Nighttime Light Exposure: Does It Increase Your Risk of Breast Cancer?

Women who live in areas with higher levels of outdoor light at night may be at higher risk for breast cancer than those living in areas with lower levels, according to a large long-term study from the Harvard T.H. Chan School of Public Health. The link was stronger among women who worked night shifts.

 

Background: Previous studies have suggested that exposure to light at night may lead to decreased levels of the hormone melatonin, which in turn can disrupt circadian rhythms – out internal “clocks” that regulate sleepiness and alertness. As a result, your risk of breast cancer may increase.

The Study: In the most comprehensive study to date (investigating possible links between  outdoor light at night and breast cancer, researchers examined data from nearly 110,000 women enrolled in the Nurses’ Health Study II from 1989-2013. The researchers linked data from satellite images of earth taken at nighttime to residential addresses for each study participant, and also considered the influence of night shift work. The study also factored in detailed information on a variety of health and socioeconomic factors among participants.

Results: Women exposed to the highest levels of outdoor light at night — those in the top fifth — had an estimated 1.14-times increased risk of breast cancer during the study period, as compared with women in the bottom fifth of exposure. As levels of outdoor light at night increased, so did breast cancer rates. The association between outdoor light at night and breast cancer was found only among women who were premenopausal and those who were current or past smokers. In addition, the link was stronger among women who worked night shifts, suggesting that exposure to light at night and night shift work contribute jointly to breast cancer risk, possibly through mechanisms involving circadian disruption.

 

My Take: While provocative and consistent with historic studies, there are many potential variables for which the investigators did not control. Still, while we need confirmatory studies, this may be a caution regarding night exposure. For my patients, this typically means limiting blue light exposure in the hour before bedtime. Watch out for those computer screens, cell phones, and televisions! I’m Dr. Michael Hunter.

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

And, one more thing: NEW free apps for Android and iOS (Apple): In apps, search My Breast Cancer by Michael Hunter.

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Reference: Peter James, Kimberly A. Bertrand, Jaime E. Hart, Eva Schernhammer, Rulla M. Tamimi, Francine Laden. Outdoor Light at Night and Breast Cancer Incidence in the Nurses’ Health Study II. Environmental Health Perspectives, 2017 DOI: 10.1289/EHP935

 

Aerobic, resistance exercise combo boost brain power

A combination of aerobic and resistance exercises can significantly boost the brain power of the over 50s, according to the most comprehensive review of the available evidence to date.

 

Background: Physical exercise for older adults appears to be a very promising way to ward off (or perhaps halt) a decline in brain health and cognitive abilities. Unfortunately, the evidence is not yet high-level. In the current study, researchers systematically reviewed 39 relevant studies published up to the end of 2016 to assess the potential impact of varying types, intensities, and durations of exercise on the brain health of the over 50s. They analyzed the impact of aerobic exercise, resistance training (such as weights), multi-component exercise (containing elements of both aerobic and resistance training), tai chi, and yoga.

Results: Pooled analysis of the data showed that exercise improves the brain power of the over 50s, irrespective of the starting state of their brain health. Aerobic exercise significantly enhanced cognitive abilities, while resistance training had a profound effect on executive function, memory, and working memory. Tai chi also improved cognitive abilities, but the authors note that this analysis was based on just a few studies.

My Take: How much, and how often? The analysis points to a session lasting 45 to 60 minutes, of moderate to vigorous intensity, and of any frequency as good for brain health. While we need a large clinical trial to confirm the tai chi benefits, it is nice to know that such exercises may help those unable to perform more challenging forms of physical activity. I’m Dr. Michael Hunter.

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

And, one more thing: NEW free apps for Android and iOS (Apple): In apps, search My Breast Cancer by Michael Hunter.

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Reference: Hsu, CL et al. Aerobic exercise promotes executive functions and impacts functional neural activity among older adults with vascular cognitive impairment. British Journal of Sports Medicine, 2017; bjsports-2016-096846 DOI: 10.1136/bjs-ports-2016-096846

Alternative Medicine for Cancer Ups Death Risk

Researchers from the Yale Cancer Center (USA) found that reject conventional medicine (for a potentially curable cancer) in favor of alternative treatments have a 2.5-fold higher risk for death.

 

Complementary versus alternative: If a non-mainstream practice is used together with conventional medicine, it is considered “Complementary.” If a non-mainstream practice is used inlace of conventional medicine, it is considered “alternative.” Today, we are addressing the latter. In my practice, we often bring conventional and complementary approaches in a coordinated way, an approach known as integrative medicine.

The Study: Researchers examined records (2004-2013) in National Cancer Database (USA) to find 280 patients with early-stage cancer (breast, prostate, lung, or colorectal) whose treatment was coded as “other-unproven: cancer treatment administered by non-medical personnel.” They then matched the alternative medicine group to 560 patients with the same types of cancer who received conventional treatments.

The Findings: Alternative medicine use was associated with a nearly 6-fold increased risk of death among patients with breast cancer. For those with colorectal cancer, the risk increased by a factor of 4.5, and among patients with lung cancer, the risk of death doubled. The risk among prostate cancers did not differ between the conventional and alternative treatment groups. The last is not a surprise, given the long natural history of prostate cancer and the short median follow-up of this study.

I’m Dr. Michael Hunter.

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

And, one more thing: NEW free apps for Android and iOS (Apple): In apps, search My Breast Cancer by Michael Hunter.


Reference: This new study was published online in the Journal of the National Cancer Institute.

Yoga reduces symptoms of depression

A multi-week regimen of yoga may be an effective complement to traditional therapy for depression, multiple studies suggest.

 

Individuals who suffer from depression may want to look to yoga as a complement to traditional therapies as the practice may lessen symptoms, according to studies presented at the 125th Annual Convention of the American Psychological Association.

 

Study #1: Lindsey Hopkins (San Francisco Veterans Affairs Medical Center) focused on the acceptability and antidepressant effects of hatha yoga, the branch of yoga that emphasizes physical exercises, along with meditative and breathing exercises, to enhance well-being. She examined outcomes for 23 male veterans who participated in twice-weekly yoga classes for eight weeks. On a 1-10 scale, the average enjoyment rating for the yoga classes for these veterans was 9.4. All participants said they would recommend the program to other veterans. More importantly, participants with elevated depression scores before the yoga program had a significant reduction in depression symptoms after the eight weeks.

 

Study #2: Nyer and Nauphal presented data from a pilot study of 29 adults that also showed eight weeks of at least twice-weekly Bikram yoga significantly reduced symptoms of depression and improved other secondary measures including quality of life, optimism, and cognitive and physical functioning.

“The more the participants attended yoga classes, the lower their depressive symptoms at the end of the study,” said Nyer, who currently has funding from the National Center for Complementary and Integrative Health to conduct a randomized controlled trial of Bikram yoga for individuals with depression.

 

Study #3: Another and more specific version of hatha yoga commonly practiced in the West is Bikram yoga, also known as heated yoga. Sarah Shallit, MA, (Alliant University, San Francisco) investigated Bikram yoga in 52 women, age 25-45. Just over half were assigned to participate in twice-weekly classes for eight weeks. The rest were told they were wait-listed and used as a control condition. All participants were tested for depression levels at the beginning of the study, as well as at weeks three, six and nine. Shallit and her co-author Hopkins found that eight weeks of Bikram yoga significantly reduced symptoms of depression compared with the control group.

 

Study #4: Nina Vollbehr MS (Center for Integrative Psychiatry, the Netherlands) presented data from two studies on the potential for yoga to address chronic and/or treatment-resistant depression. In the first study, 12 patients who had experienced depression for an average of 11 years participated in nine weekly yoga sessions of approximately 2.5 hours each. The researchers measured participants’ levels of depression, anxiety, stress, rumination and worry before the yoga sessions, directly after the nine weeks and four months later. Scores for depression, anxiety and stress decreased throughout the program, a benefit that persisted four months after the training. Rumination and worry did not change immediately after the treatment, but at follow up rumination and worry were decreased for the participants.

 

Study #5:  Among 74 mildly depressed university students, Vollbehr and her colleagues compared yoga to a relaxation technique. Individuals received 30 minutes of live instruction on either yoga or relaxation and were asked to perform the same exercise at home for eight days using a 15-minute instructional video. While results taken immediately after the treatment showed yoga and relaxation were equally effective at reducing symptoms, two months later, the participants in the yoga group had significantly lower scores for depression, anxiety and stress than the relaxation group.

 

My Take: While yoga is not a cure-all (and recognizing the the results are suggestive of benefit, but not yet definitive) for depression , low-level evidence points to a lot of potential. If you are considering incorporating it into standard management, please check with a valued health care provider. I’m Dr. Michael Hunter.

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

And, one more thing: NEW free apps for Android and iOS (Apple): In apps, search My Breast Cancer by Michael Hunter.


References:
American Psychological Association (APA). “Yoga effective at reducing symptoms of depression.” ScienceDaily. ScienceDaily, 3 August 2017. <www.sciencedaily.com/releases/2017/08/170803152917.htm>.

Can Mediterranean Diet Reduce Your Chances of Becoming Blind?

Better adherence to a Mediterranean diet reduces the risk of developing age-related macular degeneration, according to a study reported in 2016 in Ophthalmology.

 

Background: Macular degeneration is the leading cause of vision loss, affecting more than 10 million Americans – more than cataracts and glaucoma combined. At present, it is considered incurable. One can compared the human eye to a camera, with the macula the central and most sensitive area of the so-called film. When it is working properly the macula collects highly detailed images at the center of your field of vision and sends the information up the optic nerve to the brain, where we interpret the signals as sight. When the cells of the macula deteriorate, images are not received correctly. While early macular degeneration may not affect your vision, as the disease progresses, you may experience wavy or blurred vision. If the condition continues to worsen, central vision may be completely lost (although peripheral vision may be retained). A Mediterranean diet has been inversely associated with heart attack, stroke, cancer, and mortality. But what about eye health, including macular degeneration?

The Study: Researchers evaluated 5060 patients aged 65 years or older, chosen randomly from centers in Norway, Estonia, the United Kingdom, France, Italy, Greece, and Spain between 2001 and 2002. Dietary intake during the previous 12 months was evaluated, which captured information about consumption of items such as olive oil, fish, wine, fruit, legumes, and meat/meat products. All patients had eye exams, including digital retinal photographs, and blood samples were collected to evaluate antioxidant levels (including lutein, zeaxanthin, carotene, and lycopene). In addition, information was collected regarding smoking and alcohol use and environmental exposure. The mean age among participants was 73.6 years, and 55% were women.

Results: The researchers found that, among the 4753 participants with full dietary data, individuals with a high adherence to a Mediterranean diet had the lowest odds of neovascular advanced macular degeneration, dropping their risk by about half.

My Take:  We cannot establish causality between consuming a Mediterranean diet and the risk of macular degeneration. In addition, self-reporting of dietary information may lead to bias. Still, given the good effects of the diet on the risk of heart attack stroke, and cancer, I am gonna go have some Italian food! I’m Dr. Michael Hunter.

New: Free apps for Android and iOS (Apple): Search My Breast Cancer by Michael Hunter. Please let me know what you think!

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

References: Ophthalmology. Published online November 5, 2016; https://www.macular.org/what-macular-degeneration

CAR T Cells as “Living Drugs”

“Incredibly exciting” is how experts are describing the new development with chimeric antigen receptor (CAR) T cells, as the first of these novel therapies approaches the market.

“Living Drugs”

The treatment product is made individually for each patient. After blood is taken from the patient, it undergoes a process that involves extracting immune system T cells, subjecting the cells to CAR cell engineering, and then infusing the engineered T cells back into the patient. The engineering changes the T cell in two ways. First, it adds a receptor that targets the CD19 antigen that is found on most leukemia cells. When the cells are returned to the patient’s body, they home in on this antigen, latch on, and destroy the leukemia cell. Second, the process inserts a viral vector mechanism into the cells that, once the cells have latched onto the leukemia cell, triggers these T cells to expand and proliferate, so that they seek out and destroy all the remaining leukemia cells.

Because they grow and expand in the body and then lie dormant, CAR T cells have been described as “living drugs.” It is not clear whether CAR T cells will also last a lifetime or whether will they gradually disappear over decades. It is also not clear how long immunosurveillance may be needed, he said. While policing the blood, these cells wipe out any leukemia B cells that may reappear, but there can be a downside. In some patients, this has also led to depletion of healthy B cells, a condition known as known as B cell aplasia. “This is not a major problem, at least not so far,” commented one expert, because this deficiency can be corrected by giving immunoglobulin supplements, in some cases long-term.

The worst of the side effects occur within a week or two of infusion, when the cells are expanding and attacking the leukemia. Some of the side effects can be very severe, even life-threatening. The two most concerning side effects are cytokine release syndrome, which was severe in about half of the patients in the pivotal trial, and neurologic toxicity, which developed in nearly half of the patients (44%). Because there can be severe side effects, patient care needs to be overseen by clinicians with experience in this field, and suitable facilities are required. Patients may need to be treated in the intensive care unit, for example, and some patients may need to undergo intubation.

Having industry involvement has streamlined a complicated production process and has shortened the manufacturing time. Whereas patients at the beginning of the clinical trial needed to wait 44 days between giving blood and undergoing CAR T-cell infusion, the process now takes only 22 days from “vein to vein,” the drug company Novartis reports. For the future, there is hope that it may be possible to make “off the shelf” products that would require no waiting time. There is also work underway to incorporate a “genetic switch” into the CAR T cell, which would make it possible to “turn off” the therapy by taking another drug. This could be useful when side effects become very severe, he suggested.

There is a tremendous amount of work ongoing involving other blood cancers, all of which appear suitable to this approach. There is also hope that the therapy could be made to work against solid tumors. This first product that is heading to market is just the tip of the iceberg. I’m Dr. Michael Hunter. Medscape did a great job reporting it, and I thought I’d share this news with you.

Reference: http://www.medscape.com/viewarticle/882968#vp_3

 

New app for Android: My Breast Cancer by Dr. Michael Hunter

 

Gum Disease and Cancer Risk

dental exam oral cavity white male head and neck oropharynx

New data supports the need to further investigate an association between periodontal disease and cancer risk.

Background: Previous studies have found periodontal disease is a risk factor for breast, oral, and esophageal cancers. Case-control studies have shown a link between tooth loss and the risk for esophagus and stomach cancers.

The Study: Investigators examined periodontal disease information in 65,869 women ages 54 to 86 at 40 centers in the USA. Mean age 68 years. Most were non-Hispanic whites with some college education. Participants answered this question: “Has a dentist or dental hygienist ever told you that you had periodontal or gum disease?”

The Results: This large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gall bladder, and melanoma skin cancers.Although periodontal disease and cancer share important risk factors (such as increased risk with increasing age and increased in smokers), this study showed that after adjustment for age, the risk of periodontal disease history and cancer persists regardless of smoking history.

My Take: This study adds to a growing body of evidence from smaller studies that link periodontal disease to total cancer risk. Oral hygiene is important not only in preventing tooth loss, but may have important implications for prevention of systemic diseases, including cancer. I’m Dr. Michael Hunter.

Cancer Epidemiol Biomark Prev. Published online 01 Aug 2017.

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