This document summarizes a presentation given by James R. Coughlin and Astrid Nehlig at the 24th International Conference on Coffee Science in San Jose, Costa Rica in November 2012. The presentation evaluated the experimental and epidemiological evidence on the relationship between coffee consumption and cancer risk. It discussed hundreds of epidemiology studies that have found no association or an inverse association between coffee drinking and cancers of the esophagus, stomach, pancreas, ovary, kidney, endometrial, prostate, colorectal, liver and skin cancer. However, some studies have found a potential increased risk of bladder cancer among heavy coffee drinkers. The presentation also discussed potential carcinogens found in coffee like acrylamide and fur
Estimating the proportion cured of cancer: Some practical advice for usersCancer Council NSW
Cure models can provide improved possibilities for inference if used appropriately, but there is potential for misleading results if care is not taken. In this study, we compared five commonly used approaches for modelling cure in a relative survival framework and provide some practical advice
on the use of these approaches.
Levels of Dichlorodiphenyltrichloroethane (DDT) and Hexachlorocyclohexane (HC...Premier Publishers
Serum levels of Dichlorodiphenyltrichloroethane (DDT) and Hexachlorocyclohexane (HCH) of breast cancer patients and controls were compared with a view to determining association between exposure of organochlorine pesticides (OCPs) and breast cancer. Fifty breast cancer patients and fifty age-matched control women were recruited from the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Questionnaires were administered to collect information on demography and essential breast cancer risk factors. Five millilitres of blood was collected from each participant and the serum was analysed for DDT and HCH using Gas Chromatography coupled with Electron Capture Detector. The results showed that almost all case women had no identifiable risk factors for breast cancer. The median DDT levels among case and control women were 11.87 ppb and 6.395 ppb, respectively. The levels of δ-HCH among case and control women were 5.82 ppb and 0.00 ppb while that of γ-HCH were 10.84 ppb and 0.00 ppb, respectively. This study confirmed exposure to OCPs among the studied population and revealed significantly higher levels (p≤0.05) in case women than controls, thereby, suggesting that exposure to OCPs may be a significant risk factor for breast cancer in Nigeria.
Cancer Council NSW Research Report Newsletter - November 2013Cancer Council NSW
Inside you will find:
Forgotten cancers: Bringing research funds and resources to bear on this area
Our Staff: 5 minutes with Dr Lini Nair-Shalliker
Our Insight: TA small change to the Death Registration Notice could save lives
Research Discovery: How cancer cells learn to resist the drug treatments
Join a Research Study - Make yourself available for research and help reduce the burden of cancer by completing a 5 minute questionnaire.
Inside you will find:
* 8 Australians a day saved from cancer: Over 61,000 Australian lives have been saved by improvements in cancer prevention, screening and greatment over the past 20 years
* CLEAR Study: What might happen next with the data we've collected
* Our achievements: The results of our cancer resarch over the past 20 years
* Annual resarch awards: New research projects that were awarded funding
* Join a Research Study - Make yourself available for research and help reduce the burden of cancer
Red meat, ancestral diet and environment are not to be solved with prohibitions. I describe in this opinion the biases of observational studies and the mistakes in environment issues.
Estimating the proportion cured of cancer: Some practical advice for usersCancer Council NSW
Cure models can provide improved possibilities for inference if used appropriately, but there is potential for misleading results if care is not taken. In this study, we compared five commonly used approaches for modelling cure in a relative survival framework and provide some practical advice
on the use of these approaches.
Levels of Dichlorodiphenyltrichloroethane (DDT) and Hexachlorocyclohexane (HC...Premier Publishers
Serum levels of Dichlorodiphenyltrichloroethane (DDT) and Hexachlorocyclohexane (HCH) of breast cancer patients and controls were compared with a view to determining association between exposure of organochlorine pesticides (OCPs) and breast cancer. Fifty breast cancer patients and fifty age-matched control women were recruited from the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Questionnaires were administered to collect information on demography and essential breast cancer risk factors. Five millilitres of blood was collected from each participant and the serum was analysed for DDT and HCH using Gas Chromatography coupled with Electron Capture Detector. The results showed that almost all case women had no identifiable risk factors for breast cancer. The median DDT levels among case and control women were 11.87 ppb and 6.395 ppb, respectively. The levels of δ-HCH among case and control women were 5.82 ppb and 0.00 ppb while that of γ-HCH were 10.84 ppb and 0.00 ppb, respectively. This study confirmed exposure to OCPs among the studied population and revealed significantly higher levels (p≤0.05) in case women than controls, thereby, suggesting that exposure to OCPs may be a significant risk factor for breast cancer in Nigeria.
Cancer Council NSW Research Report Newsletter - November 2013Cancer Council NSW
Inside you will find:
Forgotten cancers: Bringing research funds and resources to bear on this area
Our Staff: 5 minutes with Dr Lini Nair-Shalliker
Our Insight: TA small change to the Death Registration Notice could save lives
Research Discovery: How cancer cells learn to resist the drug treatments
Join a Research Study - Make yourself available for research and help reduce the burden of cancer by completing a 5 minute questionnaire.
Inside you will find:
* 8 Australians a day saved from cancer: Over 61,000 Australian lives have been saved by improvements in cancer prevention, screening and greatment over the past 20 years
* CLEAR Study: What might happen next with the data we've collected
* Our achievements: The results of our cancer resarch over the past 20 years
* Annual resarch awards: New research projects that were awarded funding
* Join a Research Study - Make yourself available for research and help reduce the burden of cancer
Red meat, ancestral diet and environment are not to be solved with prohibitions. I describe in this opinion the biases of observational studies and the mistakes in environment issues.
Colorectal cancer screening and subsequent incidence of colorectal cancer: re...Cancer Council NSW
Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study
Annika Steffen, Marianne F Weber, David M Roder and Emily Banks
The ban on phenacetin is associated with changes in the incidence trends of u...Cancer Council NSW
Australian and New Zealand Journal of Public Health "The ban on phenacetin is associated with changes
in the incidence trends of upper-urinary tract
cancers in Australia"
Sebastien Antoni,1 Isabelle Soerjomataram,1 Suzanne Moore,1 Jacques Ferlay,1 Freddy Sitas,2-4
David P. Smith,2,5 David Forman1
Presentation by Prof. George Gray, Director of the Centre for Risk Science and Public Health, George Washington University, at the Workshop on Risk Assessment in Regulatory Policy Analysis (RIA), Session 9, Mexico, 9-11 June 2014. Further information is available at http://www.oecd.org/gov/regulatory-policy/
Characteristics of cases with unknown stage prostate cancerCancer Council NSW
Stage of cancer at diagnosis (e.g. localised, regional involvement, metastatic) is an important predictor of survival. This paper identifies there is cause for concern surrounding the 40% of "unknown" or unrecorded stage of diagnosis on prostate cancer patient records in NSW. This means crucial information is missing from their records. The second stage of this project, scheduled for completion in late 2014, is to identify the reasons for these missing data. Once this has been completed we can inform policy makers to ensure the data completeness can be improved. Studies using cancer staging data can then increase in quality and quantity.
Cancer patients’ physical activity levels are thought to decline by at least one third following diagnosis and are often not recovered several years post treatment. Only 29.6% of cancer survivors are meeting the American Cancer Society’s and Public Health’s guidelines of 150 min of moderate intensity exercise per week. Previous research suggested that adherence to physical activity recommendations might be the most important lifestyle behavior associated with lower mortality and higher quality of life in cancer survivors.
CATCH ESR2 Gabriel Signorelli
The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)Cancer Council NSW
The NSW CLEAR case-control study commenced in 2006.
It collects lifestyle and demographic information as well as
biospecimens from people with all types of cancer and controls, which are available as an open resource for researchers.
Taking place under the tagline ‘We can. I can.’, World Cancer Day 2016-2018 will explore how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer.
Just as cancer affects everyone in different ways, all people have the power to take various actions to reduce the impact that cancer has on individuals, families and communities.
World Cancer Day is a chance to reflect on what you can do, make a pledge and take action. Whatever you choose to do ‘We can. I can.’ make a difference to the fight against cancer.
WCD2016 website http://www.worldcancerday.org/ materials http://www.worldcancerday.org/materials and ways to help http://www.worldcancerday.org/get-involved
SILS 2015 - Connecting Precision Medicine to Precision Wellness Sherbrooke Innopole
By: Joel Dudley, Mount Sinai School of Medicine
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com
Colorectal cancer screening and subsequent incidence of colorectal cancer: re...Cancer Council NSW
Colorectal cancer screening and subsequent incidence of colorectal cancer: results from the 45 and Up Study
Annika Steffen, Marianne F Weber, David M Roder and Emily Banks
The ban on phenacetin is associated with changes in the incidence trends of u...Cancer Council NSW
Australian and New Zealand Journal of Public Health "The ban on phenacetin is associated with changes
in the incidence trends of upper-urinary tract
cancers in Australia"
Sebastien Antoni,1 Isabelle Soerjomataram,1 Suzanne Moore,1 Jacques Ferlay,1 Freddy Sitas,2-4
David P. Smith,2,5 David Forman1
Presentation by Prof. George Gray, Director of the Centre for Risk Science and Public Health, George Washington University, at the Workshop on Risk Assessment in Regulatory Policy Analysis (RIA), Session 9, Mexico, 9-11 June 2014. Further information is available at http://www.oecd.org/gov/regulatory-policy/
Characteristics of cases with unknown stage prostate cancerCancer Council NSW
Stage of cancer at diagnosis (e.g. localised, regional involvement, metastatic) is an important predictor of survival. This paper identifies there is cause for concern surrounding the 40% of "unknown" or unrecorded stage of diagnosis on prostate cancer patient records in NSW. This means crucial information is missing from their records. The second stage of this project, scheduled for completion in late 2014, is to identify the reasons for these missing data. Once this has been completed we can inform policy makers to ensure the data completeness can be improved. Studies using cancer staging data can then increase in quality and quantity.
Cancer patients’ physical activity levels are thought to decline by at least one third following diagnosis and are often not recovered several years post treatment. Only 29.6% of cancer survivors are meeting the American Cancer Society’s and Public Health’s guidelines of 150 min of moderate intensity exercise per week. Previous research suggested that adherence to physical activity recommendations might be the most important lifestyle behavior associated with lower mortality and higher quality of life in cancer survivors.
CATCH ESR2 Gabriel Signorelli
The NSW Cancer, Lifestyle and Evaluation of Risk Study (CLEAR)Cancer Council NSW
The NSW CLEAR case-control study commenced in 2006.
It collects lifestyle and demographic information as well as
biospecimens from people with all types of cancer and controls, which are available as an open resource for researchers.
Taking place under the tagline ‘We can. I can.’, World Cancer Day 2016-2018 will explore how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer.
Just as cancer affects everyone in different ways, all people have the power to take various actions to reduce the impact that cancer has on individuals, families and communities.
World Cancer Day is a chance to reflect on what you can do, make a pledge and take action. Whatever you choose to do ‘We can. I can.’ make a difference to the fight against cancer.
WCD2016 website http://www.worldcancerday.org/ materials http://www.worldcancerday.org/materials and ways to help http://www.worldcancerday.org/get-involved
SILS 2015 - Connecting Precision Medicine to Precision Wellness Sherbrooke Innopole
By: Joel Dudley, Mount Sinai School of Medicine
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com
Hey, these are the slides me n my friends made... Use them if u want to... for viewing the videos used click on the links given ahead.
http://www.youtube.com/watch?v=jzOti_MtmBk
http://www.youtube.com/watch?v=N9MARqmqSf4
http://www.youtube.com/watch?v=yokcKhqq48c
http://www.youtube.com/watch?v=rJZVFRJmc9M
Kindly leave your comment if you found this helpful ;)
Some of the slides, i hide it from my real presentations for my own reference. Download to see all of them.
What is the current evidence between alcohol and cancer?
Presentation given by Giota Mitrou PhD MSc, Head of Research Funding and Science Activities, World Cancer Research Fund International (WCRF International).
The LANCET Oncology is the world-leading clinical oncology research journal globally (2021 Journal Citation Reports®, Clarivate 2022) With an Impact Factor of 54·433.
Publisher: Elsevier's Oncology Journal Network
Total Indexing – 11
Some Indexing sites are – Scopus , MEDLINE ,PubMed , Chemical Abstracts , Essential Science Indicators ,etc .
Editor :David Collingridge, Editor-in-Chief , gained a PhD in Tumour Biology from the Gray Cancer Institute/University College London (UK) and held research posts in the Department of Therapeutic Radiology, Yale University (USA) and in the PET Oncology Group, Imperial College School of Medicine, Hammersmith Hospital (UK)
UP College of Medicine Class 1993 & UP Medical Alumni Society Postgraduate Course on Cancer Prevention
Notre Dame de Chartres Hospital, Baguio City
25 November 2016
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Coffee and Cancer_Benefit-Risk Evaluation_Coughlin and Nehlig_ASIC Costa Rica_2012
1. Coffee and Cancer: A Benefit-Risk
Evaluation of the Experimental
and Epidemiological Evidence
James R. Coughlin, Ph.D.
Coughlin & Associates, California
and
Astrid Nehlig, Ph.D.
INSERM, France
24th International Conference on
Coffee Science
San Jose, Costa Rica
November 12, 2012
2. Presentation Outline
Human Epidemiologic Evidence (Dr. Nehlig)
Animal Carcinogens in Coffee
Acrylamide, Furan and 4-MEI
California “Proposition 65” Update
Benefit-Risk Evaluation – The “Holistic Approach”
“Coffee - Cancer Paradox”
3. A 30-Year Coffee/Health Perspective
…on Rats, Mice and Humans
…on “Good” and “Bad” Science
…on “Good” and “Bad” Media Coverage
…on Coffee’s Beneficial Health Effects
4. Conclusions: 1980 to Mid-1990’s
Mostly Bad News!
Coffee and Caffeine were being linked
to almost every known animal and
human disease!
5. As we entered the 21st Century
The preponderance of medical and scientific
evidence clearly supported the conclusion that
moderate coffee consumption (3 - 4 cups per day),
as part of a varied, balanced diet, is safe and is not
associated with any adverse human health
consequences.
6. But since 2000 or so…
The “Good News” is that almost all of the
Bad News was WRONG!
Evidence has been building strongly that
coffee may actually be GOOD for us!!!
Let’s examine the evidence on coffee and
cancer…
8. Coffee and Cancer Epidemiology
Coffee consumption is a major and frequent dietary exposure in
diverse cultures around the globe, but its safety related to cancer
causation has been questioned and studied for decades.
A substantial body of epidemiologic evidence (over 500 studies)
relating coffee consumption to cancer of various organ sites has been
accumulated to date.
Numerous, organ-specific studies using meta-analysis, as well as
comprehensive reviews, have been undertaken more recently.
9. Lack of association between coffee and
some cancer types
Type of cancer
Number of
studies
Effect of coffee
Doses
Oesophagus
17 studies
No influence
Increased risk
sometimes linked
to beverage
temperature
Stomach
23 studies
No influence
Pancreas
37 studies
No influence
Ovary
11 studies
No influence
Kidney
26 studies
No influence
10. Reduced risk for some cancer types
Type of cancer
Number of
studies
Effect of coffee
Doses
Breast
5 recent studies
*No effect after
menopause
*Risk reduced by 40%
before menopause, 2570% in women at risk
4 cups/day
Effect limited to regular
coffee: caffeine involved
Upper aerodigestive 10 studies
and respiratory tract
Risk reduction: 39-44%
4 cups/day
Endometrial
9 studies
Risk reduction: up to 60% 3 cups/day
inverse link with obesity
Prostate
14 studies
18% reduced risk for
prostate cancer overall,
60% for lethal prostate
cancer
4-6 cups/day
Both regular and
decaffeinated coffee
Skin
6 studies
Reduced risk in animals
Caffeine applied
topically
In humans reduced risk of
basal cell carcinoma (1321%) but not other types
3 cups/day (caffeine is
the active ingredient)
11. Coffee and bladder cancer
Date
Number of studies
Effect of coffee
Doses
Zeegers et al., 2001 Systematic review
16 studies in men
12 studies in
women
No link in women,
26% risk increase in men
Villanueva et al.,
2006
6 case-control
studies
Variable effects,
Increased risk,
Increased risk with tap
water alone
>5 cups/day vs
<5 cups/day
De Stefani et al.,
2007
Case-control study
Increased risk, up to 60%
3 cups/day
Pelucchi et al.,
2009
4 cohort studies
17 case-control
studies
Some studies show
increased risk, but
no dose-response
First highlighted by IARC Monograph (1991) – Limited evidence
Very variable outcome with possible increased risk in some populations?
Possible link with tap water and increased drinking with the disease
Presence of many counfounders, especially smoking
12. Most Recent Epidemiology Study of Coffee and
Bladder Cancer
Zhou et al. 2012. “A dose-response meta-analysis
of coffee consumption and bladder cancer.” Prev.
Med. 55: 14-22
23 case-control studies with 7,690 cases and 13,507
controls, and 5 cohort studies with 700 cases and
229,099 participants
“CONCLUSIONS: Although data from case-control
studies suggested that coffee was a risk factor
for bladder cancer, there was no conclusive evidence
on this association because of inconsistencies
between case-control and cohort studies.”
13. Coffee and colorectal cancer
Number of studies
5 cohort and 15 case-control
studies
Risk reduction 24-60% except in 3
cohort studies
Inverse relation with coffee intake,
maximal protection for a
consumption over 3-4 cups per day
Possible mechanisms
Presence in coffee of polyphenols
and diterpenes with antimutagenic
and antioxidant properties
Stimulation of colon motility and
hence reduction of time of contact
of mutagenic substances with the
intestinal mucosa
Tavani & La Vecchia 2004; La Vecchia & Tavani
2007; Galleone et al, 2010
14. Coffee and liver cancer
Meta-analysis of 6 case-control and 8 cohort studies
43% reduction in risk among coffee drinkers compared to nondrinkers
Dose-dependent association
Both in studies from Europe, where coffee is frequently consumed, and from
Japan, where coffee consumption is less frequent
Consistency exists between cohort and case-control studies.
Bravi et al., 2009
15. “Epidemiologic Evidence on Coffee and Cancer.”
Lenore Arab (U. of California, Los Angeles)
Nutrition and Cancer 62: 271-283 (2010)
“For most cancer sites, there is a significant amount of evidence
showing no detrimental effect of consumption of up to 6 cups of
coffee/day in relation to cancer occurrence. In fact, some of the
evidence…suggests that coffee might prevent some cancers.”
[review based on over 500 publications]
Liver and endometrial cancers - a strong and consistent protective
association
Colorectal cancer - the association is borderline protective
Breast, pancreatic, kidney, ovarian, prostate, gastric cancer - no
association
Bladder cancer - very weak increase in risk for heavy coffee consumption
in some studies, but this may be an indication of confounding by smoking
Childhood leukemia - ambiguous risk with mother’s consumption of coffee
at high levels of daily consumption, needs further study.
16.
17. So with all this good news, why
are we still concerned?
Animal Carcinogens in Coffee
18.
19. Early Animal Cancer Bioassays of Coffee
Wurzner H-P, Lindstrom E, Vuataz L and Luginbuhl H. 1977.
A 2-year feeding study of instant coffee in rats. II. Incidence and
types of neoplasms. Food Cosmet. Toxicol. 15:289-296.
Palm PE, Arnold EP, Nick MS, Valentine JR and Doerfler TE. 1984.
Two-year toxicity/carcinogenicity study of fresh-brewed coffee in
rats initially exposed in utero. Toxicol. Appl. Pharmacol. 74:364382.
Stadler R, Luginbuhl H, Bexter A and Wurzner H-P. 1984.
Preliminary findings of a carcinogen bioassay of coffee in mice.
In: MacMahon B and Sugimura T, eds., Coffee and Health
(Banbury Report 17), Cold Spring Harbor, New York, CSH Press,
pp. 79-88.
26. Acrylamide Snapshot: Chemistry and Toxicology
Human occupational neurotoxin, genotoxic / mutagenic in cell
cultures
Known rat carcinogen, classified as “probable human carcinogen”
Metabolized to glycidamide (an epoxide), an animal carcinogen
Acrylamide & glycidamide can bind to DNA/amino acids/proteins
DNA adducts carcinogenic potential
Blood hemoglobin adducts biomarker of exposure
Dietary proteins may reduce acrylamide uptake in humans
Protective enzymes can detoxify acrylamide and glycidamide
NTP Acrylamide Bioassay in rats and mice (July 2012 Report) –
“Clear Evidence of Carcinogenicity” for both species & sexes
27. U.S. National Toxicology Program (NTP)
Bioassay of Acrylamide
2-year cancer bioassay in rats and mice fed acrylamide in drinking
water (untreated control + 4 treatment doses), with ancillary studies on
metabolism, genotoxicity and toxicokinetics
Draft Technical Report No. 575 was peer-reviewed by the NTP Peer
Review Panel in April 2011; Panel accepted the conclusions that there
was “Clear Evidence of Carcinogenicity” in male and female rats and
male and female mice in numerous organs; Final Technical Report was
issued in July 2012
For industry’s consideration: the observed tumor findings and cancer
potencies may be useful in decreasing acrylamide’s risk potency
[JECFA, various national authorities]
28.
29. Risk Assessment Considerations based on NTP
JECFA should consider reevaluating its 2010 acrylamide risk
assessment by dismissing consideration of the NTP’s benign
tumors in the rat mammary gland and mouse Harderian gland as not
biologically relevant to human risk assessment
While these were the most sensitive tumor endpoints, they are not
malignant tumors, and these two tumor types are not relevant to
human risk
JECFA and others (FDA, EU, Health Canada) should reevaluate
acrylamide’s potential for human risk based on the lower incidences
of relevant NTP malignant rat and mouse tumor endpoints
I firmly believe that acrylamide is too important and too widespread
a contaminant in the human diet to have its risk determined by
biologically irrelevant rodent tumor endpoints and with no
consideration of the lack of increased risk in humans.
33. Food Drink Europe “Acrylamide Toolbox” (Sept 2011)
Restructured by Product Category around 3 main foods:
potatoes, cereals and coffee
Now includes text on the Concept of ALARA - “As Low as
Reasonably Achievable”
Methods of Analysis and Sampling better describe uncertainty
and standardization work
Risk/Risk and Risk/Benefit Positioning: re-written to more closely
align it with the “General Considerations and Constraints in
Developing Preventative Measures” within the CODEX “Code of
Practice for the Reduction of Acrylamide in Foods” (2009).
34. Progress on Acrylamide “Mitigation” for Coffee
Government regulators, university scientists and the food industry
have been working together for 10 years to develop/implement feasible
ways to reduce the presence of acrylamide in many foods
Studies have demonstrated some mitigation success for foods, but
much of the research was lab scale using techniques and ingredients
that have little commercial viability or organoleptic acceptability
Unfortunately, there has been very little success with coffee mitigation:
Baum M, Bohm N, Gorlitz J, Lantz I, Merz KH, Ternite R and Eisenbrand G.
2008. Fate of 14C-acrylamide in roasted and ground coffee during storage. Mol.
Nutr. Food Res. 52: 600-608.
Guenther H, Anklam E, Wenzl T and Stadler RH. 2007. Acrylamide in coffee:
Review of progress in analysis, formation and level reduction. Food Addit.
Contam. Part A: Chemistry, Analysis, Control, Exposure & Risk Assessment 24
(Suppl 1):60-70.
Lantz I, Ternit R, Wilkens J, Hoenicke K, Guenther H and van der Stegen GHD.
2006. Studies on acrylamide levels in roasting, storage and brewing of coffee.
Mol. Nutr. Food Res. 50:1039-1046.
35. Recent Dietary Epidemiology Studies of Acrylamide
Pelucchi et al. 2011. “Exposure to Acrylamide and
Human Cancer - A Review and Meta-analysis of
Epidemiologic Studies.” Annals Oncology 22: 14871499.
“Conclusions: Available studies consistently
suggest a lack of an increased risk of most types of
cancer from exposure to acrylamide.”
Lipworth et al. 2012. “Review of Epidemiologic Studies
of Dietary Acrylamide Intake and the Risk of Cancer.”
Eur. J. Cancer Protection 21: 375-386.
36.
37. “Acrylamide in Foods: A Review of the Science and
Future Considerations”
David R. Lineback, James R. Coughlin and Richard H. Stadler,
Ann. Rev. Food Sci. & Technol. 3: 15-35 (April 2012)
Most of the major countries of the world have advised
consumers to follow the dietary recommendations for a
balanced diet issued by their food regulatory and public
health agencies.
The data available to date have been insufficient to warrant
any recommendation for a significant change in the dietary
recommendations because of acrylamide.
Current epidemiological and toxicological evidence are
insufficient to indicate that the amounts of acrylamide
consumed in the normal diet are likely to result in adverse
human health effects, particularly cancer.
38. Does Acrylamide in Food Pose a Real Risk to
Human Health?
Risk characterization traditionally includes:
Rodent cancer bioassay results (like the NTP bioassay)
Biomarker and metabolic studies in animals and humans
Bioavailability may be less in human diets than in water
Need more reliable data on human intake estimates
But for acrylamide in heated foods…
Consideration of thresholds and non-linear dose modeling
Dietary epidemiology studies support lack of risk globally
Health-protective, beneficial components of acrylamidecontaining foods must be considered in a risk-benefit
evaluation.
39. Furan
Maillard Browning compound; rat and mouse liver carcinogen (NTP, 1993)
and “possibly carcinogenic to humans” (IARC, 1995); FDA, EFSA and
Health Canada have all provided data analyses and exposure assessments
“Margin of Exposure” = 750 - 4,300 lower than the lowest risk level
(Carthew et al., 2010), better than acrylamide; JECFA (2010) concluded that
dietary exposures to furan “indicate a human health concern for a
carcinogenic compound which may act via a DNA‐reactive metabolite”
Brewed coffee is about 70% of total furan exposure, the highest dietary
contributor of all foods and beverages; up to 200 ppb in some coffees; but
coffee PROTECTS against human liver cancer…Benefit-risk argument!
Guenther et al. (2010): furan is reduced significantly during roasting,
grinding, storage, brewing and drinking; levels are actually closer to
10 - 35 ppb.
40.
41. “Proposition 65”
A California Law “Safe Drinking Water and Toxic
Enforcement Act of 1986”
- Right-to-Know Warnings
- Prohibition of Discharge
42.
43. Acrylamide Battleground under Prop 65
Industrial chemical listed in 1990 as a carcinogen, with an adopted “Safe
Harbor” level = 0.2 μg/day; must stay below this level to avoid giving cancer
warnings; but if you can detect it, even a 1-ounce serving of any food
exceeds this level
French fries: Attorney General sued and settled case (2008) against Heinz
frozen fries/tater tots for $600,000 and demanded a 50% reduction in levels;
fast-food restaurant fries have had cancer warnings posted for years
Potato chips (crisps): AG settled (2008) the case against Frito-Lay & others;
agreement to cut levels to 275 ppb by end of 2011 (20 - 85% reductions) to
avoid warnings; much browner chips (e.g., Kettle chips) will be difficult to
mitigate to these lower levels
Cereals: Private “bounty hunter” group sued cereal manufacturers
(Cheerios, etc.) in 2009; the case is still pending.
44. Acrylamide in Coffee under Prop 65
Private “bounty hunter” group (CERT) sued 11 coffee shop
chains (Starbucks, Peet’s) in April 2010 for failure to provide
cancer warnings (“brewed coffee” suit)
In April 2011, some retail coffee shops began posting 10 inch x
10 inch cancer warning placards covering coffee, baked goods
and other products
CERT filed a related suit in May 2011 against coffee roasters,
distributors and retailers, over 100 companies are now sued
(“roasted coffee” suit)
These coffee roasters are fighting hard to avoid cancer warning
labels on packaged products; Acrylamide levels average only
about 10 ppb in brewed coffee.
45. Text of Coffee Shops’ Warning
“Proposition 65 WARNING. Chemicals known to the state of California
to cause cancer and reproductive toxicity, including acrylamide, are
present in coffee, baked goods, and other foods and beverages sold
here.
Acrylamide is not added to our products, but results from
cooking, such as when coffee beans are roasted or baked goods are
baked.
As a result, acrylamide is present in our brewed coffee,
including coffee made at home or elsewhere from our beans, grounds
or instant coffee, baked goods or other foods sold here, in grocery
stores or other retail locations.
Your personal cancer risk is affected by a wide variety of factors. The
FDA has not advised people to stop drinking coffee or eating baked
goods that contain acrylamide. For more information regarding FDA’s
views, see www.fda.gov. For more information about acrylamide and
Proposition 65, visit www.oehha.ca.gov/prop65/acrylamide.html.
47. 4-Methylimidazole (4-MEI)
Maillard Browning Reaction chemical proposed for carcinogen
listing based on the NTP bioassay in Jan. 2008, then listed in Jan.
2011 after we waged a strong scientific battle; but IARC (Feb. 2011)
also classified 4-MEI and 2-MEI as Group 2B “possibly
carcinogenic to humans” (based on sufficient evidence in animals)
Occurs naturally in added caramel colors (cola beverages, darker
beers) and in many browned foods/beverages (coffee, soy sauce,
others)
NTP oral cancer bioassay (2007) showed only increased lung
tumors in mice; however, 4-MEI reduced many other tumors in
rats, but that made no difference to the state agency
The state adopted a “Safe Harbor” level = 29 µg/day in February
2012 after industry efforts failed o raise it from a lower draft level
(16 µg/day); we still believe it should be a much higher number.
48. 4-Methylimidazole (4-MEI) – cont’d
Our Industry coalition sued the state to reverse the listing in
February 2011 but lost this case in November; case went to appeal
in February 2012, but industry abandoned the appeal in August
Center for Environmental Health threatened lawsuits early this
year against Coca Cola, PepsiCo, Dr. Pepper Snapple Group and
numerous supermarket chains for “failure to warn”
Major cola manufacturers switched to lower 4-MEI formulations
nationwide, with significant cost upcharge
Prop 65 does have “reach” – Brazil, UK, others clamoring for the
“safer” caramel in cola beverages
We in coffee worry about the global “reach” of potential cancer
warnings on coffee products (acrylamide, furan, 4-MEI).
50. Benefit-Risk Evaluation to Assess the Safety of Foods
Containing Heat-produced Carcinogens
Doing it the WRONG WAY for decades, by simply
evaluating the risk of individual chemicals in a food
one by one
Going forward, the RIGHT WAY is to evaluate the
safety of the whole food (compare its risks vs. benefits)
Use the “Holistic Approach”
Various “Benefit-Risk” evaluations have recently been
published –
U.S. FDA’s 2009 “Draft Risk and Benefit Assessment of
Fish” (Methyl mercury risks vs. Omega-3 fatty acid
benefits)
51. “Risk-Benefit Considerations of Mitigation Measures on
Acrylamide Content of Foods – A Case Study on Potatoes, Cereals
and Coffee.” Seal et al., Br. J. Nutr. 99 [Suppl 2]:S1-S46 (2008).
Expert Report commissioned by the “International Life Sciences
Institute/Europe” Process Related Compounds Task Force
(12 collaborating institutes, universities and companies)
1.
2.
3.
Studied the impact of pre-harvest, post-harvest and processing
conditions on acrylamide formation in potatoes, cereals and
coffee.
Considered the nutritional value and beneficial health impact of
consuming these commodities.
Calculated the impact of mitigation using probabilistic riskbenefit modeling to demonstrate the principle of this approach.
52.
53.
54. Problems Presented by Focusing on a Single
Toxic Chemical in a Food or Beverage
Consumer confidence in the food is eroded by media scares
Disruption of business & international trade
Scarce resources do not always go to the most critical risks
(trace chemicals vs. microbiological and nutritional threats); do
we have the resources to pursue all these individual chemicals
in food as major issues?
There is no end in sight…new chemicals are coming to the
forefront all the time; analytical advances drive detection levels
to near “zero”; continued high-dose animal testing identifies
potential health problems that will probably never occur in
humans
Can’t toxicology and epidemiology guide us to agree on some
toxicologically insignificant level of a chemical compared to the
benefits of the whole food? I believe they can!
56. The “Coffee / Cancer Paradox”
Coffee contains ~ 2,000 identified compounds (hundreds are flavors and
aromas), including trace levels of many animal carcinogens (such as
acrylamide, furan, 4-MEI, various aldehydes, PAHs, ochratoxin A, etc.)
But global health and regulatory authorities now agree that coffee
drinking is NOT causing any increased risk of human cancer
In fact, epidemiological studies show significant risk reductions for liver,
colorectal, breast and endometrial cancers in spite of the presence of
numerous animal carcinogens
How can this be?
Naturally occurring antioxidants (chlorogenic acids)
Heat-formed antioxidants (the brown melanoidin polymers)
Inducers of detoxification enzymes (Glutathione-S-transferase)
So, here is the Paradox – Coffee is loaded with
carcinogens but most likely reduces human
cancer risk!
57. Coffee provides 64% of per capita AOXs from beverages
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58. Use the Holistic Benefit-Risk Approach
The beneficial health effects of certain whole foods may
outweigh the effects of trace levels of animal carcinogens
and other toxicants – COFFEE is one of these foods!
We must press global health and regulatory authorities to:
Use improved toxicology and risk assessment methods
on individual chemicals tested at high doses
Do more research / evaluation on qualitative and
quantitative assessment of the benefits of whole foods
Consider the health benefits of protective compounds
naturally occurring and produced by heating
Assess the safety and benefits of the whole food, not
just individual food carcinogens / toxicants one by one.