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Breast cancer Paper

Breast cancer is one of the deadliest agents of death and suffering to the humankind. This is one of the largest incidence cancers. Like any other cancers, breast cancer is multifactorial, and among these, the most significant and directly implicated is estrogen stimulation. Since estrogen is synthesized in the body from lipids, high dietary fat has been debatably and theoretically associated with breast cancer incidence.

Many studies have demonstrated that apart from other factors related to several stages and parameters of menarche, menopause, child birth, family history, women having a high dietary fact intake tend to develop breast cancer more. The reason is very much environmental since a woman’s dietary behavior has a great role to play in this apparently simple connection, and simple maneuvers in order to make modifications in the diet could prevent many cases of breast cancer due to the simple reason that estrogen, so strongly implicated in the causation and proliferation of cancer cells would be less available.

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High fiber and vegetable intake would also do the same thing to reduce the fat level of the body. In this work, a strategy has been developed for a region with a clusters of increased breast cancer incidence based on the determinants derived from contemporary intervention strategies with the same goal of reduction of incidence of breast cancer. These strategies are based on behavior modification of the target population to adjust their diet and change their dietary habits with low fat servings and high vegetable, fruit, and grain servings that are optimized and customized.

Obviously these intervention strategies are not empirical, and these are based on professional nutritionist recommendations depending on the anthropometric requirements of the individual participants. In the following pages, the detailed plan of a proposal has been laid out, and implementation of such strategies would definitely lead to reduction in incidence of breast cancer in the said population. Introduction: Breast cancer represents a malignant proliferation of epithelial cells lining the ducts or lobules of the breast.

This is the most common cancer in women resulting in suffering and death for many in the United States (Smith-Warner, S. A. , Spiegelman, D. , Adami, H. O. et al. , 2001). Although about 10% of the human breast cancer cases have been linked to genetic causes and familial origin, basically cancer of the breast is hormone dependent. Many cases of breast cancers cluster in a family, and in many cases sisters and daughters are affected (Kipnis, V. , Midthune, D. , Freedman, L. S.

et al. , 2001). Studies have shown that there had been geographical clustering of cases in very many different parts of the world, and the predilection cannot be explained on the basis of genetics because despite anthropometric variations, geographical clustering and predisposition to cancer breast cases seem to be due to some element related to environment of that particular geographic region (Bingham, S. A. , Luben, R. , Welch, A. , Wareham, N. , Khaw, K. T. , and Day, N.

, 2003). One would always try to find out the easiest solution, that is, environmental pollution. Fortunately, several researches have been undertaken to demonstrate unequivocally that environmental pollutants have little to do in causation of breast cancer. As a result, in an attempt to answer an apparent paradox of geographical clustering of breast cancer cases, the role of diet has long been investigated (Day, N. , McKeown, N. , Wong, M. , Welch, A. , and Bingham, S. , 2001).

There is definitive associative link between total caloric intake and breast cancer risk. The strongest link that has been established is with dietary fat intake. The results in case-control studies, international comparisons, and laboratory experiments in animals generally support a positive association between fat consumption and incidence of breast cancer (Prentice, R. L. , 2003). In 2003, there was a report of statistically significant positive association between total fat intake and breast cancer incidence.

Nutritional epidemiologic studies that had studied the diet-disease relationship in an attempt to answer the specific question whether or not there is any relationship and association between dietary fat intake and breast cancer incidence have indicated that low fat, high fruits and vegetables, and fibers can impact breast cancer incidence (Ritenbaugh, C. , Patterson, R. , Chlebowski, R. T. , et al. , 2003). Research has demonstrated that in premenopausal women, total fiber is protective against breast cancer, in particular, fibers from cereals and fruit and vegetables (Hays, J.

, Hunt, J. R. , Hubbell, A. et al. , 2003). Scientifically, there is evidence that high dietary fiber intake is protective. Fibers and certain fiber fractions have been hypothesized to reduce cancer risk through a number of mechanisms including inhibition of estrogen reabsorption, inhibition of human estrogen synthetase leading to a reduction of estrogen synthesis and reduction in levels of androgens which influence levels of estrogens and proliferation of breast tissue (Stram, D. O. , Hankin, J. H. , Wilkens, L. R. et al. , 2000).

Additionally since fibers are known to involve the levels of insulin and insulin-like growth factors and since increased serum levels of IGF-1 are associated with increased breast cancer risk, fibers have been postulated to have an association with breast cancer (Subar, A. F. , Thompson, F. E. , Kipnis, V. et al. , 2001) (Toniolo, P. , Bruning, P. F. , Akhmedkhanov, A. , et al. , 2000). In this particular case and given the geographic clustering of breast cancer cases, it is pertinent to investigate the role of dietary fat and fibers in this population (Flagg, E. W. , Coates, R. J. , Calle, E. E. , Potischman, N.

, and Thun, M. J. , 2000). Health survey and hospital morbidity data indicates that there, indeed, is high prevalence of breast cancer. However, despite being in the vicinity of the pulp factory and growing claims from the newspaper reports that this local pulp mill could have leaked environmental carcinogens, one would be tempted to suspect that the usual culprit is the culprit carcinogen here. Fortunately, there is till date no evidence that environmental or industrial carcinogens. As a result, it would be justified to investigate the problem from a different perspective based on the recent regional dietary intake data.

It is evident that the adult women in the community consume food that that has high fat, and obviously, there is low level of fruit and vegetable consumption, indicating low fiber content (Prentice, R. M. , Caan, B. , Chlebowski, R. T. et al. , 2006). This is pertinent since there had been trials and intervention determinants involving dietary and lifestyle modification. These largely consisted of consumption of a reduced amount of fat and an increased amount of vegetables and adjusting the life styles (Kipnis, V. , Subar, A. F. , Midthune, D. et al.

, 2003). It was noted that many non-dietary factors contribute to dietary variability leading to a condition where inordinate estrogen stimulation of the breast tissue may lead to neoplastic transformation of the breast tissue. Apart from race, marital status, parity, and other factors, feasibility of achieving a dietary fat reduction among healthy postmenopausal women would demonstrate reduction in serum estradiol level when the diet is low in fat (Boyd, N. F. , Stone, J. , Vogt, K. N. , Connelly, B. S. , Martin, L. J. , and Minkin, S. , 2003).

Observational studies have both linked low dietary fat intake with low estrogen levels and low breast cancer risk. Likewise, increased amount of vegetables and fruit would increase fiber intake and reduce fat absorption (Day, N. E. , Wong, M. Y. , Bingham, S. et al. , 2004). The strategies that can be employed is first to assess the dietary status of the target population by means of a questionnaire. Many women now are working outside home, and this single factor has contributed to the change in conventional dietary pattern to a high fat one (Day, N.

E. , McKeown, N. , Wong, M. Y. , Welch, A. , Bingham, S. A. , 2001). This can be done by an eligibility screening form containing pertinent history of breast cancer in family or relations and other detailed data about the lifestyle and dietary habits. A consent form will be signed of the willing candidates after explaining the goal of the intervention pointing out all the determinants. Those who are willing would be contacted over telephone or physical face to face meetings, where a survey of the diet will be undertaken (Willett, W. , 2001).

The dietary judgment would decide what modification is to be implemented without affecting the cultural beliefs of the candidates. The intervention would be designed to promote dietary change with the goals of reducing total fat intake and increasing fruit, whole grain, or vegetable intake (Goris, A. H. , Westerterp-Plantenga, M. S. , Westerterp, K. R. , 2000). The target reduced total fat intake would be 20% of total food energy as fat and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to 6 servings daily.

By reducing the total fat to 20% of total energy, the amount of saturated fat also would be reduced to about 7% of energy. This is acceptable since this would not hamper the balance of the nutritional requirements, and at the same time, it would take care of reduction of weight (Vuckovic, N. , Ritenbaugh, C. , Taren, D. L. , Tobar, M. , 2000). Physical activity is an important denominator of body fat, and lifestyle modification interventions would invariably reduce the body lipid content and thereby would help estrogen stimulation (Curb, J. D. , McTiernan, A. , Heckbert, S. R. , et al.

, 2003). The intervention group would receive an intensive behavioral modification program that would consist of 18 group sessions in the first year and quarterly maintenance sessions thereafter. Each group would consist of 8 to 15 women and would be led by specially trained and certified nutritionists. Each participant would be given her own total fat gram goal based on her height. Self-monitoring techniques would need to be employed in this intervention depending on the determinants, and the active participation would need to be ensured by other individual and targeted strategies.

Motivational interviewing is one such method (Robins, J. M. and Finkelstein, D. M. , 2000). Very many intervention projects have been employed with the goal of reduction of dietary fat in women in menopausal age group to reduce the risk of breast cancer, but almost all involved a process of data collection and followup designed specifically with such goal. Many interventions involve a 4-day food record as baseline. Some projects contacted the study participants every 6 months for outcome ascertainment which is not unreasonable (Kalbfleisch, J. D.

and Prentice, R. L. , 2002). In these visits, the participants would be measured for their height, weight, waist line, blood pressure in annual clinical visits. Fasting serum samples of estrogen would be the greatest parameter for success of the designed nutritional intervention. Diet related biomarkers could be studied for assessment of adequacy of the diet and also to determine the determinant intervention efficacy so as to be able to know whether this is at all suitable to reduce the dietary lipids (Women’s Health Initiative Study Group, 2004).

Some intervention projects measure changes in the level of alfa carotene, beta carotene, total carotenoids, alfa-tocopherol, and these measures might provide an objective assessment of some aspects of the dietary changes reported by the participating women (Fung, T. T. , Hu, F. B. , Holmes, M. D. , et al. , 2005). To examine whether a low fat diet could influence breast cancer risk through changes in circulating hormones serum hormone concentration has been measured by all (Fung, T. T. , Hu, F. B. , Holmes, M. D. , et al. , 2005).

Conclusion: This proposal is guided by the studies and intervention strategies employed by different authors, and this points to the direct correlation of high dietary fat intake and high incidence of breast cancer. Dietary interventions and strategies of behavior modification would go a long way to prevent breast cancer if proper and appropriate intervention strategies are undertaken with close followup. Laboratory measurements and anthropometric measurements could serve as guides to the success of such interventions. References Bingham, S. A. , Luben, R. , Welch, A.

, Wareham, N. , Khaw, K. T. , and Day, N. , (2003). Are Imprecise Methods Obscuring A Relation Between Fat And Breast Cancer? Lancet ; 362: pp. 212–214. Boyd, N. F. , Stone, J. , Vogt, K. N. , Connelly, B. S. , Martin, L. J. , and Minkin, S. , (2003). Dietary Fat And Breast Cancer Risk Revisited: A Meta-Analysis Of The Published Literature. British Journal of Cancer; 89: pp. 1672–85. Curb, J. D. , McTiernan, A. , Heckbert, S. R. , et al. , (2003). Outcomes Ascertainment And Adjudication Methods In The Women’s Health Initiative. Annals of Epidemiology; 13(9S):S122-S128.

Day, N. , McKeown, N. , Wong, M. , Welch, A. , and Bingham, S. , (2001). Epidemiological Assessment Of Diet: A Comparison Of A 7-Day Diary With A Food: COMPARISON OF TWO DIETARY INSTRUMENTS 1019 Frequency Questionnaire Using Urinary Markers Of Nitrogen, Potassium And Sodium. International Journal of Epidemiology ; 30: pp. 309–17. Day, N. E. , McKeown, N. , Wong, M. Y. , Welch, A. , Bingham, S. A. , (2001). Epidemiological Assessment Of Diet: A Comparison Of A 7-Day Diarywith A Food Frequency Questionnaire Using Urinary Markers Of Nitrogen, Potassium And Sodium.

International Journal of Epidemiology ;30: pp. 309–17. Day, N. E. , Wong, M. Y. , Bingham, S. et al. , (2004). Correlated Measurement Error—Implications For Nutritional Epidemiology. International Journal of Epidemiology; 33: 1373–81. Flagg, E. W. , Coates, R. J. , Calle, E. E. , Potischman, N. , and Thun, M. J. , (2000). Validation of the American Cancer Society Cancer Prevention Study II Nutrition Survey Cohort Food Frequency Questionnaire. Epidemiology; 11: pp. 462–68. Fung, T. T. , Hu, F. B. , Holmes, M. D. , et al. , (2005).

Dietary Patterns And The Risk Of Postmenopausal Breast Cancer. International Journal of Cancer; 116: pp. 116-121. Fung, T. T. , Hu, F. B. , Holmes, M. D. , et al. , (2005). Dietary Patterns And The Risk Of Postmenopausal Breast Cancer. International Journal of Cancer; 116: pp. 116-121. Goris, A. H. , Westerterp-Plantenga, M. S. , Westerterp, K. R. , (2000). Undereating And Underrecording Of Habitual Food Intake In Obese Men: Selective Underreporting Of Fat Intake. American Journal of Clinical Nutrition; 71: pp. 130–34. Hays, J. , Hunt, J. R.

, Hubbell, A. et al. , (2003). The Women’s Health Initiative Recruitment Methods And Results. Annals of Epidemiology; 13: pp. S18–77. Kalbfleisch, J. D. and Prentice, R. L. , (2002). The Statistical Analysis of Failure Time Data. 2nd ed. New York, NY: John Wiley & Sons Inc; 2002:255. Kipnis, V. , Midthune, D. , Freedman, L. S. et al. , (2001). Empirical Evidence Of Correlated Biases In Dietary Assessment Instruments And Its Implications. American Journal Of Epidemiology; 153: pp. 394–403. Kipnis, V. , Subar, A. F. , Midthune, D. et al. , (2003).

The Structure Of Dietary Measurement Error: Results Of The OPEN Biomarker Study. American Journal of Epidemiology; 158: pp. 14–21. Prentice, R. L. , (2003). Dietary Assessment And The Reliability Of Nutritional Epidemiology Reports. Lancet; 362: pp. 182–83. Prentice, R. M. , Caan, B. , Chlebowski, R. T. et al. , (2006). Low Fat Dietary Pattern And Risk Of Invasive Breast Cancer: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. Journal of American Medical Association ; 295:pp. 629–42. Ritenbaugh, C. , Patterson, R.

, Chlebowski, R. T. , et al. , (2003). The Women’s Health Initiative Dietary Modification Trial: Overview And Baseline Characteristics Of Participants. Annals of Epidemiology; 13:pp. S87–97. Robins, J. M. and Finkelstein, D. M. , (2000). Correcting For Noncompliance And Dependent Censoring In An AIDS Clinical Trial With Inverse Probability Of Censoring Weighted (IPCW) Log-Rank Tests. Biometrics; 56: pp. 779-781. Smith-Warner, S. A. , Spiegelman, D. , Adami, H. O. et al. , (2001). Types Of Dietary Fat And Breast Cancer: A Pooled Analysis Of Cohort Studies.

International Journal of Cancer; 92:pp. 767–74. Stram, D. O. , Hankin, J. H. , Wilkens, L. R. et al. , (2000). Calibration Of The Dietary Questionnaire For A Multiethnic Cohort In Hawaii And Los Angeles. American Journal of Epidemiology; 151: pp. 358–70. Subar, A. F. , Thompson, F. E. , Kipnis, V. et al. , (2001). Comparative Validation Of The Block, Willett, And National Cancer Institute Food Frequency Questionnaires: The Eating At America’ Table Study. American Journal of Epidemiology ;154: pp. 1089–99.

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