Physical Activity, Occasional Drinking Associated With Decrease in Vision Impairment Risk

eye iris eyelashes

What You Need to Know: A physically active lifestyle and occasional drinking are associated with a reduced risk of developing visual impairment.

The Study:  To help determine ways to decrease the growing burden of visual impairment, researchers from the University of Wisconsin School of Medicine and Public Health examined the relationships between the incidence of visual impairment and three modifiable lifestyle behaviors: smoking, drinking alcohol and staying physically active. The research was conducted as part of the Beaver Dam Eye Study, a long-term population-based cohort study from 1988 to 2013 of nearly 5,000 adults aged 43 to 84 years.

The Evidence: Over 20 years, visual impairment developed in 5.4 percent of the population and varied based on lifestyle behaviors as follows:

  • Physically active persons (people who engage in regular activity three or more times a week): Over 20 years, 6.7 percent of sedentary persons and 2 percent of physically active persons developed visual impairment. After adjustment for age, these figures show a 58 percent decrease in odds of developing visual impairment in those who were physically active compared to those who were sedentary.
  • Occasional drinkers (those who have consumed alcohol in the past year, but reported fewer than one serving in an average week): Over 20 years, 11 percent of non-drinkers (people who have not consumed alcohol within the past year) developed visual impairment while 4.8 percent of occasional drinkers did so. After adjustment for age, these figures show a 49 percent decrease in odds of developing visual impairment in those who were occasional drinkers compared to those who consumed no alcohol.
  • While the odds were higher in heavy drinkers and smokers compared to people who never drank heavily and never smoked, respectively, the associations were not statistically significant.

My Take: While the study provides risk estimates of associations of lifestyle factors with the incidence of visual impairment, the findings may be due, in part, to unmeasured factors related to both lifestyle behaviors and development of visual impairment. The data does not prove that these lifestyle behaviors are directly responsible for increased risk. The lead investigator frames it well:

“While age is usually one of the most strongly associated factors for many eye diseases that cause visual impairment, it is a factor we cannot change,” said Ronald Klein, M.D., MPH, lead researcher of the study. “Lifestyle behaviors like smoking, drinking and physical activity, however, can be altered. So, it’s promising, in terms of possible prevention, that these behaviors are associated with developing visual impairment over the long term. However, further research is needed to determine whether modifying these behaviors will in fact lead to a direct reduction in vision loss.”

 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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Ronald Klein, Kristine E. Lee, Ronald E. Gangnon, Barbara E.K. Klein. Relation of Smoking, Drinking, and Physical Activity to Changes in Vision over a 20-Year Period. Ophthalmology, 2014; DOI: 10.1016/j.ophtha.2014.01.003

Sports Reduces Breast Cancer Risk

Seniors jogging exercise on forest woods road

Practising sport for more than an hour day reduces the risk of contracting breast cancer, and this applies to women of any age and any weight, and also unaffected by geographical location, according to research presented to the 9th European Breast Cancer Conference (EBCC-9). Compared with the least active women, those with the highest level of physical activity reduced their risk of breast cancer by 12%, researchers say.

The Study: Professor Mathieu Boniol, Research Director at the International Prevention Research Institute, Lyon, France, recently reported the results of a meta-analysis (study of a group of studies) of 37 studies published between 1987 and 2013, representing over four million women. “These are all the studies looking at the relationship between physical exercise and breast cancer risk that have been published to date, so we are confident that the results of our analysis are robust,” he said.

The Evidence: Although the results varied according to tumour type, the overall message was encouraging, the researchers say. However, in women taking hormone replacement therapy (HRT), the protective effect of exercise seemed to be cancelled out. But increased awareness of the side effects of HRT means that its use is decreasing in a number of countries, and this means that the beneficial effects of activity will most likely grow in the years to come. “Whether or not this will be the case is an interesting question and deserves to be followed up at a later date,” Prof Boniol said.

Physical activity is known to have a protective role in other cancers, as well as in disorders such as cardiovascular disease. Although the mechanisms for its effect are unclear, the results are largely independent of body mass index (BMI), so the effect must be due to more than weight control. And the age at which sporting activity starts also appears to be immaterial; the researchers found no indication that breast cancer risk would decrease only when physical activity started at a young age.

“Adding breast cancer, including its aggressive types, to the list of diseases that can be prevented by physical activity should encourage the development of cities that foster sport by becoming bike and walk-friendly, the creation of new sports facilities, and the promotion of exercise through education campaigns,” said Prof Boniol. “This is a low cost, simple strategy to reduce the risk of a disease that currently has a very high cost, both to healthcare systems and to patients and their families. It is good news both for individuals and for policy makers.”

My Take: Women have a real impetus to increase their physical activity by even modest increments. This review comfirms that improvements in breast health can now be added to the other established health benefits of physical activity. So keep moving! I love for my patients to get a minimum of the equivalent of a brisk walk, 5 times per week. If you can do more, great. But even that small amount of additional activity can add years to your life, while potentially lowering your risk of heart attack, stroke, dementia, and cancer. 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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: The European CanCer Organisation (ECCO). “Regular physical activity reduces breast cancer risk irrespective of age.” ScienceDaily. ScienceDaily, 20 March 2014. <www.sciencedaily.com/releases/2014/03/140320100816.htm>.

Acupuncture Helps with Breast Cancer Drug Pain

acupuncture

What You Need to Know: For women with breast cancer receiving aromatase inhibitors (AIs), real acupuncture (RA) and sham acupuncture (SA) seem to improve patient-reported outcomes, according to a study published online Dec. 23 in Cancer.

The Study: Ting Bao, M.D., from the University of Maryland Greenebaum Cancer Center in Baltimore, and colleagues randomized postmenopausal women with stage 0 through III breast cancer who received an AI and had treatment-associated musculoskeletal symptoms to receive eight weekly RA (23 patients) or SA (24 patients) sessions.

Results: The researchers identified significantly improved scores from baseline to week eight in the RA arm for the Center for Epidemiological Studies Depression scale (P = 0.022); hot flash severity and frequency (P = 0.006 and 0.011, respectively); the Hot Flash-Related Daily Interference Scale (HFRDI; P = 0.014); and National Surgical Adjuvant Breast and Bowel Project (NSABP) menopausal symptoms (P = 0.022). In the SA arm, significant improvements from baseline were seen for the European quality-of-life survey (P = 0.022), the HFRDI (P = 0.043), and NSABP menopausal symptoms (P = 0.005). Compared with the 38 non-African-American patients, the nine African-American patients benefited more from RA than SA in reduction of hot flash severity and frequency scores (P < 0.01 for both).

“Both RA and SA were associated with improvement in patient-reported outcomes among patients with breast cancer who were receiving AIs, and no significant difference was detected between arms,” the authors conclude.

My Take: Small study, but provides some support for those who wish to try acupuncture for aromatase inhibitor-related symptoms.The authors disclosed no financial ties to the pharmaceutical industry. 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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cancer 120(3)

Common Types of Skin Cancer Raise Risk for Subsequent Primary Cancers

skin mole on back - doctor examining patient

Individuals with a history of non-melanoma skin cancer (NMSC) have an increased risk of subsequent primary cancers, according to a study published in the March issue of Cancer Epidemiology, Biomarkers & Prevention.

The Evidence: Eugene Liat Hui Ong, BMBCh, from the University of Oxford in the United Kingdom, and colleagues used data from an all-England record-linked hospital and mortality dataset from 1999 to 2011 to examine the risk of primary malignant cancers in individuals with a history of NMSC.

Two cohorts were constructed: one including 502,490 people with a history of NMSC and a second that included people without a history of NMSC. The cohorts were followed electronically to ascertain the observed and expected numbers of people with subsequent primary cancers. The researchers found that the standardized relative risk for all subsequent malignant cancers was 1.36 for the NMSC cohort versus the non-NMSC cohort.

Results: For 26 of the 29 cancer types studied, the relative risks were significantly increased (P < 0.05), in particular for salivary gland, melanoma, bone, and upper gastrointestinal tract cancers. Younger people with versus those without NMSC had particularly high relative risks.

“NMSC is strongly associated with a broad spectrum of other primary cancers, particularly in younger age groups,” the researchers wrote. “The pattern suggests a genetic or early-acquired etiologic association.”

My Take: I am not sure this data is yet actionable. Still, it reminds me of two things: 1) Protect yourself against excessive sun exposure; 2) If you have a history of skin cancer, do the recommend cancer screening, don’t drink to excess, and don’t use tobacco! 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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References

  1. Ong ELH, Goldacre R, Hoang U, et al. Subsequent Primary Malignancies in Patients with Nonmelanoma Skin Cancer in England: A National Record-Linkage Study. Cancer Epidemiol Biomarkers Prev. 2014; 23(3):490-498.

IS Breast Cancer Gene Linked to Obesity and Diabetes?

DNA genes

What You Need To Know: The gene known to be associated with breast cancer susceptibility, BRCA 1, plays a critical role in the normal metabolic function of skeletal muscle, according to a new study. Mutations in the BRCA1 gene may also put people at increased risk for metabolic diseases like obesity and type 2 diabetes, this research indicates.

Background: The gene known to be associated with breast cancer susceptibility, BRCA 1, plays a critical role in the normal metabolic function of skeletal muscle, according to a new study led by University of Maryland School of Public Health researchers. Dr. Espen Spangenburg, associate professor of kinesiology, and his laboratory team are the first to identify that the BRCA1 protein is expressed in the skeletal muscle of both mice and humans, and that it plays a key role in fat storage, insulin response and mitochondrial function in skeletal muscle cells.

“Our findings suggest that certain mutations in the BRCA1 gene may put people at increased risk for metabolic diseases like obesity and type 2 diabetes,” said Dr. Spangenburg. “Without BRCA1, muscle cells store excess fat and start to look diabetic. We believe that the significance of the BRCA1 gene goes well beyond breast cancer risk.”

The Evidence: Dr. Spangenburg and colleagues, including researchers from the University of Maryland School of Medicine, Brigham Young University, Karolinska Institutet in Sweden, and East Carolina University, found that the BRCA1 protein exists in both mouse and in human skeletal muscle. This is the first evidence since the discovery of BRCA1 in 1994 that the gene is expressed in human muscle cells.

  • They further established that the protein produced by the BRCA 1 gene binds with a protein known to play an important role in the metabolism of fat in muscle cells known as Acetyl-CoA carboxylase or ACC. After a period of exercise, the BRCA 1 protein binds to ACC, which helps “turns it off.” This deactivation of ACC encourages the utilization of fatty acids by the muscle.
  • Once they established that the two proteins complex together, they sought to answer if BRCA1 plays a critical role in regulating muscle metabolic function. To do so, they “knocked out” the gene so that it was no longer being expressed in the muscle cells cultured from healthy, active and lean female subjects. This was done using shRNA technology specific for BRCA1 in human myotubes (skeletal muscle fiber cells).

The result was that the muscle cells started to look diseased. The removal of BRCA1 from the cells, which simulated what could happen in the cells of a person with a BRCA1 mutation, resulted in increased lipid storage, decreased insulin signaling, reduced mitochondrial function and increased oxidative stress. These are all key risk factors for the development of metabolic diseases, such as obesity, type 2 diabetes and cardiovascular disease.

“Our findings make it clear that BRCA1 plays a protective role against the development of metabolic disease,” Dr. Spangenburg explains. “This gene needs to be there, and should be considered a target to consider in the treatment of type 2 diabetes and/or obesity.”

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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References:

1. K. C. Jackson, E.-K. Gidlund, J. Norrbom, A. P. Valencia, D. M. Thomson, R. A. Schuh, P. D. Neufer, E. E. Spangenburg. BRCA1 is a Novel Regulator of Metabolic Function in Skeletal Muscle.. The Journal of Lipid Research, 2014; DOI: 10.1194/jlr.M043851;

2. University of Maryland. “Breast cancer gene could play critical role in obesity, diabetes.” ScienceDaily. ScienceDaily, 12 March 2014. <www.sciencedaily.com/releases/2014/03/140312114836.htm>.

PSA for Prostate Cancer Screening? Yes. No. Yes. Maybe.

puzzled man
 
What You Need to Know: Mortality in prostate cancer is lower in areas with frequent use of PSA testing compared with areas with little testing shows a new study. Results from the study show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, which indicates an early and rapid uptake of PSA testing.
 
The Evidence: The study is based on data from nation-wide, population-based registers in Sweden including the Cancer Register, The Cause of Death Register and the National Prostate Cancer Register (NPCR) of Sweden.

“Our results show that prostate cancer mortality was 20 percent lower in counties with the highest incidence of prostate cancer, indicating an early and rapid uptake of PSA testing, compared with counties with a slow and late increase in PSA testing,” says Pär Stattin, lead investigator of the study. “Since the difference in the number of men diagnosed with prostate cancer is related to how many men undergo PSA testing, we think our data shows that PSA testing and early treatment is related to a modest decrease in risk of prostate cancer death,” says Håkan Jonsson statistician and senior author of the study.

“In contrast to screening in randomized studies our data is based on unorganized, real life PSA testing. We therefore used a statistical method that excludes men that were diagnosed prior to the introduction of PSA testing since these men could not benefit from the effect of PSA testing,” continues Håkan Jonsson.

“The results in our study are very similar to those obtained in a large European randomized clinical study (ERSPC) thus confirming the effect of PSA testing on the risk of prostate cancer death. However, we have to bear in mind that the decrease in mortality is offset by overtreatment and side effects from early treatment. PSA testing sharply increases the risk of overtreatment, i.e. early treatment of cancers that would never have surfaced clinically. We also know that after surgery for prostate cancer most men have decreased erectile function and that a small group of men suffer from urinary incontinence. Our data pinpoints the need for refined methods for PSA testing and improved prostate cancer treatment strategies,” concludes dr Stattin.

My Take: The role of PSA as a screening tool remains unclear. My take is that it leads to overtreatment, but that this is more an issue of how we use the test, rather than the test itself. PSA testing is the best means that we now have available to identify those patients who have prostate cancer.  After a prostate biopsy is done, and if the biopsy identifies cancer, a patient must decide whether to treat the disease or to undergo active surveillance. To make such a decision, the patient needs to be completely informed of their disease status. So have a chat with your health care provider to see if the PSA makes sense for you. Clearly, not everyone benefits from PSA. Still, I think PSA does diminish the risk of death, especially among higher risk populations such as African American men. So don’t ignore PSA testing: Have a dialog with a valued health professional to see if it is appropriate 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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References:

Umeå universitet. “PSA testing, early treatment decreases risk of prostate cancer death.” ScienceDaily. ScienceDaily, 10 March 2014. www.sciencedaily.com/releases/2014/03/140310090749.htm.

P. Stattin, S. Carlsson, B. Holmstrom, A. Vickers, J. Hugosson, H. Lilja, H. Jonsson. Prostate Cancer Mortality in Areas With High and Low Prostate Cancer Incidence. JNCI Journal of the National Cancer Institute, 2014; DOI: 10.1093/jnci/dju007


Vitamin D May Increases Breast Cancer Patient Survival

Breast cancer patients with high levels of vitamin D in their blood are twice as likely to survive the disease as women with low levels of this nutrient, report University of California, San Diego School of Medicine researchers.

Background: In previous studies, Cedric F. Garland, DrPH, professor in the Department of Family and Preventive Medicine, showed that low vitamin D levels were linked to a high risk of premenopausal breast cancer. That finding prompted him to question the relationship between 25-hydroxyvitamin D — a metabolite produced by the body from the ingestion of vitamin D — and breast cancer survival rates.

The Evidence: Garland and colleagues performed a statistical analysis of five studies of 25-hydroxyvitamin D obtained at the time of patient diagnosis and their follow-up for an average of nine years. Combined, the studies included 4,443 breast cancer patients.

“Vitamin D metabolites increase communication between cells by switching on a protein that blocks aggressive cell division,” said Garland. “As long as vitamin D receptors are present tumor growth is prevented and kept from expanding its blood supply. Vitamin D receptors are not lost until a tumor is very advanced. This is the reason for better survival in patients whose vitamin D blood levels are high.”

Women in the high serum group had an average level of 30 nanograms per milliliter (ng/ml) of 25-hydroxyvitamin D in their blood. The low group averaged 17 ng/ml. The average level in patients with breast cancer in the United States is 17 ng/ml.

“The study has implications for including vitamin D as an adjuvant to conventional breast cancer therapy,” said co-author Heather Hofflich, DO, UC San Diego associate professor in the Department of Medicine.

Garland recommended randomized controlled clinical trials to confirm the findings but suggested physicians consider adding vitamin D into a breast cancer patient’s standard care now and then closely monitor the patient.

“There is no compelling reason to wait for further studies to incorporate vitamin D supplements into standard care regimens since a safe dose of vitamin D needed to achieve high serum levels above 30 nanograms per milliliter has already been established,” said Garland.

A 2011 meta-analysis by Garland and colleagues estimated that a serum level of 50 ng/ml is associated with 50 percent lower risk of breast cancer. While there are some variations in absorption, those who consume 4,000 International Units (IU) per day of vitamin D from food or a supplement normally would reach a serum level of 50 ng/ml. Garland urged patients to ask their health care provider to measure their levels before substantially increasing vitamin D intake.

According to the National Institutes of Health (USA), the current recommended daily allowance for vitamin D is 600 IU for adults and 800 IU for people over 70 years old.

My Take: While there is an association between low levels of vitamin D and a myriad of diseases, we still don’t know if taking vitamin D reduces the risk of breast cancer. And one can take too much. I think it is not unreasonable to check the vitamin D levels of patients with breast cancer, but do not have high-level evidence to say that I should do so. In a future blog, we’ll turn to foods that are rich in vitamin D. 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 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References

1. University of California, San Diego Health Sciences. “Vitamin D increases breast cancer patient survival, study shows.” ScienceDaily. ScienceDaily, 6 March 2014. <www.sciencedaily.com/releases/2014/03/140306163236.htm>.

2. Sharif B. Mohr, Edward D. Gorham, June Kim, Heather Hofflich And Cedric F. Garland. Meta-analysis of Vitamin D Sufficiency for Improving Survival of Patients with Breast CancerAnticancer Research, March 2014