**2.5.3 Calorie restriction**

Calorie restriction in *Apc*Min mice at the rate of 40% reduced the number of intestinal polyps by 57%, compared with mice fed ad libium. The serum levels of IGF-1 and leptin, and urinary corticosterone output were significantly reduced in the calorie restriction group, compared with that of the ad libium group. Supplementation of freeze-dried fruit and vegetable extract with a diet high in olive oil also reduced the number of polyps, even though this group had a calorie intake of about 90% of ad libium. The supplementation of fruit and vegetables significantly reduced the urinary corticosterone output levels, but did not show any effect on the serum levels of IGF-1 and leptin (Mai et al., 2003).

These results indicate that calorie restriction has a great potency for colon cancer prevention, and a diet in high fruit and vegetable without calorie restriction showed less, but still significant, intestinal tumorigenesis preventive effects.

Calorie restriction or increased exposure to n-3 fatty acid, sulforaphe, chafrroside, curcumin and dibenzoylmethane reduced the risk of colon cancer, while total fat, a diet high in calories and all-trans retinoic acid increased the risk (Tammariello & Milner, 2010).

However, even considering these interesting results, the frequency of colon polyps in the calorie restriction group and the fruit and vegetable group did not show any significant changes, compared with the ad libium group (van Kranen et al., 1998).

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### **3. Conclusion**

The contribution of diet in all cancer-related death estimates was 30-35% in the environmental factors, greater than tobacco, which was 25-30%. Colorectal cancer was strongly associated with diet, and linked to 70% of cancer related-deaths (Anand et al., 2008). Eating habits are the most important factor for colorectal cancer prevention, however, it is still difficult to specify how we should eat. It has been proposed that an increase in the consumption of fruit and vegetables and less intake of red and processed meat will comprise a better diet. However, it has not been proven yet how much of a respective increase and decrease is the best quantity, and which nutrients exactly play a key role in carcinogenesis and anti-carcinogenesis. Plenty of studies have been published on food components or nutrients to protect from carcinogenesis *in vitro*, describing the molecular action mechanisms involved. In human trials, individual nutrients, such as supplements, often showed no or less intended function, while nutrients contained in food functioned as expected. Accordingly, the judgement from a global perspective concluded that it was not appropriate to recommend the usage of supplements for cancer prevention at the present (World Cancer Research Fund, 2007d). The ideal diet for cancer prevention may be a wellbalanced diet, and no one food or ingredient should be considered a miracle food. Further studies are required to elucidate precisely the disposition and safety of nutrients and the interaction of each nutrient.

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**9** 

*USA* 

**Cervical Cancer Screening and Prevention for** 

**HIV-Infected Women in the Developing World** 

Cervical cancer ranks as the third most common cancer in women worldwide and is the fourth leading cause of cancer deaths in women, with an estimated 270,000 deaths annually. Over 85% of both cervical cancer cases and deaths occur in developing countries with only 5% of global cancer resources (Lancet 2010). Cervical cancer is the most common cancer in women in most developing countries and most common cause of cancer deaths (Cervical Cancer Action: Report Card 2011). It is the leading cause of years of life lost to cancer in low resource settings (Yang et al. 2004). In sub-Saharan Africa cervical cancer represents 22% of

Currently, an estimated 33.3 million individuals worldwide are living with HIV/AIDS, approximately 68% of whom live in Sub-Saharan Africa; globally over 50% of all those living with HIV are female and in Sub-Saharan Africa, women account for 60% of HIV infections. In 2009 there were an estimated 7000 new infections per day, 51% of these among women (UNAIDS 2010). However, there have been dramatic advances in prevention, care and treatment in the areas that are hardest hit by HIV over the past 10 years, coincident with unprecedented global commitment for funding and other support. These include a global decline of 19% in number of new HIV infections and a >25% decline in HIV prevalence among young people 15–24 years of age in 15 high burden countries, a decrease in global AIDS deaths by 19% from 2004–2009, and an increase in access to antiretroviral therapy (ART) in low and middle-income (LMIC) countries from 400,000 in 2003 to 5.25 million by the end of 2009 (this however, comprises only 35% of those estimated to be in need of therapy) (WHO 2011).

The areas where cervical cancer rates are highest also often have high prevalence of HIV and the presence of HIV increases the risk of cervical precancerous and cancerous changes; furthermore there is general unavailability of effective cervical cancer screening programs in these lower resource settings. This paper will review issues related to cervical cancer screening and prevention for HIV-infected women in low resource settings, with a focus on

The causal relationship between some microbial pathogens, primarily viral, and human carcinogenesis have been suspected but it has only been in the last 20 years that knowledge

**2. Human papillomavirus infection and cervical cancer** 

**1. Introduction** 

all cancers in women (Parkin et al. 2003).

non-cytology-based techniques.

Jean Anderson, Enriquito Lu, Harshad Sanghvi,

Sharon Kibwana and Anjanique Lu

*Jhpiego, Johns Hopkins University* 

