Articles

Tax-efficient giving

Deed of Covenant
An individual or company agrees to pay a set amount to Ovacome for at least three years (usually four). This payment is made net of tax and Ovacome can claim the tax back from the Inland Revenue, e.g. an individual donates £75 per annum to Ovacome, Ovacome can then claim a further £25 from the Inland Revenue, this being the tax deducted from the individual at source.

For a form to set up a covenant, please send a stamped addressed envelope to David Grant, 18 Pentreath Avenue, Guildford, Surrey GU2 5TA.

Gift Aid
If you don’t want to commit to regular payments to Ovacome, Gift Aid is a way for us to reclaim from the Inland Revenue the tax paid on a single donation. The donation must be a minimum of £250 and accompanied by a Gift Aid Certificate. A gift of £250 with a Gift Aid Certificate from a basic rate taxpayer would allow Ovacome to claim a further £83 from the Inland Revenue.

Again, if you would like a Gift Aid Certificate, please send an s.a.e. to David at the above address.

Charities Aid Foundation
The CAF Charity Account works like a bank account. Individuals can open an account, pay money into that account via covenant, Gift Aid, or Give As You Earn and the CAF reclaims the tax paid at 25% and adds that into the account. Individuals get a charity card and a cheque book, so they can make donations (gross of tax) to the charity or charities of their choice.

For more details contact CAF at Kings Hill, West Malling, Kent ME19 4TA, telephone 01732 520000.

Give As You Earn
Many companies operate a payroll giving scheme. The employer deducts money from an employee’s pay and passes it to an agency, who in turn passes the money to the charity of your choice, before PAYE tax is deducted. The donation is therefore paid gross. The maximum an individual can give in one year is £900.

Contact your employer for an application form if they operate this scheme.

Why use supplements?

If I was asked to list the main nutritional issues amongst women with gynaecological cancer it would have to include the use of vitamin and mineral supplements. So, in this issue, I answer some of the most commonly asked questions and cover a couple of other relevant topics such as calcium, vitamin B6 and vitamin C.

Vitamin and mineral supplements are a relatively new concept in healthcare, yet in Britain we spend over £300 million each year on these products. An enormous industry: but do we need such supplements?

People take vitamin and mineral supplements for a whole host of reasons; some to optimise well being, others to stimulate the immune system or perhaps to "kill off" the cancer cells. Such examples clearly demonstrate that people take supplements for their possible "drug" effect rather than to meet nutritional requirements.

The recommended level of intake for each nutrient is set by a panel of experts after careful consideration of current research. These are referred to as recommended daily amounts (RDA). You will often see the content of vitamin and mineral supplements expressed in actual amounts and the percentage of the RDA. It is often more meaningful to look at the percentage value rather than the specific levels.

So, are there any vitamin and/or mineral supplements which will reduce my risk of recurrence?

At present there is no evidence that taking extra vitamins will reduce the chance of cancer recurring. In fact, exceptionally high doses, well above recommended daily intake, may be harmful and have unpleasant side effects. For example, high doses of vitamin C (more than
2-3 g/day) can cause diarrhoea and large amounts of beta carotene can result in skin discoloration (orange!). In general, it is advisable not to take large doses of vitamins or minerals without first speaking to a dietician who can check the vitamin and mineral content of your diet.

Do I need vitamin C to boost my immune system?

Whilst most life forms are able to make their own vitamin C (ascorbic acid), humans, guinea-pigs, an Indian fruit-eating bat and certain birds have to rely on daily dietary sources. To us they are "essential" vitamins, in other words, we need adequate amounts from our diet daily as we are unable to store it in our body.

Of all the vitamins, ascorbic acid is probably the most controversial because it is claimed to have wide-ranging effects such as protection from cancer, heart disease and even the common cold. Unfortunately, whilst many may take vitamin C, the evidence to support its benefits, including its effect on the immune system, is lacking in trials on human subjects. In most cases, you can easily achieve a more than adequate intake of vitamin C from fruit and vegetables. If you are following a low- or reduced-fibre diet, you can still meet your vitamin C requirements by having a daily glass of fruit juice.

Why is there concern about vitamin B6 supplements?

There is evidence that regular high doses of vitamin B6 may have toxic side effects such as nerve problems leading to clumsiness, numbness and pins and needles. General advice is to limit daily intakes of vitamin B6 from food supplements to 10 mg, unless acting on professional advice.

The most popular reason for taking large supplements is to help relieve the symptoms of pre-menstrual syndrome (PMS) and menopause. Whilst some women report that it does help, there are very few well conducted scientific studies to support this. PMS and menopausal symptoms may be helped by a range of lifestyle changes and it is worth discussing these issues with a dietician or clinical nurse specialist.

If I am feeling tired, should I be taking an iron supplement?

One of the symptoms of low levels of iron in the blood (anaemia) is tiredness. This is because the iron helps to transport oxygen around the body and if we have insufficient we are unable to provide the oxygen our tissues need. However, there are many other causes of tiredness, so it is always a good idea to get your blood level checked before you start taking iron supplements. You can have this done at your GP practice or by your hospital doctor.

Most of us can meet our iron requirements from our diet. Good sources are red meats and offal. The absorption of iron from dark green vegetables, cereals, pulses, and beans can be inhibited by factors present in the food or meal. However, vitamin C can enhance the availability of iron from these sources so have a glass of fruit juice or fruit with the meal.

I’ve heard that the level of selenium in our foods is decreasing and therefore we are all at risk of selenium deficiency.

The amount of selenium in our diet varies according to the selenium content of the soil from which the foods are derived, so adult intakes of selenium can vary greatly. In China dietary intakes range from 11 to 5000 mg/day, at which extremes deficiency and toxicity syndromes occur (according to Garrow JS, James WPT. Human Nutrition and Dietetics, 1993, Churchill Livingstone). However, in the UK the range of intake is much less extreme, causing neither deficiency nor toxicity problems.

Is it worth taking a calcium supplement to help prevent osteoporosis?

Osteoporosis is characterised by reduced bone density, leading to a deterioration of bone tissue and an increase in fracture risk. A number of dietary and non-dietary factors may contribute to its development. As the most important mineral constituent of the skeleton is calcium, some interest has been shown in calcium intake and bone density, particularly in women. Whilst there is debate whether additional calcium in the diet will actually improve bone density and thus reduce the risk of osteoporosis, it is prudent to have a good dietary intake of calcium. Calcium can be obtained from milk, milk products (low-fat varieties are still a good source of calcium), fish which contains bones such as sardines, pilchards, tinned salmon and to a lesser extent vegetables and flour. A useful information booklet on calcium and dietary sources is currently being updated by the National Dairy Council and will be available from October this year (Our Daily Calcium, National Dairy Council, 5-7 John Princes Street, London W1M 0AP: Telephone 0171 499 7822).

I’ve heard beta carotene is meant to be good for you

There has been a great deal of interest in this nutrient and its possible benefit in the prevention of cancer. However, a recent study has shown that beta carotene supplements produced more lung cancer in smokers than those not taking the supplement. Whilst this is not related to gynaecological cancers, it does illustrate that purified nutritional supplements are not necessarily innocuous and may be harmful.

So, should I be taking vitamin and mineral supplements?

If you have a good appetite and are eating well it is unlikely that you need extra vitamins and minerals in tablet form; in fact getting vitamins and minerals from food is by far the best way of taking them. Vitamins naturally present in food are "balanced", interacting with other nutrients and constituents in the food which are absent in vitamin and mineral supplements. However, in certain circumstances, if your intake is poor or restricted in fruit and vegetables, then you may need to take a one-a-day multivitamin and mineral supplement such as Forceval (which is prescribeable), Centrum, Sanatogen Gold or any others which contain 100% of the RDA or RNI. These types of multi supplements contain "safe" levels of vitamins and minerals and the nutrients are able to interact and work most effectively in combination.

In general, apart from vitamin C, it is not advisable to take vitamins and mineral supplements separately: not only are they expensive but you could be taking double doses of the same nutrient, perhaps at toxic levels. However, if you are taking different vitamins and minerals and wish to continue doing so, it is always a good idea to check with a dietician who will be able to highlight if any levels may cause harm.

Next issue I will be looking at alternative and complementary dietary therapies.

Jane Power
Senior Dietician

VITAMINS

Vitamin A (beta-carotene)

• Needed for: Eye function, bone and tooth formation, growth and tissue repair
• Main Sources: Oily fish, fish oils, butter, margarine, liver, cheese, carrots, yellow and green vegetables

Vitamin B1 (thiamine)

• Needed for: The release of energy from carbohydrates (starchy foods)
• Main Sources: Whole grains, brown rice, pulses, fruit and vegetables, meat, fish, eggs, milk

Vitamin B2 (riboflavin)

• Needed for: Helps cells to use oxygen
• Main Sources: Flour, milk, eggs, green vegetables, meat, yeast extracts

Vitamin B6 (pyridoxine)

• Needed for: Enzyme function (specific chemical reactions)
• Main Sources: Whole grains, fish, meat, pulses

Vitamin B12

• Needed for: All cells
• Main Sources: Animal products

Nicotinic acid (niacin)

• Needed for: Cells to use oxygen
• Main Sources: Meat, fish, pulses, yeast, meat extracts

Folate

• Needed for: Making red cells in the blood
• Main Sources: Liver, green leafy vegetables, pulses

 Vitamin C (ascorbic acid)

• Needed for: Healthy cells, wound healing
• Main Sources:  Fruit and fruit juices, green vegetables, potatoes

Vitamin D

• Needed for: Absorption of nutrients such as calcium and phosphate, healthy bones
• Main Sources: Oily fish, fish liver oils, butter, margarine, milk, eggs

Vitamin E

• Needed for: Healthy cells and cell walls
• Sources: Vegetable oils, eggs, butter

MINERALS

Iron

• Needed for: Red blood cells to carry oxygen
• Sources: Liver, red meat, fish, eggs, green leafy vegetables

Calcium

• Needed for: Strong bones and teeth, nerve and muscle function, blood clotting
• Main Sources: Milk, milk products, tinned fish, e.g. pilchards and sardines

Zinc

• Needed for: Cell function and growth, woundhealing
• Main Sources: Meat, pulses, whole grains

Magnesium

• Needed for: Many body functions
• Main Sources: Cereals, vegetables, meats, fish, dairy products

A postscript on green tea

As a follow-up, to Diane Chapman’s report in the newsletter more than a year ago, about American research which has identified cathechins in green tea as potentially cancer-inhibiting chemicals, I have come across another interesting report which adds another interesting piece to the puzzle.

Investigators at the Case Western Reserve University School of Medicine in Cleveland, Ohio, tested the cathechins, epigallocathechin-3-gallate (EGCG), on cancerous human and mouse cells of the skin, lymph system and prostate, as well as on normal skin cells.

In the test tube, EGCG, led to "programmed" cell death in the cancer cells but left the healthy cells unharmed, according to a report in the US Journal of the National Cancer Institute. Professor Hasan Mukhtar, senior author of the report, said, "We found that this particular compound, which is present in the amount of about 200 milligrams in one cup of green tea, can kill a variety of cancer cells."

It is thought likely that this compound conveys a message to cancer cells through a highly ordered and well regulated signal transduction pathway which says, "You must commit suicide or I am going to kill you." The cells then decide that instead of being murdered, they will commit suicide, Professor Mukhtar reports.

The next step, the investigation suggests, is to evaluate the cancer preventative properties of green tea in human trials.

The tea provides a very acceptable substitute for our usual tea and coffee and can be purchased from: Imperial Teas of Lincoln, 26 Steep Hill, Lincoln, telephone, 01522 560008. There is a discount price for Ovacome members of £3.25 for 4 oz (including post and packing).
Mary Shenton
Scotland

Power to the patient

As I mentioned in my Summer letter I have been attending conferences that involve patient advocacy groups and treatment funding etc. Although Ovacome is not an advocacy group we have some very determined and knowledgeable members. I felt inspired by some of the letters I received and am covering some snippets from them below. I am sure you will agree that these ladies deserve recognition for what they have achieved. They are an inspiration to us all, and I would like to thank them all on behalf of Ovacome. Copies of the articles can be obtained from the Editor.

Rachel Solemani (London) was horrified by Understanding clinical trials in the Spring newsletter and feels that progress with AIDS treatment is proof enough that, unless we make more noise, more resources will not be poured into ovarian cancer treatment. She says "the support of Ovacome members has been invaluable to me in the year since my diagnosis. I know the committee are working terribly hard to give the disease a higher profile. This is fantastic, but as I feel a new self emerging after almost a year of grim treatments, it’s no longer a ladylike person here, it’s an angry one. We need more resources for research and quickly. I would like to know what other women think? Perhaps we could use the newsletter to exchange ideas?"

Susan Harrison has been liaising with the South Essex Health Authority, registering her strong opposition to proposed cuts, particularly with regard to ovarian cancer treatment and Taxol. She said "Little money is spent on ovarian cancer as it is, when compared with breast or cervical cancer, there is no screening and no health education, so many sufferers are in the advanced stage when diagnosed. You now propose to limit the relatively small amount spent on treatment. I find it hard to express the upset that reading your proposals has caused me and, I assume, any person suffering from ovarian cancer. I write on behalf of all ovarian cancer sufferers in Essex at a time when the Government is making proposals for equality of treatment country wide."

She wrote again in February to report that the proposal had been withdrawn, obviously very good news for all in South Essex.

Barbara Mackay (Edinburgh) wrote with copies of articles from the Scottish press criticising the care of ovarian cancer patients in Scotland and stating that only 29% of women were alive five years after diagnosis and that only nine of 26 hospitals followed the recommendation that patients with suspected ovarian cancer should be referred instantly to a specialist gynaecologist. Sixteen had implemented the recommendation that, after surgery, patients should be referred to a combined gynaecology and oncology unit.

Barbara was not in sympathy with these articles and felt impelled to tell the paper her personal story. The care she received was exceptional and her operation and follow-up treatment were impeccable. She said "I would like to reassure ovarian cancer patients that diagnosis and care here are excellent. It is a devastating diagnosis, one of the worst and now well known as the ‘silent killer’: let it be no more so! We need accurate publicity not alarmist about the varying symptoms of this cancer. Let us hope that the ovary will be of as much media interest as the breast."

Mary Shenton (a Fone Friend from Scotland) wrote to me about the same articles. She had also felt impelled to reply, and congratulated the paper for the "quite superb front-page article, in which you rightly called ovarian cancer the ‘silent killer’. On the surface at least, the attitude is as you describe, but as a patient suffering from this condition, I have nothing but the highest praise and gratitude for the treatment I received. The care, consideration and above all support which has been offered and accepted over the last 20 months has been outstanding. Having been referred to the Borders General Hospital, I was fortunate that I was seen by a consultant gynaecologist who moved heaven and earth on my behalf to such an extent that I received the surgical treatment required within three days. I was then referred by him to the Western General Hospital where the same standards would appear to apply since I was put on to a course of chemotherapy almost at once. I have since been reviewed, scanned and above all considered and advised at all levels to a degree which is quite outstanding".

She went on to talk about Ovacome and described our main aims and stated that it was her wish to raise awareness of both the condition and the charity throughout Scotland. She has written to 24 NHS trusts enclosing a brief questionnaire asking for details of a gynaecologist/oncologist in their area with the intention of sending them information on Ovacome. So far she has received one response (Edinburgh Royal Infirmary) and has asked that they receive regular literature from us so that they can help to raise the profile of Ovacome.