- Email: [email protected]
Voices from the front: July
Cancer and Society
the juice of the gods and encouraged them to worship him in frenzied festivals. Red wine is still used in Christian Eucharist ceremonies (as the blood of Jesus Christ) and the Jewish Kiddush. Many Christians believe that God approves the moderate use of wine, but overlook that the Bible actually condemns drunkenness (Ephesians 5:18). Meanwhile, the health benefits of wine are clearly stated in the Jewish Talmud (Tractate Berachoth 35b and 58b): “Wine taken in moderation induces appetite and is beneficial to health...Wine is at the head of all medicines; where wine is lacking, drugs are necessary.” Light-to-moderate wine consumption (150–300 mL daily) is associated with a reduced risk of major cardiovascular events, and much work has been published about the so-called French paradox—ie, a low incidence of heart disease, despite a diet high in saturated fats. The possible anticancer properties of red wine have also been considered. At first glance, the basic constituents of wine seem nothing special; mostly water and alcohol, with some sugars, polysaccharides, acids, aromatics, vitamins, and minerals. However, oenology (the science of wine and winemaking), which we casually note is only one letter away from oncology, has developed substantially over the past 20 years, and advances in analytical methods have been exploited to examine the chemical composition of wine more accurately. These analyses have helped to identify more than 500 chemical
compounds—including 160 esters—all of which contribute to its colour, taste, and aroma. Red wine contains a range of biologically active polyphenols, including phenolic acids, trihydroxystilbenes, and flavonoids. Dietary polyphenols are antioxidants, and thus attenuate the development of atherosclerosis and inflammatory diseases, but their role in cancer prevention is inconclusive. Wine consumption might decrease the risk of several cancers, including those of the upper digestive tract, lung, colon, and skin, but studies are typically small. One of the most investigated polyphenols in red wine is resveratrol, and an investigation published in Science suggests that it interferes with several stages of carcinogenesis. Japanese researchers profiled resveratrol’s molecular effects and noted an increase in microRNAs involved in suppression of breast cancer. Other polyphenols found in red wine include piceatannol and myricetin, which kill some forms of cancer cells in culture but not others. No studies of any of these compounds have been done in people. Interestingly, a study in postmenopausal women noted that red but not white wine has similar effects on hormone concentrations to those of aromatase inhibitors and could therefore help to prevent breast cancer. However, in another study, investigators analysed data gathered between 1980 and 2008, from more than 100 000 registered nurses who
were asked to report every 2 years the type, amount, and frequency of their alcohol consumption and the development of any disease. More than 7500 participants developed invasive breast cancers, and even those consuming as few as three glasses of wine per week had a slightly increased risk of breast cancer. The type of alcohol consumed had no effect (ie, wine was no better than spirits), suggesting that any potential benefits associated with components such as resveratrol in red wine could be outweighed by the damaging effects of the other compounds present. Red wine has become the elixir of the rich and can command enormous sums of money. It brings immense pleasure to people who appreciate its taste and certain vintages are considered magical. Perhaps some primordial instinct in us recognises that these are the wines that will benefit our health the most. However, this possibility does not excuse overindulgence, and we should not be blinded by the fact that red wine contains 12% alcohol on average. Although wine might be delicious, its health benefits are uncertain and no strong evidence shows that it can prevent cancer. Thus, we are a long way from advocating the regular consumption of red wine to help prevent cancer.
Adam E Frampton, *Justin Stebbing Imperial College, London, UK (AEF, JS) [email protected]
Voices from the front: July Click… click. His now silent voice was replaced by the sound of the traffic light as the signal changed. The man whom I had known as a young attending physician for 3 years had died. He was my age, muscular and indestructible despite the low-grade lymphoma lurking inside him. Together we conspired to ignore it. We arranged his treatments so he could spend more time with his foster son, and enjoyed sharing our common interests. All was well in our world until the lymphoma suddenly consumed him in 6 weeks of explosive growth. He died at two in the morning, and as I sat by his bedside I could not believe he was gone. Later, in my car in the quiet hospital parking lot, I was angry that the world kept going and the traffic light kept changing without him.
David M Mastrianni
670
www.thelancet.com/oncology Vol 13 July 2012
the juice of the gods and encouraged them to worship him in frenzied festivals. Red wine is still used in Christian Eucharist ceremonies (as the blood of Jesus Christ) and the Jewish Kiddush. Many Christians believe that God approves the moderate use of wine, but overlook that the Bible actually condemns drunkenness (Ephesians 5:18). Meanwhile, the health benefits of wine are clearly stated in the Jewish Talmud (Tractate Berachoth 35b and 58b): “Wine taken in moderation induces appetite and is beneficial to health...Wine is at the head of all medicines; where wine is lacking, drugs are necessary.” Light-to-moderate wine consumption (150–300 mL daily) is associated with a reduced risk of major cardiovascular events, and much work has been published about the so-called French paradox—ie, a low incidence of heart disease, despite a diet high in saturated fats. The possible anticancer properties of red wine have also been considered. At first glance, the basic constituents of wine seem nothing special; mostly water and alcohol, with some sugars, polysaccharides, acids, aromatics, vitamins, and minerals. However, oenology (the science of wine and winemaking), which we casually note is only one letter away from oncology, has developed substantially over the past 20 years, and advances in analytical methods have been exploited to examine the chemical composition of wine more accurately. These analyses have helped to identify more than 500 chemical
compounds—including 160 esters—all of which contribute to its colour, taste, and aroma. Red wine contains a range of biologically active polyphenols, including phenolic acids, trihydroxystilbenes, and flavonoids. Dietary polyphenols are antioxidants, and thus attenuate the development of atherosclerosis and inflammatory diseases, but their role in cancer prevention is inconclusive. Wine consumption might decrease the risk of several cancers, including those of the upper digestive tract, lung, colon, and skin, but studies are typically small. One of the most investigated polyphenols in red wine is resveratrol, and an investigation published in Science suggests that it interferes with several stages of carcinogenesis. Japanese researchers profiled resveratrol’s molecular effects and noted an increase in microRNAs involved in suppression of breast cancer. Other polyphenols found in red wine include piceatannol and myricetin, which kill some forms of cancer cells in culture but not others. No studies of any of these compounds have been done in people. Interestingly, a study in postmenopausal women noted that red but not white wine has similar effects on hormone concentrations to those of aromatase inhibitors and could therefore help to prevent breast cancer. However, in another study, investigators analysed data gathered between 1980 and 2008, from more than 100 000 registered nurses who
were asked to report every 2 years the type, amount, and frequency of their alcohol consumption and the development of any disease. More than 7500 participants developed invasive breast cancers, and even those consuming as few as three glasses of wine per week had a slightly increased risk of breast cancer. The type of alcohol consumed had no effect (ie, wine was no better than spirits), suggesting that any potential benefits associated with components such as resveratrol in red wine could be outweighed by the damaging effects of the other compounds present. Red wine has become the elixir of the rich and can command enormous sums of money. It brings immense pleasure to people who appreciate its taste and certain vintages are considered magical. Perhaps some primordial instinct in us recognises that these are the wines that will benefit our health the most. However, this possibility does not excuse overindulgence, and we should not be blinded by the fact that red wine contains 12% alcohol on average. Although wine might be delicious, its health benefits are uncertain and no strong evidence shows that it can prevent cancer. Thus, we are a long way from advocating the regular consumption of red wine to help prevent cancer.
Adam E Frampton, *Justin Stebbing Imperial College, London, UK (AEF, JS) [email protected]
Voices from the front: July Click… click. His now silent voice was replaced by the sound of the traffic light as the signal changed. The man whom I had known as a young attending physician for 3 years had died. He was my age, muscular and indestructible despite the low-grade lymphoma lurking inside him. Together we conspired to ignore it. We arranged his treatments so he could spend more time with his foster son, and enjoyed sharing our common interests. All was well in our world until the lymphoma suddenly consumed him in 6 weeks of explosive growth. He died at two in the morning, and as I sat by his bedside I could not believe he was gone. Later, in my car in the quiet hospital parking lot, I was angry that the world kept going and the traffic light kept changing without him.
David M Mastrianni
670
www.thelancet.com/oncology Vol 13 July 2012