Increased fish and omega-3 fatty acid intake linked with improved survival following breast cancer diagnosis

Tuesday, December 1, 2015

Increased fish and omega-3 fatty acid intake linked with improved survival following breast cancer diagnosis

The results of an investigation of breast cancer patients found a lower risk of mortality from all causes over a median period of 14.7 years among women with a higher intake of omega-3 polyunsaturated fatty acids and fish.

Nikhil K. Khankari, PhD, MPH, of the University of North Carolina and colleagues analyzed data from 1,463 women with breast cancer enrolled in the Long Island Breast Cancer Study Project (LIBCSP). Dietary questionnaires completed within three months after diagnosis were analyzed for the intake of fish, omega-3 fatty acids (alpha-linolenic acid [ALA], docosapentaenoic acid [DPA], eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]); and the omega-6 polyunsaturated fatty acids linoleic acid and arachidonic acid.

Over a median follow-up period of 14.7 years, there were 485 deaths, among which 210 were attributed to breast cancer. Compared to those who never consumed baked or broiled fish, women whose intake was among the highest one-fourth of subjects had a 25% lower adjusted risk of dying from any cause over follow-up, and for tuna, the risk was 29% lower.

When omega-3 fatty acids were analyzed, having an intake of EPA that was among the top one-fourth of participants was associated with a 25% lower risk of dying over follow-up compared with those whose intake was among the lowest fourth. Women among the top 25% of DHA intake had a 29% lower risk of death, and for DPA, the risk was 34% and 16% lower for those among the third and fourth highest groups.

"In the current population-based follow-up study of women with breast cancer on Long Island, New York, we observed reductions of 16% to 34% in all-cause mortality after 15 years of follow-up for a high intake of fish and long-chain omega-3 PUFAs (DPA, DHA, and EPA), which is consistent with laboratory evidence and what to the best of our knowledge is the one other United States-based epidemiologic study considering this issue," Dr Khankari and colleagues conclude. "Thus, pending additional replication, dietary intake of fish and other sources of long-chain omega-3 fatty acids may provide an additional strategy with which to improve survival after breast cancer."

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Greater vitamin C intake linked with reduced risk of breast cancer mortality
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The results of a meta-analysis conducted by researchers at Sweden's Karolinska Institutet indicate improved survival among women with breast cancer who had a higher intake of vitamin C from supplements or food sources. The findings were reported in the May 2014 issue of the European Journal of Cancer.

For their analysis, Holly R. Harris and her colleagues selected nine reports describing ten observational studies that included a total of 17,696 women diagnosed with breast cancer, among whom there were 1,558 deaths attributable to the disease and 2,791 total deaths. Studies examined the effect of supplementing with vitamin C following breast cancer diagnosis and/or the effect of vitamin C obtained in the diet.

When the studies that reported the effects of vitamin C supplements were evaluated, their use was associated with a 19% lower risk of total mortality and a 15% lower risk of dying from breast cancer in comparison with no use. Analysis of vitamin C from food sources uncovered a 27% lower risk of mortality and a 22% lower risk of breast cancer death in association with each 100 milligram per day increase. Comparison of high versus low dietary intake resulted in a 20% lower risk of dying and a 23% reduction in the risk of breast cancer mortality among women whose intake was categorized as high.

"To our knowledge this is the first meta-analysis to combine the limited number of published studies available on vitamin C supplement intake and dietary vitamin C intake and survival following breast cancer diagnosis,"the authors announce. "More studies of post-diagnosis supplement use, including vitamin C, are warranted to further our understanding of how their intake during chemotherapy or radiation therapy may influence breast cancer outcomes."

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Health Concern

Breast cancer

A higher omega-3:omega-6 ratio (n-3: n-6 ratio) may reduce the risk of breast cancer, especially in premenopausal women (Goodstine et al. 2003). In a prospective study of 35,298 Singapore Chinese women aged 45-74 years, it was determined that high levels of dietary omega-3 fatty acids from marine sources (fish/shellfish) were significantly associated with reduced risk of breast cancer. Furthermore, women who consumed low levels of marine omega-3 fatty acids had a statistically significant increased risk of breast cancer (Gago-Dominguez et al. 2003).

Omega-3 fatty acids, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found naturally in oily fish and fish oil, have been consistently shown to retard the growth of breast cancer in vitro and in animal experiments, inhibit tumor development and metastasis. Fish oils have antiproliferative effects at high doses, which means they can inhibit tumor cell growth through a free radical-mediated mechanism, while at more moderate doses omega-3 fatty acids inhibit Ras protein activity, angiogenesis, and inflammation. The production of pro-inflammatory cytokines can be modified by dietary omega-3 PUFAs (Mancuso et al. 1997).

High consumption of fatty fish is weakly associated with reduced breast cancer risk (Goodstine et al. 2003). Flaxseed, the richest source of alpha-linoleic acid inhibited the established growth and metastasis of human breast cancer implanted in mice. This effect was found to be due to its down-regulation of insulin-like growth factor I (IGF-1) and epidermal growth factor receptor (EGF-R) expression (Chen et al. 2002).

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