion among clinicians and the public about the role of diet in cancer prevention. Jeffrey A. Meyerhardt, MD, MPH, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, discussed dietary prevention strategies.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EA higher body mass index is associated with a greater risk of death from multiple types of cancer [Calle EE et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2003]. In addition, consumption of red meat and processed meat is associated with an increased risk of cancer mortality, whereas the consumption of white meat appears to have a protective effect [Sinha R et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2009]. Furthermore, an expert report by the World Cancer Research Fund and the American Institute for Cancer Research indicated that red meat and processed meat increase the risk of colorectal cancer and that Cantonese-style salted fish increases the risk of nasopharyngeal cancer [WCRF\/AICR 2007]. A meta-analysis showed that higher consumption of red and processed meat is associated with an increased relative risk of developing colorectal cancer [Chan DS et al. \u003Cem\u003EPLoS ONE\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe benefit of fruit and vegetable intake is less clear. A pooled multivariate analysis did not suggest a significant benefit of fruit or vegetable consumption in the development of breast cancer [Jung S et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2013]. Similarly, a meta-analysis did not yield a significant effect of fruit or vegetable consumption and the risk of developing pancreatic cancer in men or women [Koushik A et al. \u003Cem\u003EAm J Epidemiol\u003C\/em\u003E 2012]. Another meta-analysis revealed mixed results for the association of fruit and vegetable intake and the risk of colon cancer, with a pooled relative risk of 0.91 (95% CI, 0.82 to 1.01) [Koushik A et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ERandomized clinical trials with supplemental \u03b2-carotene failed to show a benefit in the prevention of lung cancer. In fact, CARET and the ATBC trial revealed an increased incidence of lung cancer in patients who received \u03b2-carotene supplements compared with placebo [Omenn GS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1996; ATBC Cancer Prevention Study Group. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1994]. A study of patients with colorectal cancer found that high-tertile (median, 31.0 ng\/mL) serum vitamin D levels were associated with survival over 12 years (log rank p\u0026lt;0.04) [Ng K et al. \u003Cem\u003EBr J Cancer\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe effect of diet on cancer outcome or recurrence is also uncertain. Although multiple studies have indicated that a high-fat diet is associated with a poor prognosis in women with breast cancer, many studies have also showed no effect. However, women with breast cancer who participated in the WINS trial and decreased their fat to 8% of calories, resulting in a mean decrease in body weight of 2.7 kg, experienced a decrease in disease-free survival, which was particularly evident in patients with estrogen receptor\u2013 and progesterone receptor\u2013negative disease [Chlebowski RT et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2006]. A Western-style diet\u2014including high total carbohydrates, high glycemic load, and high consumption of sugar-sweetened beverages\u2014is associated with cancer recurrence or death (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Meyerhardt JA et al. \u003Cem\u003EJ Natl Cancer Inst\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/14\/4\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Western Diet and Risk of Colon Cancer Recurrence or Death\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-516561138\u0022 data-figure-caption=\u0022Western Diet and Risk of Colon Cancer Recurrence or Death\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/14\/4\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/14\/4\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/14\/4\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14582\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EWestern Diet and Risk of Colon Cancer Recurrence or Death\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from JA Meyerhardt, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-8\u0022\u003EVictor G. Vogel, MD, MHS, Geisinger Health System, Danville, Pennsylvania, USA, presented on the role of hormones in cancer prevention. Preventative therapy with tamoxifen, a selective estrogen receptor modulator (SERM), has been shown to reduce the risk of invasive breast cancer in high-risk women. The SERM raloxifene also reduces the risk of invasive breast cancer in high-risk women, albeit to a lesser extent than tamoxifen. However, tamoxifen is associated with a greater rate of endometrial cancer and thrombotic events. A benefit-risk assessment of the 5-year projected risk for invasive breast cancer revealed that the benefits of tamoxifen outweigh the risk when the 5-year projected risk of invasive breast cancer reaches 4.5 in women aged 50 to 59 years [Freedman AN et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2011]. The benefits of raloxifene outweigh the risk when it reaches 2.0 in patients aged 50 to 59 years. The aromatase inhibitors (AIs) anastrozole and exemestane have also been shown to reduce the risk of invasive breast cancer.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EDespite the risk reduction in invasive breast cancer with SERM or AI treatment in high-risk women, uptake has been low, likely as a result of lack of training in the benefit-risk counseling technique, lack of reimbursement, insufficient time, and concerns of side effects.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EWilliam Nassib William Jr, MD, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, discussed the interception approach of cancer prevention. This approach attempts to use rational selection of effective agents to target early molecular drivers of cancer. In addition, Dr. William advocated reverse migration, in which drugs and strategies used to treat advanced cancers can be migrated to the premalignancy setting, thus preventing invasive tumors [Gold KA. \u003Cem\u003ECancer Prev Res (Phila)\u003C\/em\u003E 2011].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EA challenge of chemoprevention is determining the population that is at highest risk for cancer and would theoretically benefit more from an intervention. One study indicated that loss of heterozygosity (LOH) at certain chromosomal sites is associated with an increased risk of developing cancer in patients with oral premalignant lesions [Mao L et al. \u003Cem\u003ENat Med\u003C\/em\u003E 1996], and these findings were corroborated in independent cohorts of patients with oral premalignant lesions, with or without a history of oral cancer [Rosin M et al. \u003Cem\u003EClin Cancer Res\u003C\/em\u003E 2000; Rosin M et al. \u003Cem\u003ECancer Res\u003C\/em\u003E 2002; Zhang et al. \u003Cem\u003ECancer Prev Res (Phila)\u003C\/em\u003E 2012]. As a result of these findings, the Erlotinib Prevention of Oral Cancer trial [EPOC; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00402779\u0026amp;atom=%2Fspmdc%2F14%2F14%2F4.atom\u0022\u003ENCT00402779\u003C\/a\u003E] was initiated, in which patients with oral premalignant lesions harboring high-risk LOH profiles, with or without oral cancer history, were randomly assigned to receive erlotinib or placebo. Over 72 months of follow-up, erlotinib treatment did not improve oral cancer\u2013free survival in patients with LOH compared with placebo; nevertheless, a first-month rash was associated with survival among patients who received erlotinib [William WN et al. \u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAlthough some aspects of cancer prevention have been associated with reduced incidence, such as SERM or AI use for the prevention of invasive breast cancer, uptake of chemoprevention is low. In addition, more data are needed to determine role of diet and supplements in the prevention of cancer.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/14\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp4jq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp4jq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}