Cancer

JESSICA GRATIGNY SILAS HARNESS LINDSEY OWNBY MOLLY CHAFFIN JENNIFER BAILEY

Cancer Today
Cancer can be described as uncontrolled growth of

abnormal body cells. Cancer occurs when cellular DNA is damaged, but the cell does not repair itself or die but continues to reproduce unneeded cells.

Cancer Today
Cancer is the 2nd leading cause of death in the USA Accounts for nearly 1 in 4 deaths Lung cancer Greatest risk factor is cigarette use and other tobacco-related products Accounts for about 14% of cancer diagnosises Largest percentage of cancer-related deaths (~27%) Death rates have decreased since the early 1990s

American Cancer Society http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf

Methods of Cancer Prevention

Healthy lifestyle Diet

Variation and moderation Decreased alcohol consumption and tobacco use

Lifestyle

Physical activity

Each year, more than 572,000 Americans die of

cancer; about one-third of these deaths are linked to poor diet, physical inactivity, and carrying too much weight.
American Cancer Society http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf

Current Methods of Cancer Treatment

Surgery Chemotherapy Radiation

Vitamin D and Cancer Overview

1,25-dihydroxyvitamin D has been shown to decrease

tumor invasion, metastasis, and angiogenesis in many cancer models of tobacco-related cancer Tobacco smoke chemicals may influence vitamin D metabolism and function, and conversely vitamin D may modify the carcinogenicity of tobacco smoke chemicals Reduced concentrations of vitamin D are associated with increased proliferation, decreased apoptosis, and inhibited differentiation in cells

Calcium and Cancer Overview

Although the exact mechanism is unclear, Calcium

supplementaion has been shown to decrease the risk of cancer. According to the National Cancer Institute, Calcium may indirectly reduce cell proliferation and improve cell signaling, causing cancer cells to differentiate and/or die.

http://www.cancer.gov/cancertopics/factsheet/prevention/calcium

Introduction of Tobacco-Related Study

Study design

Population
n= Duration

Follow-up method/time

Objective for Tobacco-Related Cancer Study

Tobacco smoke chemicals may influence vitamin D

metabolism and function, and conversely vitamin D may modify the carcinogenicity of tobacco smoke chemicals Hypothesis: lower plasma 25-hydroxyvitamin D [25(OH)D] is associated with a higher risk of tobacco-related cancer in the general population The endpoint of this study was incident tobaccorelated cancer

Ascertain information on other cancers The most common cancer associated with smoking is lung

Maybe insert Table 1 from the study here?

Method for Tobacco-Related Study

Method of selection

Plasma sample collection method

Questionnaires Tobacco consumption Alcohol consumption Lifestyle BMI Statistical analyses Cox proportional hazards regression (95% CI)

Results from Tobacco-Related Study

Associations with low 25(OH)D

Insert Table 2?

Possible Limitations
Participant bias

Degree of sun exposure Seasonal variation

Delay in measurement

Residual confounding Observational shows no causality, only associations

Strengths of the Study

Homogenous population

28 year follow up
Detailed smoking history Strong statistical power

Significant Findings of Tobacco-Related Study

Lower concentrations of 25(OH)D were associated

with a higher risk of tobacco-related cancer but not other cancers Biologic plausibility Smoking is associated with reduced 25(OH)D concentrations

Reduced concentrations of vitamin D are associated with increased proliferation, decreased apoptosis, and inhibited differentiation in both normal and neoplastic cells

Introduction of CaD RCT

Study design

Population
n= Duration

Follow-up method/time

Objective for CaD RCT

Associations have been established for high calcium

intake and reduced cancer risk.

Luminal effect of high calcium intake provided a plausible mechanism

Determine the efficacy of calcium alone and calcium

plus vitamin D in reducing incident cancer risk of all types

Null hypothesis was that there would be no difference in all cancer incidence between the 3 calcium and vitamin D tx groups

The primary outcome was fracture incidence and the

principal secondary outcome was cancer incidence

Method for CaD RCT

Recruited on a population-based sample Random telephone dialing of all listed numbers in the counties Inclusion criteria Subjects were randomly assigned to receive 1,400-

1,500 mg supplemental calcium/D alone (Ca-only), supplemental calcium plus 1,100 IU vitamin D3/d (Ca + D), or placebo Serum samples taken Primary designed endpoints of the study concerned skeletal status and the calcium economy

Methods of CaD RCT

Statistical analyses Survival analysis used to plot and evaluate differences in cancer incidence Various logistic regression models were developed to estimate relative risk of being in the cancer group at conclusion of the trial and to explore the determinants of observed rates of cancer incidence

Results of CaD RCT

50 women developed nonskin cancer during the

course of the study

13 in first year 37 thereafter

Table 1

While the findings for the effect of vitamin D are not

considered a chance association, it is uncertain whether the marginal calcium effect represents a chance occurrence

Few other calcium trials have cancer outcome as the endpoint

Explain the possible method of calcium on cancer tx

Significant Findings of CaD RCT

Strengths of CaD RCT

Population based

Low drop out rate

High level of tx adherence (compliance)

Weaknesses of CaD RCT

Cancer was not the principal outcome variable

Mechanisms are not well known at this time

Several of the effects of vitamin D in cancer model

systems require concentrations of of calcitriol substantially higher than can be achieved physiologically in intact humans aw3

Conclusion from Studies

Unsolved Problems in Cancer Research

No cure

Tx is hard on patients

Future Research Needed

Understand tx mechanisms

Take Home Message

Sources