Audio and slides for this presentation are available on YouTube: http://youtu.be/Fs6wfCFeFOU Wendy Chen, MD, MPH, a breast oncologist in the Susan F. Smith Center for Women's Cancers at Dana-Farber, shares new data and research studies linking a healthy lifestyle to better treatment outcomes.

2. Diet, nutrition, and women’s cancer:
Current status and future research
Wendy Chen, MD MPH

3. Willett,1992

4. Study design – diet and cancer
Observational
studies
Randomized
trials
Laboratory
studies

5. Challenges to studying nutrition and cancer
• Many food items inter-related
– People who eat more meat, eat less vegetables
– Nutrition often related to weight/health behaviors
• Long-term trends more important than short-term
• Unlikely to have one magic bullet
=> Beware of findings from
small individual studies!

6. Alcohol

7. Alcohol Intake and Breast Cancer
0.8
1
1.2
1.4
1.6
1.8
0 5 10 15 20 25 30 35 40 45 50 55 60
Alcohol Intake (g/d)
RelativeRisk

8. Feeding Studies
• 51 postmenopausal women rotated through three 8-
week periods of placebo, 15 g, or 30 g alcohol daily
– Estrone sulfate↑↑ by 7.5 and 10.7% respectively
– Androgen (DHEAS) ↑↑ by 5.1 and 7.5%
Dorgan 2001, JNCI

9. Alcohol and breast cancer survival
• Although studies consistent on alcohol and getting
breast cancer, survival studies mixed
– breast cancer recurrence
– heart disease risk
= > Bottom line is moderation
– Several glasses per week OK

10. Soy

11. Why the interest in soy?
• Soy high in isoflavones – phytoestrogens
– Isoflavones – similar chemical structure to estrogen
• Some laboratory studies suggest that soy protein
isolates  cancer growth
• Soy intake studies show protective effect for breast
/gynecologic cancers

12. Soy and breast cancer survival
Shanghai breast cancer study
0
0.2
0.4
0.6
0.8
1
1.2
Quartile 1 Quartile 2 Quartile 3 Quartile 4
Isoflavone intake
Recurrence
Mortality
Soy intake
high throughout
life
Mainly
dietary soy
Shu JAMA 2009

13. Tea

14. Tea consumption
=>Laboratory data
show anti-cancer
effect
=> Randomized trial
of green tea for
ovarian cancer
survivors

15. Dietary patterns
Rather than evaluating
individual nutrients,
study dietary patterns
since food items inter-
related

16. Dietary patterns and breast cancer
• Prudent (fruits, vegetables, whole grain, legumes,
poultry, fish) vs Western (refined grains, processed
and red meat, dessert, high-fat dairy)
– Prudent pattern may  breast cancer risk
– Stronger association with ER negative breast cancer
• Western diet  mortality from other causes
– No associations with breast cancer development

17. Women’s Health Initiative
• Federally funded study of dietary modification,
calcium/vitamin D, and menopausal hormones
• Dietary modification arm – random assignment
– 18 group sessions in 1st year then quarterly maintenance
– Goal was 20% energy from fat and  fruit/vegetable and
grain intake
• Weight loss was not a goal of the intervention

18. Women’s Health Initiative
• Was this study a “failure”?
After 8.1 yrs => no significant
difference in total cancer
=> Only 14% of intervention
group met goal of 20%

19. • Was this study a “failure”?
Breast Cancer Ovarian Cancer

20. Conclusions
• Alcohol
– From breast cancer standpoint, should be limited to
several servings per week
• Diet
– Diet high in fruits/vegetables and low in meat/saturated
fat clearly associated with best overall health
– Stick to food based sources rather than supplements

21. • 1st began running at 55
• 1st ultramarathon at 61
• World record marathon
holder for 85-89 yr olds
– 5 hrs 36 minutes
Helen Klein

22. THANK YOU!