6/25 - JEOPARDY QUESTIONS Nutrition in Cancer

Question 1

Answer: This “fallacy” may occur in interpreting results from a study in which exposure is known only for groups, but not for individuals in the group

Answer 1

Question: What is “ecological” fallacy in an “ecological” or correlational study

Question 2

Answer: For potentially hazardous exposures, it is only ethical to conduct this type of study

Answer 2

Question: What are observational studies?

Question 3

Answer: This bias occurs when methods of measurement are dissimilar between groups of patients or errors occur in classification of exposure or outcome.

Answer 3

Question: What is measurement (or information) bias?

Question 4

Answer: This factor is associated with the “exposure of interest” E, is also associated with or is a risk factor for the “outcome of interest” O, and is not in the causal pathway from E to O, thus it may distort the association between the study exposure and outcome.

Answer 4

Question: What is a confounder?

Question 5

Answer: The father of toxicology, noted for stating that “All things are poison and nothing is without poison. Solely the dose determines that a thing is not a poison.” (Robbins-slightly different version)

Answer 5

Question: Who is Paracelsus?

Question 6

Answer: The normal range in terms of physiologic parameters that each cell and the organism as a whole tries to maintain for optimal functioning (multiple sources).

Answer 6

Question: What is homeostasis?

Question 7

Answer: It is estimated that up to this proportion of cancers may be due to diet. (Doll & Peto, The Causes of Cancer, JNCI,1981)

Answer 7

Question: What is 35%?

Question 8

Answer: 2 of the Bradford Hill criteria used in assessing causality (Fletcher).

Answer 8

Question: What are

1) temporality,
2) strength of association,
3) Dose-response,
4) Reversibility,
5) Consistency
6) Biologic Plausibility,
7) Specificity,
8) Analogy

Question 9

Answer: These are the 4 steps in Risk Assessment. (EPA link).

Answer 9

Question: What are

1) Hazard Identification,
2) Dose Response,
3) Exposure Assessment,
4) Risk Characterization

Question 10

Answer: The 3 stages of chemical carcinogenesis (Robbins, others).

Answer 10

Question: What are initiation, promotion, and progression?

Question 11

Answer: These four classes of normal regulatory genes are the primary targets of genetic damage in carcinogenesis. (Name 2) (Robbins)

Answer 11

Question: What are proto-oncogenes, tumor suppressor genes, apoptosis genes, and DNA repair genes.

Question 12

Answer: TP53 is an example of this type of regulatory gene which is a common target for mutation in many different cancers (Robbins).

Answer 12

Question: What is a tumor suppressor gene?

Question 13

Answer: Mutations affecting these regulatory genes may result in a “mutator phenotype” (Robbins).

Answer 13

Question: What are DNA repair genes? (Robbins)

Question 14

Answer: There is a strong correlation between contamination of food with this agent, produced by a mold which grows on grains/nuts, and the incidence of hepatocellular carcinoma (Robbins).

Answer 14

Question: What is aflatoxin B1? (Produces a signature mutation in TP53)

Question 15

Answer: Reversible, heritable changes in gene expression, without mutation, involving post-translational modification of histones and DNA methylation, which may directly contribute to tumor development.

Answer 15

Question: What are epigenetic changes?

Question 16

Answer: As opposed to a direct acting carcinogen, an indirect carcinogen must undergo this process (Robbins).

Answer 16

Question: What is metabolic conversion/activation (or biotransformation/bioactivation)?

Question 17

Answer: These chemical species have a single unpaired electron, and when they are in excess, oxidative stress and cellular damage or cell death may occur (Robbins).

Answer 17

Question: What are free radicals?

Question 18

Answer: Most of the known carcinogens are metabolized by this family of enzymes (Robbins).

Answer 18

Question: What are cytochrome p-450-dependent mono-oxygenases?

Question 19

Answer: The Shanghai study showed a 30% increase in risk for THIS cancer in those with a “meat-sweet” diet profile.

Answer 19

Question: What is breast cancer?

Question 20

Answer: In addition to increased estrogen being produced with excess body fat, a high fat/low fiber diet may increase estrogen levels through this mechanism.

Answer 20

Question: What is enterohepatic circulation?

Question 21

Answer: Reviewing nutrition and breast cancer survival studies, Dr Barnard presented information showing increased breast cancer survival associated with these 4 things. (Name 2).

Answer 21

Question: What are 1)Decreased body fat, 2)Decreased dietary fat, 3)Increased Vegetables/fruits/exercise, 4)Soy 2servings/day

Question 22

Answer: These 2 mechanisms are proposed to explain the apparent association between increased prostate cancer risk with increased dairy consumption.

Answer 22

Question: What are increased IGF1 levels and impaired Vitamin D metabolism?

Question 23

Answer: The charring of meats produces this class of known carcinogens.

Answer 23

Question: What are heterocyclic amines? (Charring also produces polycyclic aromatic hydrocarbons, also known carcinogens)

Question 24

Answer: The ACS guidelines recommend a healthy diet with emphasis on these foods.

Answer 24

Question: What are plant foods?

Question 25

Answer: Fatty acids considered PRO-inflammatory and ANTI-inflammatory. (CanFam MD article)

Answer 25

Question: What are omega-6 fatty acids and omega-3 fatty acids?

Question 26

Answer: This CLASS of chemicals provide the chemopreventive properties of plant-based food thought to aid in blocking the progression of latent microtumours. (Can Fam MD article)

Answer 26

Question: What are phytochemicals?

Question 27

Answer: Eating fruits & vegetables was associated with Level I evidence of a decrease in cancer risk for THESE organs (Name 2) (Can Fam MD article).

Answer 27

Question: What is stomach, esophagus, mouth and pharynx, colon, rectum and lung? (As much as 75% of colon CA may be prevented with plant based diets)

Question 28

Answer: The Role of Nutrition in Preventing Cancer article described these 2 classes of anticancer properties of plant-based food. (Can Fam MD)

Answer 28

Question: 1)Direct Inhibitory Actions [Reduction of DNA damage (enzyme modulation), cytotoxicity (pro-apoptotic influence)], 2.Microenvironment (antiangiogenic properties, anti-inflammatory effects)

Question 29

Answer: In non-smoking Americans, these are the 3 most important MODIFIABLE risk factors for cancer (ACS).

Answer 29

Question: What are weight control, diet, and physical activity?

Question 30

Answer: These are the 10 Recommendations for Cancer Prevention from the WCRF/AICR second expert report. (Name 3)

Answer 30

Question: 1.Be as lean as possible. 2.Be physically active (30 min/d min) 3.Avoid sugary drinks 4.Eat a variety of fruits, vegetables, whole grains, legumes 5.Limit red meat and avoid processed meat 6.Limit alcohol 2/1 7.Limit salt 8.Don’t use supplements** 9.Breast feed at least 6mos 10.After CA tx, follow **preg,child,elderly

Question 31

Answer: These are the TWO overarching concepts of the Dietary Guidelines for Americans 2010.

Answer 31

Question: 1.Maintain calorie balance to achieve/maintain a healthy weight 2.Consume nutrient dense food and beverages.

Question 32

Answer: Nitrates and nitrites used to process meat are converted to this substance which has been shown to be a mutagen/carcinogen in animals. (ACS)

Answer 32

Question: What are nitrosamines?

Question 33

Answer: Overweight and obesity are thought to impact cancer risk through a variety of mechanisms, including effects on these 4 areas (Name 2)(ACS).

Answer 33

Question: What are 1)immune function and inflammation, 2)hormone levels and metabolism (insulin, estradiol), 3)factors influencing cell proliferation and growth (IGF-1), 4)proteins that make hormones more or less available (sex hormone binding globulin, IGF binding protein) [reflux for adenoCA of esophagus as well]