Breast Cancer: Radiation Therapy Gives Long-term Benefit

stop cancer

What You Need To Know: The Uppsala/Orebro (Sweden) study with 10 years of follow-up was one of the first randomized clinical trials to shoe the benefit of adding whole breast radiation therapy to lumpectomy. Now, we have reaffirmation of radiation therapy benefit with 20 year follow-up.

The Evidence: A total of 381 women with stage I breast cancer were randomized to sector resection (bigger than a standard lumpectomy, but smaller than a quandrantectomy) with or without external radiation therapy (54 Gy in 27 fractions). Here are the results:

  • Overall mortality 50% with radiation, and 54% without it.
  • Cumulative first breast cancer event 31% with radiation, and 45% without it. The benefit of radiation was achieved within the first 5 years of followup.

My Take: This research update reaffirms the benefit of postoperative radiation therapy as a critical part of breast-conserving surgery for early invasive breast cancer. The radiation therapy appears to exert its benefit in the first 5 years, hinting at the fact that some of the later cancers developing in the breast may be new events, rather recurrences. More recent results show that a local control probability can be achieved that is much better than what was achieved in historic clinical trials.

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: Journal of Clinical Oncology 2014 Mar 10; 32:791.

Not So Fast: Water Pipe Smoking May Increase Cancer Risk

hookah smoking water pipe

What You Need to Know: Young adults who smoked water pipes in hookah bars had elevated levels of nicotine, cotinine, tobacco-related cancer-causing agents, and volatile organic compounds (VOC) in their urine, and this may increase their risk for cancer and other chronic diseases, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

“This study reports systemic intake of tobacco-specific nitrosamines and VOCs after a typical water pipe-smoking session in a hookah bar setting, thus making the findings generalizable to most water pipe users in the United States,” said Gideon St.Helen, Ph.D., postdoctoral fellow in the Division of Clinical Pharmacology and the Center for Tobacco Control Research and Education at the University of California, San Francisco.

After a single evening of water pipe smoking in a hookah bar, young men and women had in their urine a 73-fold increase in nicotine; fourfold increase in cotinine; twofold increase in NNAL, a breakdown product of a tobacco-specific nitrosamine, NNK, which can cause lung and pancreatic cancers; and 14 to 91 percent increase in the breakdown products of VOC such as benzene and acrolein that are known to cause cancer and cardiovascular and respiratory diseases.

“There was also a substantial increase in nicotine levels, which raises concerns about the potential addictiveness of water pipe smoking and possible effects on the developing brains of children and youths who use water pipes,” added St.Helen. “Water pipe smoking is generally perceived to be a safe alternative to cigarette smoking, even for children and youths. Our study shows that water pipe use, particularly chronic use, is not risk-free.”

St. Helen and colleagues recruited 55 healthy, experienced water pipe smokers, ages 18 to 48 years, to the study. Participants were instructed to refrain from any type of smoking for a week. At the end of this period they provided a “before” urine sample and smoked water pipes at a hookah bar of their choice in the San Francisco Bay area. Soon after the visit, they provided the “after” urine sample, and filled a form to provide detailed information on their smoking session including total time spent smoking, number of bowls smoked, and number of shared users. They also provided a first-voided urine sample the next morning, which helped researchers estimate the clearance of the tobacco-related chemicals of interest. The study participants spent on average 74 minutes smoking water pipes and smoked an average 0.6 bowls of water pipe tobacco per person. Results: The researchers found that the elevated levels of nicotine, cotinine, and NNAL, which were detected immediately after the water pipe-smoking session, remained significantly elevated in the next-day urine samples, compared with the “before” samples: Nicotine was 10.4-fold higher; cotinine, 3.2-fold; and NNAL, 2.2-fold. Water pipe-smoking duration correlated significantly with the increase in post-exposure urine nicotine levels, and number of bowls smoked per person significantly correlated with the increase in post-exposure and next-day urine cotinine levels, respectively. The average increase in nicotine levels was comparable to levels obtained after smoking at least one cigarette, explained St.Helen.

“I have seen entire families, including young children, smoking water pipes. I have even been offered a smoke by my friend who thought water pipe smoking was ‘totally safe,'” St.Helen added. “Our study provides evidence that water pipe smoking leads to significant intake of tobacco-related addictive and harmful substances, and is therefore not without risk, particularly among children and youths.”

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: American Association for Cancer Research (AACR). “Water pipe smoking causes significant exposure to nicotine, cancer-causing agents.” ScienceDaily. ScienceDaily, 16 May 2014. <www.sciencedaily.com/releases/2014/05/140516091920.htm>.

Sitting Too Long? You May Increase Your Risk of Cancer

African American young woman

What You Need to Know: If you’re spending a lot of time sitting every day, either in front of the TV or at work, you may be at higher risk for developing certain types of cancer, according to new research published this week in the Journal of the National Cancer Institute.

The Evidence: The study found an additional two hours a day of sedentary behavior was linked to an 8% increase in colon cancer risk, a 10% increase in endometrial cancer risk and a 6% increase in risk for lung cancer. It did not find the same connection for breast, rectum, ovary and prostate cancers or for non-Hodgkin lymphoma.

  • Researchers came to these conclusions by analyzing 43 existing studies – that included more than 4 million study participants and 68,936 cancer cases – to measure the relationship between hours spent sitting and certain types of cancers.
  • It’s important to note that while the study identifies a link between sedentary behavior and an increased risk for certain cancers, the research doesn’t prove cause and effect.

“Does sitting in front of the TV cause colon cancer? No,” said Dr. Martin Heslin, chief of surgical oncology at the University of Alabama at Birmingham. “But the recommendations (of the study) are awesome.” Heslin, who was not involved in the research, says that in addition to sedentary behavior, several factors can increase your risk of cancer, including drinking or smoking too much, being obese and having a genetic predisposition.

 

It’s nearly impossible to say that any one of these factors causes someone to get a specific cancer, he says, but these are the behaviors we can control to help reduce our risk.

“You can affect TV time by turning it off,” said Heslin, though he acknowledges it’s not so easy to turn off work if you’re stuck in an office all day.

In that case, Heslin suggests looking for opportunities to leave your desk, such as standing up while working or taking a walk, to reduce the number of hours you spend sitting down.

“If I ever have the opportunity to design (a meeting room), I’m putting a waist-high table in the room, and no chairs,” Heslin said.

According to an editorial accompanying the study, organizations such as the American Cancer Society and the UK Department of Public Health address the need to reduce hours spent sitting, but do not offer any quantitative recommendations or strategies to help people improve. Daniela Schmid, one of the study’s co-authors and a faculty member in the University of Regensburg’s department of epidemiology and preventive medicine, hopes to change that.

“The findings of our study may encourage public health efforts to expand physical activity recommendations to reduce time spent in sedentary behavior,” Schmid said.

Previous studies support the findings in Schmid’s study. A 2012 study conducted by the National Institutes of Health concluded that sitting for several hours a day is bad for you, even if you are physically active. Researchers found even exercising at least 150 minutes each week – the generally accepted public health guideline for physical activity – can’t reverse the negative effects of sitting down for hours. In that study, sitting increased an individual’s risk for major chronic diseases such as Type 2 diabetes, cardiovascular disease, and breast and colon cancers.

My Take: If you sit regularly, get up periodically (even if that means every 20-30 minutes for a few minutes). In addition, aim for a minimum of 150 minutes per week of the equivalent of a brisk walk (for example, 30 minutes daily for five times per week). 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: CNN Health, 16 June 2014

Too Few Breast Cancer Survivors Get Enough Exercise

women walking exercise

What You Need to Know: Exercise has been linked to better survival, less morbidity, and improved quality of life after a diagnosis of breast cancer, according to the researchers. Many women diagnosed with breast cancer do not meet the national guidelines for weekly exercise, especially black women, according to a new study.

“Our results suggest that physical activity education should be incorporated into breast cancer care,” said researcher Brionna Hair, MPH, a PhD candidate in the Department of Epidemiology at the University of North Carolina at Chapel Hill. The hope is that our study will encourage medical care providers to talk with their patients about the benefits of physical activity, not only for prolonging survival, but also for improving quality of life,” Hair told Medscape Medical News.

The study was published online June 9 in Cancer. National guidelines recommend 150 minutes of moderate-intensity exercise each week, or 75 minutes of vigorous exercise.

The Evidence:

  • The 1735 study participants were part of the prospective Carolina Breast Cancer Study.
  • All were diagnosed with invasive breast cancer from 2008 to 2011, and 48% of the cohort was black.
  • Hair and her colleagues assessed self-reported physical activity levels in women 20 to 74 years of age before and after diagnosis.

Just 35% of the women met suggested guidelines for physical activity after diagnosis, and 59% reported a decrease in physical activity. Black women were less likely than white women to meet exercise guidelines after diagnosis (odds ratio,1.38), according to a multivariate analysis adjusted for age, race, income, education, marital status, body mass index, alcohol consumption, smoking status, comorbidities, cancer stage, type of treatment, lymph node removal, and prediagnosis exercise.

In black women, there was an association between treatment and physical activity after diagnosis (P < .01). Exercise levels were lowest in black women who received chemotherapy only or who received neither chemotherapy nor radiotherapy. For black women in particular, who experience higher rates of breast cancer morbidity and mortality, “these results suggest that strategies to increase physical activity among breast cancer patients should be tailored to each patient’s individual needs,” Hair stated.

Results from the Black Women’s Health Study highlight the benefits of exercise, linking it to lower risk for aggressive breast cancer. The researchers acknowledge that an overestimation of activity levels could have resulted because participants might have been more motivated to exercise than women in the general population. In addition, the fact that the study used self-reported recall of activity could have led to an over- or underestimation of levels.

“This study provides evidence that although physical activity after a breast cancer diagnosis is important, the majority of breast cancer survivors do not meet recommended guidelines,” said Vanessa Sheppard, PhD, associate professor of oncology and assistant director of health disparities research at Georgetown University Lombardi Comprehensive Cancer Center in Washington, DC. In fact, for many women, levels of physical activity are lower than they were before their diagnosis,” she added.

Reasons for this might be related to insufficient knowledge about the benefits of exercise, physical limitations resulting from treatment, or problems with access to safe and affordable places to exercise, she told Medscape Medical News. She noted that the results for black women are concerning. Increased awareness is needed about the importance of exercise for breast cancer survivors in general and for some at-risk groups in particular, such as black and low-income women.

“From a clinical perspective, providers can encourage and facilitate exercise among breast cancer survivors by becoming aware of and providing referrals to local resources, like survivorship programs or exercise physiologists with a background in cancer rehabilitation,” Dr. Sheppard said. “In many instances, simply encouraging people to walk is important. Trying to get to 10,000 steps per day is a goal that is low cost and could be encouraged.”

My Take: Check in with a valued health professional regarding exercise. Then: Aim for a minimum of 150 minutes per week of the equivalent of a brisk walk (for example, walk 30 minutes, 5 times per week). 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. Published online June 9, 2014. Abstract; http://www.medscape.com/viewarticle/826642

Learning Second Language Slows Brain Aging

brain

What You Need to Know: Learning a second language can have a positive effect on the brain, even if it is taken up in adulthood, a University of Edinburgh study suggests. Researchers found that reading, verbal fluency and intelligence were improved in a study of 262 people tested either aged 11 or in their seventies.

Background: A previous study suggested that being bilingual could delay the onset of dementia by several years. The big question in this study was whether learning a new language improved cognitive functions or whether individuals with better cognitive abilities were more likely to become bilingual. Dr Thomas Bak, from the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh, said he believed he had found the answer.

“Millions of people around the world acquire their second language later in life. Our study shows that bilingualism, even when acquired in adulthood, may benefit the aging brain,” offers Dr. Bak.

The Evidence: Using data from intelligence tests on 262 Edinburgh-born individuals at the age of 11, the study looked at how their cognitive abilities had changed when they were tested again in their seventies. The research was conducted between 2008 and 2010.

  • All participants said they were able to communicate in at least one language other than English.
  • Of that group, 195 learned the second language before the age of 18, and 65 learned it after that time.

The findings indicate that those who spoke two or more languages had significantly better cognitive abilities compared to what would have been expected from their baseline test. The strongest effects were seen in general intelligence and reading. The effects were present in those who learned their second language early, as well as later in life.

Dr Bak said the pattern they found was “meaningful” and the improvements in attention, focus and fluency could not be explained by original intelligence. “These findings are of considerable practical relevance. Millions of people around the world acquire their second language later in life. Our study shows that bilingualism, even when acquired in adulthood, may benefit the aging brain.”

But he admitted that the study also raised many questions, such as whether learning more than one language could also have the same positive effect on cognitive ageing and whether actively speaking a second language is better than just knowing how to speak it.

Dr. Alvaro Pascual-Leone, professor of medicine at Harvard Medical School in Boston, US, said: “The epidemiological study provides an important first step in understanding the impact of learning a second language and the ageing brain.

“This research paves the way for future causal studies of bilingualism and cognitive decline prevention.”

I’m Dr. Michael Hunter, and I am a big fan of japanesepod101.com (they have a number of other languages that you can study on the fly). The site has both free and for sale components.

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: http://www.bbc.com/news/health-27634990; Annals of Neurology 2014: DOI: 10.1002/ana.24158

Video: Red Meat Consumption and Breast Cancer Risk

grilled meat steak diet french fries dinner

Here is a link to a CNN video examining the relationship between red meat consumption and breast cancer. While no definitive link has been established, this study suggests that earlier consumption (say, in your 30s) may increase risk.

CLICK HERE: http://www.cnn.com/video/data/2.0/video/health/2014/06/14/pkg-red-meat-increases-breast-cancer-risk.cnn.html

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.

Breast Cancer Risk Increases as Red Meat Intake Increases

Fresh raw beef on cutting board red meat

What You Need to Know: Higher red meat intake in early adulthood might be associated with an increased risk of breast cancer, and women who eat more legumes — such as peas, beans and lentils — poultry, nuts and fish might be at lower risk in later life, suggests a paper.

Background: Studies have suggested no significant association between red meat intake and breast cancer. However, most have been based on diet during midlife and later, and many lines of evidence suggest that some exposures, potentially including dietary factors, may have greater effects on the development of breast cancer during early adulthood.

The Evidence: A team of US researchers investigated the association between dietary protein sources in early adulthood and risk of breast cancer. They analyzed data from 88,803 premenopausal women (aged 26 to 45) taking part in the Nurses’ Health Study II who completed a questionnaire on diet in 1991.

  • Red meat items included unprocessed red meat (beef, pork, or lamb and hamburger) and processed red meat (such as hot dogs, bacon and sausage); poultry included chicken and turkey; fish included tuna, salmon, mackerel, sardines; legumes included beans, lentils and peas; and nuts.
  • Nine categories of intake frequency were recorded from “never or less than once per month” to “six or more per day.”
  • Factors such as age, height, weight, race, family history of breast cancer, history of benign breast disease, smoking, menopausal status, hormone and oral contraceptive use were taken into account. Adolescent food intake was also measured and included foods that were commonly eaten from 1960 to 1980, when these women would have been in high school.

Medical records identified 2,830 cases of breast cancer during 20 years of follow-up. Putting these real life data into a statistical model allowed the researchers to estimate breast cancer risks for women with different diets. They estimated that, for each step-by-step increase in the women’s consumption of red meat, there was a step-by-step increase in the risk of getting breast cancer over the 20 year study period.

Specifically, the statistical model worked out the number of cases of breast cancer during the total years of follow up for all the women in the study (rate/person years).

For example, the model estimated that there would be 493 cases of breast cancer over 306,298 person years among women with the lowest intake of red meat. This compared with 553 cases per 31,169 person years among women with the highest intake.

  • Higher intake of red meat was associated with a 22% increased risk of breast cancer overall. Each additional serving per day of red meat was associated with a 13% increase in risk of breast cancer (12% in premenopausal and 8% in postmenopausal women).
  • In contrast, estimates showed a lower risk of breast cancer in postmenopausal women with higher consumption of poultry. Substituting one serving per day of poultry for one serving per day of red meat was associated with a 17% lower risk of breast cancer overall and a 24% lower risk of postmenopausal breast cancer.
  • Furthermore, substituting one serving per day of combined legumes, nuts, poultry, and fish for one serving per day of red meat was associated with a 14% lower risk of breast cancer overall and premenopausal breast cancer.

The authors conclude that higher red meat intake in early adulthood “may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer.” Further study of the relation between diet in early adulthood and risk of breast cancer is needed, they add.

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:

  • M. S. Farvid, E. Cho, W. Y. Chen, A. H. Eliassen, W. C. Willett. Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study. BMJ, 2014; 348 (jun10 3): g3437 DOI: 10.1136/bmj.g3437
  • BMJ-British Medical Journal. “Estimated risk of breast cancer increases as red meat intake increases, study suggests.” ScienceDaily. ScienceDaily, 10 June 2014. <www.sciencedaily.com/releases/2014/06/140610205257.htm>.