The American Health Foundation (AHF), founded in 1969, is a not-for-profit private research organization devoted primarily to the prevention of chronic diseases, especially cancer. This is realized through an interdisciplinary research and intervention approach implemented by investigators in epidemiology and biostatistics; analytical, synthetic, biological and clinical chemistry; molecular biology; cell biology; nutrition; endocrinology; pathology; and behavioral sciences.

The Foundation is a National Cancer Institute-designated Cancer Center. The Foundation has received a Cancer Center Support Grant (CCSG) since 1974 and is the only Center engaged specifically in multidisciplinary research on cancer prevention, the definitive means of cancer control.

The Foundation's mission is based on the following concept: mortality and morbidity from cancer, heart disease and stroke (which account for more than two-thirds of all premature deaths) can be reduced by a rational program of disease prevention. Many of the current chronic diseases are due to lifestyle choices. These include smoking, nutritional habits, drug and alcohol abuse, sedentary lack of activity, and exposure to occupational and environmental hazards. It is within the power of individuals, and society as a whole, to eliminate or at least reduce the risk factors for chronic disease. Health practices and well-being can be improved by implementing research findings through practical health promotion programs.

AHF scientists have been honored nationally and internationally for their research in the area of disease prevention. Founder, Dr. Ernst L. Wynder, was the first to establish the link between tobacco smoking and cancer 50 years ago. AHF scientists were also among the first to identify the relationship between cancer of the colon and breast and typical American eating habits: diets that are high in fat and low in fiber, vegetables and fruits.

Each year, the AHF staff publishes more than 120 scientific papers in peer-reviewed scientific and medical journals. Dr. Wynder was the founder of the international journal Preventive Medicine which fosters worldwide exchange of information obtained from disease prevention research among professionals. The AHF also has various programs for informing the general public on healthy lifestyles for children and adults, with topics including health-promotion, nutrition, exercise, weight control and smoking cessation.

AHF approach toward disease prevention

Prevention is the best cure.

While society presently allocates most of its resources to the treatment and care of illness rather than its prevention, the cost of treatment and care grows progressively higher without achieving a commensurate reduction in disease, suffering and death. The price of this approach, which is paid by all individuals, employees, insurance policyholders, consumers and taxpayers, is more than a trillion dollars annually. Yet, chronic diseases such as cancer, heart disease and stroke, which account for more than 70% of all premature deaths, can be greatly reduced by increasing our national emphasis on prevention. The hopes set in miracle drugs and treatments have obscured the fact that the health of human beings - particularly in modern society - depends largely on such seemingly ordinary factors as food choices, lifestyles, exercise, tobacco use and the environment. Paradoxically, less than 3% of all health care dollars are allocated for improving these critical elements in health promotion and disease prevention.

The American Health Foundation was founded in 1969 to address this problem. Its quarter-century growth from modest beginnings to a world-renowned authority in preventive medical research is a validation of philosophy and achievements, and a tribute to the dedication of its leadership.

An intelligent approach to prevention

Practicing what it preaches, the American Health Foundation has focused its efforts on programs with the greatest potential for cost-effective improvement of public health: prevention of cancer, heart disease and stroke, the major premature killing diseases. Programs are directed toward four principal goals: 1) identifying lifestyle elements and substances in the environment that increase risk for these diseases, 2) finding practical, cost effective methods for reducing or eliminating them, 3) educating the public to understand risks, and 4) collaborating with industry and institutions to produce more healthful products and to promote a sound environment for all.

While simple to state, these goals are less readily achieved. As an independent organization funded by a combination of grants and contributions, the AHF must focus on areas where it can achieve the most with its resources. Because the targeted diseases are particularly complex, advanced interdisciplinary efforts, complemented by sophisticated equipment and techniques are essential. From its beginnings, the AHF has cultivated a multi-disciplinary, collaborative approach embracing a broad spectrum of activities ranging from basic research to public health promotion. This approach has produced many important new technologies and insights.

Unraveling the enigmas of cancer

Perhaps the most devastating human affliction in terms of suffering and cost, cancer is a complex and elusive adversary, claiming more than 500,000 lives a year in the United States alone. Specific cancers arising from different causes affect individuals of all ages and attack almost anywhere in the body. The Foundation has studied many types of cancers to determine their causes and growth processes. Understanding the mechanisms by which cancer-causing chemicals operate, particularly how they are activated or detoxified in the body, is critical to cancer prevention. Most of the relevant chemicals are associated with lifestyle habits, tobacco and nutritional elements.

Researchers at the American Health Foundation provided the first clear demonstration of the link between tobacco use and cancer, and have identified and characterized the adverse biological effects of many of the more than 4,000 chemical compounds in cigarette smoke and smokeless tobacco. Since its inception, the Foundation has been in the forefront of tobacco-related cancer research. This is especially significant because lung cancer is responsible for over 150,000 deaths annually. Since 1987, more American women have died of lung cancer than of breast cancer; the latter had been the major cause of cancer deaths among women for over 40 years. As a result of its leadership, AHF is often asked to advise regulatory and legislative bodies, as well as to provide reliable information to the media and the public.

Colorectal cancer, which claims the lives of more than 55,000 persons annually, is another key area of study at the AHF. The Foundation has been a leader in pivotal research ranging from epidemiologic investigations to biomolecular assays. Laboratory studies and population surveys conducted by AHF researchers have demonstrated the link between high-fat diets and increased cancer risk, as well as the risk-reducing potential of diets rich in fiber. In addition to making major strides in understanding the progression of colon cancer, AHF scientists have developed a highly-sensitive, noninvasive method for early identification of individuals at risk.

Breast cancer, responsible for 45,000 female fatalities a year commands a central focus at the Foundation. Research to date has indicated that dietary factors are important contributors to the development of this disease. Diverse compounds, such as those produced by broiling foods, estrogen-like substances, and pesticide contaminants are being examined for their possible role in this disease. AHF has demonstrated that diets with high fat content contribute to breast cancer risk, especially in postmenopausal women. Conversely, a high-fiber, low-fat diet has tumor-suppressive effects and may help prevent reoccurrence of cancer. Of equal importance are studies on growth mechanisms in prostate cancer, the elucidation of causes of stomach, liver, pancreatic and bladder cancer, and the development of sensitive methods to detect early harmful effect of ultraviolet radiation in sunlight which can lead to skin cancer and melanoma.

Nutrition and chemoprevention of cancer: Fundamental deterrents

AHF has pioneered research directed toward understanding the critical role of nutrition in preventing cancer development, in particular the effects of factors such as high-fiber, low-fat diets, and caloric intake and expenditure. Such research is exemplified in the ongoing Woman's Intervention Nutrition Study (WINS), which explores the role of dietary fat in breast cancer development and reoccurrence in postmenopausal women.

Because nutrition strongly affects cancer risk, the Foundation scientists continually seek natural as well as related synthetic agents that can prevent or delay the development of neoplasms. AHF research scientists have identified a number of promising compounds, including vitamins, minerals and a variety of foods with specific anti-cancer properties. Among the vitamins, special significance is attributed to vitamins C and E, which act as antioxidants. Vitamin C may prevent formation of carcinogens produced from certain foods and additives in the stomach, while vitamin E is also helpful in preventing cardiovascular diseases. Ordinary black and green tea and tomatoes are rich in other natural antioxidant compounds, with demonstrated preventive effects.

Among the minerals, calcium and selenium have been of particular interest. Beyond its nutritive properties, calcium slows cell turnover, making the body less susceptible to carcinogens. To help utilize selenium, an effective cancer-fighting mineral that is, however, toxic at high doses, several much less toxic organic selenium compounds have been designed. Several of these have been very effective in the inhibition of breast, liver, lung and kidney tumors in model studies.

Foundation scientists are investigating functional foods, including certain vegetables and teas. Thiocyanates (found in watercress and cruciferous vegetables) show particular promise against lung cancer. Isoflavones, related compounds found in soy, also seem to be potent anticancer agents. Other functional foods include polyphenols (found in green and black tea) and dietary fish oil, as well as synthetic phenols, which show promise as valuable antioxidants. Nutritional replacement of glutathione which is considered a key protector against active metabolites of carcinogenic compounds and free radicals, and is diminished in older people, is also being explored.

Yet another promising area is the use of non-steroidal antiinflammatory drugs. These NSAIDs, including ibuprofen, aspirin, sulindac and piroxicam have proven to be particularly encouraging in laboratory assays and have been translated into Phase I and II human clinical trials. A most intriguing new approach explores the effects of certain lactic bacteria for preventing intestinal, liver and mammary cancers.

Sensitive detection and measurement: An early warning system

Enhancing the detection and quantitation of biomarkers and various pathogenic agents provides important tools for early identification of people at risk of disease. Several research groups at the AHF have contributed to major gains in this area. Their studies have utilized sensitive techniques such as gas chromatography with mass spectrometric detection, mass or thermal energy analyses, and molecular biomarkers of exposure. These highly sensitive and specific tools provide a number of important advantages. They enable the identification of early exposure to carcinogens, and can signal the onset of disease prior to evident symptoms. At the AHF, biomarkers have been used in diverse applications ranging from environmental exposure studies to helping understand the mechanisms of DNA replication and repair.

Health promotion and outreach: Translating knowledge into action

No amount of health research, particularly in the field of prevention, can produce a positive social change without effective communication with the public. Knowledge gained from research studies is only the beginning. Success in disease prevention is impossible without understanding the needs and attitudes of the target audience. The right delivery mechanisms with properly and persuasively framed messages must be employed. In addition, their effectiveness must be determined by monitoring feedback.

The Foundation's achievements in this area involve a number of projects. Most notable, perhaps, is the wellestablished Know Your Body (KYB) Program. Designed as a complete, interactive health promotion syllabus for children and their teachers from Kindergarten through 6th grade, it is one of the most thoroughly validated programs of its type. The only truly comprehensive program in the nation, it has reached well over 100,000 students to date. The AHF's extensive experience in health promotion includes work with children at risk (behavioral programs, drug abuse, AIDS), smoking cessation among women and minorities, and programs that promote screening for groups at risk for heart disease, stroke and obesity.