Allium vegetables and organosulfur compounds: do they help prevent cancer?

Allium vegetables have been shown to have beneficial effects against several diseases, including cancer. Garlic, onions, leeks, and chives have been reported to protect against stomach and colorectal cancers, although evidence for a protective effect against cancer at other sites, including the breast, is still insufficient. The protective effect appears to be related to the presence of organosulfur compounds and mainly allyl derivatives, which inhibit carcinogenesis in the forestomach, esophagus, colon, mammary gland, and lung of experimental animals. The exact mechanisms of the cancer-preventive effects are not clear, although several hypotheses have been proposed. Organosulfur compounds modulate the activity of several metabolizing enzymes that activate (cytochrome P450s) or detoxify (glutathione S-transferases) carcinogens and inhibit the formation of DNA adducts in several target tissues. Antiproliferative activity has been described in several tumor cell lines, which is possibly mediated by induction of apoptosis and alterations of the cell cycle. Allium vegetables and organosulfur compounds are thus possible cancer-preventive agents. Clinical trials will be required to define the effective dose that has no toxicity in humans.

Prevention of disease with pharmaceuticals.

The idea that diseases such as cardiovascular disease and cancer can be prevented by taking a 'pill' is attractive to many people. Chemoprevention is an established method in the primary and secondary prevention of cardiovascular disease such as myocardial infarct and stroke. Clinical trials have demonstrated beyond reasonable doubt that both fatal and non-fatal coronary events and strokes can be prevented. Antihypertensive drugs have been shown to be effective through clinical trials in preventing myocardial infarctions, stroke and other cardiovascular morbidity and mortality. Statins are commonly used to lower the blood cholesterol concentration, and aspirin is widely used to prevent occlusive vascular disease. Aspirin and other non-steroidal antiinflammatory agents have shown promise in the chemoprevention of colorectal cancer. While observational epidemiological studies have consistently suggested that diets rich in antioxidants such as beta-carotene might be useful in preventing coronary heart disease and cancer, the published reports of randomized trials clearly indicate that beta-carotene supplements are of no value in persons of high risk for such conditions. Although the chemoprevention of cancer is decades behind that of cardiovascular disease, there is no reason to believe that progress in cancer chemoprevention will differ substantially from that in cardiovascular disease. Better understanding of the molecular steps critical to carcinogenesis should open new avenues for cancer chemoprevention.

Evaluation of cancer-preventive agents and strategies a new program at the International Agency for Research on Cancer.

About five years ago, the International Agency for Research on Cancer (IARC) initiated a new program, IARC Handbooks of Cancer Prevention, aimed at evaluating the evidence base for the cancer-preventive activity of various agents and strategies. To date (2001) 5 volumes have been published--1. Non-steroidalAnti-inflammatory Drugs, 2. Carotenoids, 3. Vitamin A, 4. Retinoids, and 5. Sunscreens--and volume 6 (Weight Control and Physical Activity) is in press. Future volumes will include evaluations of breast cancer screening (vol. 7) and fruits and vegetables (vol. 8).

The cancer-preventive potential of Panax ginseng: a review of human and experimental evidence.

OBJECTIVE: We have reviewed the potential cancer-preventive and other relevant properties of Panax ginseng C. A. Meyer, which has been traditionally used as a natural tonic in Oriental countries. DATA IDENTIFICATION AND STUDY SELECTION: Publications on Panax ginseng and its relation to cancer were obtained from the Medline database (1983-1998) and by checking reference lists to find earlier reports. The reports cover experimental models and human studies on cancer-preventive activity, carcinogenicity and other beneficial or adverse effects. In addition, possible mechanisms of chemoprevention by ginseng were considered. RESULTS: Published results from a cohort and two case-control studies in Korea suggest that the intake of ginseng may reduce the risk of several types of cancer. When ginseng was tested in animal models, a reduction in cancer incidence and multiplicity at various sites was noted. Panax ginseng and its chemical constituents have been tested for their inhibiting effect on putative carcinogenesis mechanisms (e.g., cell proliferation and apoptosis, immunosurveillance, angiogenesis); in most experiments inhibitory effects were found. CONCLUSION: While Panax ginseng C. A. Meyer has shown cancer-preventive effects both in experimental models and in epidemiological studies, the evidence is currently not conclusive as to its cancer-preventive activity in humans. The available evidence warrants further research into the possible role of ginseng in the prevention of human cancer and carcinogenesis.

Chemoprevention of cancer: lessons to be learned from beta-carotene trials.

Observational studies indicate a lower incidence of chronic diseases, including various cancers and cardiovascular disease, related to higher intakes of carotenoid containing foods (fruits and vegetables). Beta-carotene, one of the large number of naturally occurring carotenoids, thus appears to actively participate in health. However, recent intervention trials indicate that beta-carotene supplements are not efficacious in the prevention of cardiovascular disease and major cancers occurring in well-nourished populations. In fact, supplemental beta-carotene appears to increase, rather than to reduce, lung cancer incidence and deaths from cardiovascular disease in current smokers and in asbestos exposed workers. In order to resolve these paradoxes, we need to better understand the underlying biology, identify interactions, develop mechanistic hypotheses and test them in clinical trials in humans. Until that time, we should confine any premature enthusiasm for chemopreventive supplementation.

Modulation of genotoxic and related effects by carotenoids and vitamin A in experimental models: mechanistic issues.

The mechanisms involved in the modulation of genotoxic and related effects by carotenoids and vitamin A were inferred from a critical review of an ad hoc constructed database. Almost 500 results were generated in experimental models evaluating the activity of 32 structurally, metabolically and functionally related nutrients, including beta-carotene and 26 other carotenoids, retinol, retinal, all-trans-retinoic acid and retinyl esters. As many as 67 experimental test systems, either in vitro or in vivo, used a variety of cellular targets and/or end-points suggestive of distinctive mechanisms of action. The bulk of available data support the view that carotenoids and vitamin A do not induce genotoxic effects per se. Even in the absence of any genotoxic agent, these nutrients appeared, on the contrary, to display some mechanisms which play protective roles in tumor promotion and progression, such as inhibition of N-myc gene expression resulting in antiproliferative effects, up-regulation of cell-to-cell communication, an increase in connexin 43 gene expression, a decrease in the 'spontaneous' cell transformation frequency and induction of differentiation in vitro. A large number of studies investigated the modulation by carotenoids and vitamin A of genotoxic and related effects produced by 69 genotoxicants, including biological agents, physical agents, chemical compounds and complex mixtures. In spite of some discrepant data, the general trend was that both carotenoids and vitamin A are poorly effective in acting as nucleophiles, nor do they appear to substantially interfere with the induction or repair of DNA damage produced by direct-acting agents. In contrast vitamin A and carotenoids, irrespective of their provitamin A role, in most studies inhibited those genotoxicants which require metabolic activation to electrophilic derivatives in either bacterial or mammalian cells. Coupled with biochemical data, the distinctive patterns observed with genotoxic agents belonging to different chemical classes suggest a complex modulation of both phase I and phase II enzymes involved in the metabolism of xenobiotics. Furthermore, carotenoids and vitamin A shared other protective mechanisms, such as scavenging of genotoxic oxygen species, modulation of signal transduction pathways, inhibition of cell transformation induced by physical and chemical agents, and facilitation of intercellular communication inhibited by genotoxic compounds. Therefore, carotenoids and vitamin A appear to work via multiple mechanisms, which would support a potential protective role in cancer initiation and in the pathogenesis of other mutation-related diseases. These conclusions are consistent with the recognized cancer-preventive activity of these nutrients in certain animal models and with the evidence provided by observational epidemiological studies, which suggested cancer-protective effects at many sites as related to their dietary intake or plasma levels. However, all these lines of evidence and mechanistically based premises contrast with the unexpected outcome of recent clinical intervention trials, which raised the concern that supplemental use of beta-carotene and vitamin A may increase the risk of lung cancer amongst high risk individuals such as tobacco smokers and asbestos-exposed workers.

Chemoprevention of cancer: a controversial and instructive story.

Increased intake of fruits and vegetables seems to be one of the simplest means of decreasing the risk for cancer. Cancer-preventive effects of fruits and vegetables have been observed in epidemiological studies, which could not, however, distinguish the effects of the various ingredients. Antioxidant defence has been proposed as a mechanism of chemoprevention, although inconclusive results have been obtained. The results of randomized intervention trials have shown that beta-carotene supplements are of limited value and may even be deleterious. Vitamins are a good marker of the ingestion of fruits and vegetables, and vitamin E (alpha-tocopherol) is a lipid-soluble antioxidant which can scavenge free radicals. It has no significant effect on the risk for lung cancer of long-term smokers in an intervention trial, but it decreased both the incidence of and mortality from prostate cancer; however, there was a 50% increase in the occurrence of cerebral haemorrhage among the men given vitamin E. Aspirin and aspirin-like drugs appear to decrease the risk for intestinal tumours; the mechanism of action appears to involve diminishing prostaglandin production due to inhibition of cyclooxygenases. Dietary fibre has been linked to a reduced risk for colorectal cancer in many observational studies, but opposite findings were reported recently. In order to resolve these paradoxes, we need to understand better the underlying biology, develop mechanistic hypotheses and test them in clinical trials in humans. Until that time, we should confine any premature enthusiasm for chemopreventive micronutrient supplementation.

An international evaluation of the cancer preventive potential of carotenoids.

The IARC convened a Working Group of experts in December 1997 to evaluate the cancer-preventive potential of carotenoids and to compile the second volume of the IARC Handbooks of Cancer Prevention. In observational epidemiological studies, beta-carotene is associated with reduced risks for cancer at many but not all sites. It is unclear, however, to what extent beta-carotene itself is responsible for the decreased risks observed. Three large, randomized, placebo-controlled clinical trials indicate, however, that, in substantial doses, supplementation with beta-carotene not only does not prevent lung cancer but may actually increase the risk among individuals initially at high risk of lung cancer. These trials do not provide clear evidence concerning cancers at other specific sites. Thus, the Working Group considered that there is evidence suggesting a lack of cancer-preventive activity for beta-carotene when it is used as a supplement at high doses. At usual dietary levels of beta-carotene, the evidence for cancer-preventive activity was considered inadequate. However, there is sufficient evidence that beta-carotene has cancer-preventive activity in experimental animals, based on models of skin carcinogenesis in mice and buccal pouch carcinogenesis in hamsters. The observational epidemiological data on alpha-carotene, lycopene, and lutein are much less extensive than those for beta-carotene. For canthaxanthin, there are no published data regarding associations with cancer risk. These carotenoids have not been studied in human trials for cancer prevention. In animal models, there is sufficient evidence for canthaxanthin and limited evidence for alpha-carotene, lycopene, and lutein of cancer-preventive activity. Pending further research, supplemental beta-carotene, canthaxanthin, alpha-carotene, lutein, and lycopene should not be recommended for cancer prevention in the general population.

Aspirin for the second hundred years: new uses for an old drug.

The history of aspirin can be traced back to ancient Egypt where extract of willow bark was used to treat inflammation. The active component of the extract was identified as the glucoside of salicylic alcohol. The severe gastric side effects associated with the use of sodium salicylate prompted the synthesis of the o-acetyl-derivative as a possible pro-drug. In fact, acetylsalicylic acid was antiinflammatory, analgesic and antipyretic but also ulcerogenic to the stomach. Acetylsalicylic acid was synthesized one hundred years ago, and was mass-produced under the commercial name of 'Aspirin' (Dreser, 1899) by the German company Bayer for the treatment of fever and rheumatism.

Coffee consumption not associated with risk of pancreas cancer in Finland.

BACKGROUND: Coffee consumption has been brought to focus as a possible risk factor for pancreas cancer. After having reviewed the available evidence, an International Agency for Research on Cancer working group concluded in 1991 that the evidence in humans that coffee drinking is carcinogenic in the pancreas is "inadequate," since the available data were considered suggestive of a weak relationship with high levels of coffee consumption, but the possibility that this was due to bias or confounding was judged tenable. METHODS: The association between coffee consumption and pancreas cancer risk was examined in a case-referent study in Finland. Data on coffee consumption 20 years prior to the diagnosis of cancer were obtained from the next of kin of 662 cases of pancreas cancer and 1,770 referent (stomach, colon, and rectum) cancers. The results were expressed as crude and age-, gender-, and tobacco smoking-adjusted odds ratios and 95% confidence intervals for three daily coffee dose categories 20 years prior to cancer diagnosis. RESULTS: The data failed to demonstrate any association between coffee consumption and risk for pancreas cancer. The crude odds ratios varied between 0.7 (95% confidence interval 0.3-1.5) and 1.3 (0.7-2.6), the adjusted ones between 0.5 (0.2-1.2) and 1.1 (0.6-2.1) in the different daily dose categories of coffee and between contrasts with the three referent cancers. The highest odds ratios were associated with the contrast between pancreas and colon cancer, the lowest between pancreas and rectum cancer. Adjustment for gender, age, and tobacco smoking slightly decreased the values of the odds ratios. The power of the study was low, however, to detect possible weak increases associated with coffee consumption. CONCLUSIONS: The results are unlikely to be negatively biased, and are compatible with the majority of epidemiologic results advanced, suggesting no positive association between coffee consumption and the risk of pancreas cancer.

Phenoxy acid herbicides cause peroxisome proliferation in Chinese hamsters.

An increase in either the size or amount of peroxisomes was obtained in the liver cells of Chinese hamsters after the animals were exposed to the phenoxy herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) or 4-chloro-2-methylphenoxyacetic acid (MCPA). At the dose level studied, 2,4-D was found to be more potent than MCPA in increasing the number of peroxisomes. A phenoxy acid derivative, clofibrate, one of the peroxisome proliferators known to possess carcinogenic properties in rodents, appeared to be still more potent in inducing peroxisome proliferation than either of the herbicides studied. Further investigations are warranted to clarify the significance of peroxisome proliferation to the toxicity of phenoxy herbicides.

Comparison of alkylation rates and mutagenicity of directly acting industrial and laboratory chemicals: epoxides, glycidyl ethers, methylating and ethylating agents, halogenated hydrocarbons, hydrazine derivatives, aldehydes, thiuram and dithiocarbamate derivatives.

Groups of industrial and laboratory chemicals were tested for their alkylation activity using 4-(p-nitrobenzyl)-pyridine and deoxyguanosine as nucleophiles. The alkylation activity was compared with mutagenicity of the chemicals to E. coli WP2 uvrA without metabolic activation. All the epoxide-containing compounds including simple epoxides and glycidyl ethers elicited alkylation activity and mutagenicity. Furthermore there was a reasonable correlation between the rate of alkylation and the mutagenic potency. All the methylating and ethylating compounds tested were active but no correlation was observed between the rate of alkylation and the mutagenic potency, apparently due to the different types of alkylation products formed. The other compounds tested including halogenated hydrocarbons, hydrazine derivatives, aldehydes, thiuram and dithiocarbamate derivatives elicited a slow or no alkylation activity while many of the compounds were mutagenic. There was no evidence among the chemicals tested of an alkylating non-mutagen. Thus evidence of alkylation activity appears to indicate mutagenic risk.