J Korean Med Assoc.  2008 May;51(5):411-426. 10.5124/jkma.2008.51.5.411.

Evidence-based Complementary and Alternative Medicine for Cancer Prevention

• Paek YJ

• KMID: 2185869
• DOI: http://doi.org/10.5124/jkma.2008.51.5.411

Abstract

Cancer prevention with complementary and alternative medicine (CAM), especially based upon biologically-based practices, is a major concern among physicians, health care providers, and general population. Biologically-based practices include diet-based therapies, botanicals and herbs, vitamins and minerals, animal-derived extracts, and amino acids. We searched databases since the late 1990s and reviewed what have been done in the area of cancer prevention with specific CAM therapies to provide the most recent and updated materials and to be able to serve as a reference for physicians. Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Clinical Excellence (NICE) methodologies were adopted to classify the study design, study quality assessment, and determination of the evidence level. Some have more or less protective effects but there are conflicting evidences regarding the effectiveness of certain CAM therapies for the prevention of cancer, and most of them are epidemiologic studies, whereas clinical trials are relatively rare in the context of evidence-based medicine (EBM). More researches are mandatory to assess the effectiveness for the prevention of cancer by specific CAM therapies that allow the clinicians and health care providers to give EBM based advice to the patients and inspire them to study CAM therapies for cancer prevention.

Keyword

Complementary & alternative medicine; Cancer prevention; Evidence-based medicine

MeSH Terms

Amino Acids
Complementary Therapies
Epidemiologic Studies
Evidence-Based Medicine
Health Personnel
Humans
Minerals
Vitamins
Amino Acids
Minerals
Vitamins

Reference

1. Caraballoso M, Sacristan M, Serra C, Bonfill X. Drugs for preventing lung cancer in healthy people. Cochrane Database of Systematic Reviews 2003. (Issue 2):Art. No.: CD002141. DOI: 10.1002/14651858.CD002141.

2. Virtamo J, Pietinen P, Huttunen JK, Korhonen P, Malila N, Virtanen MJ, Albanes D, Taylor PR, Albert P. ATBC Study Group. Incidence of cancer and mortality following alpha-tocopherol and beta-carotene supplementation: a postintervention follow-up. JAMA. 2003. 290:476–485.

3. Bjelakovic G, Nikolova D, Simonetti RG, Gluud C. Antioxidant supplements for preventing gastrointestinal cancers (Review). Cochrane Database of Systematic Reviews 2004. (Issue 4):Art. No.: CD004183. DOI: 10.1002/14651858.CD004183 pub2.

4. Kubo A, Corley DA. Meta-analysis of antioxidant intake and the risk of esophageal and gastric cardia adenocarcinoma. Am J Gastroenterol. 2007. 102:2323–2330.

5. Baron JA, Cole BF, Mott L, Haile R, Grau M, Church TR, Beck GJ, Greenberg ER. Neoplastic and antineoplastic effects of beta-carotene on colorectal adenoma recurrence: results of a randomized trial. J Natl Cancer Inst. 2003. 95:717–722.

6. Malila N, Virtamo J, Virtanen M, Pietinen P, Albanes D, Teppo L. Dietary and serum alpha-tocopherol, beta-carotene and retinol, and risk for colorectal cancer in male smokers. Eur J Clin Nutr. 2002. 56:615–621.

7. Lee JE, Giovannucci E, Smith-Warner SA, Spiegelman D, Willett WC, Curhan GC. Intakes of fruits, vegetables, vitamins A, C, and E, and carotenoids and risk of renal cell cancer. Cancer Epidemiol Biomarkers Prev. 2006. 15:2445–2452.

8. García-Closas R, Castellsagué X, Bosch X, González CA. The role of diet and nutrition in cervical carcinogenesis: a review of recent evidence. Int J Cancer. 2005. 117:629–637.

9. McNaughton SA, Marks GC, Gaffney P, Williams G, Green AC. Antioxidants and basal cell carcinoma of the skin: a nested case-control study. Cancer Causes Control. 2005. 16:609–618.

10. Frieling UM, Schaumberg DA, Kupper TS, Muntwyler J, Hennekens CH. A randomized, 12-year primary-prevention trial of beta carotene supplementation for nonmelanoma skin cancer in the physician's health study. Arch Dermatol. 2000. 136:179–184.

11. Cho E, Hunter DJ, Spiegelman D, Albanes D, Beeson WL, van den Brandt PA, Colditz GA, Feskanich D, Folsom AR, Fraser GE, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Miller AB, Rohan TE, Sellers TA, Virtamo J, Willett WC, Smith-Warner SA. Intakes of vitamins A, C and E and folate and multivitamins and lung cancer: a pooled analysis of 8 prospective studies. Int J Cancer. 2006. 118:970–978.

12. Bjelakovic G, Nagorni A, Nikolova D, Simonetti RG, Bjelakovic M, Gluud C. Meta-analysis: antioxidant supplements for primary and secondary prevention of colorectal adenoma. Aliment Pharmacol Ther. 2006. 24:281–291.

13. Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a randomized controlled trial. JAMA. 2005. 294:56–65.

14. Lonn E, Bosch J, Yusuf S, Sheridan P, Pogue J, Arnold JM, Ross C, Arnold A, Sleight P, Probstfield J, Dagenais GR. HOPE and HOPE-TOO Trial Investigators. Effects of long-term vitamin E supplementation on cardiovascular events and cancer: a randomized controlled trial. JAMA. 2005. 293:1338–1347.

15. Zhuo H, Smith AH, Steinmaus C. Selenium and lung cancer: A quantitative analysis of heterogeneity in the current epidemiological literature. Cancer Epidemiol Biomarkers Prev. 2004. 13:771–778.

16. Duffield-Lillico AJ, Dalkin BL, Reid ME, Turnbull BW, Slate EH, Jacobs ET, Marshall JR, Clark LC. Nutritional Prevention of Cancer Study Group. Selenium supplementation, baseline plasma selenium status and incidence of prostate cancer: an analysis of the complete treatment period of the Nutritional Prevention of Cancer Trial. BJU Int. 2003. 91:608–612.

17. Brinkman M, Reulen RC, Kellen E, Buntinx F, Zeegers MP. Are men with low selenium levels at increased risk of prostate cancer? Eur J Cancer. 2006. 42:2463–2471.

18. Li H, Li HQ, Wang Y, Xu HX, Fan WT, Wang ML, Sun PH, Xie XY. An intervention study to prevent gastric cancer by micro-selenium and large dose of allitridum. Chin Med J (Engl). 2004. 117:1155–1160.

19. Duffield-Lillico AJ, Slate EH, Reid ME, Turnbull BW, Wilkins PA, Combs GF Jr, Park HK, Gross EG, Graham GF, Stratton MS, Marshall JR, Clark LC. Nutritional Prevention of Cancer Study Group. Selenium supplementation and secondary prevention of nonmelanoma skin cancer in a randomized trial. J natl Cancer Inst. 2003. 95:1477–1481.

20. Reid ME, Duffield-Lillico AJ, Sunga A, Fakih M, Alberts DS, Marshall JR. Selenium supplementation and colorectal adenomas: An analysis of the nutritional prevention of cancer trial. Int J Cancer. 2006. 118:1777–1781.

21. Jacobs ET, Jiang R, Alberts DS, Greenberg ER, Gunter EW, Karagas MR, Lanza E, Ratnasinghe L, Reid ME, Schatzkin A, Smith-Warner SA, Wallace K, Martínez ME. Selenium and colorectal adenoma: results of a pooled analysis. J Natl Cancer Inst. 2004. 96:1669–1675.

22. Kamangar F, Qiao YL, Yu B, Sun XD, Abnet CC, Fan JH, Mark SD, Zhao P, Dawsey SM, Taylor PR. Lung cancer chemoprevention: a randomized, double-blind trial in Linxian, China. Cancer Epidemiol Biomarkers Prev. 2006. 15:1562–1564.

23. Qu CX, Kamangar F, Fan JH, Yu B, Sun XD, Taylor PR, Chen BE, Abnet CC, Qiao YL, Mark SD, Dawsey SM. Chemoprevention of primary liver cancer: a randomized, double-blind trial in Linxian, China. J Natl Cancer Inst. 2007. 99:1240–1247.

24. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004. 164:2335–2342.

25. Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev. 2008. 1:CD003548.

26. Wactawski-Wende J, Kotchen JM, Anderson GL, Assaf AR, Brunner RL, O'Sullivan MJ, Margolis KL, Ockene JK, Phillips L, Pottern L, Prentice RL, Robbins J, Rohan TE, Sarto GE, Sharma S, Stefanick ML, Van Horn L, Wallace RB, Whitlock E, Bassford T, Beresford SA, Black HR, Bonds DE, Brzyski RG, Caan B, Chlebowski RT, Cochrane B, Garland C, Gass M, Hays J, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Jackson RD, Johnson KC, Judd H, Kooperberg CL, Kuller LH, LaCroix AZ, Lane DS, Langer RD, Lasser NL, Lewis CE, Limacher MC, Manson JE. Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med. 2006. 354:684–696.

27. Cho E, Smith-Warner SA, Spiegelman D, Beeson WL, van den Brandt PA, Colditz GA, Folsom AR, Fraser GE, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Miller AB, Pietinen P, Potter JD, Rohan TE, Terry P, Toniolo P, Virtanen MJ, Willett WC, Wolk A, Wu K, Yaun SS, Zeleniuch-Jacquotte A, Hunter DJ. Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst. 2004. 96:1015–1022.

28. Gao X, LaValley MP, Tucker KL. Prospective studies of dairy product and calcium intakes and prostate cancer risk: a meta-analysis. J Natl Cancer Inst. 2005. 97:1768–1777.

29. Giovannucci E, Liu Y, Stampfer MJ, Willett WC. A prospective study of calcium intake and incident and fatal prostate cancer. Cancer Epidemiol Biomarkers Prev. 2006. 15:203–210.

30. Park Y, Mitrou PN, Kipnis V, Hollenbeck A, Schatzkin A, Leitzmann MF. Calcium, dairy foods, and risk of incident and fatal prostate cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol. 2007. 166:1270–1279.

31. Kesse E, Bertrais S, Astorg P, Jaouen A, Arnault N, Galan P, Hercberg S. Dairy products, calcium and phosphorus intake, and the risk of prostate cancer: results of the French prospective SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) study. Br J Nutr. 2006. 95:539–545.

32. Ahn J, Albanes D, Peters U, Schatzkin A, Lim U, Freedman M, Chatterjee N, Andriole GL, Leitzmann MF, Hayes RB. Prostate, Lung, Colorectal, and Ovarian Trial Project Team. Dairy products, calcium intake, and risk of prostate cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev. 2007. 16:2623–2630.

33. Baron JA, Beach M, Wallace K, Grau MV, Sandler RS, Mandel JS, Heber D, Greenberg ER. Risk of prostate cancer in a randomized clinical trial of calcium supplementation. Cancer Epidemiol Biomarkers Prev. 2005. 14:586–589.

34. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007. 85:1586–1591.

35. Larsson SC, Giovannucci E, Wolk A. Folate intake, MTHFR polymorphisms, and risk of esophageal, gastric, and pancreatic cancer: a meta-analysis. Gastroenterology. 2006. 131:1271–1283.

36. Sanjoaquin MA, Allen N, Couto E, Roddam AW, Key TJ. Folate intake and colorectal cancer risk: a meta-analytical approach. Int J Cancer. 2005. 113:825–828.

37. Zhang SM, Moore SC, Lin J, Cook NR, Manson JE, Lee IM, Buring JE. Folate, vitamin B6, multivitamin supplements, and colorectal cancer risk in women. Am J Epidemiol. 2006. 163:108–115.

38. Kune G, Watson L. Colorectal cancer protective effects and the dietary micronutrients folate, methionine, vitamins B6, B12, C, E, selenium, and lycopene. Nutr Cancer. 2006. 56:11–21.

39. Cole BF, Baron JA, Sandler RS, Haile RW, Ahnen DJ, Bresalier RS, McKeown-Eyssen G, Summers RW, Rothstein RI, Burke CA, Snover DC, Church TR, Allen JI, Robertson DJ, Beck GJ, Bond JH, Byers T, Mandel JS, Mott LA, Pearson LH, Barry EL, Rees JR, Marcon N, Saibil F, Ueland PM, Greenberg ER. Polyp Prevention Study Group. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA. 2007. 297:2351–2359.

40. Larsson SC, Giovannucci E, Wolk A. Folate and risk of breast cancer: a meta-analysis. J Natl Cancer Inst. 2007. 99:64–76.

41. Bunker CH, McDonald AC, Evans RW, de la Rosa N, Boumosleh JM, Patrick AL. A randomized trial of lycopene supplementation in Tobago men with high prostate cancer risk. Nutr Cancer. 2007. 57:130–137.

42. Etminan M, Takkouche B, Caamaño-Isorna F. The role of tomato products and lycopene in the prevention of prostate cancer: a meta-analysis of observational studies. Cancer epidemiology, biomarkers & preventio. 2004. 13:340–345.

43. Kirsh VA, Mayne ST, Peters U, Chatterjee N, Leitzmann MF, Dixon LB, Urban DA, Crawford ED, Hayes RB. A prospective study of lycopene and tomato product intake and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev. 2006. 15:92–98.

44. Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC. Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer. 2007. 21:1571–1578.

45. Peters U, Leitzmann MF, Chatterjee N, Wang Y, Albanes D, Gelmann EP, Friesen MD, Riboli E, Hayes RB. Serum lycopene, other carotenoids, and prostate cancer risk: a nested case-control study in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer Epidemiol Biomarkers Prev. 2007. 16:962–968.

46. Nouraie M, Pietinen P, Kamangar F, Dawsey SM, Abnet CC, Albanes D, Virtamo J, Taylor PR. Fruits, vegetables, and antioxidants and risk of gastric cancer among male smokers. Cancer Epidemiol Biomarkers Prev. 2005. 14:2087–2092.

47. Männistö S, Smith-Warner SA, Spiegelman D, Albanes D, Anderson K, van den Brandt PA, et al. Dietary carotenoids and risk of lung cancer in a pooled analysis of seven cohort studies. Cancer Epidemiol Biomarkers Prev. 2004. 13:40–48.

48. Nöthlings U, Wilkens LR, Murphy SP, Hankin JH, Henderson BE, Kolonel LN. Vegetable intake and pancreatic cancer risk: the multiethnic cohort study. Am J Epidemiol. 2007. 65:138–147.

49. Männistö S, Yaun SS, Hunter DJ, Spiegelman D, Adami HO, Albanes D, van den Brandt PA, Buring JE, Cerhan JR, Colditz GA, Freudenheim JL, Fuchs CS, Giovannucci E, Goldbohm RA, Harnack L, Leitzmann M, McCullough ML, Miller AB, Rohan TE, Schatzkin A, Virtamo J, Willett WC, Wolk A, Zhang SM, Smith-Warner SA. Dietary carotenoids and risk of colorectal cancer in a pooled analysis of 11 cohort studies. Am J Epidemiol. 2007. 65:246–255.

50. Koushik A, Hunter DJ, Spiegelman D, Anderson KE, Buring JE, Freudenheim JL, Goldbohm RA, Hankinson SE, Larsson SC, Leitzmann M, Marshall JR, McCullough ML, Miller AB, Rodriguez C, Rohan TE, Ross JA, Schatzkin A, Schouten LJ, Willett WC, Wolk A, Zhang SM, Smith-Warner SA. Intake of the major carotenoids and the risk of epithelial ovarian cancer in a pooled analysis of 10 cohort studies. Int J Cancer. 2006. 19:2148–2154.

51. Zhang M, Holman CD, Binns CW. Intake of specific carotenoids and the risk of epithelial ovarian cancer. Br J Nutr. 2007. 98:187–193.

52. Prentice RL, Caan B, Chlebowski RT, Patterson R, Kuller LH, Ockene JK, Margolis KL, Limacher MC, Manson JE, Parker LM, Paskett E, Phillips L, Robbins J, Rossouw JE, Sarto GE, Shikany JM, Stefanick ML, Thomson CA, Van Horn L, Vitolins MZ, Wactawski-Wende J, Wallace RB, Wassertheil-Smoller S, Whitlock E, Yano K, Adams-Campbell L, Anderson GL, Assaf AR, Beresford SA, Black HR, Brunner RL, Brzyski RG, Ford L, Gass M, Hays J, Heber D, Heiss G, Hendrix SL, Hsia J, Hubbell FA, Jackson RD, Johnson KC, Kotchen JM, LaCroix AZ, Lane DS, Langer RD, Lasser NL, Henderson MM. Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006. 295:629–642.

53. Saadatian-Elahi M, Norat T, Goudable J, Riboli E. Biomarkers of dietary fatty acid intake and the risk of breast cancer: a meta-analysis. Int J Cancer. 2004. 11:584–591.

54. Boyd NF, Stone J, Vogt KN, Connelly BS, Martin LJ, Minkin S. Dietary fat and breast cancer risk revisited: a meta-analysis of the published literature. Br J Cancer. 2003. 89:1672–1685.

55. Lanza E, Yu B, Murphy G, Albert PS, Caan B, Marshall JR, Lance P, Paskett ED, Weissfeld J, Slattery M, Burt R, Iber F, Shike M, Kikendall JW, Brewer BK, Schatzkin A. Polyp Prevention Trial Study Group. The polyp prevention trial continued follow-up study: no effect of a low-fat, high-fiber, high-fruit, and -vegetable diet on adenoma recurrence eight years after randomization. Cancer Epidemiol Biomarkers Prev. 2007. 16:1745–1752.

56. Beresford SA, Johnson KC, Ritenbaugh C, Lasser NL, Snetselaar LG, Black HR, Anderson GL, Assaf AR, Bassford T, Bowen D, Brunner RL, Brzyski RG, Caan B, Chlebowski RT, Gass M, Harrigan RC, Hays J, Heber D, Heiss G, Hendrix SL, Howard BV, Hsia J, Hubbell FA, Jackson RD, Kotchen JM, Kuller LH, LaCroix AZ, Lane DS, Langer RD, Lewis CE, Manson JE, Margolis KL, Mossavar-Rahmani Y, Ockene JK, Parker LM, Perri MG, Phillips L, Prentice RL, Robbins J, Rossouw JE, Sarto GE, Stefanick ML, Van Horn L, Vitolins MZ, Wactawski-Wende J, Wallace RB, Whitlock E. Low-fat dietary pattern and risk of colorectal cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006. 295:643–654.

57. Prentice RL, Thomson CA, Caan B, Hubbell FA, Anderson GL, Beresford SA, Pettinger M, Lane DS, Lessin L, Yasmeen S, Singh B, Khandekar J, Shikany JM, Satterfield S, Chlebowski RT. Low-fat dietary pattern and cancer incidence in the Women's Health Initiative Dietary Modification Randomized Controlled Trial. J Natl Cancer Inst. 2007. 99:1534–1543.

58. Genkinger JM, Hunter DJ, Spiegelman D, Anderson KE, Beeson WL, Buring JE, Colditz GA, Fraser GE, Freudenheim JL, Goldbohm RA, Hankinson SE, Koenig KL, Larsson SC, Leitzmann M, McCullough ML, Miller AB, Rodriguez C, Rohan TE, Ross JA, Schatzkin A, Schouten LJ, Smit E, Willett WC, Wolk A, Zeleniuch-Jacquotte A, Zhang SM, Smith-Warner SA. A pooled analysis of 12 cohort studies of dietary fat, cholesterol and egg intake and ovarian cancer. Cancer Causes Control. 2006. 17:273–285.

59. Huncharek M, Kupelnick B. Dietary fat intake and risk of epithelial ovarian cancer: a meta-analysis of 6,689 subjects from 8 observational studies. Nutr Cancer. 2001. 40:87–91.

60. Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough ML. Dietary lipids and endometrial cancer: the current epidemiologic evidence. Cancer Causes Control. 2007. 18:687–703.

61. Steinmaus CM, Nuñez S, Smith AH. Diet and bladder cancer: a meta-analysis of six dietary variables. Am J Epidemiol. 2000. 51:693–702.

62. Wallström P, Bjartell A, Gullberg B, Olsson H, Wirfält E. A prospective study on dietary fat and incidence of prostate cancer (Malmö, Sweden). Cancer Causes Control. 2007. 18:1107–1121.

63. Park SY, Murphy SP, Wilkens LR, Henderson BE, Kolonel LN. Fat and meat intake and prostate cancer risk: the multiethnic cohort study. Int J Cancer. 2007. 21:1339–1345.

64. Smith-Warner SA, Ritz J, Hunter DJ, Albanes D, Beeson WL, van den Brandt PA, Colditz G, Folsom AR, Fraser GE, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Kushi LH, Miller AB, Rohan TE, Speizer FE, Virtamo J, Willett WC. Dietary fat and risk of lung cancer in a pooled analysis of prospective studies. Cancer Epidemiol Biomarkers Prev. 2002. 11(10 Pt 1):987–992.

65. Saadatian-Elahi M, Norat T, Goudable J, Riboli E. Biomarkers of dietary fatty acid intake and the risk of breast cancer: a meta-analysis. Int J Cancer. 2004. 11:584–591.

66. Shannon J, King IB, Moshofsky R, Lampe JW, Gao DL, et al. Erythrocyte fatty acids and breast cancer risk: a case-control study in Shanghai, China. Am J Clin Nutr. 2007. 85:1090–1097.

67. Engeset D, Alsaker E, Lund E, Welch A, Khaw KT, Clavel-Chapelon F, Thiébaut A, Chajès V, Key TJ, Allen NE, Amiano P, Dorronsoro M, Tjønneland A, Stripp C, Peeters PH, van Gils CH, Chirlaque MD, Nagel G, Linseisen J, Ocké MC, Bueno-de-Mesquita HB, Sacerdote C, Tumino R, Ardanaz E, Sánchez MJ, Panico S, Palli D, Trichopoulou A, Kalapothaki V, Benetou V, Quirós JR, Agudo A, Overvad K, Bjerregaard L, Wirfält E, Schulz M, Boeing H, Slimani N, Riboli E. The European Prospective Investigation into Cancer and Nutrition (EPIC). Fish consumption and breast cancer risk. Int J Cancer. 2006. 19:175–182.

68. Brouwer IA, Katan MB, Zock PL. Dietary-Linolenic Acid Is Associated with Reduced Risk of Fatal Coronary Heart Disease, but Increased Prostate Cancer Risk: A Meta-Analysis. Nutr. 2004. 34:919–922.

69. Koralek DO, Peters U, Andriole G, Reding D, Kirsh V, Subar A, Schatzkin A, Hayes R, Leitzmann MF. A prospective study of dietary alpha-linolenic acid and the risk of prostate cancer (United States). Cancer Causes Control. 2006. 17:783–791.

70. Theodoratou E, McNeill G, Cetnarskyj R, Farrington SM, Tenesa A, Barnetson R, Porteous M, Dunlop M, Campbell H. Dietary Fatty Acids and Colorectal Cancer: A Case-Control Study. Am J Epidemiol. 2007. 166:181–195.

71. MacLean CH, Newberry SJ, Mojica WA, Khanna P, Issa AM, Suttorp MJ, Lim YW, Traina SB, Hilton L, Garland R, Morton SC. Effects of Omega-3 Fatty Acids on Cancer Risk: A Systematic Review. JAMA. 2006. 295:403–415.

72. Hooper L, Thompson RL, Harrison RA, Summerbell CD, Ness AR, Moore HJ, Worthington HV, Durrington PN, Higgins JP, Capps NE, Riemersma RA, Ebrahim SB, Davey Smith G. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ. 2006. 332:752–760.

73. Seely D, Millis EJ, Wu P, Verma S, Guyatt GHl. The effects of grean tea consumption on incidence of breast cancer and recurrence of breast cancer: a systematic review and meta-analysis. Integrative Cancer Therapy. 2005. 4:144–155.

74. Yang G, Shu XO, Li H, Chow WH, Ji BT, Zhang X, Gao YT, Zheng W. Prospective cohort study of green tea consumption and colorectal cancer risk in women. Cancer Epidemiol Biomarkers Prev. 2007. 16:1219–1223.

75. Sasazuki S, Inoue M, Hanaoka T, Yamamoto S, Sobue T, Tsugane S. Green tea consumption and subsequent risk of gastric cancer by subsite: the JPHC Study. Cancer Causes Control. 2004. 15:483–491.

76. Kurahashi N, Sasazuki S, Iwasaki M, Inoue M, Tsugane S. JPHC Study Group. Green tea consumption and prostate cancer risk in Japanese men: a prospective study. Am J Epidemiol. 2008. 67:71–77.

77. Steevens J, Schouten LJ, Verhage BA, Goldbohm RA, van den Brandt PA. Tea and coffee drinking and ovarian cancer risk: results from the Netherlands Cohort Study and a meta-analysis. Br J Cancer. 2007. 97:1291–1294.

78. Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N, Nishino Y, Tsubono Y, Tsuji I. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan. JAMA. 2007. 296:1255–1265.

79. Fleischauer AT, Poole C, Arab L. Garlic consumption and cancer prevention: Meta-analyses of colorectal and stomach cancers. American J Clinical Nutrition. 2000. 72:1047–1052.

80. González CA, Pera G, Agudo A, Bueno-de-Mesquita HB, Ceroti M, Boeing H, Schulz M, Del Giudice G, Plebani M, Carneiro F, Berrino F, Sacerdote C, Tumino R, Panico S, Berglund G, Simán H, Hallmans G, Stenling R, Martinez C, Dorronsoro M, Barricarte A, Navarro C, Quiros JR, Allen N, Key TJ, Bingham S, Day NE, Linseisen J, Nagel G, Overvad K, Jensen MK, Olsen A, Tjønneland A, Büchner FL, Peeters PH, Numans ME, Clavel-Chapelon F, Boutron-Ruault MC, Roukos D, Trichopoulou A, Psaltopoulou T, Lund E, Casagrande C, Slimani N, Jenab M, Riboli E. Fruit and vegetable intake and the risk of stomach and oesophagus adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST). Int J Cancer. 2006. 18:2559–2566.

81. Tanaka S, Haruma K, Kunihiro M, Nagata S, Kitadai Y, Manabe N, Sumii M, Yoshihara M, Kajiyama G, Chayama K. Effects of aged garlic extract (AGE) on colorectal adenomas: a double-blinded study. Hiroshima J Med Sci. 2004. 53(3-4):39–45.

82. Lee YH, Lee CW, Lee HJ, Lee MY, Jeon JC, Shon SS. Stomach cancer related variables by case-control study in some Korean. J Korean Public Health Assoc. 2000. 26:484–496.

83. Schuurman AG, Goldbohm RA, Dorant E, van den Brandt PA. Vegetable and fruit consumption and prostate cancer risk: a cohort study in The Netherlands. Cancer Epidemiol Biomarkers Prev. 1998. 7:673–680.

84. Galeone C, Pelucchi C, Levi F, Negri E, Franceschi S, Talamini R, Giacosa A, La Vecchia C. Onion and garlic use and human cancer. Am J Clin Nutr. 2006. 84:1027–1032.

85. Kirsh VA, Peters U, Mayne ST, Subar AF, Chatterjee N, Johnson CC, Hayes RB. Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Prospective study of fruit and vegetable intake and risk of prostate cancer. J Natl Cancer Inst. 2007. 99:1200–1209.

86. Ambrosini GL, de Klerk NH, Fritschi L, Mackerras D, Musk B. Fruit, vegetable, vitamin A intakes, and prostate cancer risk. Prostate Cancer Prostatic Dis. 2008. 11:61–66.

87. Brennan P, Hsu CC, Moullan N, Szeszenia-Dabrowska N, Lissowska J, Zaridze D, Rudnai P, Fabianova E, Mates D, Bencko V, Foretova L, Janout V, Gemignani F, Chabrier A, Hall J, Hung RJ, Boffetta P, Canzian F. Effect of cruciferous vegetables on lung cancer in patients stratified by genetic status: a mendelian randomisation approach. Lancet. 2005. 366:1558–1560.

88. Lin HJ, Probst-Hensch NM, Louie AD, Kau IH, Witte JS, Ingles SA, Frankl HD, Lee ER, Haile RW. Glutathione transferase null genotype, broccoli, and lower prevalence of colorectal adenomas. Cancer Epidemiol Biomarkers Prev. 1998. 7:647–652.

89. Hara M, Hanaoka T, Kobayashi M, Otani T, Adachi HY, Montani A, Natsukawa S, Shaura K, Koizumi Y, Kasuga Y, Matsuzawa T, Ikekawa T, Sasaki S, Tsugane S. Cruciferous vegetables, mushrooms, and gastrointestinal cancer risks in a multicenter, hospital-based case-control study in Japan. Nutr Cancer. 2003. 46:138–147.

90. Shin HR, Kim JY, Lee DH, Yun TK, Morgan G, Vainio H. The Cancer-preventive Potential of Panax ginseng: A Review of Human and Experimental Evidence. Korean J Prev Med. 2000. 33:383–392.

91. Byun JS, Ohrr H, Yi SW, Hong JS, Sohn TY. A Study on the Association Between Ginseng Intake and Incidences of Cancer: Kangwha Cohort Study. Korean J Prev Med. 2003. 36:367–372.

92. Kamangar F, Gao YT, Shu XO, Kahkeshani K, Ji BT, Yang G, Li HL, Rothman N, Chow WH, Zheng W. Ginseng intake and gastric cancer risk in the Shanghai Women's Health Study cohort. Cancer Epidemiol Biomarkers Prev. 2007. 16:629–630.

93. Ye B, Aponte M, Dai Y, Li L, Ho MC, Vitonis A, Edwards D, Huang TN, Cramer DW. Ginkgo biloba and ovarian cancer prevention: Epidemiological and biological evidence. Cancer Letters. 2007. 251:43–52.

94. Michaud DS, Spiegelman D, Clinton SK, Rimm EB, Willett WC, Giovannucci EL. Fruit and vegetable intake and incidence of bladder cancer in a male prospective cohort. J Natl Cancer Inst. 1999. 91:605–613.

95. Radosavljevic V, Jankovic S, Marinkovic J, Dokic M. Diet and bladder cancer: a case-control study. Int Urol Nephrol. 2005. 37:283–289.

96. Akedo I, Ishikawa H, Nakamura T, Kimura K, Takeyama I, Suzuki T, Kameyama M, Sato S, Nakamura T, Matsuzawa Y, Kakizoe T, Otani T. Randomized trial of dietary fiber and Lactobacillus casei administration for prevention of colorectal tumors. Int J Cancer. 2005. 16:762–767.

97. Rafter J, Bennett M, Caderni G, Clune Y, Hughes R, Karlsson PC, Klinder A, O'Riordan M, O'Sullivan GC, Pool-Zobel B, Rechkemmer G, Roller M, Rowland I, Salvadori M, Thijs H, Van Loo J, Watzl B, Collins JK. Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients. Am J Clin Nutr. 2007. 85:488–496.