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Dr. Vincent DeVita speaks out on cancer prevention with fiber.

All America should be glad that Dr. Vincent T. DeVita is in charge of the $1,100,000,000 budget that will be spent on cancer this year by the National Cancer Institute. Why? Because he's a gutsy, no-nonsense researcher with a practical, imaginative, down-to-earth approach to tackling cancer. He wants to help prevent cancer as well as help cancer-afflicted people everywhere benefit quickly from treatment breakthroughs. He isn't afraid of stepping on a few toes, where necessary, to accomplish the most good for all. He is courageous in that. He is the kind of fearless leader we need at the helm of this mammoth organization, which employs many thousands of fighters in the war on cancer.

If he hadn't chosen medicine, he would have been a good intelligence officer for the CIA. He'll sleuth for what causes cancer. He listens. That's why, after he had breakfast with Dr. Denis Burkitt some 15 years ago, he started eating bran every day.

Unlike some professionals, Dr. DeVita isn't afraid to give the people facts they can act on now, instead of waiting until we have elegant proof to the "nth" degree. He's won his stripes; he's strong enough to take criticism from snipers who would cry for "more proof" before advocating a harmless diet change.

He cares. If he has been eating bran for 15 years, he wants the people to know that it's more than a good bet--and that cruciferous vegetables (brussel sprouts, cabbage, cauliflower, etc.) are a good bet whether because of their fiber content, their antioxidant properties or the beta carotene they contain.

He's risked raising a few eyebrows with the Physicians' Data Query (PDQ) system, a computer data base that provides lists of some 10,000 cancer specialists in the country as well as the centers or hospitals where specific rare cancers are best treated. The computerized information also enables local physicians treating common cancers to learn quickly about new therapies.

He's a productive researcher who has coauthored a cancer textbook and authored or coauthored more than 300 scientific papers.

You'll be hearing a lot more about this young man who is in a hurry to lessen your cancer risks. The goal: 50 percent less cancer mortality by the year 2000!

We began the interview by asking Dr. DeVita his views about fiber.

Dr. DeVita: I started eating bran almost 15 years ago when I met Dr. Denis Burkitt and we were both at a conference on lymphomas. He was going to talk about Burkitt's lymphoma and I was going to talk about Hodgkin's disease. He said that he didn't want to talk about lymphomas. He wanted to talk about bowel cancer, fiber and diet. He gave a very charming lecture about the hypothesis that fiber is the major factor that is being deleted from Western diets and that reduced fiber leads to colon cancer. He completely surprised me. We had breakfast the next morning, and he totally persuaded me. He poured bran all over his cereal, which did not have bran in it, and I have been eating bran ever since.

Dr. SerVaas: How do you eat your bran?

Dr. DeVita: I do it in a variety of ways now. In the beginning I just had to get All-Bran cereal and that's mostly the way I get it now. I also eat it in muffins. I run, and when I visit cities, I stop at the same restaurants I have been stopping at for ten years. Where I couldn't get bran ten years ago, I now notice that bran muffins are available in some cities. In other cities, they're not available. But, I think fiber is catching on. I know many places in New York that make good bran muffins. In most of the cities that I visit, I know where they make the good bran muffins, and I know what cities don't have bran muffins. There are some cities that are very interesting but haven't taken to that kind of food yet. I know in Baltimore, for example, you can look up and down Charles Street in every bakery and every restaurant, and you won't find a bran muffin. You won't find anything but white flour and sugar in it in the morning.

Dr. SerVaas: Well, I think that you were pretty much ahead of your time when you started eating bran, because back then a lot of physicians really didn't put that much importance on bran. Tell me, what do you now see in cancer of the colon as evidence that Dr. Denis Burkitt was right all along?

Dr. DeVita: I believe the data are overwhelming when you look at all the people in all the populations that we've studied around the world who have a low incidence of colon cancer: the Finns, the Mormons, the Seventh-day Adventists, just to mention a few. People who live in Third World countries--you can always find that the fiber in their diet is high. It's not always the same kind of fiber. In some cases it's fruits-and-vegetables type fiber, and in other cases it's wheat-grain type fiber. And in many cases, fat is low. That has led many people to say that it's not the fiber, it's the low fat. In some cases the fat is high. The Finnish diet is a very high-fat diet. They eat a good deal of meat and dairy products. They have a lot of heart attacks. But because of the very large amount of fiber from rye, they have a lower incidence of colon cancer. The weakness in the data was always the Japanese, because the Japanese had a low incidence of colon cancer and a low mortality. They have the same fiber level as the American people, but if you look at what the Japanese fat intake is, it's half of the American people's. I have a feeling the ratio of the fiber to the fat makes a big difference.

Again, the data are overwhelming: If fiber were put back into Western diets, the incidence and mortality from diseases like colon cancer most certainly would come down. Breast cancer, which tends to follow the same pattern, although it's not as easily explained, probably would come down, too. In fact, it did in Great Britain. In World War II there was a study that showed that right after the war started, when fat intake fell and grain intake went up, breast cancer mortality fell very dramatically and stayed down for a long time. So I think that the argument for fiber is very, very sound.

Dr. SerVaas: I think there are some studies now showing that the bacteria are different in the bowels of those eating a low-fiber diet.

Dr. DeVita: Yes. The most interesting study is one that was developed independently by Dr. Tracy Wilkins at the Virginia Polytechnic Institute and Dr. W. Robert Bruce in Canada. They found a material in the stool now called fecapentaene. It's a shorter name, believe it or not, for a much, much longer chemical name, and it's produced by bacteria that are normally in your bowel and mine. It's produced by bacteria that die. In other words, it's an internal product of the bacteria. When the bacteria die, they release it. It turns out that it's a very potent mutagen, as potent as one of the most potent carcinogens that we know, benzopyrene. The important point that they've shown is that when you add fiber into the diet in a couple of cases, the bacteria stay healthy. They don't die in the colon and they don't release the material. So you can see where fiber might make a difference. The reason that fiber was thought to work was because it shortened the transit time in the colon and diluted out carcinogens and so forth. And here is an example where it may work because it keeps the bacterial population in the colon healthy. If that's the case, it lends itself to easier manipulation than we would have thought.

Dr. SerVaas: How will the NCI help inform people about what foods contain fiber?

Dr. DeVita: We have been busily working on what we call a fiber-equivalency handbook. When a truck driver pulls in to get lunch and he wants more fiber, he's got to know what it is that he needs to eat. So we are in the business of recommending a diet to the best of our ability. I've seen the first draft of the handbook. We should have it out in a few months. The data on fiber are very limited, and one of the things that we had to decide was whether to go with what we call the gross data on fiber. Since we know that increased gross-fiber intake seems to do good things for people, we can offer them information on gross fiber and then refine it as we go along, or we can wait until it's refined down to the "nth" detail and then give it to people. I frankly don't see any reason to wait. So we're going with the data that we can find on fiber. We'll make the necessary acknowledgments that it's not perfect, but it's enough to have half of my staff running around looking at it and saying, "I'm going to get this in my diet and that in my diet to get my fiber content up to a certain level."

Once you know what foods contain fiber, it's very interesting to try to manipulate your diet and get it up to a high level. We think American people have to double their fiber intake in order to get all the good benefits. It's not so terribly difficult to do. Some foods are surprisingly high in fiber. I always use cantaloupe as an example. Cantaloupe is low in calories. An average cantaloupe is about 100 calories. A whole cantaloupe has about ten grams of fiber. So if you eat a half-cantaloupe for breakfast, you get about five grams of fiber. It's a very, very good source of beta carotene, and it tastes good. So unlike bran cereal, which some people don't like, it has a lot of positive features. It's not the same kind of fiber that's in bran cereal, however, so you get into different kinds of fiber. It's a cellulose fiber.

There are two general classes of fiber called lignins, which are the very, very indigestible fibers that you find on the outer coating of wheat grains. Then there are celluloses. You find those in the structural part of plants, apples and other fruits--things like cantaloupe and bananas are high in the celluloses.

It may make a difference as to which type of fiber you eat. It seems to make a difference in some things like controlling blood glucose. Some fiber makes it easier to control the blood glucose in diabetes. There may be certain kinds of fiber that are important there. But in terms of the gross effects on cancer, some populations, like the Finns, that have very high grain intake have a lower cancer incidence. If you look at the Mormons, they have a lower incidence and mortality from colon cancer. Most of their fiber comes from fresh fruits and vegetables and things of that sort. It may be that both work. That's why I say we have to give people the option to get both kinds of fiber--lignin and cellulose.

Dr. SerVaas: Could you tell us about cruciferous vegetables?

Dr. DeVita: First of all, they do have a high content of fiber. They also contain materials that may be antioxidants, materials that will actually prevent certain kinds of things from causing cancer. They can quench free radicals. They can stimulate enzyme systems that detoxify carcinogens. There is another side of it that may have a positive effect. We have done 18 studies on dietary surveys of people in different parts of the world who took in a lot of dark green, leafy vegetables, compared to people who didn't. Those studies told us that people who had a high beta-carotene index have a lower incidence of certain kinds of cancer. This meant that the time had come for us to put beta carotene into a clinical trial. You might say, "Well, why not package it and give it to people?" The answer is, the beta-carotene index could have been a red herring, or, if you'll excuse me, an orange herring, because it came with a vegetable, and the vegetable has fiber and all kinds of things in it. In other words, by going to the people and saying you should take a pill of beta carotene, we may be giving them the wrong information.

Dr. SerVaas: So what did you do?

Dr. DeVita: In 1980 we began prospectively studying beta carotene, and we're still in the process of evaluating it. However, we can recommend to people that they won't harm themselves by taking in large amounts of highly colored vegetables. In that material there is beta carotene as well as other things that may be useful. It is our guess that they may well lead to a reduction of cancer.

Dr. SerVaas: And you are recommending this?

Dr. DeVita: Yes, and some of our colleagues who spend all their time in the laboratory tell us we shouldn't do so if we aren't 100 percent sure that we can reduce the incidence of cancer by what we are recommending. The answer to that is: The public pays for these programs, and they're entitled to the information as soon as we think it's a reasonable amount to go on. Looking at a population like the Seventhday Adventists, we can see that they have a very low incidence of colon cancer. And their mortality for colon cancer is 50 percent less than the rest of the American people, even when they eat meat. So the big factor seems to be dietary fiber.

Dr. serVaas: Could you tell us your views on obesity and cancer?

Dr. DeVita: I think that ties into the business of carbohydrates and fiber. If you look back in paintings of 200 or 300 years ago, you'll find that people began to appear fat in oil paintings at the time we began to introduce into the the diet refined carbohydrates [foods with the fiber taken out]. You can eat a lot more calories than you need with refined carbohydrates. If you start eating the wholegrain foods and vegetables, you're eating a certain quantity beyond which you can't go, and people who do that tend to be more slender. I'm not sure that's the only explanation for it, but it's at least one reasonable explanation. You have to be careful, because a very low-fat diet is not a very palatable diet. The American people take about 40 percent of their calories in fat. Japanese take about 20 percent of their calories in fat, and they have low colon-cancer and low breast cancer rates, which seem to be partly related to fat. Thirty percent seems to be a good target to shoot for. Now, it's quite simple for me to say, "Reduce your diet from 40 to 30 percent in terms of total calories from fat." The problem is that you've got to tell people how to do that. You've got to tell them where the fat is. It's not always just on the edge of the meat. It's hidden in various places, and we haven't done a very good job, I think, in being very clear about how you get from 40 to 30 percent. It's simple in principle but a little more difficult to practice. Ditto with the fiber in the vegetables, although it's a little bit easier if you're eating what I said-- lots of deeply colored vegetables. You get both fiber and the chemicals embedded in those vegetables that seem to protect people against certain kinds of cancers.

Dr. SerVaas: Wouldn't a good cancer-prevention diet also help prevent heart attacks?

Dr. DeVita: Yes. A lot of people who are conscious of diet because of the heart are, in fact, reducing their fat intake. But we've got ot get the fiber up from our point of view.

Dr. SerVaas: How can patients be sure they are getting the most up-to-date treatment for their cancer?

Dr. DeVita: We now have the PDQ [Physicians' Data Query] system, which is probably the best source of information. All the files can be accessed according to what city and state you live in. It has about 10,000 physicians who belong to organizations where physicians spend most of their time taking care of cancer patients. In terms of picking a specialist, it's easy to find someone from this computerized list and geographic matrix. Doctors have access to the PDQ. We are hoping that doctors will, in fact, use this on their office computers. They can search the files for a disease, find the people who are doing the research and find the practitioners who have the most experience with it. PDQ also has what we call state-of-the-art therapy for given cancer. So a doctor who normally desn't take care of cancer patients can put in a diagnosis. Immediately the system will say that this is a curable cancer 50 percent of the time (if it happens to be that); to cure it, you'd have to use different approaches. Then the "user-friendly" system gives you options to continue querying for more and more detail, if you want. Or you can switch immediately, if you happen to be a general physician and don't want to treat the patient yourself, to search for the proper person to do it. If the system gives you bad news and says that this cancer in this stage is not treatable, that we have no treatment that is standard, then you can find out who is doing research in that particular type of cancer. By searching the protocol file, it's all quite easy.

Some said that you shouldn't do that; you should let patients go where they want to. The question I would ask is, "If you had cancer, wouldn't you rather go to someone who had a lot of experience managing that cancer?"

They've got to be able to go to their doctors and just ask a very important question: "Doctor, do you take care of this kind of cancer often?" If he says, "Well, I treat two or three patients a year," I think you should say, "Could you find me somebody with experience?" Then telephone the cancer society's cancer-information servtices, and we can help you find the people with experience. Experience is what really counts in this whole business. That's really the crux of the situation. If you had cancer, I'm assuming you'd want to go to the person who has the experience. Then the answer to anybody who gets cancer is to go find find the people who have experience. That is not always in a big cancer center. For example, our cancer center in Bethesda is one of the finest in the world. We study certain kinds of cancers, but there are certain kinds of cancers that we don't study at all. So for the ones that we don't study at all, we're not a good place to go.

We're large, but if you had some kinds of cancer we'd be small in terms of experience. Almost every cancer center in the country that I know of is that way, with only a couple of exceptions. Sloan-Kettering, because of its size, sees a little bit of everything. But most of the cancer centers have a personality because of the researchers they have attracted. They see a lot of one kind of cancer and not much of another kind; they study certain kinds. It's very hard for the public to identify the centers that have great expertise in one area and not in another. So, I don't think you can say it's large institution versus small. Exprerience is what counts. Patients are so shy about going to their doctors and saying, "You know, doctor, you just told me I have cancer and you said my chances are 50/50." They are facing a 50 percent chance of losing their lives and they're shy about saying, "I want to go to somebody who has experience." And the doctor says, "I don't have any experience, but I'll read it from the book." They seem to be shy about saying, "Well, I'd rather go to somebody with experience." Doctor intimidate people, not that they mean to, in many cases, but they often intimidate. Have you ever tried to find a lawyer to do some specific task for you? It's not easy. Every time I go to a lawyer for something it's the wrong lawyer. I've got to go to another one who does something else. I've often thought it would be nice if they had a PDQ system for lawyer. I don't think medicine is unique in that sense. The people in the field know, but the patients have a hard time making those kinds of distinctions. Not all doctors are so carefull that they will say, "I don't know enough about this disease, and I'm going to send you off to somebody who does." Now for the common cold, for pneumonia or diseases that are self-limiting or easily treatable, that is not such a serious problem. But cancer is something that can possibly take your life. Getting experienced judgment becomes a very serious problem. I'd be a pest. In fact, one more thing. I've been taking care of cancer patients for a long time. I have never taken care of a doctor who didn't get a second opinion. I've never taken care of a doctor who didn't have his microscopic slides read twice, by more than one pathologist, to make sure that he had cancer, knowing already that he had gotten into a pretty good system. And I think there's a message in that.

I just had a phone call yesterday. I get one practically every day, and it's the same thing: a young woman with Hodgkin's disease was in a place where Hodgkin's disease was not commonly treated. It was not far from our institution, where it is commonly treated. The husband was saying that he was a litlle bit uncertain about hurting the doctor's feelings if he elected to come to probably the finest institution in the world for the treatment of Hodgkin's disease. And finally he agreed to go ahead and do it.

Dr. Ser Vaas: I had a phone call like that from a minister in North Carolina whose parishioner's son had Burkitt's lymphoma. He wanted Dr. Burkitt's telephone number in London so that he could call him about treating it. I offered to call for him. Dr. Burkitt said, "The thing to tell the minister is that there are two centers in America where there are leading experts in treating this. They are at the National Cancer Institute in Washington, D.C., and M.D. Anderson Hospital in Houston, Texas. You couldn't go anywhere better in the world than those two places. I am not the right person to treat the boy. I would be 20 years behind these experts in treatment knowledge." I relayed this information to the caller, and he was completely satisfied with that honest answer.

Dr. DeVita: Exactly. Burkitt's lymphoma in this country is very rare. So it's not the kind of disease that you want to just walk into the average doctor's office and be treated for, although the treatment isn't terribly complicated. What the PDQ system would show you is people who are listed as doing research in Burkitt's lymphoma. That would be the best place to go. It is good for rare tumors. For example, there are melanomas, tumors or moles on your skin that occur sometimes in the back of the eye. You want to salvage the eye and cure the patient at the same time. If it's a small enough tumor and the machine tells you all of this, and you want to save your eye, particlebeam radiotherapy may be indicated, and there are only two places in the country with the equipment to do it. One happens to be in California and one's up in Massachusetts, It's quite simple for somebody in Indiana to say he can either go to Massachusetts or California to have this kind of therapy. For a general doctor to find that information out, just like that, is, I think, very useful. Normally they have to go through all kinds of shenanigans. For common tumors it gives you the kind of information you need that's more regional. For most common tumors there are resources available nearby that can be used. I want to emphasize that it's not just centers versus noncenters, because the centers in this country can't care for all of the cancer patients.

Dr. SerVaas: What about the campaign to prevent cancer by eliminating tobacco?

Dr. DeVita: I think public opinion is on our side. There's an awful lot of momentum to stop cigarette smoking. That's why R.J. Reynolds has started their new advertising campaign, and that's why the cigarette companies are diversifying--they're worried and they have right to be worried.

Dr. SerVass: How do you respond to the cigarette companies' argument that evidence linking cancer and smoking is only statistical?

Dr. DeVita: The evidince is absolutely overwhelming. All scientific evidence is statistical, so it's a vicious argument. No matter what you're studying, you always look to see if one group is affected significantly more than another; there isn't a carcinogen that all would agree on--including the tobacco industry--that we think causes cancer in humans and that hasn't been determined by statistical evidence. They always say that there is no acceptable scientific evidence that tobacco causes cancer. I'd like to ask them what they would consider acceptable evidence. I'm sure we've got it--there are thousands and thousands of studies. There never has been a study that has gone the other way. We don't really investigate whether or not smoking is a cause of cancer anymore. It's an overwhelming cause of cancer. The evidence is that cigarette smoke is a carcinogen. The national debate that they want to have about whether smoking is harmful or not is really ludicrous. There isn't any evidence on the other side. It's probably the one thing in science that there's unanimity of opinion on.

Dr. SerVass: But the public doesn't know that. Would you debate the chairman of R.J. Reynolds if you had the opportunity?

Dr. DeVita: Sure. I'd like to have them explain a couple of things, like the business of chewing tobacco and dipping snuff. Something like 10 to 15 percent of oral cancers in this country are directly related to snuff dipping. They're increasing that market, and I understand that some high-level tobacco officail in one of the tobacco companies has been quoted as saying, "When the kids chew tobacco and they get hooked on the nicotine, you've got them forever." That means they'll be hooked on nicotine and they more likely will smoke cigarettes after that. I'd like to hear an explanation of how one could justify that. I'd be very interested.

Recent data, for example, from our Institute show that snuff dipping among populations in the South--where they have been doing this for a long time--is associated with such a very high incidence of cancers of the oral cavity and mouth. A relationship is unequivocable. We do have cancer-mortality maps, and the spots stand out on the map so brightly that we had to go down there and find out what was going on in the areas with the high incidence of oral-cavity cancer. We found out it was due to snuff dipping. i don't understand how they can look us wquarely in the eyes and tell us that we should have an open debate when they're packaging chewing tobacco in packages that resemble bubble gum so they can attract known teen-agers to chewing tobacco. I'd like to be in a public debate and ge an answer to that one!

I'd also be very interested in hearing what data the tobacco industry leaders would believe in terms of the causation between lung cancer and cigarette smoke. For example, we know that there are animal data showing that inhalation of smoke will, in fact, cause cancer. We certainly know that when you take smoke, condense it and paint it on the skin or put it in the lungs, no matter what you do with it, it causes cancer. There are at least 40 known carcinogens in cigarette smoke. There are thousands of chemicals that are potentially carcinogenic in cigarette smoke. i think they're just hiding behind a facade. There are no data they would accept, because it would prove what we have said.

Dr. SerVaas: I heard Bill Monroe say the only campaign left that the cigarette companies could come up with would be a campaign stating, "Cancer Is Good for Your."

Dr. DeVita: And by the way, if you take all the causes of death from smoking, cancer is the minor one. The smoking deaths from heart disease and lung disease are atrocious. About 350,000 people a year in this country die as a result of smoking. And only about 150,000 of those are cancer deaths, so that the majority are heart attacks caused by cigarette smoking. It's just a dreadful problem. Dr. SerVaas: In Norway, no cigarette advertising is permitted at all. Have you thought of trying to get cigarette ads of publications now that they're off the airwaves?

Dr. DeVia: We were just having a little dialogue with Ms. magazine about that. If you look at the ads in Ms. magazine, women are being used terribly, and they show cigarettes and elegant women in very stylish situations where the cigarette is very much a part of the image. It's part of this "you've come a long way, baby." This is why deaths from lung cancer in women will pass deaths from breast cancer. We would question why Ms. would accept ads like that, because it's part of this business of "this is how you're going to be acceptable in this social setting if you take a cigarette out." They've come a long way, now they have to catch up to men because more men have quit smoking than women, which is the challenge we have tried to make. We got a letter back from Ms. saying that they feel part of being a lberated woman is to have a choice, and that's why they have used these ads in their magazines. Our feeling is that they're probably getting pretty good revenue and they don't want to give it up.

Dr. SerVaas: Do you have any plans to ban smoking in the National Cancer Institute?

Dr. DeVita: We have sent a memo around to everybody asking them not to smoke, and we'll make special arrangements for people who feel that they just can't quit. We don't want people smoking in offices and polluting the air for the other people in the office. We have a few examples where people who feel that they have to smoke are leaving their offices and going to a special place to smoke. In most cases, it's the men's room and ladies' room. Some of the people who we've said cannot smoke in these offices have had to make a special effort to go someplace else to smoke. They've said that after doing that for a couple of months, they found that their consumption of cigarettes at home, where they're free to smoke, has gone down. It's helped them get away fron the heavy smoking. You can do people a lot of good by making it inconvenient for them to smoke. You do it in a very nice way and they know you're trying to help them. Then they will quit.

Dr. SerVaas: Do you make a special effort to hire nonsmokers at NCI?

Dr. DeVita: I just hired a new secretary and she's a delightful lady. To tell you the truth, I never even asked her if she smoked, and I guess it's because I naively assume that people don't smoke. She didn't cough and she didn't have cigarettes in sight. Supposedly she didn't smoke. I can't afford to have secretaries in my office who smoke. I probably wouldn't hire a smoker. No, it just would not be the right thing for me to do.

We have to be able to stop as many people from smoking in the next 5 years as we did in the past 15 in order to be able to reach our goal--50 percent less cancer mortality by the year 2000. I think there's every sign that we can do that.
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Author:SerVaas, Cory
Publication:Saturday Evening Post
Article Type:Interview
Date:Jul 1, 1984
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