Comprehensive Cancer Care: Integrating Complementary & Alternative Therapies New Therapies in Breast Cancer- Antioxident use during chemotherapy & radiation, green tea Presenters: Charles B. Simone, MD Dr. Simone: My name is Dr. Charles Simone. I’m a medical oncologist trained at the National Cancer Institute, and also a radiation oncologist trained at the University of Pennsylvania. I got involved in this field a while ago when I got a phone call from a cancer nutritionist. That was in 1981. Since 1971 when the war was declared on cancer, there are so many thousand deaths – 337; now in 1998 there are well over 560,000 deaths. This is an important slide, very busy, but briefly I want to show you a few things. This is cancer survival, 1930, 1995. One cancer has gone up dramatically, lung cancer, no surprise. One cancer survivorship has come down, stomach cancer. With the advent of refrigeration in the 20’s and 30’s, less food additives, less stomach cancer. This data is published every year by the American Cancer Society. They obtain the data from the National Cancer Institute. The key is that all these other survival curves are horizontal, which means that there’s been no significant progress in the treatment of most cancers, adult. This is the curve culled out for breast cancer, 1930. It means a woman today who gets breast cancer will live as long as a woman who got it in 1930 – despite radioactive materials, despite combination chemotherapies in the 60’s, despite immunotherapies in the 70’s – essentially no difference in survivorship since 1930. We know that breast cancer is related to a high-fat diet as the key factor, and many other factors you’ve heard already. We know a lot about this issue because of the Japanese data. Women in Japan, the older generation, have much less breast cancer than we do. Younger Japanese women do not. They have the same rates that we have. When you look at their rates of cancer, the number of calories derived from fat is only 20% compared to our 40% dietary fat calories. When they come into this country, after a mere 20 years they have the same rate of colon cancer, and after only two generations, the same rate of breast cancer. Likewise, another corollary to this information is that the Japanese women who do get breast cancer live much longer than our women do. Why? Because they’re on a lower fat diet, higher fiber, and few other risk factors that we’ll talk about. Participant: What about green tea? Dr. Simone: Green tea, black tea, that’s a part of it, yes. We know that certain nutrients can be used to prevent disease based on free radical formation, and the neutralization of free radicals. Mother nature gave us some natural protection, like the large protein coat around every cell, certain enzymes and large vitamin E molecules. We had natural protectors against it, but free radicals now are known to be causing all these illnesses, including cancers. We developed a ten-point plan a number of years ago to show 1) we can reduce the risk of getting cancer and heart disease, and 2) we can actually decrease the breast cancer recurrence rates. Let’s go through that. This is a very key piece of information. The survival curve I showed you before, from 1930 to the present, is pretty much a flat line. Whether a woman has hormonal therapy or chemotherapy, she will live about the same length of time. The life span is unchanged whether you get chemotherapy. This is not new. In 1991 major articles came out in Lancet to discuss this. When we looked at all the data, we found out no matter what systemic therapy you had, if you change your lifestyle, you can change the outcome. If lifestyle changes are implemented, you will increase life span. We know that certain factors influence the immune system. Nutritional factors can enhance it by eating a low-fat, high-fiber diet, antioxidants, exercise, stress modification, a loving situation, clean air, pure water. Corollary, things that suppress the immune system are shown there. I’m just trying to stress the important factors. This is point one of our ten-point plan. Maintain an ideal weight. We know that people who are overweight will get a higher risk of certain cancers including breast cancer, but also have a higher risk of recurrence rates. Maintain an ideal weight no matter what the issue. Much misinformation is given to patients. One of them is, don’t lose weight as a cancer patient. That’s wrong. If you’re overweight as a breast cancer patient you should bring yourself down to the ideal weight by eating a low-fat diet – fish, poultry without the skin, little or no red meat, little or no dairy products unless you need dairy, then use skim products. If you decrease the fats, you’ll decrease risk and weight. You need to get around a 20% diet in fats compared to what we’re normally eating, about a 40% diet. This is simply how to read a food label, a cute little cartoon I saw a long time ago. It says, "Stay away from them. They’re very dangerous, loaded with cholesterol." We continue with nutritional factors. High fiber is critical. Four or five vegetables, two or three fruits a day. Vitamins and minerals. People should be taking nutrients during chemotherapy, radiation therapy. We’ll get into the actual data for that. Smoking. Anyone who smokes should not be smoking, as a cancer patient or otherwise. Nobody should be smoking. Do vitamins and minerals interfere with combination chemotherapy or radiation therapy? This is an important question I get asked all the time. There is a tremendous amount of misinformation. We know from the late 70’s that we used N-acetyl-cysteine at the NCI to help protect the heart against the effects of Adriamycin, a powerful anti-cancer agent used in breast disease. Since then many other agents, all antioxidants have been used – carotene, E, C, selenium, two other agents that are commonly prescribed now by doctors developed by the Army – ICRF 187 and WR 2721 – and also vitamin A. But what is the data for this? Can we actually augment oncology care by changing nutritional factors and lifestyle factors? We know that during chemotherapy and radiation therapy, serum levels of antioxidants decrease as a result of lipid peroxidation. The fact that you’re getting chemotherapy or radiation therapy will decrease antioxidants in your bloodstream. There are over 12 good references for that. We know that 40% of all cancer patients are malnourished, and many die of malnutrition and not the cancer. We can see an increased response rate, which means a shrinkage of the tumor; we can see a decrease in side effects when nutrients are given with chemotherapy and radiation therapy. How do we know this? In over 51 references, cellular studies using vitamins C, A, K, E, D, B6, B12 and carotene, selenium, cystine, in combination or as single agents, used with chemotherapy, tamoxifen, interferon, radiation or any of these combined will show these effects. In animal studies, over 53 references have been shown in the peer-reviewed literature. The same nutrients were used, except for a few. They were used as single agent, or in combination, with chemotherapy or radiation therapy. In human studies, these are not new, either. There are almost 2,000 people studied in various human studies that show the same thing. We can increase the response rate – that is, shrink down the tumor quicker, decrease side effects – when nutrients are given with chemotherapy or radiation therapy. We also see in over eight human observational trials an increase in survivorship, which is very, very rare in any cancer care. Now, how new is this information? This is very old stuff. In the 1970’s this number of papers were published. These are cellular studies, animal studies, human studies. In the 1980’s you can see it progressing, and in the 1990’s those number of studies. This is not new, this has been around a long time, but there is lots of misinformation out there. In fact, in a front-page article in The New York Times in October of ‘97, Jane Brody interviews Larry Norton, a doctor at Memorial Sloan-Kettering, and he says this: "Research at Memorial Sloan-Kettering shows large dose vitamin C could blunt the effects of chemotherapy in breast cancer cells." Nothing about cancer patients. This information has never been published. In over 200 peer-reviewed references, the exact opposite is the case, and not one reference in the medical literature shows otherwise. He also goes on to say that it is known that folic acid, which is a vitamin, negates the effects of methotrexate. This is absolutely wrong. It is not folic acid, but rather folinic acid, which is a cousin, a chemical analog to folic acid. Folic acid has absolutely no effect, and we published that information in Lancet not long ago. Folic acid has no effect at all on methotrexate. So misinformation abounds. Patients are told not to take chemotherapy with nutrients, not to use nutrients with radiation therapy, and it’s all wrong. You can actually decrease side effects and increase the effectiveness of the chemotherapy. This is a quick study we did and I’ll end with this. We looked at over 425 consecutive patients who are all cancer patients. We asked them five questions. Do you take vitamins and minerals? They almost all said yes. Did you take them before your cancer diagnosis? They said no. Did your doctor tell you not to take them with chemotherapy or radiation therapy? The majority said yes. After being told not to do so, did you do it? They said no. Now here’s the kicker. Knowing that vitamins could help you, would you take them if your doctor said no? The patients said no. So the patient-doctor relationship is a very, very strong one. If the doctor is misinformed, misinformation gets translated directly to the patient. If you’re undergoing chemotherapy or radiation therapy, vitamins and minerals will actually help you, not harm you at all. ============================================================== Breast Cancer News is brought to you by the The MID HUDSON OPTIONS PROJECT, INC a grassroots Breast Cancer Health Advocacy, Support and Activist Group. The information is intended for educational purposes only, in order to help you make informed health choices and may not have been touched upon by your doctors. We are not doctors and we do not recommend any particular treatments. 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