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ONE HUNDRED THINGS YOU MIGHT

WANT TO KNOW ABOUT CANCER PREVENTION AND SURVIVORSHIP

Page | 2

ONE HUNDRED THINGS YOU MIGHT WANT TO KNOW ABOUT CANCER PREVENTION

AND SURVIVORSHIP ALCOHOL 1 Alcohol consumption is associated with laryngeal pharyngeal oesophageal liver breast and colorectal cancers (Parkin 2011) 2 Alcohol is felt responsible for 6 of cancers per year (Parkin 2011) 3 One unit of alcohol per day is associated with a 15 increased risk of breast cancer (Chen et al 2011) 4 Two units of alcohol per day is associated with an overall increase in the risk of cancer and a greater risk in seven specific types of cancer (Allen et al 2009) 5 Three units of alcohol per day is associated with an 86 increased risk of mouth cancer (Corrao et al 2004) 6 One unit of alcohol a day can reduce the risk of heart disease by 14ndash25 (Ronksley et al 2011) 7 Non Hodgkin lymphoma (Chiu et al 2002) and pancreatic cancer (Klein 2012) have increased risks with alcohol consumption in familial cancers 8 Alcohol can decrease the amount of folate in your body and lead to DNA damage which can then cause cancer such as colorectal cancer (Giovannucci 2002) 9 Alcohol consumption can add calories to the diet which can lead to obesity and can also be linked to hormonal changes in the types of oestrogen that lead to an increased risk of breast cancer (Onland-Moret et al 2005) 10 Can cause liver disease leading to cirrhosis and liver cancer three units a day can increase the risk by 19 (Corrao et al 2004) Summary advice On average a small amount of alcohol is probably good for your heart but if you have a family history of cancer it is best keep to seven units per weeks or less Guidelines also suggest that it is good have two alcohol-free days in each week Studies also suggest that taking small amounts of alcohol regularly carry less of a risk than saving all seven weekly units for one specific period of the week Moderation is the key In the UK the recommendation is no more than two to three units of alcohol a day for women and three to four units for men with at least two or three alcohol-free days each week References D M Parkin 2011 The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010 British Journal of Cancer 105 S2ndashS5

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ONE HUNDRED THINGS YOU MIGHT WANT TO KNOW ABOUT CANCER PREVENTION

AND SURVIVORSHIP ALCOHOL 1 Alcohol consumption is associated with laryngeal pharyngeal oesophageal liver breast and colorectal cancers (Parkin 2011) 2 Alcohol is felt responsible for 6 of cancers per year (Parkin 2011) 3 One unit of alcohol per day is associated with a 15 increased risk of breast cancer (Chen et al 2011) 4 Two units of alcohol per day is associated with an overall increase in the risk of cancer and a greater risk in seven specific types of cancer (Allen et al 2009) 5 Three units of alcohol per day is associated with an 86 increased risk of mouth cancer (Corrao et al 2004) 6 One unit of alcohol a day can reduce the risk of heart disease by 14ndash25 (Ronksley et al 2011) 7 Non Hodgkin lymphoma (Chiu et al 2002) and pancreatic cancer (Klein 2012) have increased risks with alcohol consumption in familial cancers 8 Alcohol can decrease the amount of folate in your body and lead to DNA damage which can then cause cancer such as colorectal cancer (Giovannucci 2002) 9 Alcohol consumption can add calories to the diet which can lead to obesity and can also be linked to hormonal changes in the types of oestrogen that lead to an increased risk of breast cancer (Onland-Moret et al 2005) 10 Can cause liver disease leading to cirrhosis and liver cancer three units a day can increase the risk by 19 (Corrao et al 2004) Summary advice On average a small amount of alcohol is probably good for your heart but if you have a family history of cancer it is best keep to seven units per weeks or less Guidelines also suggest that it is good have two alcohol-free days in each week Studies also suggest that taking small amounts of alcohol regularly carry less of a risk than saving all seven weekly units for one specific period of the week Moderation is the key In the UK the recommendation is no more than two to three units of alcohol a day for women and three to four units for men with at least two or three alcohol-free days each week References D M Parkin 2011 The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010 British Journal of Cancer 105 S2ndashS5

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Ronksley PE Brien SE Turner BJ Mukamal KJ Ghali WA 2011 Association of alcohol consumption with selected cardiovascular disease outcomes a systematic review and meta-analysis BMJ 342 Chiu BC Weisenburger DD Cantor KP Zahm SH Holmes F Burmeister LF Blair A 2002 Alcohol consumption family history of hematolymphoproliferative cancer and the risk of non-Hodgkins lymphoma in men Ann Epidemiol 12(5)309-15 Klein AP2012 Genetic susceptibility to pancreatic cancer Mol Carcinog 51(1)14-24 Chen WY Rosner B Hankinson SE Colditz GA Willett WC 2011 Moderate alcohol consumption during adult life drinking patterns and breast cancer risk JAMA 306(17)1884-90 Corrao G Bagnardi V Zambon A La Vecchia C 2004 A meta-analysis of alcohol consumption and the risk of 15 diseases Prev Med 38(5)613-9 Allen NE Beral V Casabonne D Kan SW Reeves GK Brown A Green J Million Women Study Collaborators 2009 Moderate alcohol intake and cancer incidence in women J Natl Cancer Inst 101(5)296-305 Giovannucci E 2002 Epidemiologic studies of folate and colorectal neoplasia a review J Nutr132(8 Suppl)2350S-2355S Onland-Moret NC Peeters PH van der Schouw YT Grobbee DE van Gils CH 2005 Alcohol and endogenous sex steroid levels in postmenopausal women a cross-sectional study J Clin Endocrinol Metab 90(3)1414-9 Science and Technology Committee - Eleventh Report Alcohol Guidelines House of Commons SMOKING 1 Tobacco is the most important avoidable cause of cancer and is responsible for 20 of all cancer (Peto 2011) 2 Smoking can increase the risk of lung bladder cervical kidney larynx pharynx nose mouth oesophagus pancreas stomach and liver cancers as well as some types of leukaemias (Sasco et al 2004) 3 Smoking just two cigarettes a day show increased risks of mouth and oesophageal cancers (Polesel et al 2008) 4 Smokers who smoke up to four cigarettes a day had much greater risks of dying from lung cancer than those that didnrsquot (Doll et al 2004) 5 Smoking has a higher impact on stomach cancer than alcohol consumption (Tominaga et al 1991) 6 Smokeless or chewing tobacco can also cause oral and pancreatic cancers (Cogliano et al 2004)

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7 Carriers of hMLH1 gene mutations have a 48 increased risk of colorectal cancer with smoking 8 Toxic chemicals like nitrosamines benzopyrenes benzene acrolein cadmium and polonium-2 10 can accumulate in the body through smoking These toxins can damage DNA and lead to cancer (Denissenko et al 1996)

9 Smokers with a familial history of pancreatic cancer are at 9x greater risk of the disease (James et al 2004) Summary advice The tobacco and the cocktail of toxic substances found in cigarettes can harm almost every organ in your body Even occasional or very low frequency smokers are at a greater risk of cancer Statistics show that around 50 of smokers die from their habit In some familial cancers smoking can increase the risk of developing tumours more importantly some studies show that smoking increases risk to the same extent in smokers and non smokers The age at which one starts to smoke the period for which they smoke and the amount they smoke a day are all factors that increase the risks to their health In general smoking is very harmful to the body 20 of women and 28 of men in the UK have given up smoking (wwwbbccouk 2012) Many people fail at their initial attempts however it is important to persist and ensure that you can beat the habit References Peto R 2011 The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010 British Journal of Cancer105 Tominaga K Koyama Y Sasagawa M Hiroki M Nagai M 1991 A case-control study of stomach cancer and its genesis in relation to alcohol consumption smoking and familial cancer history Jpn J Cancer Res 82(9)974-9 Kenfield SA Stampfer MJ Rosner BA Colditz GA 2008 Smoking and smoking cessation in relation to mortality in women JAMA 299(17)2037-47 Sasco AJ Secretan MB Straif K 2004 Tobacco smoking and cancer a brief review of recent epidemiological evidence Lung Cancer 45 Suppl 2S3-9 Doll R Peto R Boreham J Sutherland I 2004 Mortality in relation to smoking 50 years observations on male British doctors BMJ 328(7455)1519 Cogliano V Straif K Baan R Grosse Y Secretan B El Ghissassi F 2004 Smokeless tobacco and tobacco-related nitrosamines Lancet Oncol 5(12)708 Polesel J Talamini R La Vecchia C Levi F Barzan L Serraino D Franceschi S Dal Maso L 2008 Tobacco smoking and the risk of upper aero-digestive tract cancers A reanalysis of case-control studies using spline models Int J Cancer 122(10)2398-402 httpwwwbbccoukradio1advicefactfile_azcigarettes_tobacco Accessed 26042012 Denissenko MF Pao A Tang M Pfeifer GP 1996 Preferential formation of benzo[a]pyrene adducts at lung cancer mutational hotspots in P53 Science 274(5286)430-2

Page | 5

James TA Sheldon DG Rajput A Kuvshinoff BW Javle MM Nava HR Smith JL Gibbs JF 2004 Risk factors associated with earlier age of onset in familial pancreatic carcinoma Cancer101(12)2722-6 FRUIT AND VEGETABLES 1 Around 7000 cancers could be prevented annually from eating fruit and vegetables (Key 2010) 2 Eating fruit and vegetables can probably reduce the risk of the oesophagus stomach lung colorectum mouth pharynx larynx kidney and urinary bladder stomach and ovary cancer (Parkin and Boyd 2011) 3 71 of cancers are thought to be caused by a low intake of fruit and vegetables (Parkin and Boyd 2011) 4 Anthocyanidins found in pigments of fruits and vegetables have been shown to inhibit human tumor cells (Zhang et al 2005) 5 Eating fruit and vegetables is thought to protect against mouth larynx pharynx oesophagus stomach and lung cancer (WHO 2003) 6 Eating fruit and vegetables is thought to reduce the risk of cancer by 25 (Key 2010) 7 Antioxidants in fruit and vegetables have been shown to fight against bowel cancer (Lim do et al 2012) Summary advice Fruit and vegetables are very important parts of a health balanced diets it is recommended that each person eats five portions of fruit and vegetables a day Different types of fruit and vegetables can contain different chemicals that are useful for the body it is therefore good to contain a whole variety of different items in the diet References D M Parkin and L Boyd 2011 Cancers attributable to dietary factors in the UK in 2011 Low consumption of fruit and vegetables British Journal of Cancer 105 S19ndashS23

Key TJ2010 Fruit and vegetables and cancer risk British Journal of Cancer 104 6ndash11

Lim do Y Cho HJ Kim J Nho CW Lee KW Park JH 2012 Luteolin decreases IGF-II production and downregulates insulin-like growth factor-I receptor signaling in HT-29 human colon cancer cells BMC Gastroenterol 129 WHOFAO (2003) Diet Nutrition and The Prevention of Chronic Diseases Report of a Joint WHOFAO Expert Consultation WHO Technical Report Series 916 WHO Geneva Lea MA Ibeh C desBordes C Vizzotto M Cisneros-Zevallos L Byrne DH Okie WR Moyer MP 2008 Inhibition of growth and induction of differentiation of colon cancer cells by peach and plum phenolic compounds Anticancer Res (4B)2067-76

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Freedman ND Park Y Subar AF Hollenbeck AR Leitzmann MF Schatzkin A Abnet CC 2008 Fruit and vegetable intake and head and neck cancer risk in a large United States prospective cohort study Int J Cancer122(10)2330-6 Zhang Y Vareed SK Nair MG 2005 Human tumor cell growth inhibition by nontoxic anthocyanidins the pigments in fruits and vegetables Life Sci 76(13)1465-72 Annema N Heyworth JS McNaughton SA Iacopetta B Fritschi L 2011 Fruit and vegetable consumption and the risk of proximal colon distal colon and rectal cancers in a case-control study in Western Australia J Am Diet Assoc 111(10)1479-90 OBESITY 1 Obesity and being overweight is linked to cancers of the colon endometrium kidney oesophagus pancreas gall bladder rectum and also postmenopausal breast cancer (Parkin and Boyd 2011) 2 Obesity and being overweight cause 17000 cancers in the UK every year (Parkin and Boyd 2011) 3 Increased BMI and obesity are linked to increased chances of developing primary liver cancer (Chen et al 2012) 4 Obese individuals are at 140 increased risk of oesophageal cancer (Parkin and Boyd 2011) 5 Oestrogen hormone levels are linked to cancer when found in excess studies have shown that obese women have twice the amount of oestrogen and are therefore are higher risk of post menopausal breast cancer (Huang et al 1997) 6 Insulin is found at high levels in people with cancer it is known that obese people have a higher level of insulin secreted and this may increase the risk of cancer (Stolzenberg-Solomon et al 2005) 7 An increase in weight of 25kg can increase the risk of breast cancer by 45 (Eliassen et al 2006) 8 Obesity can increase the risk of bowel cancer by 50 whereas familial bowel cancer risks in families with one affected individual are only 20 (NHS) 9 A 5 kgm2 increase in BMI in men and women increased the risk of renal cancer by 24 and 34 respectively (Renehan et al 2008) 10 A 10cm increase in waist size can increase colorectal cancer risk in men by 33 and in females by 16 (Larsson and Wolk 2007) 11 Between ages of 20-50 the risk of cancer doubles with an increase in weight of 20kg (Eliassen et al 2006) 12 Being overweight can increase the risk of pancreatic cancer by 24 (World Cancer Research Fund)

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Summary advice Obesity and being overweight are very dangerous as they are not easy to control Lifestyle and stress can be huge factors that decide our eating habits Eating smaller portions and exercising on a regular basis are of great importance Quick fixes are not recommended as people can return to their bad eating habits and put their weight back on Ensuring that high calorie food is replaced for healthier options is essential Ensuring a healthy balanced diet is good ensure red meat alcohol and sugary snacks are taken in moderation Try eating more fresh fruit and vegetables The Expert Review guidelines from the World Cancer Research Fund suggest that the BMI for men and women should be between 185-249 References Parkin DM and Boyd L 2011 8 Cancers attributable to overweight and obesity in the UK in 2010 British Journal of Cancer 105 S34ndashS37 Chen Y Wang X Wang J Yan Z Luo J 2012 Excess body weight and the risk of primary liver cancer An updated meta-analysis of prospective studies Eur J Cancer Huang Z Hankinson SE Colditz GA Stampfer MJ Hunter DJ Manson JE Hennekens CH Rosner B Speizer FE Willett WC 1997 Dual effects of weight and weight gain on breast cancer risk JAMA 278(17)1407-11 Eliassen AH Colditz GA Rosner B Willett WC Hankinson SE 2006 Adult weight change and risk of postmenopausal breast cancer JAMA 296(2)193-201 Stolzenberg-Solomon RZ Graubard BI Chari S Limburg P Taylor PR Virtamo J Albanes D 2005 Insulin glucose insulin resistance and pancreatic cancer in male smokers JAMA 294(22)2872-8 httpwwwnhsukConditionsCancer-of-the-colon-rectum-or-bowelPagesCausesaspx Renehan AG Tyson M Egger M Heller RF Zwahlen M 2008 Body-mass index and incidence of cancer a systematic review and meta-analysis of prospective observational studies Lancet 371(9612)569-78 Larsson SC Wolk A 2007 Obesity and colon and rectal cancer risk a meta-analysis of prospective studies Am J Clin Nutr 86(3)556-65 RED MEAT 1 36000 people in Britain are diagnosed with bowel cancer each year and around 16500 die from it This makes it Britainrsquos second biggest killer after lung cancer (World Cancer Research Fund) 2 An intake of 120g of red meat per day can increase the risk of colorectal cancer by 24 (Norat et al 2006) 3 An intake of 30g processed meat a day can increase colorectal cancer risk by 36 (Norat et al 2006)

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4 Meat that is fried and has a heavily browned surface can increase rectal cancer risk by 6 times (Gerhardsson et al 1991) 5 One portion of red meat (beef lamb or pork) a day can increase risk of death by 13 cardiovascular disease 18 and cancer mortality by 10 One portion is the equivalent in size to a deck of cards (Pan et al 2012) 6 One portion of processed meat a day can increase risk of death by 20 cardiovascular disease 21 and cancer mortality by 16 This is the equivalent of one hot dog or two rashes of bacon (Pan et al 2012) 7 It is advised that any processed meat (meat that is smoked preserved with salt or chemical preservatives ham salami and some sausages) is eaten very rarely if not at all This is because the preservatives can create carcinogens chemicals that cause cancer (World Cancer Research Fund) 8 The safe amount of red meat per week is 500g (cooked meat which is the same as 700g of uncooked meat) This could be divided into 3 meals over the week of 150g or six meals around 80g each Any more then this significantly increases your risk of bowel cancer (World Cancer Research Fund) 9 In familial gastric cancers it was found that those with a high consumption of red meat and a genetic defect (microsatellite instability) were 25 times more likely to get gastric cancer (Palli et al 2001) Summary advice The World Cancer Research Fund suggests that red meat and processed meat consumption should be kept to a minimum Several meals in the week could be meat free and minced Quorn could be used as a good alternative to minced beef Eating vegetables and whole grains are not only protective against cancer but they could be eaten instead eating large portions of meat Poultry and fish have not been found to have any links to cancer therefore they may be healthier meat alternatives Beans and pulses such as chickpeas and lentils could be used to create interesting dishes in opposition to eating red meat Eggs cottage cheese and houmous are also good source of protein that could act as replacements for red meat dishes References Norat T Lukanova A Ferrari P Riboli E 2002 Meat consumption and colorectal cancer risk dose-response meta-analysis of epidemiological studies Int J Cancer 2)241-56 Gerhardsson de Verdier M Hagman U Peters RK Steineck G Overvik E 1991 Meat cooking methods and colorectal cancer a case-referent study in Stockholm Int J Cancer 49(4)520-5 Pan A Sun Q Bernstein AM Schulze MB Manson JE Stampfer MJ Willett WC Hu FB 2012 Red meat consumption and mortality results from 2 prospective cohort studies Arch Intern Med 172(7)555-63

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Red and processed meat Finding the balance for cancer prevention World Cancer Research Fund Palli D Russo A Ottini L Masala G Saieva C Amorosi A Cama A DAmico C Falchetti M Palmirotta R Decarli A Mariani Costantini R Fraumeni JF Jr 2001 Red meat family history and increased risk of gastric cancer with microsatellite instability Cancer Res 61(14)5415-9 THE USE OF ASPIRIN IN CANCER PREVENTION 1 Studies have shown that taking aspirin over a number of years can affect oesophageal pancreatic brain lung stomach colorectal prostate (Rothwell et al 2011) and breast cancer (Holmes et al 2010) 2 In a study containing 1121 participants it was found that those taking 81mg of aspirin a day for at least a year had the risk of colorectal adenomas reduced by 19 (Baron et al 2003) 3 A study containing a cohort of 498 people showed that taking 75mg aspirin daily for a year or longer decreased the risk of breast cancer by 33 (Garciacutea Rodriacuteguez and Gonzaacutelez-Peacuterez 2004) 4 In a study with 871 carriers of Lynch syndrome taking 600mg aspirin over 56 months decreased the risk of colorectal cancer by 63 (Burn et al 2011) 5 A study containing 19934 women who took 100mg of aspirin every other day for an average of 10 years found that lung cancer risk was decreased by 22 (Cook et al 2005) 6 A study with 10931 men and 7196 women found that 325mg daily doses of aspirin decreased prostate cancer risk by 19 and colorectal cancer risk by 22 (Jacobs et al 2007) 7 Taking low doses (75-100mg) of aspirin has been shown to give a 10 reduction in overall cancer incidence that begins during the first 10 years of treatment (Thun et al 2012) 8 Of 17285 Participants taking 75mg or greater doses gave rise to a decrease in risk of 36 in cancer with distant metastases (Rothwell et al 2012) 9 A 24 year study of 1537 women who were taking 325mg aspirin for 2 or more times a week were found to have increased gastrointestinal bleeding by 43 (Huang et al 2011) 10 Another study with 1024 patients investigating the side effects of aspirin found that in some people micro-bleeds in the brain can occur as a result of taking aspirin (Vernooij et al 2009) Summary advice Studies show that taking aspirin can be beneficial in certain cancers The effective dose can change depend on which cancer a person is trying to prevent In general the use of aspirin is most effective if taken over a period of 3 to 5 years or longer If you are thinking of taking aspirin to prevent a cancer please talk to you specialist in regards to the options you have and the steps that you should take

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References Baron JA Cole BF Sandler RS Haile RW Ahnen D Bresalier R McKeown-Eyssen G Summers RW Rothstein R Burke CA Snover DC Church TR Allen JI Beach M Beck GJ Bond JH Byers T Greenberg ER Mandel JS Marcon N Mott LA Pearson L Saibil F van Stolk RU 2003 A randomized trial of aspirin to prevent colorectal adenomas N Engl J Med 348(10)891-9 Burn J Gerdes AM Macrae F Mecklin JP Moeslein G Olschwang S Eccles D Evans DG Maher ER Bertario L Bisgaard ML Dunlop MG Ho JW Hodgson SV Lindblom A Lubinski J Morrison PJ Murday V Ramesar R Side L Scott RJ Thomas HJ Vasen HF Barker G Crawford G Elliott F Movahedi M Pylvanainen K Wijnen JT Fodde R Lynch HT Mathers JC Bishop DT CAPP2 Investigators 2011 Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer an analysis from the CAPP2 randomised controlled trial Lancet 378(9809)2081-7 Garciacutea Rodriacuteguez L A and Gonzaacutelez-Peacuterez A 2004 Risk of breast cancer among users of aspirin and other anti-inflammatory drugs British Journal of Cancer 91 525ndash529 Cook NR Lee IM Gaziano JM Gordon D Ridker PM Manson JE Hennekens CH Buring JE 2005 Low-dose aspirin in the primary prevention of cancer the Womens Health Study a randomized controlled trial JAMA 294(1)47-55 Jacobs EJ Thun MJ Bain EB Rodriguez C Henley SJ Calle EE (2005) A large cohort study of long-term daily use of adult-strength aspirin and cancer incidence J Natl Cancer Inst 99608 Thun MJ Jacobs EJ Patrono C 2012 The role of aspirin in cancer prevention Nat Rev Clin Oncol 2012 Apr 3 doi 101038nrclinonc2011199 [Epub ahead of print] Rothwell PM Wilson M Price JF Belch JF Meade TW Mehta Z 2012 Effect of daily aspirin on risk of cancer metastasis a study of incident cancers during randomised controlled trials Lancet 379(9826)1591-601 Huang ES Strate LL Ho WW Lee SS Chan AT 2011 Long-term use of aspirin and the risk of gastrointestinal bleeding Am J Med124(5)426-33 Vernooij MW Haag MD van der Lugt A Hofman A Krestin GP Stricker BH Breteler MM 2009Use of antithrombotic drugs and the presence of cerebral microbleeds the Rotterdam Scan Study Arch Neurol 66(6)714-20 TAMOXIFEN AND AROMATASE INHIBITORS 1 In a study with 13 388 women those taking 20mg tamoxifen a day over 5 years were found to have a 49 reduction in invasive breast cancer (Fisher et al 1998) 2 In a study with 13388 women those taking 20mg tamoxifen a day over 5 years were found to have a 50 reduction in non-invasive breast cancer (Fisher et al 1998) 3 A five year study following 10000 women found that taking tamoxifen increased the risks of thromboembolisms (blood clots that can obstruct the flow in blood vessels) by 7 times (Meier and Jick 1998)

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4 A seven years study with 13388 women found that the risk of endometrial cancer was increased by 29 when taking 20mg of tamoxifen daily (Fisher et al 2005) Endometrial cancers of stage III and IV occurred more frequently in long-term tamoxifen users 2 years or more (174 risk) than in non-users (54 risk) (Bergman et al 2000) 5 The risks of endometrial cancer were 2 times more for 2-5 years of tamoxifen use and 69 times greater for at least five years compared with non-users (Bergman et al 2000) 6 Three year endometrial-cancer-specific survival was significantly worse for long-term tamoxifen users than for non-users (76 for 5 years or more 85 2-5 years and 94 for non-users) (Bergman et al 2000) 7 Postmenopausal breast cancer patients who have been treated for 12 months or more with tamoxifen (40mg 30mg or less) daily are at a 23 times increased risk of endometrial cancer that for people who have never used it (Van Leeuwen et al 1994) 8 Aromatase is an enzyme that makes oestrogen a chemical needed for tumours to grow 4560 women exemestane (aromatase inhibitor) taking were followed for 35 months the annual incidence for invasive breast cancer was decreased from 55 to 19 (Goss et al 2011) 9 Anastrozole (aromatase inhibitor) compared with tamoxifen with women taking the drugs over 3-years success (prevention of breast cancer) of anastrozole was 912 versus 893 for tamoxifen in hormone receptor-positive patients (Baum et al 2002) References van Leeuwen FE Benraadt J Coebergh JW Kiemeney LA Gimbregravere CH Otter R Schouten LJ Damhuis RA Bontenbal M Diepenhorst FW et al1994Risk of endometrial cancer after tamoxifen treatment of breast cancer Lancet 343(8895)448-52 Bergman L Beelen ML Gallee MP Hollema H Benraadt J van Leeuwen FE 2000 Risk and prognosis of endometrial cancer after tamoxifen for breast cancer Comprehensive Cancer Centres ALERT Group Assessment of Liver and Endometrial cancer Risk following Tamoxifen Lancet 356(9233)881-7 Fisher B Costantino JP Wickerham DL Redmond CK Kavanah M Cronin WM Vogel V Robidoux A Dimitrov N Atkins J Daly M Wieand S Tan-Chiu E Ford L Wolmark N 1998 Tamoxifen for prevention of breast cancer report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study J Natl Cancer Inst 90(18)1371-88 Meier CR Jick H 1998 Tamoxifen and risk of idiopathic venous thromboembolism Br J Clin Pharmacol 45(6)608-12 Fisher B Costantino JP Wickerham DL Cecchini RS Cronin WM Robidoux A Bevers TB Kavanah MT Atkins JN Margolese RG Runowicz CD James JM Ford LG Wolmark N 2005 Tamoxifen for the prevention of breast cancer current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study J Natl Cancer Inst 97(22)1652-62 Goss PE Ingle JN Aleacutes-Martiacutenez JE Cheung AM Chlebowski RT Wactawski-Wende J McTiernan A Robbins J Johnson KC Martin LW Winquist E Sarto GE Garber JE Fabian CJ Pujol P Maunsell E Farmer P Gelmon KA Tu D Richardson H NCIC CTG MAP3 Study Investigators 2011 Exemestane for breast-cancer prevention in postmenopausal women N Engl J Med 364(25)2381-91

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Baum M Budzar AU Cuzick J Forbes J Houghton JH Klijn JG Sahmoud T ATAC Trialists Group 2002 Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer first results of the ATAC randomised trial Lancet 359(9324)2131-9 BREASTFEEDING 1 A review of 7000 previous studies has shown that breastfeeding can reduce womenrsquos risks of breast cancer by 43 (Collaborative group on hormonal factors in breast cancer 2002) 2 Breastfeeding can also benefit the baby by increasing immunity and decreasing the likelihood of obesity both of which are factors that can prevent a range of future illnesses including cancer within the child (World Cancer Research Fund 2007) 3 Breastfeeding for 6 months and decreasing the risk of cancer by 4 would potentially result in 1000 fewer cases of breast cancer in the UK each year (Cancer Research UK 2001) 4 A study suggested that for each birth a motherrsquos risk of breast cancer decreases by 7 (Collaborative group on hormonal factors in breast cancer 2002) 5 A study with 685 women with inherited significant alterations in BRCA1 found that breastfeeding for up to a year or more caused a 45 reduction in the risk of breast cancer (Jernstroumlm et al 2004) Summary advice Experts say that breastfeeding every child exclusively for six months and complementarily for a further 6 months is advisable This means for the first 6 months after birth the baby should only be give breast milk for food after this stage breast milk may still be given alongside other foods This should also be repeated with all babies This benefits the mother and the baby providing the mother with hormonal changes that prevent cancer and giving the baby a strong immunity and lower likelihood of obesity in later life References Collaborative Group on Hormonal Factors in Breast Cancer 2002 Breast cancer and breastfeeding collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries including 50302 women with breast cancer and 96973 women without the disease Lancet 360(9328)187-95 Jernstroumlm H Lubinski J Lynch HT Ghadirian P Neuhausen S Isaacs C Weber BL Horsman D Rosen B Foulkes WD Friedman E Gershoni-Baruch R Ainsworth P Daly M Garber J Olsson H Sun P Narod SA 2004 Breast-feeding and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers J Natl Cancer Inst 96(14)1094-8

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SALT INTAKE 1 Salt intake is linked to 14 of cancers in the UK (World Cancer Research Fund 2007) 2 Salt salty food salted foods increase stomach cancer risk (World Cancer Research Fund 2007) 3 Ensure that you keep your salt intake to less than 6g a day or less than 24g of sodium (Davies et al 2011) 4 In a study of 5576 people a high salt intake was linked to a higher mortality from stomach cancer 61 in men and 54 in women (Joossens et al 1996) References Experts Review 2007 World Cancer Research Fund Davies NJ Batehup L and Thomas R 2011 The role of diet and physical activity in breast colorectal and prostate cancer survivorship a review of the literature British Journal of Cancer 105 S52ndashS73 Joossens JV Hill MJ Elliott P Stamler R Lesaffre E Dyer A Nichols R Kesteloot H 1996 Dietary salt nitrate and stomach cancer mortality in 24 countries European Cancer Prevention (ECP) and the INTERSALT Cooperative Research Group Int J Epidemiol 25(3)494-504 EXERCISE 1 Exercise can reduce the risk of bowel postmenopausal breast cancer and endometrial cancer (World Cancer Research Fund 2007) 2 More than 3 of breast cancers more than 5 of colon cancers and around 4 of endometrial cancers in 2010 were linked to people doing fewer than 150 minutes of physical activity per week (Parkin 2010) 3 12 of Bowel cancer cases in the UK could be prevented by people becoming more active and participating in exercise (World Cancer Research Fund 2007) 4 Prostate cancer mortality is reduced by 30 by incorporating exercise into the lifestyle (Thomas and Davies et al 2007) 5 Incorporating exercise into the lifestyle can reduce the breast cancer recurrence risk by 40 (Thomas and Davies et al 2007) 6 Doing six hours of physical activity a week can reduce the risk of death from bowel cancer by 50 (Thomas and Davies et al 2007) 7 A meta-analysis found that those people who participated in physical activity were at 23 less risk of lung cancer (Tardon et al 2005) 8 Women who exercise may have a 20-30 decreased risk of endometrial cancer (Monninkhof et al 2007)

Page | 14

9 A study collating previous research found that people who regularly exercise were 16 less likely to develop bowel polyps (Wolin et al 2011) 10 Those who regularly exercise are 35 less likely to develop large or advanced polyps (Wolin et al 2011) Summary advice Exercise is important for health current guidelines state that everyone should aim to do a minimum of 30 minutes of activity a day It is not necessary to have to go to a gym Walking running sports or swimming may be as beneficial The more you can do the more of a benefit it will be Try spending less time in front of the television and computer and do more active things like gardening which is more physical Current guidelines state adults 19 or over should do 150 minutes a week involving moderate physical activity Two days a week should be for muscle strength and activity should be in 10 minute or longer intervals Children 5-18 should do 60 minutes of vigorous activity a day and children below 5 should do 180 minutes of activity a day References Bekkering T Beynon R Davey Smith G Davies A Harbord R Sterne J Thomas S Wood L (2006) A systematic review of RCTs investigating the effect of dietal and physical activity interventions on cancer survival updated report World Cancer Research Fund Thomas R Davies N 2007 Lifestyle during and after cancer treatment Clin Oncol (R Coll Radiol) 19(8)616-27 Tardon A Lee WJ Delgado-Rodriguez M Dosemeci M Albanes D Hoover R Blair A 2005 Leisure-time physical activity and lung cancer a meta-analysis Cancer Causes Control 16(4)389-97 Monninkhof EM Elias SG Vlems FA van der Tweel I Schuit AJ Voskuil DW van Leeuwen FE TFPAC 2007 Physical activity and breast cancer a systematic review Epidemiology 18(1)137-57 Wolin KY Yan Y Colditz GA 2011 Physical activity and risk of colon adenoma a meta-analysis Br J Cancer 104(5)882-5 VITAMINS and SPICES 1 Folate in the diet can reduce pancreatic cancer risk by 23 (WCRF 2007) 2 A high zinc diet was found to be related to a lower mortality from prostate cancer and showed to decrease the risk of death by 36 (Epstein et al 2011) Zinc can be found in oysters sesame seeds peanuts and a range of other foods 3 A study found that women with low levels of vitamin D had a 71 greater chance of recurrence and a 60 greater risk of death (Goodwin et al 2009) 4 Curcumin a chemical found in turmeric was found to be useful in oesophageal cancer cells as studies found that it kills cancer cells within 24 hours (OSullivan-Coyne et al 2009) 10mg a day had no side effects on any patients (Aggarwal et al 2003)

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5 Curcumin has antioxidant and anti-inflammatory properties lab tests shows that colon cancer tumours were reduced by greater than 57 with the use of the spice as a drug (Rao et al 1995) References Experts Review 2007 World Cancer Research Fund Epstein MM Kasperzyk JL Andreacuten O Giovannucci EL Wolk A Haringkansson N Andersson SO Johansson JE Fall K Mucci LA 2011 Dietary zinc and prostate cancer survival in a Swedish cohort Am J Clin Nutr 93(3)586-93 Goodwin PJ Ennis M Pritchard KI Koo J Hood N 2009 Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer J Clin Oncol 27(23)3757-63 OSullivan-Coyne G OSullivan GC ODonovan TR Piwocka K McKenna SL 2009 Curcumin induces apoptosis-independent death in oesophageal cancer cells Br J Cancer 101(9)1585-95 Aggarwal BB Kumar A Bharti AC 2003 Anticancer potential of curcumin preclinical and clinical studies Anticancer Res 23(1A)363-98 Rao CV Rivenson A Simi B Reddy BS 1995 Chemoprevention of colon carcinogenesis by dietary curcumin a naturally occurring plant phenolic compound Cancer Res 55(2)259-66 COMBINED ORAL CONTRACEPTIVE PILL 1 Individuals with inherited significant BRCA1 gene alterations who used oral contraceptive (oestrogen and progesterone) before the age of 30 had a 29 increased risk of cancer (Narod et al 2002)

2 Individuals with inherited significant BRCA1 gene alterations who used oral contraceptive (oestrogen and progesterone) for a period of 5 years or more had a 33 increased risk of cancer (Narod et al 2002) References Narod SA Dubeacute MP Klijn J Lubinski J Lynch HT Ghadirian P Provencher D Heimdal K Moller P Robson M Offit K Isaacs C Weber B Friedman E Gershoni-Baruch R Rennert G Pasini B Wagner T Daly M Garber JE Neuhausen SL Ainsworth P Olsson H Evans G Osborne M Couch F Foulkes WD Warner E Kim-Sing C Olopade O Tung N Saal HM Weitzel J Merajver S Gauthier-Villars M Jernstrom H Sun P Brunet JS 2002 Oral contraceptives and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers J Natl Cancer Inst 94(23)1773-9

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HORMONE REPLACEMENT THERAPY 1 Hormone replacement therapy can cause ovarian uterine and breast cancer (Parkin 2010) 2 Hormone replacement therapy is responsible for 11 of all cancers in women and 05 of all cancers in the UK This is around 1700 cases a year (Parkin 2010)

3 Women using hormone replacement therapy have a 66 increased risk of breast cancer but this risk decreases after 5 years of stopping the medication (Cancer Research UK) 4 948000 women were studied for 5-6 years the findings suggested that those on HRT had a 20 increased risk of ovarian cancer and a 23 increased risk of death (Beral et al 2007) 5 Women on combined HRT have a higher breast cancer risk than the oestrogen-only HRT (NHS) 6 Oestrogen-only HRT may protect against breast cancer after hysterectomy (Anderson et al 2012) 7 The risk of breast cancer after surgical menopause is decreased by 60 and is safe for BRCA1 and BRCA2 mutation carriers (Rebbeck et al 2005) 8 A study found that using Oestrogen only HRT resulted in five breast cancers in 1000 over five years Using oestrogen-progestagen HRT over the same amount of time resulted in 19 additional cancers per 1000 users (Beral et al 2003) References Beral V Million Women Study Collaborators Bull D Green J Reeves G 2007 Ovarian cancer and hormone replacement therapy in the Million Women Study Lancet 369(9574)1703-10 Anderson GL Chlebowski RT Aragaki AK Kuller LH Manson JE Gass M Bluhm E Connelly S Hubbell FA Lane D Martin L Ockene J Rohan T Schenken R Wactawski-Wende J 2012 Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy extended follow-up of the Womens Health Initiative randomised placebo-controlled trial Lancet Oncol 476-86 Rebbeck TR Friebel T Wagner T Lynch HT Garber JE Daly MB Isaacs C Olopade OI Neuhausen SL van t Veer L Eeles R Evans DG Tomlinson G Matloff E Narod SA Eisen A Domchek S Armstrong K Weber BL PROSE Study Group 2005 Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers the PROSE Study Group J Clin Oncol 23(31)7804-10 Beral V Million Women Study Collaborators 2003 Breast cancer and hormone-replacement therapy in the Million Women Study Lancet 362(9382)419-27