Bulletin du cancer
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Remarkably, although 60% of new cancer cases and over 70% of cancer deaths occur in patients aged 65 years and older in Europe, standard treatment strategies have been mostly validated in younger adults. This demographic trend has led to the emergence of a new medical discipline, geriatric oncology and the development worldwide of geriatric oncology programs for the individualized management of elderly cancer patients. Elderly cancer patients represent an increasing share of the population and strategies for treating cancer must evolve to face this ineluctable reality. ⋯ French geriatric oncology programs have been mostly based on the interdependence of geriatricians, oncologists and auxiliary nursing people. This approach represent the best way to offer patients optimal management; oncologists and geriatricians collaborate to assess both global health status by means of Comprehensive Geriatric Assessment (CGA) and tumor stage by means of Comprehensive Tumor Assessment (CTA) and to initiate individualized care plans, involving comprehensive management and follow-up of all identified problems. This paper focuses on progress observed in the field of geriatric oncology both in France and worldwide.
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This study reviews epidemiological works having studied the associations of dietary fatty acids, especially of n-6 or n-3 polyunsaturated fatty acids (PUFA), with the risks of colorectal and prostate cancers. ⋯ Most studies based on a dietary questionnaire did not find any association of the risk of colorectal cancer with the consumption of either total fatty acids or any particular fatty acid, after adjustment for total energy intake had been made. A few studies suggest that trans fatty acid consumption could increase colorectal cancer risk. Most studies based either on a dietary questionnaire or on biomarkers, did not find any association of total, saturated or monounsaturated fatty acid, as well as of linoleic or arachidonic acids, with prostate cancer risk, after adjustment for total energy intake. Most studies failed to find an association of prostate cancer risk with fish or long-chain n-3 PUFA intake, but recent cohort studies did find an inverse association of fish consumption with the risk of the latest stages of prostate cancer. In contrast, alpha-linolenic acid intake was associated with an increase of prostate cancer risk in a majority of epidemiological studies, but other studies did not find this association. This latter point might be of concern, and needs to be clarified by other results, especially those of ongoing prospective studies.
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Experiments in animal models of mammary carcinogenesis suggest that fatty acids promote mammary tumors development. This effect depends first on the amount then on the type of fatty acids available. n-6 fatty acids such as linoleic acid generally stimulates mammary tumor growth, while n-3 fatty acids oppose this effect. Conjugated diene fatty acids (CLA) inhibit mammary carcinogenesis when brought at elevated amount. ⋯ However, on the basis of numerous published data, some important correlations have arisen that could generate hypotheses and guide new epidemiological/interventional and experimental studies. In these animal models it appears that an adequate supply of n-3 PUFAs and oleic acid in food may exert a protective effect at all stages of colon carcinogenesis. On the other hand, an excessive consumption of n-6 PUFAs and of saturated fatty acids could promote colon cancers.
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The validity of estimated association between dietary fat intake and cancer depends both on the methodology of dietary assessment used and on the quality of food composition data. The food composition database of Afssa/Ciqual shows that there is a deficiency in data on fatty acids. In order to identify the priorities for improving the quality of the database, we analysed the data quality of major dietary contributors of fatty acids in the French population. ⋯ Vegetable oils and sauces are the major contributors of polyunsaturated fatty acids before "fatty" potatoes (such as chips...) in adults whereas the opposite was observed in children. Composition tables do not presently allow the identification of contributors of specific fatty acids (omega 3, omega 6, conjugated linoleic acid). If nutritional data of milk products, fats, and oils are reliable because of existing specific tables for these products, there is a need for improving quality of composition data for other major contributors such as: meats, processed meats, fish and dishes such as pizzas, pasteries...