Fried foods, olive oil and colorectal cancer

Relationship between oily fish intake and breast cancer based on estrogen receptor status: a Mendelian randomization study

OBJECTIVE

We used a Mendelian randomization (MR) method in our research to examine the relationship between genetically determined oily fish intake and breast cancer (BC) incidence.

METHODS

The summary data pertaining to the oily fish intake were acquired from the UK Biobank, which consisted of a sample size of 460,443 people. Information on BC was received from the Breast Cancer Association Consortium (BCAC). We analyzed the causal connection between oily fish intake and BC incidence using various methods, including inverse variance weighting (IVW). Heterogeneity was investigated using Cochran's Q test. IVW, MR-Egger, and MR-PRESSO methods were used for sensitivity analysis. In addition, a multivariate MR adjusted for body mass index (BMI) and weight was used for further research.

RESULTS

Two-sample MR results showed that oily fish intake was negatively associated with total breast cancer (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.39-0.87, IVW method), estrogen receptor-positive (ER +) breast cancer (OR 0.44, 95% CI 0.21-0.93, IVW method), and estrogen receptor-negative (ER-) breast cancer (OR 0.53, 95% CI 0.30-0.93, IVW method). The sensitivity analysis did not observe the presence of heterogeneity and horizontal pleiotropy. In multivariate MR analysis, the negative association between oily fish intake and total breast cancer (P = 0.03) and ER- breast cancer (P = 0.04) risk persisted after adjusting for BMI and body weight. However, no correlation was found in ER + breast cancer (P = 0.30).

CONCLUSION

The oily fish intake has a negatively correlated with the incidence of total breast cancer, particularly in the cases of ER- breast cancer. There is a lack of substantial evidence supporting a link between the oily fish intake and the incidence of ER + breast cancer.

Oleuropein exhibits anticarcinogen effects against gastric cancer cell lines

BACKGROUND

Oleuropein (OLE), the main phenolic compound of the olive fruit and leaves, has many heathful effects. Gastric cancer is the most fatal malignancy in many parts of the world and it is generally related to harmful dietetic factors. The anticarcinogenic role of OLE in gastric cancer has not been studied sufficiently yet. In this study, we aimed to research the cytotoxic, genotoxic and apoptotic effects of OLE on gastric adenocancer (AGS) cells in vitro.

METHODS AND RESULTS

A standard cell line derived from gastric adeno cancer (AGS) cells was employed, and its performance following a 24-hour exposure to OLE at various doses was examined. The ATP cell viability assay, 2',7'-dichlorodihydrofluorescein-diacetate assay (H2DCF-DA) and alkaline single cell gel electrophoresis assay (Comet Assay) were used to study the cytotoxicity, production of reactive oxygen species (ROS) and genotoxicity respectively. The induction of apoptosis was discovered using flow cytometry. OLE reduced AGS cells viability about 60% at maximum concentration (500 µmol/L) and also resulted in approximately 100% DNA damage and about 40% apoptosis with necrosis in AGS cells depending on the increased doses. Cell viability was also significantly decreased in relation to increased intracellular reactive oxygen species (ROS) levels (p < 0.05 - 0.001).

CONCLUSIONS

Oleuropein has shown significant anticarcinogen effects against gastric adenocancer (AGS) cells in vitro. Oleuropein, a nutrient rich in olive and olive oil, seems to be both protective and therapeutic against gastric cancer and may be a new chemotherapeutic agent in the future.

Association of egg consumption with colorectal polyp prevalence: findings from the Lanxi Pre-Colorectal Cancer Cohort (LP3C) in China

Eggs contain high-quality protein, lavish vitamins and other bioactive nutrients but are rich in cholesterol. Our study is designed to assess the association of egg intake with polyp prevalence. A total of 7068 participants at a high risk of CRC from the Lanxi Pre-Colorectal Cancer Cohort Study (LP3C) were recruited. A food frequency questionnaire (FFQ) was utilized to obtain dietary data through a face-to-face interview. Cases of colorectal polyps were identified by electronic colonoscopy. The logistic regression model was exploited to achieve odds ratios (ORs) and 95% confidence intervals (CIs). Overall 2064 cases of colorectal polyps were identified in the 2018-2019 survey of LP3C. A positive association of egg consumption with colorectal polyp prevalence was found after the multivariable adjustment [OR_{Q4 vs. Q1} (95% CI): 1.23 (1.05-1.44); P_trend = 0.01]. However, a positive relationship disappeared after further adjustment for dietary cholesterol (P_trend = 0.37), which explained that the harmful role of eggs could be ascribed to the high content of dietary cholesterol. Besides, a positive trend was found between dietary cholesterol and polyp prevalence [OR (95% CI): 1.21 (0.99-1.47); P_trend = 0.04]. Furthermore, replacing 1 egg (50 g d^-1) with an equal amount of total dairy products was related to 11% lower colorectal polyp prevalence [OR (95% CI): 0.89 (0.80-0.99); P = 0.03]. In summary, higher egg consumption was correlated with a higher polyp prevalence among the Chinese population at a high risk of CRC, which was ascribed to the high content of dietary cholesterol in eggs. Besides, individuals with the highest dietary cholesterol tended to have a higher polyp prevalence. Reducing the consumption of eggs and replacing eggs with total dairy products as alternative protein sources may prevent the occurrence of polyps in China.

Levels and Health Risk Assessment of Polycyclic Aromatic Hydrocarbons in Vegetable Oils and Frying Oils by Using the Margin of Exposure (MOE) and the Incremental Lifetime Cancer Risk (ILCR) Approach in China

A total of 139 vegetable oils and 48 frying oils produced in China were tested for the levels of 15 Environmental Protection Agency-regulated polycyclic aromatic hydrocarbons (PAHs). The analysis was completed by high-performance liquid chromatography-fluorescence detection (HPLC-FLD). The limit of detection and limit of quantitation were ranged between 0.2-0.3 and 0.6-1 μg/kg, respectively. The average recovery was 58.6-90.6%. The highest mean of total PAHs was found in peanut oil (3.31 μg/kg), while the lowest content was found in olive oil (0.39 μg/kg). In brief, 32.4% of vegetable oils exceeded the European Union maximum levels in China. The detected level of total PAHs in vegetable oils was lower than the frying oils. The mean dietary exposure to PAH15 ranged from 0.197 to 2.051 ng BaPeq/kg bw/day. The margin of exposure values was greater than 10,000, and the cumulative probabilities of the incremental lifetime cancer risk of different age groups were less than the priority risk level (10^-4). Therefore, there was no potential health concern for specific populations.

Valorizing the usage of olive leaves, bioactive compounds, biological activities, and food applications: A comprehensive review

Olive oil production is a significant source of economic profit for Mediterranean nations, accounting for around 98 percent of global output. Olive oil usage has increased dramatically in recent years, owing to its organoleptic characteristics and rising knowledge of its health advantages. The culture of olive trees and the manufacture of industrial and table olive oil produces enormous volumes of solid waste and dark liquid effluents, involving olive leaves, pomace, and olive oil mill wastewaters. These by-products cause an economic issue for manufacturers and pose major environmental concerns. As a result, partial reuse, like other agronomical production wastes, is a goal to be achieved. Because these by-products are high in bioactive chemicals, which, if isolated, might denote components with significant added value for the food, cosmetic, and nutraceutical sectors, indeed, they include significant amounts of beneficial organic acids, carbohydrates, proteins, fibers, and phenolic materials, which are distributed differently between the various wastes depending on the olive oil production method and table olive agronomical techniques. However, the extraction and recovery of bioactive materials from chosen by-products is a significant problem of their reasonable value, and rigorous detection and quantification are required. The primary aims of this review in this context are to outline the vital bioactive chemicals in olive by-products, evaluate the main developments in extraction, purification, and identification, and study their uses in food packaging systems and safety problems.

Consumption of food fried in olive oil and unhealthy aging in a Mediterranean country

BACKGROUND & AIMS

Fried food has usually shown neutral or detrimental effects on many chronic diseases, possibly depending on the type of food fried and the frying oil, but its relationship with unhealthy aging is unknown. We examined how changes in fried food consumption over a 3-year period were linked to unhealthy aging over 3 and 6 years.

METHODS

Prospective cohort study in Spain with 2043 individuals aged ≥60 years, recruited in 2008-2010 and followed-up to 2012 and 2015. Fried food consumption was ascertained with a validated diet history, and unhealthy aging was measured with a 52-item health deficit accumulation index.

RESULTS

Compared with participants who reduced fried food consumption, those who increased it showed less deficit accumulation over 3 years (multivariable β [95% confidence interval]: -1.45 [-2.30, -0.61]), but not over 6 years of follow-up. More 3-year deficit accumulation was observed when replacing 100 g/day of fried food with an equal amount of non-fried food (1.48 [0.59, 2.37]); corresponding values in substitution analyses were 2.03 [1.03, 3.03] for fried protein-rich food, 10.76 [5.20, 16.33] for fried eggs, and 2.06 [0.68, 3.43] for fried fish. Also, increased olive oil intake was significantly associated with less 3-year deficit accumulation (total olive oil: -1.14 [-2.07, -0.21], and olive oil with non-fried food: -0.99 [-1.89, -0.08]).

CONCLUSIONS

In a Mediterranean country, where olive oil is the most common frying medium, increased fried food consumption was associated with delayed unhealthy aging over 3 years of follow-up; consumption of olive oil and fried protein-rich food (especially eggs and fish) were its main drivers. However, these associations did not generally remain after 6 years.

Olive Oil Effects on Colorectal Cancer

Colorectal cancer is the fourth cause of cancer-related death worldwide. A Mediterranean diet showed protective action against colorectal cancer due to the intake of different substances. Olive oil is a fundamental component of the Mediterranean diet. Olive oil is rich in high-value health compounds (such as monounsaturated free fatty acids, squalene, phytosterols, and phenols). Phenolic compounds exert favourable effects on free radicals, inflammation, gut microbiota, and carcinogenesis. The interaction between gut microbiota and olive oil consumption could modulate colonic microbial composition or activity, with a possible role in cancer prevention. Gut microbiota is able to degrade some substances found in olive oil, producing active metabolites with chemopreventive action. Further clinical research is needed to clarify the beneficial effects of olive oil and its components. A better knowledge of the compounds found in olive oil could lead to the development of nutritional supplements or chemotherapeutic agents with a potential in the prevention and treatment of colorectal cancer.

Antitumor Perspectives of Oleuropein and Its Metabolite Hydroxytyrosol: Recent Updates

Olive fruit is a significant and promising source of potential bioactive compounds such as oleuropein and hydroxytyrosol. Oleuropein is the ester of elenolic acid and 3,4-dihydroxyphenyl ethanol (HT). It is the main glycoside in olives, the degradation of which results in the formation of hydroxytyrosol in olive oil. Both plays a significant role in the reduction of coronary heart diseases and a certain type of cancers. Both olive oil phenols have an effective role counter to cell proliferation, cell growth, migration, invasion, and angiogenesis. They down regulate the expression of BCL-2 and COX-2 proteins, and reduced DNA damage. Hydroxytyrosol and oleuropein inhibited the multiple stages in colon carcinogenesis; initiation, promotion, and metastasis. They also provide protection against various human cancers including colorectal, skin, breast, thyroid, digestive, lung, brain, blood, and cervical. This review article discusses the anticancer perspectives and mechanisms of oleuropein and hydroxytyrosol in cell cultures and animal and human studies.

Mediterranean diet and colorectal cancer: A systematic review

Colorectal cancer is the third most common cancer worldwide, especially in developed countries where an estimated 60% of all cases occur. There is evidence of a higher risk for CRC in Western society, where people tend to eat more red and processed meat than those living along the Mediterranean coast, who have a decreased overall cancer mortality, which is correlated to their eating habits, such as Mediterranean diet. The aim of this review was to evaluate the correlation between three components of the Mediterranean diet (olive oil, red wine, and tomatoes) and incidence and progression of colorectal cancer. As such, we conducted a literature search using keywords "colorectal cancer," "dietary pattern," "Mediterranean diet," "olive oil," "protective effects," "resveratrol," and "lycopene." Olive oil polyphenols, red wine resveratrol, and tomato lycopene showed several characteristics in vitro that interfere with molecular cancer pathways. At the same time, many clinical studies have reported an association of these components with a reduction in cancer initiation and progression. More clinical studies are needed to identify the precise dose and administration of single agents or their combination to produce a coadjutant treatment to those already applied in chemoprevention and oncologic treatment.

Risk factors for the development of colorectal carcinoma: A case control study from South India

AIM: To study the association of colorectal carcinoma (CRC) with diet, smoking, alcohol, physical activity, body mass index, family history and diabetes.

METHODS: All consecutive patients with CRC confirmed by histopathology diagnosis were included. Age (± 5 years) and gender matched controls were selected among the patients admitted in surgery ward for various conditions without any co-existing malignancy. Food frequency questionnaire (FFQ) was developed and validated after pretesting by investigator trained in data collection techniques. Cases and controls were interviewed ensuring privacy, in similar interview setting, with same duration of time for both cases and controls without any leading question. Biological variables like family history of CRC in first degree relatives, history of diabetes mellitus; behavioral factors like tobacco use both smoking and smokeless form, alcohol consumption and physical activity were recorded. Dietary details were recorded using a FFQ consisting 29 food items with seven categories. Analysis was done using appropriate statistical methods.

RESULTS: Ninety-four histopathologically confirmed cases of CRC and equal number of age and gender matched controls treated over a period of two years were studied. Age distribution, mean age, male to female ratio, education level and socioeconomic status were similar in cases and controls. Intake of food items was categorized into tertile due to skewed distribution of subjects as per recommended cut off for consumption of food item. On univariate analysis red meat [OR = 7.4 (2.935-18.732)], egg [OR = 5.1 (2.26-11.36)], fish, fried food and oil consumption were found to be risk factors for CRC. On multivariate analysis red meat consumption of more than 2-3 times a month (OR = 5.4; 95%CI: 1.55-19.05) and egg consumption of more than 2-3 times a week (OR = 3.67; 95%CI: 1.23-9.35) were found to be independent risk factors for the development of CRC.

CONCLUSION: Egg and red meat consumption found to be independent risk factors for CRC. Smoking, alcohol, physical activity and family history were not associated with increased risk.

The presence of carbon nanostructures in bakery products induces metabolic stress in human mesenchymal stem cells through CYP1A and p53 gene expression

Ingredients commonly present in processed foods are excellent substrates for chemical reactions during modern thermal cooking or processing, which could possibly result in deteriorative carbonization changes mediated by a variety of thermal reactions. Spontaneous self-assembling complexation or polymerization of partially combusted lipids, proteins, and other food macromolecules with synthetic food additives during high temperature food processing or baking (200-250 °C) would result in the formation of carbon nanostructures (CNs). These unknown nanostructures may produce adverse physiological effects or potential health risks. The present work aimed to identify and characterize the nanostructures from the crusts of bread. Furthermore, a toxicological risk assessment of these nanostructures was conducted using human mesenchymal stem cells (hMSCs) as a model for cellular uptake and metabolic oxidative stress, with special reference to induced adipogenesis. CNs isolated from bread crusts were characterized using transmission electron microscopy. The in vitro risk assessment of the CNs was carried out in hMSCs using an MTT assay, cell morphological assessment, a reactive oxygen species assay, a mitochondrial trans-membrane potential assay, cell cycle progression assessment and gene expression analysis. Our results revealed that bread crusts contain CNs, which may form during the bread-making process. The in vitro results indicate that carbon nanostructures have moderately toxic effects in the hMSCs at a high dose (400 μg/mL). The mitochondrial trans-membrane potentials and intracellular ROS levels of the hMSCs were altered at this dose. The levels of the mRNA transcripts of metabolic stress-responsive genes such as CAT, GSR, GSTA4, CYP1A and p53 were significantly altered in response to CNs.

Effect of growing location, malaxation duration and citric acid treatment on the quality of olive oil

BACKGROUND

The total phenolic compounds of olive oil exert antiradical activity at cellular level and can prevent cardiovascular disease, metabolic syndrome and cancer. Increased awareness of its health benefits has increased the consumption of olive oil around the world. An alternative processing technique effective in increasing the amount of oil extracted while maintaining the oil quality is needed to meet the rising global demand for olive oil.

RESULTS

Addition of 0.3 g mL(-1) citric acid at 1:1000 (v/w) to olive paste followed by a 30 min malaxation period significantly increased the oil recovery, concentration of total phenolic compounds and antiradical activity by 46.23, 120.27 and 31.48% respectively. While there was no significant effect on the acidity, the peroxide value was significantly reduced by 63.85%. The organoleptic characteristics of the olive oil extracted with citric acid were also comparable to those of the control.

CONCLUSION

Addition of 0.3 g mL(-1) citric acid (i.e. 30% w/v) at 1:1000 (v/w) to olive paste followed by a 30 min malaxation period in a Blixer(®) 4.0 blender is the most promising extraction technique to improve the oil recovery, concentration of total phenolic compounds and antiradical activity of the extracted olive oil without compromising other quality parameters.

Mechanisms of action of phenolic compounds in olive

Olive oil, an oil rich in monounsaturated fatty acids (MUFCs) and minor constituents including phenolic compounds, is a major component of the Mediterranean diet. The potential health benefits of the Mediterranean diet were highlighted by the seminal Seven Countries Study, and more contemporary research has identified olive oil as a major element responsible for these effects. It is emerging that the phenolic compounds are the most likely candidates accounting for the cardioprotective and cancer preventative effects of extra virgin olive oil (EVOO). In particular, the phenolic compound, hydroxytyrosol has been identified as one of the most potent antioxidants found in olive oil. This review will briefly consider historical aspects of olive oil research and the biological properties of phenolic compounds in olive oil will be discussed. The focus of the discussion will be related to the mechanisms of action of hydroxytyrosol. Studies have demonstrated that hydroxytyrosol induces apoptosis and cell cycle arrest in cancer cells. Further, research has shown that hydroxytyrosol can prevent cardiovascular disease by reducing the expression of adhesion molecules on endothelial cells and preventing the oxidation of low-density lipoprotein (LDL). The molecular mechanisms accounting for these effects are reviewed.

Olive oil intake is inversely related to cancer prevalence: a systematic review and a meta-analysis of 13,800 patients and 23,340 controls in 19 observational studies

Dietary fat, both in terms of quantity and quality, has been implicated to cancer development, either positively or negatively. The aim of this work was to evaluate whether olive oil or monounsaturated fat intake was associated with the development of cancer. A systematic search of relevant studies, published in English, between 1990 and March 1, 2011, was performed through a computer-assisted literature tool (i.e., Pubmed). In total 38 studies were initially allocated; of them 19 case-control studies were finally studied (13800 cancer patients and 23340 controls were included). Random effects meta-analysis was applied in order to evaluate the research hypothesis. It was found that compared with the lowest, the highest category of olive oil consumption was associated with lower odds of having any type of cancer (log odds ratio = -0.41, 95%CI -0.53, -0.29, Cohran's Q = 47.52, p = 0.0002, I-sq = 62%); the latter was irrespective of the country of origin (Mediterranean or non-Mediterranean). Moreover, olive oil consumption was associated with lower odds of developing breast cancer (logOR = -0,45 95%CI -0.78 to -0.12), and a cancer of the digestive system (logOR = -0,36 95%CI -0.50 to -0.21), compared with the lowest intake. The strength and consistency of the findings states a hypothesis about the protective role of olive oil intake on cancer risk. However, it is still unclear whether olive oil's monounsaturated fatty acid content or its antioxidant components are responsible for its beneficial effects.

Microwave heating effects on the chemical composition and the antioxidant capacity of tataouine virgin olive oils from Tunisia

Four Tunisian virgin olive oils (VOOs), derived from varieties (Chemlali Tataouine, Zarrazi Douirat, Fakhari Douirat, and Dhokar Douirat) grown in the harsh pedoclimatic conditions of the region of Tataouine, were evaluated for their responses to microwave heating. Aside from fatty acid composition, all other evaluated parameters were affected by microwave heating, and their variations depend on the genetic factor. Chemlali Tataouine VOO exhibited the slowest biophenol degradation rate and the least diminution in oxidative stability and consequently, its total fraction and both lipidic and methanolic fractions remained unchanged with an exceptional antioxidant potential. In the remaining studied VOOs, the biophenol contents, the oxidative stability, and the antioxidant potential underwent gradual decreases; nevertheless, their levels at the longer treatment time are close to some fresh VOOs. These results should be taken into consideration when Tataouine VOOs are recommended for microwave heating.

Selected aspects of Mediterranean diet and cancer risk

European Mediterranean populations have a high life expectancy. Several aspects of their diet are considered favorable on health. We considered the role of various aspects of the Mediterranean diet on cancer risk in a series of Italian case-control studies including about 10,000 cases of cancer at 13 different sites and over 17,000 controls. For most epithelial cancers, the risk decreased with increasing vegetable consumption. Allium vegetables were also favorably related to cancer risk. Fruit intake was inversely associated with digestive tract and laryngeal cancers. For digestive tract cancers, the population attributable risks for low intake of vegetables and fruit ranged between 15% and 40%. Olive oil and unsaturated fats, which are typical aspects of the Mediterranean diet, were inversely related to the risk of several cancers, particularly of the upper aerodigestive tract. Whole grain food (and hence possibly fiber) intake was also related to reduced risk of various cancers. In contrast, refined grains and, consequently, glycemic load and index were associated to increased risks. Several micronutrients and food components (including folate, flavonoids, and carotenoids) showed inverse relations with cancer risk, but the main component(s) responsible for the favorable effect of a diet rich in vegetables and fruit remain undefined.

Biological activities of phenolic compounds present in virgin olive oil

The Mediterranean diet is associated with a lower incidence of atherosclerosis, cardiovascular disease, neurodegenerative diseases and certain types of cancer. The apparent health benefits have been partially ascribed to the dietary consumption of virgin olive oil by Mediterranean populations. Much research has focused on the biologically active phenolic compounds naturally present in virgin olive oils to aid in explaining reduced mortality and morbidity experienced by people consuming a traditional Mediterranean diet. Studies (human, animal, in vivo and in vitro) have demonstrated that olive oil phenolic compounds have positive effects on certain physiological parameters, such as plasma lipoproteins, oxidative damage, inflammatory markers, platelet and cellular function, antimicrobial activity and bone health. This paper summarizes current knowledge on the bioavailability and biological activities of olive oil phenolic compounds.

Diet and cancer in Mediterranean countries: carbohydrates and fats

Objective

Several aspects of the diet characteristic of the Mediterranean countries are considered favourable not only on cardiovascular disease, but also on cancer risk. We considered some aspects of the Mediterranean diet (including, in particular, the consumption of olive oil and carbohydrates) on cancer risk.

Design, Setting and Subjects

Data were derived from a series of case-control studies, conducted in Italy since the early 1990s, on over 10 000 cases of thirteen cancer sites and over 17 000 controls.

Results

Olive oil, and other mono- and unsaturated fats, appear to be favourable indicators of breast, ovarian, colorectal, but mostly of upper aero-digestive tract cancers. Whole grain foods are also related to reduced risk of upper aero-digestive tract and various other cancers. In contrast, refined grain intake and, consequently, glycaemic index and glycaemic load were associated to increased risk for several cancer sites. Fish, and hence a diet rich in n-3 polyunsaturated fatty acids, tended to be another favourable diet indicator, while frequent red meat intake was directly related to some common neoplasms. An a priori defined Mediterranean diet score was inversely related to upper digestive and respiratory tract cancers.

Conclusions

These data provide additional evidence that major characteristics of the Mediterranean diet favourably affect cancer risk.

Extra virgin olive oil phenolics: absorption, metabolism, and biological activities in the GI tract

Olive oil, a typical ingredient of the Mediterranean diet, possesses many beneficial health effects. The biological activities ascribed to olive oil consumption are associated in part to its phenolics constituents, and mainly linked to the direct or indirect antioxidant activity of olive oil phenolics and their metabolites, which are exerted more efficiently in the gastrointestinal (GI) tract, where dietary phenolics are more concentrated when compared to other organs. In this regard, we present a brief overview of the metabolism, biological activities, and anticancer properties of olive oil phenolics in the GI tract.

Dietary lipids and cancer

For many years, epidemiological studies continued to suggest that high fat diets are linked to an increased incidence of certain cancers. However, whether the oncogenic properties of fat are associated with their quantity rather than the quality has become debatable. Epidemiological studies have been suggesting that n-6 polyunsaturated fatty acids (n-6 PUFA) and saturated fats are more likely to increase the incidence of cancer, whereas monounsaturated fatty acids (MUFA) and n-3 polyunsaturated fatty acids (n-3 PUFA) are more likely to prevent or decrease the chance of carcinogenesis. A firm conclusion cannot be drawn yet because of insufficient research. This paper reviews the current knowledge of the effects of saturated fats, different types of unsaturated fats, and fat-soluble vitamins on the etiology of cancer.