|LETTER TO THE EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 779-780
Diet and colorectal cancer: Eat, pray, and live with the consequences
Department of Medical Oncology, MS Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
|Date of Submission||06-Nov-2021|
|Date of Decision||12-Nov-2021|
|Date of Acceptance||12-Nov-2021|
|Date of Web Publication||29-Dec-2021|
Department of Medical Oncology, MS Ramaiah Medical College and Hospital, Bengaluru - 560 094, Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Majumdar S. Diet and colorectal cancer: Eat, pray, and live with the consequences. Cancer Res Stat Treat 2021;4:779-80
I perused the article titled, “Dietary risk factors for colorectal cancer: A hospital-based case–control study,” published recently in Cancer Research, Statistics, and Treatment.
The study warrants attention, given its meticulous attempt at capturing the dietary practice of a northern Indian community. As pointed out by the authors, this geographical cohort is underrepresented, and very little is known about its dietary practices. Zargar et al. have made a rather meticulous effort to capture the food habits of the study participants. In addition, the authors have modified the questionnaire to include local food practices instead of employing a generic food frequency form. It was indeed refreshing to see a time-intensive, well-conducted observational study in the era of researchers clamoring to do interventional trials.
Colorectal cancer was reported to comprise 16.8% of all cancers in a hospital in Kashmir, India, however, similar data are not available from Jammu. It is reasonable to expect that the incidence may be lower, given the ethnic diversity of this region. A previous assessment of the prevalence of colon cancer in this region could have provided the readers an insight into the problem and the impact of preventive interventions undertaken by the public health sector. Heterogeneity of cancer causing agents mandates a large sample size or an umbrella review of meta-analysis to assess the significance of risk factors. The current study, with its limited sample size, could not provide new data regarding the impact of dietary factors on colon cancer pathogenesis. Moreover, confounding factors such as body mass index/obesity that are well reported to be associated with colon cancer were not taken into account in this study. A discussion on the influence of sedentary lifestyle (37% in cases vs. 18% in healthy controls) on the outcomes was lacking.
The results were rather interesting, and my brief thoughts are as follows,
- Alcohol was reported to increase the odds of colon cancer by 2.6 times compared with healthy controls. However, alcohol consumption was equally prevalent in hospital controls with cancers not reportedly associated with alcohol. Smoking is often a confounding factor in such cases and associated with alcohol intake
- It was surprising to learn that pickled vegetables increased the odds of developing colon cancer by three times. Given its wide consumption, especially in South India, the lack of supporting data merits discussion. Could the salt content and the pickling process have affected the odds of cancer development?
- Unfortunately, there was no assessment of dietary fiber intake or an assessment of micronutrient intake in the study. An evaluation of micronutrients, including vitamins and minerals, would have elevated the scope of the study
- Red meat, unsurprisingly, was strongly associated with colon cancer. This has been repeatedly reported across multiple studies and meta-analysis. Refraining from red meat consumption as a primary or secondary preventive strategy might seem logical. However, as an oncophysician dealing with protein deficient adult patients with cancer, I would think twice before advising complete meat abstinence
- The study was a missed opportunity to evaluate the effects of “junk food.” The growing habitual consumption of processed, preservative-laden, prepackaged food warrants attention.
Albeit beyond the scope of this article, a study into the colonic microbiome, inflammatory markers, and colonic mucosal microenvironment, all often associated with dietary habits, could have been discussed in some detail by the authors.
Of the many causes of cancer, dietary habits and lifestyle are apparently modifiable. An in-depth study on dietary habits of a community (genetic or geographic) often reveals significant associations with cancer, but that does not translate to causation. The burden, of course, rests on the researcher to prove a mere association as a causative factor. An interesting follow-up of the study would be to conduct a Knowledge, Attitude, and Practices survey in the same cohort. Would the knowledge that alcohol or red meat consumption led to an increased risk of cancer bring about a change in practices? More importantly, does this study and other similar analysis bring about a change in the physicians' behavior? If not, then we just eat, pray, and live with the consequences.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zargar T, Kumar D, Sahni B, Shoket N, Bala K, Angurana S. Dietary risk factors for colorectal cancer: A hospital-based case-control study. Cancer Res Stat Treat 2021;4:479-85. [Full text]
Qurieshi MA, Khan SM, Masoodi MA, Qurieshi U, Ain Q, Jan Y, et al.
Epidemiology of cancers in Kashmir, India: An analysis of hospital data. Adv Prev Med 2016;2016:1896761.
Johnson CM, Wei C, Ensor JE, Smolenski DJ, Amos CI, Levin B, et al.
Meta-analyses of colorectal cancer risk factors. Cancer Causes Control 2013;24:1207-22.