Cholesterol, cancer, and public health policy

A review of prospective cardiovascular epidemiologic studies reveals an inverse relationship between serum cholesterol levels and cancer mortality in half the studies in which this relationship has been examined. This inverse relationship has been demonstrated only for males, and is most consistently demonstrated for large bowel cancer. However, a review of international and intergroup epidemiologic data reveals that dietary fat intake is positively correlated with mortality rates for all cancers and for large bowel cancer. Internationally, there is also a positive correlation between mortality rates for ischemic heart disease and for cancer, as well as a positive correlation between mean population values of total serum cholesterol levels and cancer mortality. The biologic plausibility of the relationship between low serum cholesterol levels and cancer, and between high dietary fat intake and cancer are examined, with particular reference to large bowel cancer. Models are proposed to provide a coherent framework in which both low serum cholesterol levels and high dietary fat intake are risk factors for carcinogenesis. It is concluded that, on the basis of present knowledge, limitation of dietary fat and cholesterol intake is a prudent public health measure for the prevention of both coronary heart disease and cancer.