I’m a Breast Cancer Survivor. Can I drink alcohol?

red wine alcohol

What You Need to Know: Moderate alcohol consumption is not associated with a higher risk of breast cancer relapse, and may lower your risk of death from other causes (e.g. cardiovascular ones).

Background: Drinking more than 1 standard drink of alcohol daily increases a woman’s risk of breast cancer slightly.  But once you have breast cancer, does continued alcohol consumption affect your or breast cancer recurrence? Does it change your  survival chances?

Study Design: A large study by Newcomb and colleagues (Journal of Clinical Oncology 2013; 31:1939) provides answers.  Over 22,000 women who had breast cancer in Wisconsin, Massachusetts and New Hampshire (USA) between 1988 and 2008 were evaluated by questionnaire.  After over 11 years follow up from the time of diagnosis, the risk of death was evaluated according to the amount of alcohol ingested.

Results: Moderate alcohol intake before diagnosis was linked with improved cancer survival (hazard ratio for survival 0.93 versus patients who did not drink). Alcohol drinking after diagnosis and treatment was not associated with cancer specific survival (hazard ratio 0.88, not significant).  However, there was a marked benefit of limited drinking on overall survival, with a hazard ratio for death from any cause of 0.63 for intake of 7 or more drinks per week and a specific hazard ratio of death from cardiovascular disease of 0.50 with intake of  7 or more drinks per week. 

My Take: In this study, moderate drinking did not appear to increase the risk of breast cancer recurrence or death. It does lower your risk of a cardiovascular death (for example from a heart attack or stroke).  Modest alcohol consumption may benefit your overall survival chances following breast cancer diagnosis without worsening breast cancer outcomes. If you enjoy alcohol, and do not have reasons not to drink (health, religious, or otherwise) it’s okay to drink a bit, but I’d still keep it modest: One standard drink per day. I’m Dr. Michael Hunter.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Night Shift Work and Breast Cancer: More Evidence of a Link

night shift workers

There is a substantial body of evidence suggesting long-term shift work increases the risk of breast cancer. Now comes another study confirming the association.

Researchers in Canada found that the length of the working the night shift is an important risk factor for breast cancer. A duration of 30 years or more was associated with increased risk. The investigators stratified risk by duration: 0-14 years, 15-29 years, and 30 years or more, and compared the breast cancer incidence to a control group.

No association between night shift work and breast cancer risk was observed for the groups, except for the 30+ year one. Those with the longest history of night shift work had a 2.2x risk of developing breast cancer. The greatest proportion of night shift work was in the health field, with such jobs accounting for 44% of the 30+ year group.

My take: Some believe that light at night and melatonin are a cause of breast cancer. Still, other factors might include sleep disturbances, clock gene dysregulation, and lifestyle differences. As for you, I would consider keeping the room dark at night (no outside light seeping in; no clocks emitting low levels of light; no electronics (including TV) for the hour before sleep). For me, I stumble into the bathroom if I need it at night, sans light.

I’m Dr. Michael Hunter.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Occup Environ Med. Published online July 1, 2013. Abstract.

Which Prostate Cancers Need Treatment? A New Test May Help Answer the Question

mouse

The majority of the 200,000 prostate cancers diagnosed annually in the USA are slow growing (and will remain so). But some will become more threatening over time. What if we could have a simple tool to predict whether seemingly low-risk prostate cancer will stay slow-growing, or behave aggressively? Well, researchers at Columbia University Medical Center (New York City) have found that the use of a 3-gene biomarker (in conjunction with existing cancer staging tests) might help us to better determine which men with early prostate cancer can be safely followed with “active surveillance” and spared the side effects of aggressive treatment such as surgery or radiation therapy.

Drs. Abate-Shen and Michael Shen focused on genes related to aging, especially those affected by cell senescence, a natural process in which older cells stop dividing, but remain metabolically active). Cell senescence plays a critical role in tumor suppression, and has been linked to benign prostate tumors.

The investigators identified 19 genes in a mouse model of prostate cancer in which the cancers were always quiet (indolent). They then used a decision-tree learning model, a form of computer-driven algorithm, to find 3 genes – FGFR1, PMP22, and CDKN1A – that can accurately predict the outcome of seemingly low-risk prostate cancer.

My Take: If this turns out to work in humans, it will be a huge breakthrough, helping spare tens of thousands of men annually from aggressive treatment, and side effects. If you are a mouse with prostate cancer, it is a good day for you! I’m Dr. Michael Hunter.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Science Translational Medicine, Sept 2013

DCIS: What Does Radiation Therapy Contribute?

DCIS (solid type)

What You Need To Know: Survival after treatment for ductal carcinoma in situ (DCIS) of the breast is excellent. So, the question arises whether the current management approaches for DCIS (such as local excision and adjuvant radiation therapy + ant-estrogen therapy) represents overtreatment. While a recent report does not fully answer that question, it does provide long-term evidence that adjuvant radiation therapy after local excision reduces the incidence of both in situ and invasive local recurrences by a factor of 2, and results in an overall lower risk of mastectomy.

Background: Following the introduction of radiation therapy following breast conserving surgery (lumpectomy) for operable invasive breast cancer in the early 1980s, several trials aimed to investigate the value of radiation therapy for even earlier breast cancer, DCIS (Stage 0). Now we have long-term outcomes from the EORTC trial.

The Study: Results of the European Organization for the Research and Treatment of Cancer (EORTC) trial 10853 appear in the Journal of Clinical Oncology today. Between 1986 and 1996, the EORTC trial 10853 randomized 1010 women with complete local excision of DCIS to no further treatment or radiation therapy. The risk of local recurrence was roughly halved with the addition of radiation therapy (HR 0.52). The 15 year local recurrence-free rate was 69% with lumpectomy alone, compared to 82% for those who got radiation therapy. The 15 year invasive local recurrence free rates were 84% (no radiation) versus 90% (radiation).

The differences in local control did not translate into differences in disease specific or overall survival. However, local recurrence was associated with a lower breast cancer specific survival (18x more likely to die of breast cancer, compared to someone without such a recurrence), as well as overall survival (5x more likely to die). In summer, an invasive local recurrence resulted in a worse prognosis. Finally, the women who had radiation therapy had a lower chance of ever having a mastectomy (13% versus 19%).

My Take: These study  results represent long-term confirmation that radiation therapy improves local control after a lumpectomy for DCIS, but does not improve the odds of survival. Radiation therapy also reduced the chances a patient needed breast removal. Soon, we will better distinguish those DCIS lesions that can receive minimal (or no) treatment versus those that do. Prediction tools are beginning to be used, including ones that look at the genes driving the DCIS growth. I’m Dr. Michael Hunter, and I thank you for joining me today.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Contralateral Breast Cancer Risk in Patients With BRCA Mutations: Tamoxifen Reduces Risk

English: Tamoxifen_Structural_Formulae
Tamoxifen (Photo credit: Wikipedia)

Bottom Line: Women with BRCA1 or BRCA2 mutations who underwent adjuvant tamoxifen for breast cancer have a reduced risk of contralateral (other side) breast cancer.

The Study: Investigators used the International BRCA1 and BRCA2 Carrier Cohort Study, the Kathleen Cunningham Foundation Consortium for Research into Familial Breast Cancer, and the Breast Cancer Family Registry to identify women with primary breast cancer. Of the BRCA1 carriers, 24% received the anti-estrogen agent tamoxifen. Of the BRCA2 carriers, 52% got the drug.

Among women treated with tamoxifen after first breast cancer diagnosis, adjusted hazard ratios were 0.38 for BRCA1 mutation carriers and 0.33 for BRCA2 carriers; in other words, women on tamoxifen had a nearly 2/3 reduction in the risk of getting a cancer in the other breast. Still, among BRCA1 mutation carriers that were premenopausal. the risk reduction associated with tamoxifen appeared less apparent for those who had had their ovaries removed (HR 0.70 vs 0.26).

My Take: If you have a BRCA mutation, you should review your cancer risk management with a specialist, including whether you should consider taking tamoxifen as a risk-reducing agent. For those who take tamoxifen as a part of treatment for breast cancer, we now know that you reduce the risk of cancer developing in the other breast, even if you carry a BRCA mutation.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Phillips KA. J Clin Oncol 2013;doi:10/1200/JCO/2012.47.8313.

Can A Healthy Lifestyle Reverse Aging? Yes!

Telomere
Telomere (Photo credit: Wikipedia)

Wow. A program of healthy eating, exercise, and stress reduction can not only reverse some diseases – it may slow down the aging process as well. This headline certainly got this 50-year-old’s attention.

How: Lifestyle changes can affect the telomeres – little brush-like caps on the end of the chromosomes that carry your DNA. A team from the University of California, San Francisco just published a small series, based on men with prostate cancer. The research showed that men who switched to a vegan diet, added exercise, and stress reduction had longer telomeres. Drs. Ornish and Blackburn led a team that examined 10 patients with prostate cancer (who had no traditional treatment).

The program includes eating a diet high in whole foods, fruits, vegetables, unrefined grains, and keeping fat to 10% of calories. The men also exercised, walking at least 30 minutes a day, 6 days per week. They did yoga-based stretching end breathing exercises, practiced relaxation techniques, and had weekly one-hour stress-reduction group sessions. And they gave blood samples. About 85-95% of patients were compliant with the program.

Wow: This is the first study showing that an intervention (of any type) can reduce cellular aging. Telomerase levels increased by 30% in just 3 months. Telomerase is an enzyme that affects telomeres. They also looked at gene activity: Of 500 genes that changed, in every case it was in a beneficial way. Five years later, they drew more blood. The telomeres were an average of 10% longer. Of 25 men who did not follow the program, the telomeres were 3% shorter than average.

My Take: Dr. Ornish’s diet has been shown to reverse heart disease, diabetes, and may help keep early prostate cancer in check. Even if you or I can’t do everything the study participants did, we all can aim in that direction. I’m Dr. Michael Hunter, and I am excited to share the good news with you!

There are many problems with the study:

This was not a randomized trial. Patients in the treatment group agreed to intense and highly demanding lifestyle changes. They were compared with a group who had similar risk factors but who clearly did not share their high level of motivation. There is no way to know what other important differences might exist between the two groups.

This was a very small trial. The original 2008 trial enrolled 30 patients– there were no controls– and 24 patients had sufficient blood samples to assess telomerase activity. In the new report only 10 patients had adequate blood samples available for analysis. This limits the generalizability of the study.

What caused the changes (if there were changes)? The Ornish program is contains several interventions, including drastic reductions in dietary fat and sugar, significant increases in exercise , as well as yoga classes and group therapy. There is no way to know the relative importance, of any of the individual elements of his program.

Do we have to go vegetarian or super low fat? (I doubt it) It is entirely possible that other healthy interventions might similarly change telomere length favorably. Might a Japanese diet? Mediterranean diet? South Beach diet? And what about vigorous regular exercise (here, we have Canadian data linking it to telomere stabilization, as I recall). It is entirely possible that other, completely different interventions would have a similar effect.

Might other factors lengthen life? We know a big indicator of length of life among men over the last 100 years has been work. Keep working…

So, no. I am not foolish enough to believe that a 10 person trial proves anything. (Although it can be helpful: Hodgkin’s original observation in the 1830s of adenopathy had only a dozen or so patients included, pointed the way to some of the most extraordinary progress in the cancer business ever.) . Prospective, randomized trials will need to be conducted to provide high level evidence, and the authors make this very clear in their conclusions. For now, however, we have one more brick in the wall… As for me, I’ll stick to healthy living (hopefully with a few more fruits!). And choosing my parents well (Go mom: pushing 80 and still walking 4 miles daily, and close to her weight from 40 years ago; Go dad: pushing 85, and not a single significant health problem. Still not as good as my in-laws, who all lived 94-102 years, seemingly healthy ’til the very end).

That’s my 2 cents.

Want to Try It? The men on the study followed a program advocated by Dr. Dean Ornish, an expert who has long been an advocate of very low-fat, vegetarian diet in improving health. Dr. Ornish worked with the telomere expert (and 2009 Nobel Prize winner) Dr. Elizabeth Blackburn.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Lancet Oncology, 2013

Should I Use Soy to Prevent Prostate Cancer Recurrence?

Soybeans and tofu

What You Need to Know: Daily consumption of a soy protein powder beverage for 2 years failed to delay or prevent disease recurrence in men who had undergone surgery (radical prostatectomy) for prostate cancer, according to a randomized, double blind trial.

Background: Soy consumption has been suggested as a means to lower your risk of prostate cancer recurrence. Still, we didn’t have much data to guide us; that is, until now. Roughly half of men with prostate cancer use dietary supplements including soy. But should they?

The Current Study: 177 men at high risk for cancer relapse were treated across 7 centers between July 1997 and May 2010. All patients received a 20 gram protein powder (to be put into a drink) that contained either soy protein isolate or a placebo (calcium caseinate). Supplements began  months after surgery and continued up to 2 years. Investigators then checked PSA blood measurements every 2 months for the first year, and every 3 weeks thereafter. The trial was halted early, as the soy did not appear to have any effects on recurrence.

My Take: This study provides high level evidence that you should not use soy as a means to reduce the risk of prostate cancer recurrence following prostate cancer surgery (radical prostatectomy). Perhaps a lifetime of exposure might reduce the risk of prostate cancer, but even that is highly speculative.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad:  Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minutes. Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Bosland MC. JAMA. 2013;310:170-178.