Stacy Kennedy, MPH, RD/LDN, CSO, Senior Clinical Nutritionist at Dana-Farber Cancer Institute/Brigham & Women's Hospital, offers nutrition advice for ovarian cancer patients and survivors.
SHARE Webinar: Optimal Nutrition for Cancer Survivorsbkling
SHARE hosted a webinar featuring this presentation on May 8, 2013. Jessica Iannotta, Chief Clinical Officer at Meals to Heal, reviewed the current guidelines for nutrition and cancer survivorship, including highlights of cancer-fighting foods that can help to decrease risk of recurrence. She provided helpful strategies on how to implement these recommendations into your current diet and lifestyle. questions related to nutrition and cancer.
The information in this presentation is not intended to be a substitute for professional medical advice, diagnosis or treatment.
Stacy Kennedy, MPH, RD/LDN, CSO, Senior Clinical Nutritionist at Dana-Farber Cancer Institute/Brigham & Women's Hospital, offers nutrition advice for ovarian cancer patients and survivors.
SHARE Webinar: Optimal Nutrition for Cancer Survivorsbkling
SHARE hosted a webinar featuring this presentation on May 8, 2013. Jessica Iannotta, Chief Clinical Officer at Meals to Heal, reviewed the current guidelines for nutrition and cancer survivorship, including highlights of cancer-fighting foods that can help to decrease risk of recurrence. She provided helpful strategies on how to implement these recommendations into your current diet and lifestyle. questions related to nutrition and cancer.
The information in this presentation is not intended to be a substitute for professional medical advice, diagnosis or treatment.
Christina Lavner, RDN, Nutrition Services, presented Healthy Eating for Cancer Survivorship, as the second session of our Now What? A Cancer Survivorship Speaker Series for patients wanting to learn more about nutrition that will benefit them during and after treatment. Be sure to check out upcoming presenters in this series and pass the word on to any patients you think would be interested in the information. The next presentation in this series is November 16, Coping with Treatment Side Effects, presented by Constance Gore, RN-APN
Guide to Eating an Anti-Inflammatory Diet Virtual Lecture - Christina Lavner,...Summit Health
An anti-inflammatory diet, along with exercise, can yield many health benefits, such as improved symptoms of many chronic conditions, reduced cancer risk, and a lower risk of obesity, heart disease, and diabetes. Learn more about this healthy way of eating and how to get started.
Dietitian Shubhra has listed the best Benefits Of Vegan Diet through which we’ll understand how green food is much more beneficial than carnivorous food.
5 reasons why you should start eating plant based foods todayRonaldSsekittoK
5 Reasons Why You Should Start Eating
Plant Based Foods Today
As our society evolves, we are constantly facing the need
to change our behaviors and habits to increase our health
and quality of life. We are now facing climate change, food
insecurity and over 40% of our population is suffering from
chronic disease.
One of the recent ideas put forward to improve our world
and health is the plant-based nutrition. Even though food
regiments are not something our doctor prescribes (yet),
research is showing that food has a lot to contribute to our
health. It is also a less costly option to our society than
prescribe medication.
5 reasons why you should start eating plant based foods today UttarPra
As our society evolves, we are constantly facing the need to change our behaviors and habits to increase our health and quality of life. We are now facing climate change, food insecurity and over 40% of our population is suffering from chronic disease.
One of the recent ideas put forward to improve our world and health is the plant-based nutrition. Even though food regiments are not something our doctor prescribes (yet), research is showing that food has a lot to contribute to our health. It is also a less costly option to our society than prescribe medication.
Our understanding of plant-based eating may differ from one individual to another. In the world of nutrition, plant- based eating is having a large portion of one’s nutrition coming from vegetables, fruits, herbs, nuts, whole grains and also include legumes or other plants.
Excellent presentation on cancer
A book written by Professor Richard Beliveau and Dr Denis Ginger on “foods to fight cancer” have the following findings:
Statistic shows that one out of three people is affected by cancer before the age of 75
This represents 12 per cent of all reported deaths on Earth.
However, fear not, there is hope.
Ethnic differences, obesity and cancer,
stages of the obesity epidemic and cancer prevention
Professor TH Lam, JP, BBS
MD, FFPH, FFOM, Hon FHKCCM, FHKAM, FRCP
Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong
UICC World Cancer Congress Melbourne, Australia 3-6 December 2014
Christina Lavner, RDN, Nutrition Services, presented Healthy Eating for Cancer Survivorship, as the second session of our Now What? A Cancer Survivorship Speaker Series for patients wanting to learn more about nutrition that will benefit them during and after treatment. Be sure to check out upcoming presenters in this series and pass the word on to any patients you think would be interested in the information. The next presentation in this series is November 16, Coping with Treatment Side Effects, presented by Constance Gore, RN-APN
Guide to Eating an Anti-Inflammatory Diet Virtual Lecture - Christina Lavner,...Summit Health
An anti-inflammatory diet, along with exercise, can yield many health benefits, such as improved symptoms of many chronic conditions, reduced cancer risk, and a lower risk of obesity, heart disease, and diabetes. Learn more about this healthy way of eating and how to get started.
Dietitian Shubhra has listed the best Benefits Of Vegan Diet through which we’ll understand how green food is much more beneficial than carnivorous food.
5 reasons why you should start eating plant based foods todayRonaldSsekittoK
5 Reasons Why You Should Start Eating
Plant Based Foods Today
As our society evolves, we are constantly facing the need
to change our behaviors and habits to increase our health
and quality of life. We are now facing climate change, food
insecurity and over 40% of our population is suffering from
chronic disease.
One of the recent ideas put forward to improve our world
and health is the plant-based nutrition. Even though food
regiments are not something our doctor prescribes (yet),
research is showing that food has a lot to contribute to our
health. It is also a less costly option to our society than
prescribe medication.
5 reasons why you should start eating plant based foods today UttarPra
As our society evolves, we are constantly facing the need to change our behaviors and habits to increase our health and quality of life. We are now facing climate change, food insecurity and over 40% of our population is suffering from chronic disease.
One of the recent ideas put forward to improve our world and health is the plant-based nutrition. Even though food regiments are not something our doctor prescribes (yet), research is showing that food has a lot to contribute to our health. It is also a less costly option to our society than prescribe medication.
Our understanding of plant-based eating may differ from one individual to another. In the world of nutrition, plant- based eating is having a large portion of one’s nutrition coming from vegetables, fruits, herbs, nuts, whole grains and also include legumes or other plants.
Excellent presentation on cancer
A book written by Professor Richard Beliveau and Dr Denis Ginger on “foods to fight cancer” have the following findings:
Statistic shows that one out of three people is affected by cancer before the age of 75
This represents 12 per cent of all reported deaths on Earth.
However, fear not, there is hope.
Ethnic differences, obesity and cancer,
stages of the obesity epidemic and cancer prevention
Professor TH Lam, JP, BBS
MD, FFPH, FFOM, Hon FHKCCM, FHKAM, FRCP
Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong
UICC World Cancer Congress Melbourne, Australia 3-6 December 2014
Understant what is obesity and Bariatric Surgery, what are the risk factors and how to overcome on the it. For more information visit at http://gisurgery.info
Bringing life course epidemiology to understanding etiology and implications for timing of prevention . Studies cited in slides, but also motivated by much of my resesrch summarized here:
Colditz GA, Frazier AL 1995 CEBP Models of breast cancer show risk is set by events of early life: prevention efforts must shift focus
Terry MB, Colditz GA 2023 Cold Spring Harb Perspective Med
Colditz G, AND Bohlke K 2015 NPJ Breast Cancer
Colditz, Bohlke, Berkey 2014 Breast Ca Res Treatment
Professor Martin Wiseman presented on 'The Continuous Update Project - Breast cancer survivors and prostate cancer' on behalf of WCRF International at the SCPN conference 04/02/2015.
Obesity is now clearly established as a major risk factor for endometrial cancer.
In medium income country like ours , Obesity prevention and lifestyle initiatives should become the responsibility of public health services. Stepwise programmes with realistic time-related goals are required, starting with modification of lifestyle, progressing to pharmacotherapy and ultimately obesity surgery.
The real challenge now is to triage those women at a higher risk and offer them prophylactic measures as COCPs ,DMPA, oral progesterone or Mirena coil.
Standard treatment for endometrial cancer is surgery.
Obesity is associated with numerous disorders which put the patient at increase risk of peri-operative complications that require more detailed pre-operative assessment and more intensive post-operative care.
Thus treatment for endometrial cancer needs to be reassessed in the complex and increasingly common situation of the obese, older women with this disease.
What is the epidemiological evidence linking early life events and cancer risk and what are the potential critical windows for cancer prevention?
By Professor Ricardo Uauy, University of Chile, London School of Hygiene and Tropical Medicine
World Cancer Congress, Saturday 6 December 2014
Cancer is not all about what we inherit-- it's also about what we eat, how much we move and even how we stay connected. This is good news! This talk reviews the evidence for how we can reduce our risk of cancer through simple lifestyle changes.
Studies have shown that older women receive less aggressive screening and treatment for breast cancer. Geriatric Oncologist, Meghan Karuturi, of MD Anderson Cancer Center joins us in this webinar to discuss age bias and how it affects older patients.
Similar to Diet, obesity, lifestyle and cancer prevention: epidemiologic perspectives (20)
Breast cancer is the leading cancer diagnosed among women world wide. Over 5,000 cases are diagnosed each day. More than half of the global burden can be prevented with what we know now.
This infographic summarizes keen numbers aid prevention strategies
Colditz AACR prevention award lecture: preventing breast cancer nowGraham Colditz
AACR award lecture. The lecture addresses the global burden of breast cancer and the priority to act now on evidence that childhood and adolescent lifestyle (diet, activity, alcohol intake) can be modified to reduce the global burden of breast cancer.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
Diet, obesity, lifestyle and cancer prevention: epidemiologic perspectives
1. Diet, obesity, lifestyle and
cancer prevention:
Epidemiologic perspectives
Graham A Colditz, MD DrPH
Niess-Gain Professor
Chief, Division of Public Health Sciences
November, 2017
2. Department of Surgery
Division of Public Health Sciences
Outline
Review evidence on contribution of diet,
obesity, lifestyle and in particualr,
increasing burden of obesity on cancer
Identify:
Issues
Gaps in knowledge
Opportunities
3. Department of Surgery
Division of Public Health Sciences
Lifestyle: high income countries
Cause
% cancer
caused
Magnitude
possible
reduction
Time (yrs)
Smoking 33
Overweight/obesity 20
Diet 5
Lack of exercise 5
Occupation 5
Viruses 5-7
Family history 5
Alcohol 3
UV/ionizing radiation 2
Reproductive 3
Pollution 2 Colditz et al, Sci Transl Med 2012
4. Department of Surgery
Division of Public Health Sciences
Lifestyle: high income countries
Cause
% cancer
caused
Magnitude
possible
reduction
Time (yrs)
Smoking 33 75%
Overweight/obesity 20 50%
Diet 5 50%
Lack of exercise 5 85%
Occupation 5 50%
Viruses 5-7 100%
Family history 5 50%
Alcohol 3 50%
UV/ionizing radiation 2 50%
Reproductive 3 0
Pollution 2 0
5. Department of Surgery
Division of Public Health Sciences
Lifestyle: high income countries
Cause
% cancer
caused
Magnitude
possible
reduction
Time (yrs)
Smoking 33 75% 10-20
Overweight/obesity 20 50% 2-20
Diet 5 50% 5-20
Lack of exercise 5 85% 5-20
Occupation 5 50% 20-40
Viruses 5-7 100% 20-40
Family history 5 50% 2-10
Alcohol 3 50% 5-20
UV/ionizing radiation 2 50% 2-10
Reproductive 3 0 N/A
Pollution 2 0 N/A
7. Department of Surgery
Division of Public Health Sciences
Medical interventions proven to
prevent cancer: high-income
Intervention
Target
Magnitude of
reduction
Time (yrs)
Aspirin Colon mortality 40% 20+
SERMs Breast incidence 40-50% 5+
Salpingo
oophorectomy
Familial breast cancer 50% 3+
Screening for
colorectal cancer
Colon cancer mortality 30-40% 10
Viruses - HPV Cervical cancer incidence 50-100% 20+
- Hep B Liver cancer incidence 70-100% 20+
Mammography Breast cancer mortality 30% 10-20
Serial CT lung Lung cancer mortality 20% 6+
Colditz et al, Sci Transl Med 2012
8. Department of Surgery
Division of Public Health Sciences
Histologically confirmed cervical
abnormalities, Vic, Australia
CIN2, CIN3
Brotherton et al MJA 2016
11. Department of Surgery
Division of Public Health Sciences
Summary of evidence: Adolescent exposures
relation to risk of BBD and breast cancer
Lifestyle Relative Risk BBD Breast Cancer
(premenopausal)
Alcohol
Peak Growth Velocity
Height
Nuts
Fiber
Carotenoids Fruit and veggies
Vegetable protein
Family history
Physical activity
Colditz Bohlke Berkey Br Ca Res Treat 2015, Colditz & Bohlke 2014
12. Department of Surgery
Division of Public Health Sciences
Alcohol intake, ages 18-22,
incident proliferative BBD
Alcohol
intake
(grams/
day)
Cases
(678)
Person-
year
RR (95% CI)
None 155 64,827 1.0 reference
0.1-4.9 193 78,365 1.11 (0.89, 1.38)
5.0-14.9 236 88,310 1.36 (1.09, 1.69)
>15 30 9519 1.35 (1.01, 1.81)
p, trend <0.01
Liu et al. – Pediatrics, 2012
13. Department of Surgery
Division of Public Health Sciences
Alcohol before first pregnancy,
NHSII
Liu, Colditz, Tamimi JNCI 2013
14. Department of Surgery
Division of Public Health Sciences
Adolescent fiber & proliferative BBD:
NHSII
Su et al. Cancer Causes Control 2010
16. Department of Surgery
Division of Public Health Sciences
Obesity and cancer, time line -
• 1990s WHO, US Dietary Guidelines, adopt
common cut points
• 2002 IARC report
• 2008 et seq WCRF report
• 2016 update of IARC report
17. Department of Surgery
Division of Public Health Sciences
IARC 2002 and Calle 2003
• Review of evidence on weight obesity and
physical activity in relation to cancer
• Calle: ACS cohort published after the
IARC review panel
18. Department of Surgery
Division of Public Health Sciences
IARC 2002
“Sufficient evidence in humans for cancer-
preventive effect of avoidance of weight
gain for cancers of the colon, esophagus
(adenocarcinoma), kidney (renal cell),
breast (postmenopausal), and corpus uteri”
Translate: Obesity causes cancer
IACR Handbooks of Cancer Prevention Vol 6, 2002
19. Department of Surgery
Division of Public Health Sciences
Review of Evidence, IARC 2002
Obesity
Level of
Evidence
Risk Increase Associated with Obesity
Small
(RR 1.09-1.34)
Moderate
(RR 1.35 - 1.99)
Large
(RR 2.0 - 4.9)
Very Large
(RR 5.0+)
Convincing
Colon Breast Esophagus
Uterus
Kidney
Probable
21. Department of Surgery
Division of Public Health Sciences
Workgroup reviewed measures of adiposity; animal models;
mechanisms; and epidemiologic evidence.
Concluded lack of body fatness lowers risk,
or obesity causes cancer.
NEJM August 25, 2016
22. Department of Surgery
Division of Public Health Sciences
Evidence evolving
From only a couple of prospective cohorts in
2002, adding ACS mortality in 2003
• Now evidence from 30 to 50 or more
prospective cohorts
• Pooled analysis of individual participant
data from studies addressing BMI and less
common cancers
23. Department of Surgery
Division of Public Health Sciences
Why prospective studies and
pooled data
• Measure adiposity and risk of subsequent
cancer
• Avoid weight change due to disease
24. Department of Surgery
Division of Public Health Sciences
Individual participant data –
pooled analysis
IPD meta-analyses can improve the quality of data
and the type of analyses that can be done and
produce more reliable results (Stewart and Tierney
2002). For this reason they are considered to be a
‘gold standard’ of systematic review.
In fact, IPD meta-analyses have produced
definitive answers to clinical questions, which
might not have been obtained from summary data.
Cochrane Handbook Ch 18 and IPD methods
26. Department of Surgery
Division of Public Health Sciences
Pancreas
More than 20 prospective studies and case-
control studies indicating a positive dose-
response relation. Observed in the large
majority of studies and in both genders.
Compared to normal weigh, the RR for
overweight was 1.18 (1.03-1.36) and for
obesity 1.47 (1.23-1.75), estimated from
pooled analysis of 14 cohorts [Genkinger 2011].
27. Department of Surgery
Division of Public Health Sciences
Genkinhger et al 2011
2135 cases
During 846,340 py
Forest plot of RR for
BMI >30 vs 21-22.9
Baseline BMI
29. Department of Surgery
Division of Public Health Sciences
Relative risk of ovarian cancer by BMI and HT use
Collaborative Group on Epidemiological Studies of Ovarian Cancer (2012) Ovarian Cancer and Body Size: Individual Participant Meta-Analysis
Including 25,157 Women with Ovarian Cancer from 47 Epidemiological Studies. PLoS Med 9(4): e1001200. doi:10.1371/journal.pmed.1001200
http://journals.plos.org/plosmedicine/article?id=info:doi/10.1371/journal.pmed.1001200
Never use HT
Ever use
30. Department of Surgery
Division of Public Health Sciences
Evidence, 2016
Risk Increase Associated with Obesity
Level of
Evidence
Small
(RR 1.09-1.34)
Moderate
(RR 1.35 - 1.99)
Large
(RR 2.0 - 4.9)
Very Large
(RR 5.0+)
Convincing
Ovary Colon Breast Esophagus
Thyroid Gastric cardia
Liver
Kidney Uterus
Gall bladder
Pancreas
Meningioma
Multiple
myeloma
Probable
Male breast
Fatal prost.
Diffuse Large B-
cell lymphoma
32. Department of Surgery
Division of Public Health Sciences
Pancreatic
cancer US incidence 1992 to
2014
Age 20 to 49
Rising incidence
0.9% per year
(significant)
33. Department of Surgery
Division of Public Health Sciences
Colorectal
cancer US incidence 1992 to
2014
Age 20 to 49
Rising incidence
1.7% per year
(significant)
34. Department of Surgery
Division of Public Health Sciences
Childhood and early adult
adiposity
• Often consistent with adult adiposity and
risk
• Analysis not always clear
• Methods, correlated variables, and interpretation
• Challenges in breast cancer
• Inverse relation with adiposity at ages 5, 10, before menarche
• Weight gain increases risk
• How does childhood adiposity reduce risk for life?
35. Department of Surgery
Division of Public Health Sciences
0 10 18 30 47 Age
(years)
Premenopausal Postmenopausal
50
+kg
Post-menopausal
Breast Cancer
Risk
-
1 0.80 0.98
1.36 (weight change from 18 to attained)
Adiposity
1.37 (weight change after menopausal to attained)
Reference: Rosner, B., Eliassen, A. H., Toriola, A. T., Chen, W. Y., Hankinson, S. E., Willett, W. C., ... & Colditz, G. A. (2017). Weight and weight changes in early
adulthood and later breast cancer risk. International journal of cancer, 140(9), 2003-2014.
+kg
+kg
Age
(years)
-
1
Pre-menopausal
Breast Cancer
Risk
0.66 0.74
1.0
36. Department of Surgery
Division of Public Health Sciences
0 10 18 30 47 Age
(years)
Premenopausal Postmenopausal
50
+kg
Post-
menopausal
Breast Cancer
Risk
-
1 0.80 0.98
1.36
1.36 (weight change from 18 to attained)
Adiposit
y
1.37 (weight change after menopausal to attained)
Reference: Rosner, B., Eliassen, A. H., Toriola, A. T., Chen, W. Y., Hankinson, S. E., Willett, W. C., ... & Colditz, G. A. (2017). Weight and weight changes in early adulthood and later breast cancer
risk. International journal of cancer, 140(9), 2003-2014.
+kg
+kg
Age
(years)
-
1
Pre-menopausal
Breast Cancer
Risk 0.66 0.74
1.0
ER-/PR-
Breast Cancer Risk
RR / 30kg
0.73
(0.55-0.98)
0.70
(0.46-1.05) Weight change unrelated to risk
37. Department of Surgery
Division of Public Health Sciences
Top priorities to advance the
science –obesity and cancer
Improved (consistent) approaches to
modeling weight gain across life course and
cancer risk
Quantify benefits of weight loss
Measures of adiposity
• Do we have it right, do measures vary by
age; race/ethnicity; region of the world
38. Department of Surgery
Division of Public Health Sciences
Top priorities to advance the
science – diet, lifestyle and cancer
Improved (consistent) approaches to
modeling exposure in time course of cancer
development
Measures of diet lifestyle in childhood
adolescence
• Can biomarkers in blood banks replace
recall of childhood adolescent exposures?
39. Department of Surgery
Division of Public Health Sciences
Behavioral, Social, and Policy interventions
that impact Cancer Prevention
Intervention Target Type of Ix Evidence
review
Reduce tobacco
use
Children and
Adolescents
Smokers to quit
Combined
Pharmaco/behavioral Ixs
Smoke-free policies
Tobacco taxes
Surgeon
General
Increase physical
activity
Individuals and
community norms
Urban design
Stairs and workplace
Surgeon
General
Reduce Obesity Population School & work environment
Physical activity
Food & beverage
IOM report
2012
Limit alcohol intake Population Taxes WHO
Reduce UV exp Children, AYA All of above WHO
40. Department of Surgery
Division of Public Health Sciences
Wall-e
Captain
Will we all have
access to
driverless cars?
What will our
cancer risk be?