Panel: No need to reduce red or processed meat consumption for health

On Monday, new recommendations from a panel of independent experts (NutriRECS https://nutrirecs.com/about/) say that most people can continue to consume red and processed meat at their average current consumption levels. We asked nutritional epidemiologist Marji McCullough, ScD RD, about the new recommendations, and why they might differ from those created by the American Cancer Society and other health organizations, which recommend limiting consumption of red and processed meat.

Addendum Oct. 4, 2019: The New York Times reports that the lead author of the research failed to disclose past research ties to the meat and food industry. https://nyti.ms/2AJYWcq

meat counter“It is important to recognize that this group reviewed the evidence and found the same risk from red and processed meat as have other experts. So they’re not saying eating red and processed meat is less risky; they’re saying the risk that everyone agrees on is acceptable for individuals. This seems to be in part because they considered people’s values and preferences in making these recommendations. It’s kind of like saying: we know helmets can save lives, but some people still prefer the feeling of the wind in their hair when they ride bikes. And let’s face it, most people won’t crash. But everyone agrees you should wear a helmet when bike riding, because public health recommendations are based on their effects on the population.

“Indeed, when making recommendations public health organizations consider the full impact of an exposure on population health. So, applying the author’s own calculations of individual risk difference to the general population, we calculated that cutting back on red and processed meats could prevent 8,000 cancer deaths over the lifetime of 1,000,000 people.

“In making our dietary guidelines on red and processed meat consumption, the American Cancer Society considers evidence reviewed by scientific expert panels from global health organizations. This evidence is primarily from prospective, observational studies that have shown consistent, dose-response relationships of higher consumption with increased risk of colorectal cancer, as well as mechanistic studies. While a long-term randomized trial of red and processed meat intake and cancer risk may provide support for the observational studies, it is unlikely that a trial of that nature would ever be conducted for practical and ethical reasons.

“A 2015 World Health Organization review of the evidence concluded that processed meat is a Group 1 carcinogen and unprocessed red meat is a probable (Group 2a) carcinogen based on the evidence for colorectal cancer. Systematic literature reviews from the World Cancer Research Fund/American Institute for Cancer Research conclude that the evidence that processed meat increases colorectal cancer risk is “convincing” and that red meat increases colorectal cancer risk is “probable.” Therefore, the American Cancer Society continues to recommend limiting consumption of processed meat, as well as red meat, in order to save lives from cancer.”

Posted in Uncategorized | Leave a comment

Survey Finds Broad Support for Lowering Nicotine Levels in Cigarettes

The Center for Disease Control and Prevention (CDC)’s Office on Smoking and Health has released a report showing broad support among U.S. adults for lowering nicotine levels in cigarettes.

Below is a comment from Cliff Douglas, JD, American Cancer Society vice president of tobacco control about the survey.

“Eliminating the addictiveness of their products is the tobacco industry’s greatest fear, and the reason why industry leaders have already signaled that they will sue to block the Food and Drug Administration (FDA) from mandating such action.

“The new study released by CDC shows substantial, and growing, public support for reducing nicotine in combustible tobacco products to non-addictive levels.  It notes that the scientific underpinning for such action also continues to grow, supporting previous findings that eliminating addiction to cigarettes could bring historic public health benefits.

“The study cites an FDA report that implementation of such a policy could result in approximately 5 million fewer smokers in just the first year, rapidly averting well over 2 million smoking-related deaths.

“Importantly, the study reports that its survey of a nationally representative sample of more than 4000 adults age 18 and older found widespread support for reducing the nicotine content in cigarettes to non-addictive levels.  More than 80% of current smokers, former smokers and non-smokers favored requiring lowering nicotine levels.”

Posted in Uncategorized | Leave a comment

Panel Supports HPV Vaccination through Age 45

The Advisory Committee on Immunization Practices (ACIP), part of the Centers for Disease Control and Prevention (CDC) today made two recommendations regarding the use the human papilloma (HPV) vaccine.

  • The ACIP harmonized recommendations for men and women, saying all men and women should receive the vaccine up to age 26.
  • The ACIP recommended shared clinical decision making for men and women ages 27-45.

gardasil_vaccine_and_boxThe American Cancer Society recommends routine HPV vaccination for girls and boys  starting at age 11 or 12, and as early as age 9. HPV vaccination is also recommended for females 13 to 26 years old and for males 13 to 21 years old who have not started the vaccines, or who have started but not completed the series.  Males 22 to 26 years old may also be vaccinated. 

We asked Debbie Saslow, PhD, managing director, HPV & GYN cancers, to weigh in on the news.

“The ACIP recommendation for catch-up vaccination for men and women through age 26 is simpler and more feasible for communicating and implementing vaccination efforts.

“It’s important to note that in their second recommendation, the ACIP did not recommend routine vaccination for patients between 27 and 45. Rather, the panel said those patients should discuss with their clinician whether a catch-up vaccination is right for them. Guidance will be needed to assist clinicians and patients in making  these decisions. While HPV vaccination is safe for adults aged 27-45 years, there are limited health benefits gained vaccinating people in this age range. It’s important to note that insurance coverage may be delayed until the recommendation is officially published—usually a few months after the ACIP vote.

“Even with today’s recommendation, the primary focus of efforts by the ACS and others will continue to be increasing vaccination in early adolescents. HPV vaccination efforts will still be focused on on-time vaccination at ages 11-12, or starting at age nine, based on strong evidence that on-time vaccination will prevent about 90% of HPV cancers. Evidence has further shown that vaccination at older ages will have limited impact on preventing cancer. It will be important to determine which individuals would be most likely to benefit from vaccination at older ages as well as how to best communicate with individuals inquiring about adult vaccination.

“These new recommendations and the evidence supporting them will be reviewed by the American Cancer Society’s independent guidelines review committee. For now, our recommendations remain unchanged. Further, women who have been vaccinated should continue to follow cervical cancer screening recommendations.”

For more information on HPV vaccination, visit: www.cancer.org/hpv

**Edited June 27 to emphasize that the recommendation is not for routine vaccination in adults 27-45.

Posted in Uncategorized | Leave a comment

Too soon to draw conclusions from new data finding no health benefit to aspirin

Results from a large new study released Sunday showed no health benefit to taking daily aspirin, at least among previously healthy people 70 and over. The results were published in three studies published  in the New England Journal of Medicine.

Eric J. Jacobs, Ph.D.We asked Eric Jacobs, Ph.D., senior scientific director of epidemiology research, who himself has studied the use of aspirin in cancer prevention, to comment on the findings. He reiterates that as tempting as it may be, it’s premature to draw any firm conclusions from the study.

“Recently published results from the ASPREE study, a well-designed randomized trial, provide some evidence against the routine use of aspirin for disease prevention in men and women over age 70 without cardiovascular disease. The somewhat higher cancer death rate among aspirin users in ASPREE was unexpected, and has not been seen in other randomized trials. It could be due to chance and more evidence from randomized trials of aspirin in elderly people is needed. No clear conclusions about the effect of aspirin on risk of death from cancer can be drawn at this point.

“The new results from ASPREE do not mean that people (with or without a history of cancer) who are taking aspirin because they have had a heart attack or stroke, should stop taking aspirin. Randomized trials are currently ongoing to determine if aspirin can be useful could be helpful in treating patients with colorectal and certain other cancers.  It should also be noted that the ASPREE study was too short to contradict previous scientific evidence that long-term aspirin use lowers risk of developing colorectal cancer. The typical participant in the ASPREE study took aspirin and was followed up for about 5 years, whereas previous studies indicate that lower risk of colorectal cancer can only be expected 10 or more years after starting aspirin.

“The ASPREE trial was designed to study aspirin use in older adults, predominantly 70 or older; its results do not change recommendations about aspirin use for less elderly adults. Guidelines from the respected U.S. Preventive Services Task Force recommend low-dose aspirin use for most people in their 50s who have increased risk of heart attacks or strokes. This recommendation was based on balancing the benefits of long-term aspirin use, including lower risk of heart attacks and colorectal cancer, against the risks, including higher risk of serious bleeding events.

“People who are wondering whether or not they should take aspirin should talk to a clinician who is familiar with their personal medical history and can weigh their individual risks and benefits.”

Posted in Colorectal, Prevention | Tagged , , , | 1 Comment

The Pendulum Swings (Back) on Prostate Cancer Screening

The U.S. Preventive Services Task Force (USPSTF) has updated its guideline for prostate cancer screening. The group now recommends that men ages 55 to 69 who are interested in screening talk to their doctors about potential benefits and harms of screening for prostate cancer before deciding whether to be screened using the prostate-specific antigen (PSA) test. Previously, the USPSTF recommended against screening with PSA. Otis Brawley, M.D., MACP, American Cancer Society chief medical officer, weighs in below.

otis-brawley-potraits-5x7-2016

Otis W. Brawley, M.D.

“These revised recommendations from the US Preventive Services Task Force essentially bring all experts groups, including the American Cancer Society into alignment on prostate cancer screening using PSA.  For some years, the ACS has called for shared decision making that incorporates individualized risks and concerns. Every man who accepts screening still should realize that there is a chance of benefit and a chance of harm. While the ACS says men at average risk start having this discussion at age 50, the USPSTF says it should happen at 55.

“Many wonder why the pendulum is swinging back towards screening, considering USPSTF’s previous guideline said there was inadequate evidence to support prostate cancer screening. The fact is, over the past few years, the benefit-to-harm ratio of PSA screening has improved as men diagnosed with prostate cancer have accepted the notion that their cancer can be watched, and if there are signs of trouble, treated. This approach, called “active surveillance,” reduces the harms of unnecessary treatment, tipping the balance towards informed decision-making.

“The USPSTF recommendation takes into account the most recent randomized trial of prostate cancer treatment and the recent treatment recommendations of a number of professional organizations.  The British study, known as ProtecT, showed that a large proportion of men with screen-detected early stage prostate cancer can be safely observed and will never need treatment. Recommendations of the American Urological Association, the American Society of Therapeutic Radiation Oncology, the Society of Urologic Oncology, and the American Society of Clinical Oncology now clearly state that active surveillance is the preferred management strategy for most men with low-risk disease. Today, about half of men with newly diagnosed localized disease enter active surveillance protocols. Most will never need aggressive therapy.

“Our ability to identify life threatening disease has improved dramatically, making observation an acceptable alternative to immediate treatment for many men. In addition, our understanding of prostate cancer biology and screening will make it easier for the average man to consent to screening. Still, every man accepting screening should realize that along with a chance of benefit, there is a chance of harm; a high rate of false positives, a high chance of having a prostate biopsy, and the inconveniences and side effects associated with those are essentially exchanged for a relatively small chance of one’s life being saved.

“It’s important for those considering screening to review the estimates of benefit and harm published by the Task Force, based on the large European trial. They say among 1,000 men are invited to screening over a 13 year period, there will be 240 false positives, leading to 220 transrectal biopsies; two men will be hospitalized for complications due to biopsy.  About 100 men will be diagnosed with prostate cancer, of whom about 50 will experience sexual dysfunction due to treatment; fifteen will experience significant urinary dysfunction. Screening would prevent three cancers from metastasizing, and one prostate cancer death (5 versus 6 without screening). These are sobering numbers about the true limits of screening.”

Posted in Guidelines, Prostate, Screening, Uncategorized | Tagged , , , | Leave a comment

Highly Processed Foods & Cancer Risk

Unhealthy Male Man Eating Indoors Fast Food BoothA study out Wednesday suggests eating a lot of highly processed foods might be associated with higher rates of cancer. The study appears in BMJ, and the authors admit more study is needed, but warn that the rapid adoption of what they call “ultra-processed foods” may increase the cancer burden in the coming decades.

We asked Marji McCullough, SCD, RD, strategic director of nutritional epidemiology for her thoughts on the study.

“This was a well-conducted study but we should be cautious about interpreting what exactly is responsible for the higher cancer risk.  For example, people eating more highly processed foods are eating fewer healthy foods that may reduce the risk of cancer.

“Highly processed foods are frequently packed with sugar, salt, fat and calories. The authors did try to control for these factors, but it’s difficult to totally control for these and other dietary components.

“Of note, a large proportion of the highly processed foods in this study were sugary products and beverages, which contribute to weight gain and add little nutritional value to the diet.

“In addition, people who eat more highly processed foods tend to have other unhealthy dietary and lifestyle behaviors which might not have been fully accounted for in this study.

“We know people who eat more processed and red meat, potatoes, refined grains, and sugar sweetened beverages and foods are at a higher risk of developing certain cancers. It’s still unclear what role processing has in this relationship; more research on this will be done to more carefully tease out this risk.

“In the meantime, this is one more piece of evidence that a diet rich in whole grains, whole fruits and vegetables, as recommended in the American Cancer Society guidelines, is beneficial for lowering cancer risk.”

Marji also had an important tip for shoppers: “Focus your shopping on the perimeter of the grocery store,” she says. “That’s usually where the whole foods tend to be; vegetables, fruit, whole grains, etc.”

Posted in Behavior, Nutrition, Prevention | Tagged , , | 1 Comment

Rodents and Radiation: What to Take Away from New Study Findings

Preliminary data was released today from two rodent studies by the National Toxicology Program (NTP), to explore potential links between cell phones and cancer. The studies have found high exposure to radiofrequency radiation (RFR) resulted in tumors in tissues surrounding nerves in the hearts of male rats, but found no link in female rats nor in any mice. As is commonly done in these types of studies, researchers used exposure levels that were higher, and often far higher, than the amounts typically emitted by cell phones.

The authors say the new data does not go much further than what they reported in 2016.

Below are comments from Otis W. Brawley, M.D., in response to the new data.

otis-brawley-potraits-5x7-2016

Otis W. Brawley, M.D.

“These draft reports are bound to create a lot of concern, but in fact they won’t change what I tell people: the evidence for an association between cell phones and cancer is weak, and so far, we have not seen a higher cancer risk in people. But if you’re concerned about this animal data, wear an earpiece.

“Perhaps the most important thing to take away from today’s news may be this line from the press release:

“The levels and duration of exposure to RFR were much greater than what people experience with even the highest level of cell phone use, and exposed the rodent’s whole bodies. So, these findings should not be directly extrapolated to human cell phone usage,” said John Bucher, Ph.D., NTP senior scientist.

“The animals in this study were exposed at high levels for 9 hours per day. So while the link to some rare cancers are important, there is no reason to think this study reflects real life exposures.

“Dr. Bucher confirmed this in a press conference with reporters, and when asked whether the new data has changed how he uses cell phones, he replied that it has not, nor has he told his family to change what they do.

“Some additional cautions: as one of the reporters on the press conference pointed out, while some radiated animals did indeed have more tumors, in fact they lived longer.  Also, it’s far from a slam dunk to apply findings in one species to another. Also, these studies were negative for common tumors, which is somewhat comforting. It suggests if anything, cell phone radiation may (and only “may”) be linked to some very rare tumors. And newer, lower energy cell phones, and more cell towers are likely to make exposures even lower.

“A final point to remember is that we should not base our decisions or our point of view on a single study. When deciding where the truth lies, you really need to take all the available evidence into account. And in fact, most studies looking into cell phones and cancer are negative.”

Posted in Uncategorized | 13 Comments