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Nutrition and Cancer Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hnuc20
Pork intake and human papillomavirus‐related disease Achim Schneider
a d
Reinhard Kirchmayr
b
c
, Alfredo Morabia , Uwe Papendick & a
a
Department of Obstetrics and Gynecology , University of Ulm , Ulm, West Germany b
Department of Epidemiology , The Johns Hopkins University School of Public Health , Baltimore, MD, 21205 c
Branch of Boehringer Ingelheim , Dr. K. Thomae GmbH , Biberach, West Germany d
Universitäts‐Frauenklinik , Prittwitzstr. 43, 79 Ulm, West Germany Published online: 04 Aug 2009.
To cite this article: Achim Schneider , Alfredo Morabia , Uwe Papendick & Reinhard Kirchmayr (1990) Pork intake and human papillomavirus‐related disease, Nutrition and Cancer, 13:4, 209-211, DOI: 10.1080/01635589009514062 To link to this article: http://dx.doi.org/10.1080/01635589009514062
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Montana] at 14:50 08 April 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Brief Communication
Pork Intake and Human PapillomavirusRelated Disease
Downloaded by [University of Montana] at 14:50 08 April 2015
Achim Schneider, Alfredo Morabia, Uwe Papendick, and Reinhard Kirchmayr
Abstract Clinical and ecological evidence supporting an association between human papillomavirus (HPV)-related tumors and dietary factors are presented. Abstinence from high intake of fried pork (600-1,000 g/day) was associated with regression of an urethral condyloma in a healthy 19-year-old man treated with interferon gamma. International correlations suggest that pork intake is positively associated with incidence of cervical cancer, a disease also related to HPV. Pork meat or dietary factors associated with pork meat consumption may be involved in the development of HPV-related diseases. (Nutr Cancer 13, 209-211, 1990)
Introduction
Human papillomaviruses (HPV) are associated with the development of anogenital cancer (1). However, additional environmental factors seem to be necessary for the malignant conversion of papillomavirus-induced condylomas. In human populations, dietary components may be involved, because deficiencies of vitamins A and C and folic acid seem to be associated with cervical neoplasia (2). We present here a case of regression of a severe form of condyloma, a disease due to HPV, following a change in diet, as well as international correlations between meat intake and incidence of cervical cancer, a disease also associated with HPV. Case Report
Since August 1987 we followed a healthy 19-year-old male patient with recurrent condyloma of the urethral fossa navicularis. On examination, a giant condyloma of about 2-cm diameter was protruding from the urethral meatus. The tumor was completely removed A. Schneider and R. Kirchmayr are affiliated with the Department of Obstetrics and Gynecology, University of Ulm, Ulm, West Germany. A. Morabia is affiliated with the Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD 21205. U. Papendick is affiliated with the Dr. K. Thomae GmbH, Branch of Boehringer Ingelheim, Biberach, West Germany.
Copyright © 1990, Lawrence Erlbaum Associates, Inc.
by carbon dioxide laser vaporization. Condyloma acuminatum without atypia positive for HPV 11 was diagnosed on histology and in situ hybridization. Four weeks after laser therapy, the lesion recurred and interferon gamma (IFN) (0.2 mg subcutaneously, 3/wk) was initiated. In the following four weeks the size of the condyloma increased. On revaluation, the patient, who weighed 65 kg for 170 cm, stated that he had been consuming about 200-250 g of fried pork three to four times a day for the past five years. The meat was usually from the neck portion, with 13% fat content, and was fried to medium rare at 250°C for about five minutes using 1 Tbsp of sunflower oil. This intake corresponds to approximately 91-114 g of saturated fats and 30-40 g of fried vegetable oil per day. The patient was advised to completely abstain from eating fried pork. During the next nine weeks of IFN therapy, the condyloma continuously regressed. It had disappeared completely at the end of therapy and did not recur during the 22 months of follow-up. No sexual activity whatsoever and no change in smoking habits (20 cigarettes/day) was reported during the period of treatment.
Downloaded by [University of Montana] at 14:50 08 April 2015
International Correlations
Data on incidence of cervical cancer and on meat consumption were available for 32 countries (3,4). The analysis was limited to 25 countries with comparable age distribution because no age standardization was feasible for the dietary data. For comparison purposes, incidence rates were standardized on the basis of age distribution of the world population. National yearly per capita consumption of pork and other meats, as well as daily intake of fat derived from pork (pork fat) and from other meats (nonpork fat) were correlated with incidence data of cervical cancer. Pearson's correlation coefficient was used as a measure of linear association, and the trend was tested using linear regression (5). Positive correlations were observed between the incidence of cervical cancer and pork meat consumption (r = 0.42; p = 0.05) (Figure 1) or pork fat consumption (r = 0.16;/> = 0.20). On the other hand, negative correlations were found between the incidence of cervical cancer and nonpork meat (r = —0.34; p = 0.10) or nonpork fat consumption (r = —0.31; p = 0.15). Hongk
-
Roman i a
Singap
Denmark West-Gcr Poland
Norway Franco Yugos^
Japan
^
^
^___--—"Czechcs Hungary
Iceland -
^^^~
Italy
5
Canada
Swec en
CH
Austral
X
Spain Ireland Finland Israel
1
i
i
i
20
30
40
\ 50
BO
70
INTAKE OF PORK MEAT. (Wg/capufc/year)
Figure 1. Correlation between cervical cancer incidence and meat intake in 25 countries. Relationship between incidence of cervical cancer (per 100,000/yr) and intake of pork meat (kg/caput(person)/yr). Regression line: y = 8.98 + 0.12*.
210
Nutrition and Cancer 1990
Discussion
Downloaded by [University of Montana] at 14:50 08 April 2015
The correlation between per capita pork consumption and cervical cancer incidence in 25 countries supports the hypothesis that pork meat, or a related dietary factor, may have played a role in the clinical observation reported here. HPV infections (e.g., condyloma) seem to predispose to HPV-associated cancer (e.g., anogenital carcinoma and cervical cancer). Zur Hausen (6) suggested (hat the mechanism of carcinogenesis may be a deregulation of the expression of the E(i and E7 open reading frames of the integrated HPV genome. There is some evidence that pork intake is associated with an increased mutagenic activity in humans (7-9). Thus, pork meat intake might well enhance the potential carcinogenic effect of HPV. In summary, the influence of a dietai-y factor associated with pork consumption on HPV infection and HPV-related neoplasia seems plausible even though a single clinical observation and international correlations are weak evidence. In view of the rising incidence of HPV infections and HPV-associated diseases in the young population (10) as well as the potential public health and clinical use of dietary counseling, we suggest that the association of cervical or anogenital cancer with diet, including pork meat, warrants study with individual dietary information.
Acknowledgments and Notes This work was supported by the Deutsche Foischungsgemeinschaft (Schn 294/1-2) (Bonn, West Germany) and by the Swiss National Fund for Scientific Research (Bern, Switzerland). Address reprint requests to Dr. A. Schneider, Universitäts-Frauenklinik, Prittwitzstr. 43, 79 Ulm, West Germany. Submitted 9 August 1989; accepted in final form 27 October 1989.
References 1. Zur Hausen, H, and Schneider, A: "The Role of Papillomaviruses in Human Anogenital Cancer." In The Papovaviridae, The Papillomaviruses, P Howley and NP Salzmann (eds). New York: Plenum, 1987, pp 245-263. 2. Schneider, A, and Shah, K: "The Role of Vitamins in the Etiology of Cervical Neoplasia: An Epidemiological Review." Arch Gynecol 246, 1-13, 1989. 3. Muir, CS, Waterhouse, J, Mack, T, Powell, J, and Whelan, S: Cancer Incidence in Five Continents. Lyon, France: IARC, 1988. (IARC Sci Publ No 8!i.) 4. Food and Agricultural Organization of the United Nations: Food Balance Sheets, 1979-81 Average. Rome, Italy: FAO, 1984. 5. Armitage, P, and Berry, G: Statistical Methods in Medical Research, 2nd ed. Oxford, UK: Blackwell Scientific Publications, 1987. 6. Zur Hausen, H: "Intracellular Surveillance of Persisting Viral Infections. Human Genital Cancer Results From Deficient Cellular Control of Papillomavirus Genome Expression." Lancet 2, 489-491, 1986. 7. Baker, R, Arlauskas, A, Bonin, A, and Angus, D: "Detection of Mutagenic Activity in Human Urine Following Fried Pork or Bacon Meals." Cancer Lett 16, 81-89, 1982. 8. Overvik, E, Nilsson, L, Fredholm, L, Levin, Ö, Nord, CE, et al.: "High Mutagenic Activity Formed in Pan-Broiled Pork." Mutat Res 135, 149-157, 1984. 9. Nilsson, L, Övervik, E, Fredholm, L, Levin, Ö, Nord, CE, et al.: "Influence of Frying Fat on Mutagenic Activity in Lean Pork Meat." Mutat Res 171, 115-121, 1986. 10. Koutsky, LA, Galloway, DA, and Holmes, KK: "Epidemiology of Genital Human Papillomavirus Infection." Epidemiol Rev 10, 122-163, 1988.
Vol. 13, No. 4
211
Nutrition and Cancer Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hnuc20
Pork intake and human papillomavirus‐related disease Achim Schneider
a d
Reinhard Kirchmayr
b
c
, Alfredo Morabia , Uwe Papendick & a
a
Department of Obstetrics and Gynecology , University of Ulm , Ulm, West Germany b
Department of Epidemiology , The Johns Hopkins University School of Public Health , Baltimore, MD, 21205 c
Branch of Boehringer Ingelheim , Dr. K. Thomae GmbH , Biberach, West Germany d
Universitäts‐Frauenklinik , Prittwitzstr. 43, 79 Ulm, West Germany Published online: 04 Aug 2009.
To cite this article: Achim Schneider , Alfredo Morabia , Uwe Papendick & Reinhard Kirchmayr (1990) Pork intake and human papillomavirus‐related disease, Nutrition and Cancer, 13:4, 209-211, DOI: 10.1080/01635589009514062 To link to this article: http://dx.doi.org/10.1080/01635589009514062
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Montana] at 14:50 08 April 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Brief Communication
Pork Intake and Human PapillomavirusRelated Disease
Downloaded by [University of Montana] at 14:50 08 April 2015
Achim Schneider, Alfredo Morabia, Uwe Papendick, and Reinhard Kirchmayr
Abstract Clinical and ecological evidence supporting an association between human papillomavirus (HPV)-related tumors and dietary factors are presented. Abstinence from high intake of fried pork (600-1,000 g/day) was associated with regression of an urethral condyloma in a healthy 19-year-old man treated with interferon gamma. International correlations suggest that pork intake is positively associated with incidence of cervical cancer, a disease also related to HPV. Pork meat or dietary factors associated with pork meat consumption may be involved in the development of HPV-related diseases. (Nutr Cancer 13, 209-211, 1990)
Introduction
Human papillomaviruses (HPV) are associated with the development of anogenital cancer (1). However, additional environmental factors seem to be necessary for the malignant conversion of papillomavirus-induced condylomas. In human populations, dietary components may be involved, because deficiencies of vitamins A and C and folic acid seem to be associated with cervical neoplasia (2). We present here a case of regression of a severe form of condyloma, a disease due to HPV, following a change in diet, as well as international correlations between meat intake and incidence of cervical cancer, a disease also associated with HPV. Case Report
Since August 1987 we followed a healthy 19-year-old male patient with recurrent condyloma of the urethral fossa navicularis. On examination, a giant condyloma of about 2-cm diameter was protruding from the urethral meatus. The tumor was completely removed A. Schneider and R. Kirchmayr are affiliated with the Department of Obstetrics and Gynecology, University of Ulm, Ulm, West Germany. A. Morabia is affiliated with the Department of Epidemiology, The Johns Hopkins University School of Public Health, Baltimore, MD 21205. U. Papendick is affiliated with the Dr. K. Thomae GmbH, Branch of Boehringer Ingelheim, Biberach, West Germany.
Copyright © 1990, Lawrence Erlbaum Associates, Inc.
by carbon dioxide laser vaporization. Condyloma acuminatum without atypia positive for HPV 11 was diagnosed on histology and in situ hybridization. Four weeks after laser therapy, the lesion recurred and interferon gamma (IFN) (0.2 mg subcutaneously, 3/wk) was initiated. In the following four weeks the size of the condyloma increased. On revaluation, the patient, who weighed 65 kg for 170 cm, stated that he had been consuming about 200-250 g of fried pork three to four times a day for the past five years. The meat was usually from the neck portion, with 13% fat content, and was fried to medium rare at 250°C for about five minutes using 1 Tbsp of sunflower oil. This intake corresponds to approximately 91-114 g of saturated fats and 30-40 g of fried vegetable oil per day. The patient was advised to completely abstain from eating fried pork. During the next nine weeks of IFN therapy, the condyloma continuously regressed. It had disappeared completely at the end of therapy and did not recur during the 22 months of follow-up. No sexual activity whatsoever and no change in smoking habits (20 cigarettes/day) was reported during the period of treatment.
Downloaded by [University of Montana] at 14:50 08 April 2015
International Correlations
Data on incidence of cervical cancer and on meat consumption were available for 32 countries (3,4). The analysis was limited to 25 countries with comparable age distribution because no age standardization was feasible for the dietary data. For comparison purposes, incidence rates were standardized on the basis of age distribution of the world population. National yearly per capita consumption of pork and other meats, as well as daily intake of fat derived from pork (pork fat) and from other meats (nonpork fat) were correlated with incidence data of cervical cancer. Pearson's correlation coefficient was used as a measure of linear association, and the trend was tested using linear regression (5). Positive correlations were observed between the incidence of cervical cancer and pork meat consumption (r = 0.42; p = 0.05) (Figure 1) or pork fat consumption (r = 0.16;/> = 0.20). On the other hand, negative correlations were found between the incidence of cervical cancer and nonpork meat (r = —0.34; p = 0.10) or nonpork fat consumption (r = —0.31; p = 0.15). Hongk
-
Roman i a
Singap
Denmark West-Gcr Poland
Norway Franco Yugos^
Japan
^
^
^___--—"Czechcs Hungary
Iceland -
^^^~
Italy
5
Canada
Swec en
CH
Austral
X
Spain Ireland Finland Israel
1
i
i
i
20
30
40
\ 50
BO
70
INTAKE OF PORK MEAT. (Wg/capufc/year)
Figure 1. Correlation between cervical cancer incidence and meat intake in 25 countries. Relationship between incidence of cervical cancer (per 100,000/yr) and intake of pork meat (kg/caput(person)/yr). Regression line: y = 8.98 + 0.12*.
210
Nutrition and Cancer 1990
Discussion
Downloaded by [University of Montana] at 14:50 08 April 2015
The correlation between per capita pork consumption and cervical cancer incidence in 25 countries supports the hypothesis that pork meat, or a related dietary factor, may have played a role in the clinical observation reported here. HPV infections (e.g., condyloma) seem to predispose to HPV-associated cancer (e.g., anogenital carcinoma and cervical cancer). Zur Hausen (6) suggested (hat the mechanism of carcinogenesis may be a deregulation of the expression of the E(i and E7 open reading frames of the integrated HPV genome. There is some evidence that pork intake is associated with an increased mutagenic activity in humans (7-9). Thus, pork meat intake might well enhance the potential carcinogenic effect of HPV. In summary, the influence of a dietai-y factor associated with pork consumption on HPV infection and HPV-related neoplasia seems plausible even though a single clinical observation and international correlations are weak evidence. In view of the rising incidence of HPV infections and HPV-associated diseases in the young population (10) as well as the potential public health and clinical use of dietary counseling, we suggest that the association of cervical or anogenital cancer with diet, including pork meat, warrants study with individual dietary information.
Acknowledgments and Notes This work was supported by the Deutsche Foischungsgemeinschaft (Schn 294/1-2) (Bonn, West Germany) and by the Swiss National Fund for Scientific Research (Bern, Switzerland). Address reprint requests to Dr. A. Schneider, Universitäts-Frauenklinik, Prittwitzstr. 43, 79 Ulm, West Germany. Submitted 9 August 1989; accepted in final form 27 October 1989.
References 1. Zur Hausen, H, and Schneider, A: "The Role of Papillomaviruses in Human Anogenital Cancer." In The Papovaviridae, The Papillomaviruses, P Howley and NP Salzmann (eds). New York: Plenum, 1987, pp 245-263. 2. Schneider, A, and Shah, K: "The Role of Vitamins in the Etiology of Cervical Neoplasia: An Epidemiological Review." Arch Gynecol 246, 1-13, 1989. 3. Muir, CS, Waterhouse, J, Mack, T, Powell, J, and Whelan, S: Cancer Incidence in Five Continents. Lyon, France: IARC, 1988. (IARC Sci Publ No 8!i.) 4. Food and Agricultural Organization of the United Nations: Food Balance Sheets, 1979-81 Average. Rome, Italy: FAO, 1984. 5. Armitage, P, and Berry, G: Statistical Methods in Medical Research, 2nd ed. Oxford, UK: Blackwell Scientific Publications, 1987. 6. Zur Hausen, H: "Intracellular Surveillance of Persisting Viral Infections. Human Genital Cancer Results From Deficient Cellular Control of Papillomavirus Genome Expression." Lancet 2, 489-491, 1986. 7. Baker, R, Arlauskas, A, Bonin, A, and Angus, D: "Detection of Mutagenic Activity in Human Urine Following Fried Pork or Bacon Meals." Cancer Lett 16, 81-89, 1982. 8. Overvik, E, Nilsson, L, Fredholm, L, Levin, Ö, Nord, CE, et al.: "High Mutagenic Activity Formed in Pan-Broiled Pork." Mutat Res 135, 149-157, 1984. 9. Nilsson, L, Övervik, E, Fredholm, L, Levin, Ö, Nord, CE, et al.: "Influence of Frying Fat on Mutagenic Activity in Lean Pork Meat." Mutat Res 171, 115-121, 1986. 10. Koutsky, LA, Galloway, DA, and Holmes, KK: "Epidemiology of Genital Human Papillomavirus Infection." Epidemiol Rev 10, 122-163, 1988.
Vol. 13, No. 4
211
