Influence of dietary factors on actinically-induced skin cancer

The first indication that high dietary fat intake could influence the development of ultraviolet (UV) radiation-induced skin cancer in experimental animals was reported in 1939. In the 1980s a series of animal studies showed that a high level of dietary fat intake markedly shortened the time between UV exposure and tumor appearance and increased the number of tumors that developed. Further, high levels of dietary fat affected skin cancer development at the promotional stage of UV-carcinogenesis, i.e., after the cancer causing dose of UV had been delivered. Perhaps more important, switching from a high-fat to a low-fat diet immediately after delivery of the UV-initiating dose negated the exacerbating effect of high fat intake. The latter finding suggested that dietary modification, even after a cancer-causing exposure to UV, might represent a potentially important intervention strategy in the prevention of non-melanoma skin cancer (NMSC) and provided the rationale for undertaking a dietary intervention trial. One hundred and fifteen skin cancer patients completed the 2-year clinical trial on the effect of a low-fat diet on occurrence of actinic keratosis (AK) and NMSC. Patients were randomly assigned to either continue their usual diet (control group, NI) or to adopt a diet with 20% of total caloric intake as fat (diet intervention group, DI). All patients were examined at 4-month intervals for new AK and NMSC. At baseline, the mean percent of caloric intake as fat was 40+/-4% in the NI group and 39+/-3% in the DI group. After 4 months of dietary therapy, the percent calories as fat had decreased to 21+/-7% in the DI group. The percent of calories as fat in the NI group did not drop below 37% during the study period. The cumulative number of new AK per patient from months 4 through 24 was 11.6+/-17 in the NI group and 3.2+/-6 in the DI group (P < 0.001). Numbers of new NMSC were analyzed in 8-month periods. There were no significant changes in NMSC occurrence in the NI group. However, NMSC occurrence in the DI group declined significantly (P < 0.02) in the last 8-month period. Patients in the DI group also had significantly (P < 0.01) fewer NMSC in the last 8-month period than did patients in the NI group (0.02 versus 0.26). Practical dietary advice, with respect to reduction of percent of calories as fat, could make an important contribution to the prevention and management of AK and NMSC.