Another Reason Why Sitting is Just No Darn Good For You

What You Need to Know: Although not a life-threatening condition, benign prostatic hypertrophy (BPH) is one of the most annoying and troublesome problems that plagues aging men. A recent study from Korea shows that BPH is nearly twice as common among those with the highest sedentary time (over 7 hours per day).

Background: Risk factors for BPH include age, family history, and hormones. Lifestyle (smoking, drinking, physical activity) may also play important roles in developing BPH.

Details, details: Investigators from Korea used a cross-sectional survey performed annually for 3 years by trained interviewers to identify men with BPH and to collect information about their smoking, drinking, diet, and physical activity habits. Of the initial 779 men, 582 had urinary symptoms and underwent a digital rectal exam, PSA screening, and rectal ultrasound to assess prostate size and to identify prostate cancer. Investigators defined BPH as a prostate volume of 25 mL or more (by ultrasound) and a score of 8 or more on the International Prostate Symptom Score.

Results: Among the physical activity variables, regular exercise, frequency of exercise, non-sedentary time, and leisure time did not show a statistically significant association with BPH. However, BPH appeared to be 1.7x more frequent among those with the highest sedentary time (more than 7 hours).

My Take: An increasing body of research links prolonged sitting to the risk of dying from cardiac and metabolic diseases, even among those who work out. This study adds to the body of literature regarding the dangers of sitting. The current research does not establish causality, but I would suggest that men with sedentary occupations become more active at work. Consider using a standing dek, standing whenever chatting on the telephone, getting up to walk a bit for a few minutes every hour, and using a stability ball to engage core muscles while sitting. I’m Dr. Michael Hunter.

 

Reference: Lee HW et al. Int Neurourol J 2014; 18:155-162,

Physical Activity Increases Prostate Cancer Survival

What You Need to Know: Yet another study is confirming the benefits of physical activity following the diagnosis of cancer, this time of prostate cancer, on all-cause and prostate-specific survival. Higher levels of physical activity are associated with reduced rates of overall and prostate cancer–specific mortality.

Background: Few studies have investigated the association between post-diagnosis physical activity and mortality among men diagnosed with prostate cancer. The aim of this study was to investigate the effect of physical activity after a prostate cancer diagnosis on both overall and prostate cancer–specific mortality in a large cohort.

Methods: Data from 4,623 men diagnosed with localized prostate cancer 1997–2002 and followed-up until 2012 were analyzed. Researchers in Sweden examined the association between post-diagnosis recreational MET-h/d, time spent walking/bicycling, performing household work or exercising, and time to overall and prostate cancer–specific death. All models were adjusted for potential confounders.

Results:

  • Men who walked or cycled for 20 minutes a day or more had a 30% lower risk for all-cause mortality and a 39% decreased risk for prostate cancer–specific mortality compared with men who walked or cycled less than 20 minutes a day, investigators report.
  • For those exercising 1 or more hours a week, all-cause mortality was reduced by 26% and prostate cancer–specific mortality by 32% compared with men who reported exercising less than 1 hour a week.
  • After considering all time spent walking, cycling, exercising, and doing household work, researchers found that all-cause mortality was 37% lower while prostate cancer–specific mortality was 22% lower for men who had a total MET of 5 or more hours a day compared with those who had a total MET of less than 5 hours a day.

 

Activity After Prostate Cancer Diagnosis Overall Mortality Prostate Cancer–Specific Mortality
  Walking/cycling <20 min/day vs ≥20 min/day 0.70 0.61
  Household work <1 h/day vs ≥1 h/day 0.71 0.86
  Exercise < 1 h/wk vs ≥1 h/wk 0.74 0.68

Conclusions: Higher levels of physical activity were associated with reduced rates of overall and prostate cancer–specific mortality.

Impact: This study further strengthens previous results indicating beneficial effects of physical activity on survival among men with prostate cancer.

Reference: Cancer Epidemiol Biomarkers Prev; 1–8. ©2014 AACR.

Mae Keane, The Last ‘Radium Girl,’ Dies At 107

 Before we close the year, I wanted to remember the last of the so-called radium girls. In the early 1920s, the hot new gadget was a wristwatch with a glow-in-the-dark dial.

“Made possible by the magic of radium!” bragged one advertisement.

And it did seem magical. Radium was the latest miracle substance — an element that glowed and fizzed, which salesmen promised could extend your life, pump up your sex drive and make women more beautiful. Doctors used it to treat everything from colds to cancer. In the 1920s, a young working-class woman could land a job working with the miracle substance. Radium wristwatches were manufactured right here in America, and the U.S. Radium Corporation was hiring dial people to paint the tiny numbers onto watch faces for about 5 cents a watch.

“Of course, no one thought it was dangerous in these first couple of years,” explains Deborah Blum, author of The Poisoner’s Handbook.

In 1924, a woman named Mae Keane was hired at a factory in Waterbury Connecticut. Her first day, she remembers she didn’t like the taste of the radium paint. It was gritty. “I wouldn’t put the brush in my mouth,” she remembered many years later. After just a few days at the factory, the boss asked her if she’d like to quit, since she clearly didn’t like the work. She gratefully agreed. “I often wish I had met him after to thank him,” Keane said, “because I would have been like the rest of them.”

Other women weren’t so lucky. By the mid-1920s, dial painters were falling ill by the dozens, afflicted with horrific diseases. The radium they had swallowed was eating their bones from the inside. “There was one women who the dentist went to pull a tooth and he pulled her entire jaw out when he did it,” says Blum. “Their legs broke underneath them. Their spines collapsed.” Dozens of women died. At a factory in New Jersey, the women sued the U.S. Radium Corporation for poisoning and won. Many of them ended up using the money to pay for their own funerals. In all, by 1927, more than 50 women had died as a direct result of radium paint poisoning.

But Mae Keane was among the hundreds who survived. Over the years, she had some health problems — bad teeth, migraines, two bouts with cancer. There’s no way to know if her time in the factory contributed. “I was left with different things, but I lived through them. You just don’t know what to blame,” she said. Mae Keane died this year. At 107 years old, she was the last of the radium girls.

Deborah Blum says the radium girls had a profound impact on workplace regulations. By the time World War II came around, the federal government had set basic safety limits for handling radiation. And, she says, there are still lessons to be learned about how we protect people who work with new, untested substances. “We really don’t want our factory workers to be the guinea pigs for discovery. ‘Oops’ is never good occupational health policy.”

I’m Dr. Michael Hunter.

National Public Radio (NPR), 28 December 2014 (USA)

Do Apples and Berry Fruits Reduce Colon Cancer Risk?

Background: Colon cancer arises due to the conversion of precancerous polyps (benign) found in the inner lining of the colon.

  • Prevention is better than cure, and this is very true with respect to colon cancer.
  • Various epidemiologic studies have linked colorectal cancer with food intake.
  • Apple and berry juices are widely consumed among various ethnicities because of their nutritious values.

My Take: This thorough literature review suggests that various phenolic phytochemicals present in these fruit juices have the potential to inhibit colon cancer cell lines. We need more research on the use of diet to reduce cancer risk. In the meantime, eat those fruits and vegetables! 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: World Journal of Gastroenterology, 12/26/2014  Review Article

Aspirin May Reduce Your Risk of Prostate Cancer

What You Need to Know: A recent meta-analysis (study of a group of studies) demonstrated an association between aspirin use and a reduced risk of prostate cancer.

Background: Anti-inflammatory medications lower prostate-specific antigen (PSA) levels; therefore, whether these findings reflect reduced prostate cancer detection or lower risk of the disease is not known.

The Study: Researchers tested the association between aspirin and non-aspirin nonsteroidal anti-inflammatory drug (NSAID) on prostate cancer diagnosis in the REDUCE trial, where all men underwent biopsy at 2- and 4-years largely independent of PSA. The researchers examined the association between aspirin, NSAID, or both and total, low-grade (Gleason <7) prostate cancer, or high-grade (Gleason ≥7) prostate cancer vs. no prostate cancer using multinomial logistic regression among 6,390 men who underwent on-study biopsy one or more times. Overall, 50% of the men were nonusers, 21% used aspirin, 18% used NSAIDs, and 11% of the men used both.

Results: In multivariable analyses, aspirin was associated with reduced total prostate cancer risk, but use of NSAID or NSAIDs and aspirin was not associated with reduced risk of prostate cancer. Therefore, we created a dichotomous variable of aspirin and/or NSAID user vs. not. On multivariable analysis, the use of aspirin and/or NSAID was significantly associated with decreased total and high-grade (dangerous-type) prostate cancer risk, but not with risk in low-grade prostate cancer.

My Take: While I cannot make an across-the-board recommendation for everyone to take aspirin (we do not have high0level evidence to support doing so; in addition, there are potential serious risks associated with the use of NSAIDs and/or aspirin), I envision a future in which decisions will be individualized. We will look at your risk of heart disease, stroke, prostate and colon cancer as well as potential side effects such as stomach bleeding. I’m Dr. Michael Hunter, and I take a baby (81mg) aspirin daily (my dad had a stroke at 85 years-old).

Reference: Clinical Cancer Research, 12/18/2014 Clinical Article

Acupuncture: Can It Help With Radiation-Linked Dry Mouth?

What You Need to Know: Acupuncture can relieve the symptoms of dry mouth in patients undergoing radiotherapy, according to the largest trial yet to investigate this effect. Radiotherapy for head and neck cancer often produces this unpleasant and distressing side effect because patients’ salivary glands are damaged by the radiation.

Background: Approximately half a million people develop head and neck cancer each year, and few effective treatments currently exist for dry mouth, or xerostomia, which is a common side effect of radiotherapy. Five years after radiotherapy, as many as 41% of patients may still have dry mouth. Xerostomia affects patients’ quality of life because it interferes with taste, chewing, speaking, and sleeping.

The Study: Seven cancer centers in the United Kingdom recruited a cumulative 145 patients with radiation-induced xerostomia. The patients were randomized to receive group acupuncture sessions for 20 minutes every week for 8 weeks, or to receive two oral care educational sessions for 1 hour, 1 month apart. Four weeks after the end of these two types of care, the patients were switched to the other treatment.

Symptoms of xerostomia were measured objectively with Schirmer strips, which are paper strips that measure the amount of saliva in the mouth. A quality of life (QOL) questionnaire measured the patients’ subjective reporting of how their mouths felt through questions about individual symptoms such as sticky saliva, dry lips, needing to sip water to relieve a dry mouth, needing to sip water to swallow food, and waking at night to sip water.

Results: Although there were no significant changes in saliva production, patients who had received 8 weeks of acupuncture were twice as likely to report improved dry mouth as patients who were receiving oral care. Individual symptoms also significantly improved for the group receiving acupuncture.

The researchers stated that the subjective reporting of improvements in xerostomia was of more significance than the lack of changes in the objective test with the Schirmer strips. Richard Simcock, MRCP, FRCR, clinical oncologist at the Sussex Cancer Centre and an author of the study, explained, “There was no clear relationship between a patient indicating they had a very dry mouth and the measurement of saliva on the Schirmer strips. By definition these patients with chronic xerostomia produced little or no saliva, making objective measurements really difficult.”

The researchers did not feel the improvements in xerostomia were due to a placebo effect. Dr. Valerie Jenkins, of University of Sussex, who supervised the research, explained, “The profound impact that xerostomia exerts on functions such as eating, talking and sleeping, which were relieved by the acupuncture means that if it is entirely a placebo effect than this is a pretty powerful placebo. In addition, the results showed that patients were less likely to wake at night to sip water after treatment – this effect seems difficult to ascribe solely to placebo.”

Dr. Simcock stated, “This is a very neglected group of patients suffering from a most unpleasant side-effect of treatment for which all other ameliorative interventions have failed to address adequately. The acupuncture intervention has been designed in a way that allows it to be delivered simply and cheaply in normal hospital surroundings and yet still produces a significant benefit for patients with a chronic symptom.”

This study was reported in the Annals of Oncology (2012; doi:10.1093/annonc/mds515). Reported online October 29, 2012 in OncologyNurseAdvisor.  I’m Dr. Michael Hunter.

No Evidence for Much Television Advice

What You Need to Know: You should be skeptical about claims and recommendations made on mainstream television medical talk shows. 

In many cases, investigators found that specific details on the magnitude of benefit or harm and the cost and inconvenience of following recommendations were lacking, and evidence supporting them was contradictory or absent. Viewers had little basis for informed decision making.

The Study: The prospective observational study, led by Christina Korownyk, MD, associate professor, family medicine, University of Alberta, Edmonton, Canada, randomly recorded 40 episodes each of the widely watched programs The Dr. Oz Show and The Doctors from early January 2013 to early May 2013 and assessed all recommendations made on both shows.

  • These influential internationally syndicated shows, which in 2012 to 2013 each attracted 2 to 3 million daily viewers, typically featured a host or hosts and guests discussing one to five health topics per episode and making an average of 11 or 12 recommendations to consumers, some of which were stronger than others. On both shows, the visitors made a substantial proportion of health recommendations: 65% on Dr. Oz and 33% on The Doctors.
  • To critically assess the content of these shows, experienced evidence reviewers independently searched and then, as a team, evaluated the evidence for 80 pieces of advice, randomly selected from what they considered stronger recommendations.
  • The most frequent topic on both programs was general medical/public health advice (“Get vaccinated”; “Sneeze or cough into your sleeve to prevent the spread of germs”), followed by non-weight-loss dietary advice; for example, on immune-boosting diets. The combination of dietary and weight-loss advice represented 43.2% of the topics discussed on Dr. Oz and 16.8% of those on The Doctors.

On Dr. Oz, the recommendations were most often dietary (39.2%; eg, “Carb-load your plate at breakfast”), although the researchers reported no direct links to specific dietary products. On The Doctors, the most common advice involved consulting a healthcare provider (17.8%): “Go to your primary care doctor or talk to their nurse before going to the [emergency department] to help relieve the load in the [emergency department].” Potential conflicts of interest of hosts and guests were acknowledged only four times out of 924 recommendations.

On both shows, exercise took a definite back seat to diet, with dietary advice accounting for 39% of recommendations vs 5% for exercise on Dr. Oz and 10% versus 5% on The Doctors.

On either program, a specific benefit was mentioned for only about 40% of recommendations. Even less commonly mentioned were the magnitude of benefit (<20%), potential harms (<10%), costs (<15%), and potential conflicts of interest (<1%). “We did come across a couple that had evidence of harm associated with them, and we are compiling this data now,” Dr Korownyk told Medscape Medical News.

Overall, the Alberta investigators found that 87 of the 160 recommendations assessed (54%; 95% confidence interval, 47% – 62%) had some level of published evidence to support them. Believable or somewhat believable evidence supported 33% of recommendations from The Dr. Oz Show, and 53% on The Doctors.

Conversely, believable or somewhat believable evidence was found against 11% (Oz) and 13% (Doctors) of the recommendations. For slightly more than 1 in 3 (Oz) and 1 in 4 (Doctors) recommendations, no evidence was found. “Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence,” the authors write.

Among the limitations of the study, the authors acknowledge the shows’ complexity, the subjective nature of much of the advice, and the difficulty of distinguishing between what was said and what was implied. They raised the question of whether medical talk shows should provide more than entertainment. “If the shows are perceived as providing medical information or advice, viewers need to realize that their recommendations may not be supported by higher evidence or presented with enough balanced information to adequately inform decision making.”

The study was partly supported by a research scholarship through the University of Alberta. The authors have disclosed no relevant financial relationships.

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.

BMJ. 2014;349:g7346. Abstract; Medscape Medical News 26 December 2014