ASCO Update 3 – On cancer prevention and the language of cancer

After yesterday`s heavy medical sessions on kidney cancer specifically, today we are reporting on some of the more general patient and survivor care sessions at the ASCO confeerence. First up are some dietary issues, followed by a recap of the session on communicating about cancer.

Fish Oil and Cancer Prevention —  What is  the Evidence for Omega3?

Lots of us have heard about  the importance of Omega 3s in our diet. What do the cancer researchers have to say?

Discussion was about creating a better balance between Marine Omega 3 Fatty Oils (found in salmon*, flaxseed, canola oil, fish oil supplements*) versus Omega 6 Fatty Acids (as found in corn products and meat).

A 1:1 Omega 3:Omega 6 ratio is ideal, but today we tend to live at a 1:15 ratio of Omega 3:Omega 6.

Why does this matter? Omega 3 resolves inflammation whereas Omega 6 is pro-inflammatory. The major question is whether this huge shift in what we eat is responsible for today’s chronic inflammatory diseases including cancer. For example, 50 years ago Inuit populations had a 2.5:1 ratio of Omega 3:Omega 6 with little cancer or heart disease. Today that ratio is closer to 1:6 and figures are beginning to resemble the rest of North America with rates of breast and colon cancer and heart disease on the rise.

The bottom line is that most North Americans get too little Omega 3 and too much Omega 6 in our diets. To correct this imbalance we need to increase our intake of cold water oily fish or consider fish oil supplements with EPA and DHA. Recommended dosage 250-500mg daily (American Heart Association).

As for Omega3 and the cancer connection. Evidence points to colon cancer prevention in women, not in men, who report 3 servings per week (fewer polyps). In a study of 35,000 post-menopausal women, current fish oil users reported a 35% reduction in breast cancer. In animal trials, Omega 3 oils seem to modulate biomarkers such as AKT/mTOR in our bodies. More research needs to be done to support the use of Omega 3s for cancer prevention, and in cancer survivorship.


Green Tea as ChemoPrevention for GU Malignancies

First off, researchers noted that Green Tea preparation is key (to release Green Tea polyphenols = GTP). A cup of green tea contains 100 mg polyphenols along with 50 mg caffeine.

In prostate cancer, there seems to be a significant correlation between consumption and reduced incidence. In bladder cancer the evidence is weak — some studies show correlation, others show none. In other diseases, there is evidence of anti-cancer effects or “anti-proliferation” effects.

Part of the challenge is that animal studies are based upon continuous drinking of the green tea (versus in humans where some studies have had participants drink the tea 6x per day).  Bottom line: is there a role for green tea polyphenols in cancer prevention? No firm evidence currently, but possibly in the future.


Soy Isoflavones and Breast Cancer

Essentially there are very mixed results. Some studies have shown reduction in risk of recurrence. Others have suggested safety concerns for soy supplements for women at high risk for breast ca. Clinical trials have not shown definitively a positive or adverse effect. Some question whether soy intake is a marker of other lifestyle factors that may be confounding the results.


Communicating Cancer — the Power of Words

In a separate session, we focused on the “power of words” in communicating about cancer. Don Dizon, who writes a blog on the ASCO Connection website, spoke about the negativity surrounding the  “War” on cancer (in which death = defeat?). We often read obituaries about someone who “lost her battle” or “bravely fought”. The trouble is, if you’re in a “fight”, you win or you lose.

Other dangerous words we hear: “at least you caught it early”. We have all kinds of assumptions about what these words mean. Do they mean “excellent prognosis” or “you won’t need treatment” or “you don’t need to worry”? Means different things to different people.

Another phrase we have all heard at some point: “Go and Live Your Life!”. What is that supposed to mean? How to deal with the anxiety, the fear of recurrence, expectations?

What patients really want is more empathy, more trust. Requires some physicians to slow down, recognize emotional cues, and acknowledge the emotion as well as the facts. In a taped study of 398 metastatic oncology visits, only 11% (!) contained an explicit empathetic statement.

As patients we don’t remember everything you tell us, but you can ask us to rephrase things back to you. For example, if you said “tell me what you’re going to tell your best friend/spouse so that I will know if I’ve been clear…”.  Sometimes you tell us too much information and we might be focusing on the wrong detail or have placed news in the wrong context.

Bottom line: We all need to appreciate the work of being a patient (and a caregiver) — a few words of positive reinforcement go a long way.


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