Abstract The purpose of this literature review is to review the relationship between green tea and cancer.

Green tea is ordinarily ingested in beverage form most commonly in Asian countries. In 2009, about !2,"#0 Americans are e$pected to die of cancer, or more than %, 00 people a day. Green tea is &nown to have numerous therapeutic effects on the body and in the past % years has been heavily studied. The most promising evidence for green teas relationship with cancer is its polyphenol 'epigallocatechin'"'gallate ()G*G+. )G*G,s antio$idant activity is 2 '%00 times more than that of vitamin * and may help protect and treat cancer. There is not enough evidence to support a firm conclusion between the relationship of green tea and cancer. The author concludes that green tea may have many health benefits but without proper documentation and research green tea should remain a regular, habitual drin&.

Introduction

Tea is the second most consumed beverage worldwide, following water. The *hinese have consumed this beverage for at least ",000 years and has been one of the most popular beverages in other Asian countries for at least %,000 years (American *ancer -ociety .A*-/, 2000+. Tea, made from the Camellia sinesnsis plant, has recently been studied for its chemoprevention and overall health benefits. This beverages consumption is present in people,s everyday routine as a therapeutic drin& and as an everyday beverage. Teas are classified into three different types, depending on their production1 blac&, oolong and green. To produce blac& tea, the leaves are dried and then fermented. To produce

oolong tea, the leaves are only partially fermented. Green tea is produced by steaming the freshly harvested leaves and allowing them to dry to prevent fermentation, preserving inactive polyphenol o$idase. (*abrera, Artacho and Gimene2 , 200!1 3han, 4u&htar, 2000+. -ince the ancient times, green tea has been noted for numerous health benefits and a therapeutic effect on illness. In recent years, several epidemiological studies and numerous in vitro and animal studies have investigated the role green tea ta&es in the ris& and pathogenesis of several diseases and cancer (*abrera et al., 200!+ There are many laboratory studies in vitro and on animals that show green tea acts positively against cancer and may stop new blood vessels from forming which may prevent the blood supply from reaching the cancer cells. 4ost human studies have been epidemiologic studies in )ast Asia and have yielded mi$ed results (A*-, 2000+. 5umerous epidemiological and clinical studies have found that physiological responses to green tea may be associated to promotion of health, chemoprevention, or treatment of some chronic diseases (*abrera et al, 200!+. 4ost epidemiologic studies ta&e into account numerous confounders and covariables, but it is hard to determine cause and effect. The aim of this article is to review recent studies on green tea beneficial health effects and chemoprevention.

Green Tea 6ue to its high antio$idant content, green tea has been used for the treatment of many diseases and has many &nown health benefits.

7istory Archeologists suggest that humans have consumed boiled water steeped with tea leaves for as many as 00,000 years. Tea was thought to be discovered in *hina and India (8niversity of 4aryland 4edical *enter .844*/, 2009+. *hinese legend states that )mperor -hennong discovered tea ,000 years ago. The emperor, who was &nown for his wisdom of science, believed the safest way to drin& water was after it was boiled. 9ne day leaves fell into his boiling water that gave off a pleasant aroma and turned the water a light brown. The emperor dran& the li:uid, was pleased by the flavor, and discovered tea. Another *hinese legend states the god of Agriculture would chew leaves, stems and roots to discover medicinal plants. ;hen he consumed a poisonous herb he would chew tea leaves to deto$ify himself. 9ther *hinese legends believe that <uddha himself discovered tea (=ee, 2009+. In Indian history, tea was first referenced to in the ancient -ans&rit epic, >amayana, when 7anuman was sent to the 7imalayas to bring the -an?eevani tea plant for medicinal use. Tea has played a significant role in Asian culture for centuries and is a staple in India, *hina, @apan, and Thailand. Tea was introduced to )urope through the )ast India Trading *ompany in the %Ath century and the <ritish introduced tea to the early American colonies. Tea became a well &nown, common, social beverage ever since its introduction in )urope and the Americas. Americans commonly drin& tea iced and often with sweeteners. Tea has become a worldwide beverage and has been highly noted for its beneficial health effects.

Types All tea comes from the Camellia sinensis plant and depending on its manufacturing process and amount of specific tea polyphenols is classified into three different types1 green,

"

oolong, and blac&. <lac& tea is a fully fermented and wilted leaf that undergoes a fermentation stage before drying and steaming. 9olong tea is a partially fermented, wilted and bruised leaf that undergoes a partial fermentation stage before drying and steaming. Green tea is a non' fermented, wilted leaf that is produced by drying and steaming the fresh harvest (*abrera, 200!+. Bermentation is produced by polyphenol o$idase in the leaves and reduces the polyphenols in tea. Green tea which has had no fermentation has the highest amount of polyphenols. ;hen tea is bro&en and rolled it is o$idi2ing catechins in the tea that polymeri2e and form larger more comple$ polyphenols (7igdon, 2002+.

5utritional *ontent Tea polyphenols, &nown as catechins, a type of antio$idant, account for "0'#2C of the dried solids in green tea (3han, 4u&htar, 2000+. There are four ma?or catechins found in tea leavesD 'epigallocatechin'"'gallate ()G*G+, 'epigallocatechin ()G*+, 'epicatechin'"'gallate ()*G+ and Eepicatechin ()*+. )G*G is the ma?or catechin in tea and may account for 0'00C of the total catechin. )G*G appears to be the most powerful of all catechins with an antio$idant activity about 2 '%00 times more potent than that of vitamin * (3han, 4u&htar, 2000+. Blavonols, their glycosides, and caffeine are also present in tea. A typical tea beverage, prepared in a proportion of %g leaf to %00ml water in a " minute brew, usually contains 2 0' " 0mg tea solids, which ma&e up "0'#2C catechins and "'!C caffeine. -ee Table % for the mean percentage of solid e$tracts in blac& tea (3han, 4u&htar, 200A+.

TABLE 1.
The mean percentage of solid e$tracts in blac& tea in highest to lowest percentage.%

Solid Extract
Thearubigins Carbohydrates Amino Acids Catechins Methylxanthines Mineral Matter Fla onols Thea"la ins #roteins $olatiles
%

Mean Percentage
12-18 15 13-15 10-12 8-11 10 !-8 3-! 1 %0&1

Adapted from 3han, 4u&htar (200A+.

Borms Green tea is most commonly consumed as a beverage made from steeped leaves in hot water but is also available in many other forms. Green tea can come in an e$tract, capsule, powder, topical gel or cream, or basic tea beverage forms. In e$tract form, green tea is in a concentrated dose that can be mi$ed with water and usually contains a standard amount of polyphenols, )*G* or catechins per milligram of e$tract. *apsules of green tea are typically higher in polyphenols and catechins and may be higher or lower in caffeine depending on brand. Green tea in powder form is ground up green tea leaves that can be added to beverages or food. The topical form of green tea is Folyphenon )G, a proprietary e$tract of green tea, approved for topical use as a prescription for genital warts caused by the human papilloma virus (4edline Flus, 2009+. In basic beverage form, green tea leaves (appro$imately one teaspoon+ are steeped in hot water (appro$imately 0 o2.+ for about #'! minutes.

-ide'effects -ide'effects of green tea are limited but green tea is a source of caffeine for which multiple side'effects have been reported. <everages that contain caffeine may increase acid production in the stomach and may worsen ulcer symptoms. *affeine may cause insomnia in adults, children and infants because it is a stimulant of the central nervous system. *affeine acts on the &idneys as a diuretic, increasing urine, urine sodiumHpotassium levels and potentially decreasing blood sodiumHpotassium levels. *ertain amounts of caffeine can increase heart rate and blood pressure (4edline, 2009+. Tannin'containing beverages li&e tea, may contribute to iron deficiency, and in infants, tea has been associated with impaired iron metabolism and microcytic anemia. Tannins in tea may also cause constipation. 4edline (2009+, reported in preliminary research, green tea has been associated with decreased levels of estrogens in the body and it is not clear if side effects such as hot flashes occur. Fregnant and breastfeeding women should not consume caffeine because it crosses the placenta and has been associated with spontaneous abortion, intrauterine growth retardation and low birth weight (844*, 2009+. Iocal irritation may occur from use of the ointment Folyphenon )G (4edline, 2009+.

*ancer *ancer is a ma?or cause of mortality in the 8nited -tates of American and is only second to cardiovascular disease.

)pidemiology According to the American *ancer -ociety, 2009, cancer is a group of diseases characteri2ed by uncontrolled growth and spread of abnormal cells. The 5ational *ancer Institute estimates that in @anuary 200 , appro$imately %%.% million Americans with a history of cancer were still alive. In 2009, about !2,"#0 Americans are e$pected to die of cancer, or more than %, 00 people a day. *ancer accounts for nearly one in every four deaths in the 8- (A*-, 2009+. Bor 2009, lung and bronchus cancer were the leading &illers of cancer for both men and women. <reast and colorectal cancers are the second and third leading cancer causes of mortality in women. Bor men, prostate and colorectal cancers are the second and third leading cancer &illers (A*-, 2009+. The American *ancer -ociety (2009+ estimates 292, #0 men will die of cancer and A!!,%"0 men will be diagnosed with new cancer in 2009. Appro$imately 2!9,000 women will die of cancer and A%",220 will be newly diagnosed in 2009. *ancer rates vary by ethnicity, also. African'American women have a lower incidence rate than white females for all cancer sites combined, but have a 20C higher mortality rate. African'American men have a 2 C higher cancer incidence rate and a #"C higher mortality rate for all cancer sites combined compared to white men (5elms, -ucher J Iong, 200A+.

)tiology Any person can develop cancer at anytime but the ris& of being diagnosed with cancer increases as individuals age. -eventy seven percent of all cancers are diagnosed in adults years and older (A*-, 2009+. *arcinogenesis is a multistep process in which normal cells are transformed into cancer cells and there are many factors that contribute to carcinogenesis.

*arcinogens, genetics and nutritional factors can all play a role in the development of cancer. *arcinogens would include chemicals, physical agents, radiation and infectious microorganisms (5elms, -ucher J Iong, 200A+. 4ost cancers are not considered hereditary, but genetics are involved to a certain degree in every cancer. Appro$imately C of cancers are hereditary, in that an inherited genetic alteration confers a very high ris& or developing one or more specific types of cancer (A*-, 2009+. Genes may be damaged by carcinogens or may be affected by nutritional components such as antio$idants, soy protein, fat, &ilocalories, and alcohol. *arcinogens are e$ternal factors such as tobacco, chemicals, and sunlight. Internal factors would include damage from hormones or metabolism of nutrients within cells (5elms, -ucher J Iong, 200A+.

*ost The 5ational Institutes of 7ealth estimates overall cost of cancer in 200A at K2%9.2 billion (A*-, 2000+ and in 2000 at K220.% billion (A*-, 2009+. They include direct medical cost (total of all health e$penditures+, indirect morbidity cost (cost of lost productivity due to illness+, and indirect mortality cost (cost of lost productivity due to premature death+. The ma?or cost of cancer is the cancer treatment (A*-, 2009+. *hemotherapy costs have dramatically risen over the last ten years. A survey on the cost of initial cancer treatments in breast, lung and prostate cancer patients over the age of ! attributed the increase in cost to the increase in the use of chemotherapy. The study showed that the average cost (including surgery, chemotherapy, radiation and other hospitali2ation+ of breast cancer treatment increased from K#%09 to K20,9!#, average cost of prostate cancer treatment increased from K ,#" to K#%,%"# and the average cost of lung cancer treatment went up KA,%"9 to K"9,09%. The price of cancer drugs are raising at a

rate of % C per year and some drugs may cost K%00,000 or more for a course of treatment (<rown, >iley, -chussler, and )t2ioni, 2002+.

Types Iung and bronchus cancer accounts for appro$imately % C of cancer diagnoses and 20C of all cancer deaths (see Table 2+. -ome common signs and symptoms include persistent cough, sputum strea&ed with blood, chest pain, voice change and recurrent pneumonia or bronchitis. The most important ris& factor for lung and bronchus cancer is cigarette smo&ing. 9ther ris& factors include occupational or environmental e$posure to secondhand smo&e, radon, asbetos, certain metals, some organic chemicals, radiation, air pollution and a history of tuberculosis (A*-, 2009+. The survival rate for lung and bronchus cancer combined at all stages is only % C (see Table 2.+.

TABLE 2
Ieading sites of new cancer cases and deaths in 2009 estimates from the American *ancer -ociety%.

Adapted from American *ancer -ociety (2009+.

TABLE 3.
The five'year relative survival rates, in percentages, by stage at diagnosis from %99!'200#".

%0

"

Adapted from American *ancer -ociety (2009+.

<reast cancer will be responsible for 2AC of cancer diagnosis in women and % C of cancer deaths in women in 2009 (see Table 2.+. There are appro$imately %,9%0 new cases e$pected in men in 2009. According to the American *ancer -ociety (2009+, death rates for breast cancer have steadily decreased in women since %990, with larger decreases in women younger than 0 (a decrease of ".2C per year+ than in those 0 and older (2.0C per year+ (see Table ".+. The decrease in breast cancer death rates represents progress in both earlier detection and improved treatment. *ommon signs and symptoms of breast cancer are large masses in or around the breast, changes to the breast such as thic&ening, swelling, distortion, tenderness, s&in irritation, redness, ulceration, or discharge. <reast pain is typically not an early symptom of breast cancer but may result from benign conditions. The number one ris& factor for breast cancer is being female. The other important ris& factor for breast cancer is age. *ommon modifiable ris& factors include being overweight or obese after menopause, use of menopausal hormone therapy (47T+, physical inactivity, and consumption of one or more alcoholic beverages per day. The survival rate for women diagnosed with locali2ed breast cancer is 90C but if it has spread to nearby or distant lymph nodes or organs, the 'year survival rate is 0#C or 2AC, respectively (A*-, 2009+.

Frostate cancer is the leading cancer diagnosis for men in 2009. It is estimated that prostate cancer will account for 2 C of new cancer diagnosis in men and 9C of all cancer deaths for men in 2009 (see Table 2.+. Incidence rates for prostate cancer have been decreasing since 200% by #.#C per year, reflecting changes in prostate cancer screening with the prostate'specific

%%

antigen (F-A+ blood test. 6eath rates for African American men from prostate cancer are more than twice as high as those in white men (A*-, 2009+. There are no common signs or symptoms for prostate cancer1 therefore screening is necessary to detect early prostate cancer. ;ith more advanced stages of the disease, some individuals may urine difficulty or pain, but most symptoms are due to other conditions not directly the prostate cancer. The ris& factors for prostate cancer are age, raceHethnicity, and family history of the disease. Appro$imately !"C of all prostate cancer cases are diagnosed in men aged ! or older and African American men and @amaican men of African descent have the highest prostate cancer incidence rates in the world. 4ost prostate cancers (more than 90C+ are discovered in the local and regional stages so the 'year relative survival rate for those patients is almost %00C. The improvements in survival rates are partly attributable to earlier diagnosis and improvements in treatment (A*-, 2009+.

*olon and rectum cancer is "rd across the table for new diagnosed caner for men and women and for cancer related deaths for men and women in 2009 (see Table 2.+. There has been a steady decline from %990'200 of 2.0C per year in men and 2.2C per year in women. This decline has occurred due to the increase in screening that allowed the detection and removal of colorectal polyps before they progress to cancer. )stimated incidence rates for 2009 for colon and rectum cancer are at %0C for both men and women and estimated death rates for men and women are at 9C (A*-, 2009+. There are no early signs and symptoms for colorectal cancer. -creening is necessary to detect colorectal cancer in its early stages. In the advanced stages of colorectal cancer there may be rectal bleeding, blood in the stool, change in bowel habits, and cramping pain in the lower

%2

abdomen. There are several modifiable ris& factors associated with colorectal cancer1 obesity, physical inactivity, diet high in red or processed meat, heavy alcohol consumption, smo&ing and possibly inade:uate inta&e of fruits and vegetables. The ris& for developing colorectal cancer increases with age. The 'year survival rate for persons with colorectal cancer is !#C and survival rate declines beyond years to 0C (see Table ".+. Although, when colorectal cancer is

detected at an early, locali2ed stage, the 'year survival rate is at #0C1 however, only #0C of colorectal cancers are diagnosed at this stage (A*-, 2009+.

Treatment Treatment for cancer is determined in many different ways depending on the cell type, si2e, if it is locali2ed or has spread, where the cancer is located and health of the patient. There are many different ways to treat cancer some more aggressive than others. 4ost cancer cells divide very rapidly and do not stop dividing, li&e normal body cells will eventually do, which causes them to grow at an e$ponential rate. 4ost cancer therapies specifically act against cells that are reproducing rapidly, thereby &illing the cancer cells (5elms, -ucher, and Iong, 200A+. *ancer can be treated with chemotherapy, radiation, bone marrow transplants, surgery, target therapy, biologic therapy, gene therapy, hormone therapy, proton therapy, vaccine therapy andHor complementary medicine. 4ost cancers re:uire numerous therapies and most commonly chemotherapy, radiation and surgery are used to combat cancer. *hemotherapy is a general term for any treatment involving the use of antioneoplastic drugs or chemicals to stop the growth of cancer cells. They can be administered alone or in combination with surgery or radiation therapy. *hemotherapy can be administered intravenous, in?ected into a body cavity or ingested orally in the form of a pill. 5ormally a combination of

%"

two to four drugs are administered1 antimitotics, antimetabolites, al&ylating agents andHor antibiotics (5elms, -ucher, J Iong, 200A+. These drugs alter 65A replication and protein synthesis. They are ta&en in combination with each other to &ill the cancer cells at all different cell stages, decrease the incidence of drug resistance and decrease the ris& of overall to$icity. *hemotherapy is considered a systemic therapy because it travels throughout the entire body via the vascular system1 unli&e surgery or radiation, which are local therapies that only affect a specific site (Goldwein and Lachani, 200!+. -ince chemotherapy travels throughout the whole body the drugs can not differentiate between tumor cells and healthy rapidly dividing cells. *hemotherapy targets rapidly dividing cells li&e tumor cells, but also may affect lymph tissue, hair follicle cells, gastrointestinal cells, and bone marrow. *hemo patients must be aware that bone marrow depression may occur and transfusions may be necessary. ;hen bone marrow cell count is low there is a high ris& of infection including septecemia and pneumonia. -&in brea&down, hair loss, infection and brea&down of mucosa may occur due to chemotherapy treatment (5elms, -ucher, and Iong, 200A+. It is estimated that more than 0C of cancer patients will receive radiation at some point during their treatment (Lachani, 200!+. >adiation wor&s li&e chemotherapy, in that it also targets rapidly dividing cells. >adiation therapy uses high energy $'rays or gamma rays to damage the 65A of cells, &illing the cancer cells or at least stopping replication. >adiation bloc&s mitosis and induces cell death. There are two radiation therapiesD e$ternal, where a beam of radiation is directed toward the tumor and internal, where a source of radioactivity is placed inside the body near the tumor (5elms, -ucher and Iong, 200A+ (Lachani, 200!+. )$ternal radiation therapy is usually given once or twice a day, days a wee& for several

wee&s depending on the treatment protocol. The patient does not receive radiation on the

%#

wee&ends to give normal cells some time to heal, usually reducing the side effects. Internal radiation therapy may be done by implanting small pieces of radioactive substance or by using an implanted reservoir, where a li:uid radioactive substance is in?ected. The radioactive substances includeD radium, cesium, iodine, and phosphorus. Internal radiation delivers intense radiation to a concentrated area which limits the dose to normal tissues. Although, the patient may need to be isolated from visitors for a period of time, so as to not e$pose others to radioactivity. 6epending where the radiation is locali2ed to determines the type of normal cell damage that may occur. >adiation affects rapidly dividing cells so damage may occur in epithelial cells, lymph tissue, bone marrow and hair follicles (5elms, -ucher and Iong, 200A+. -urgery is the oldest form of cancer treatment and is also the most common form. There are many different types of surgery that range from ma?or to minor, and from preventative to palliative (non'curative+. -urgeries are commonly used to remove a malignant mass (curative+ but may also be diagnostic, supportive, staging or cytoreductive. 6octors may use surgery to diagnose the tumor or to find out the stage at which the cancer has developed to. *ytoreductive surgery is done when removing the entire tumor may cause too much damage to nearby tissue or organs. -upportive surgeries are preformed to help with other types of treatments (A*-, Surgery, 2009+. There are many complications and side effects to surgery that may occur. 6uring surgery e$cessive bleeding, damage to internal organs and blood vessels, reactions to drugs (anesthesia+, or problems with other organs may occur, but all are rather rare. After surgery the most common side effect is pain and infection may be another possible complication. 9ther rare but life threatening problems would includeD pneumonia, internal infection, internal or e$ternal bleeding,

blood clots can form in deep veins andHor slow recovery of other body functions (GI recovery+ (A*-, Surgery, 2009+.

Relationship between Green Tea and Cancer

6uring the past % years there have been many studies stating green tea contains high amounts of active antio$idants that may treat and prevent cancer.

4echanism Green tea has been used for its therapeutic effects for hundreds of years. The main component of tea that has been studied for its positive health effects is the tea catechins. *atechins are a subgroup of the active ingredient polyphenol and are powerful antio$idants. There have been numerous studies on the consumption of tea and its association, both positive and negative, with cancer for several decades. The first epidemiological study on tea and its possible effects on cancer were published in %9!! (Arts, I. *., 2000+. -ince then there has been an increasing amount of clinical animal studies, epidemiological studies, systematic review and meta'analyses.

-tudies

9ne review study, on the mulitargeted theapy of cancer by green tea polyphenols, found that due to the large amount of encouraging data from in vitro and animal models that green tea is nature,s gift molecule endowed with anticancer effects (3han and 4u&htar, 2000+. It states

%!

that the epidemiological and geographical observations suggest that the animal and in vitro studies may be applicable to humans. This review found that there inta&e of green tea provided a statistically significant reduction in the incidence of prostate cancer. It found that green tea was protective against breast cancer due to its ability to lower plasma estrone levels. It also demonstrated that a daily consumption of e:uivalent of two or three cups of green ea reduced the ris& for esophageal cancer among non'smo&ersHnon'drin&ers of alcoholic beverages. This study,s conclusion states that green tea is considered one of the most promising dietary agents for the prevention and treatment of many diseases and conse:uently, it is being studied e$tensively worldwide (3han and 4u&htar, 2000+.

A primary research paper on the inhibitory effect of epigallocatechin'" gallate ()G*G+, a polyphenol in green tea, on tumor'associated endothelial cells and endothelial progenitor, studied the direct action of )G*G on in vivo tumor growth. The study was performed on nude rats and human cell cultures. The results of this study was that the e$pression of 44F'9 (a tumor growth factor+ was down regulated by )G*G in mouse bone marrow stromal cells, in vivo model )G*7 suppressed growth of melanoma and reduced microvessel density. The study concluded that )G*G has selective antiangiogenic (growth of new blood vessels from e$isting blood vessels+ effects on tumor'associated endothelial cells and endothelial progenitor cells and )G*G could be a promising angiogenesis inhibitor for human cancer treatment (9hga et al, 2009+.

A systematic review and meta'analysis on the effects of green tea consumption on incidence of breast cancer and recurrence of breast cancer found the consumption of or more

cups of green tea per day shows a non'statistically significant trend towards prevention of breast

%A

cancer. It indicated that it may be helpful but not a significant prevention. )vidence also indicated that green tea consumption may possibly help prevent breast cancer recurrence in early stage cancers. The study did not find statistically significant evidence and only suspected a possibility in the chemo'preventative effects of green tea. The reviews concluded that the potential therapeutic application of green tea are currently impossible to ma&e due to the small number of studies conducted, lac& of any clinical trial evidence, lac& of a consistent dose' response relationship and the potential for interaction with standard care (-eely, 4ills, ;u, Lerma and Gordon, 200 +.

9ne article reviewed studies specifically on inta&e of green tea, blac& tea, flavonolsHflavones, and catechins and its association with lung cancer. Bour out of the 20 studies for tea reported significantly reduced ris&s with high inta&e of tea. Two of the 20 found significantly increased ris& ratios, but were older studies. -tudies with tea inta&e and lung cancer (never or former smo&ers studied+ # out of A reported associations were significantly protective. The authors, conclusions were that studies on tea, flavonoids, and lung cancer ris& indicate a small beneficial association, particularly among never'smo&ers (Arts, 2000+.

The most recent review article on green tea for the prevention of cancer critically assessed any associations between green tea consumption and the ris& of cancer incidence and mortality. The authors included all prospective, controlled interventional studies and observational studies, which either assessed the associations between green tea consumption and ris& of cancer incidence or that reported on cancer mortality up to @anuary 2009. Bifty'one studies were included (see Bigure %.+. The authors, concluded that there is insufficient and

%0

conflicting evidence to give any firm recommendations regarding green tea consumption for cancer prevention. The authors :uestion the results of reviewed studies and that they need to be interpreted with caution and their generalisability is :uestionable (<oehm et al, 2009+.

51 studies (1.6 million participants)

27 Case-Control

23 Cohort Studies

1 Randomized Trial

27 i!esti"e Tract 5 #reast Cancer 5 $rostate 3 %un! 2 #ladder 1 &ral 3 'arious

i!esti"e tract cancers incidences (ere hi!hl) contradictor). ecrease ris* in men +or prostate cancer. ,ncrease ris* on urinar) -ladder cancer. %imited to moderate e"idence +or all other cancers assessed.

FIGURE 1. >eviewed studies from intervention review, Green tea (*amellia sinensis+ for the prevention of cancer (<oehm et al, 2009+. *onclusion

In the last % years there has been many ongoing research and studies on the relationship between the consumption of green tea and cancer. Green tea contains high amounts of active antio$idants and there has always been a consistent consumption of green tea in most Asian countries. These countries are &nown for their low cancer and cardiovascular disease incidence rates. >esearchers are ma&ing associations between low cancer and cardiovascular disease and their diet. The world is always searching for the cure for cancer or at least a remedy.

%9

6iet can play a role in the ris& for developing cancer. There have been many promising studies on green tea and cancer, but there are is no sound clinical research. 4ost studies are epidemiological studies and there are so many confounders and covariables that a strict conclusion is hard to ma&e. >esearchers can ma&e assumptions and show significant data but most data is not statistically significant. The author believes that there is insufficient and conflicting evidence regarding green tea consumption and the prevention of cancer. 4a?ority of the epidemiological studies were carried out in Asia where the diet is specific and hard to generali2e in America and worldwide. The clinical studies on rats were usually positive on the chemoprevention of green tea, but all of the wor& is done in rats and also ma&es it hard to generali2e toward humans. The rat studies were strong in that they were able to control most confounders and covariables, so the data was statistically significant. The author,s beliefs are that green tea consumption appears to be safe at moderate, regular and habitual use. Green tea may have positive antio$idant effects, but the positive effects may be counteracted by the caffeine content. *onclusions on green tea and cancer are currently hard to ma&e due to the conflicting evidence, lac& of any clinical trial evidence, lac& of consistent dose'response relations and the potential for interactions with standard care.

20