Exercise Protects Against Aggressive Breast Cancer in Black Women

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A nearly 20-year observational study involving more than 44,700 black women nationwide found that regular vigorous exercise offers significant protection against development of an aggressive subtype of breast cancer. The findings from the Black Women’s Health Study were presented at the 2013 San Antonio Breast Cancer Symposium, December 10-14, 2013.

The research team, co-led by scientists at Georgetown Lombardi Comprehensive Cancer Center in Washington, DC, and Boston University in Massachusetts, found that black women who engaged in brisk exercise for a lifetime average of 3 or more hours a week had a 47% reduced risk of developing estrogen receptor (ER)-negative breast cancer compared with those exercising an average of 1 hour per week, according to a preliminary analysis. The study included 44,704 women age 30 years or older.

This form of breast cancer, which includes human epidermal growth factor receptor 2 (HER2)-positive and triple-negative tumors, is linked to both higher incidence and mortality in black women, relative to white women. ER-negative tumors do not respond to hormone therapies used to treat tumors that have the estrogen receptor.

“These findings are very encouraging. Knowing that exercise may protect against breast cancers that disproportionately strike black women is of great public health importance,” said Lucile Adams-Campbell, PhD, professor of oncology and associate director of Minority Health & Health Disparities Research at Georgetown Lombardi. We all want to do what we can to reduce our risk of disease and improve our health, and along with other well-known benefits, we now show that exercise can possibly stave off development of potentially lethal breast cancer in black women,” she said.

Exercise, at any level, appeared to have no effect on development of ER-positive breast cancer in these women, the researchers said. They cannot offer a reason why because their study was not designed to answer this question. They also cannot speculate on whether vigorous exercise in white or Asian women would have any effect.

My Take: This study adds to a growing body of literature pointing to a role for exercise in reducing cancer risk. While more appears to be better, many find success startnig with 15o minutes of brisk walking daily (30 minutes, 5 times per week, for example), and build up from there. 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.

Steroids Help With Fatigue Linked to Advanced Cancer

Close-up of a businesswoman resting her head on her hand

Take-Home Pearl: Dexamethasone (steroid) can significantly improve cancer-related fatigue among those with advanced cancer. It also improves lack of appetite, but not psychological distress.

Background: Fatigue is the most common cancer-related symptoms among those with advanced disease. While there is data to support the use of steroids, only about 1/3 oncologists prescribe steroids.

Study Design: Prospective, randomized double-blind, placebo-controlled multi-institutional study. 132 patients with advanced cancer had at least 3 symptoms in the prior 24 hours (pain, fatigue, nausea with lack of appetite or with significant weight loss, sleep disturbance, depression). All had hemoglobin levels of at least 9, neutrophils at least 750, and a life expectancy of at least 4 weeks.

  • Randomization: Dexamethasone 4 mg twice daily for 14 days or placebo.

Results: Compared with placebo, dexamethasone produces a rapid and significant improvement in cancer-related fatigue and quality of life, with no significant increase in adverse events among patients with advanced cancer.

My Take: Steroids typically provide only temporary relief. Thus, we don’t fully understand their use for chronic fatigue. Long-term steroid use is not without toxicity. Still, this study provides more incentive to use steroids for short-term pain relief among those with a limited life expectancy. I’m Dr. Michael Hunter.

Reference: Yennurajalingam S et al. J Clinical Oncology 2013;31 (September 1): 3076-3082.

Study Identifies Factors Associated With Pain One Year After Breast Cancer Surgery

breast cancer in female body diagram 

In a study that included more than 800 women who had undergone surgery for breast cancer, the majority reported some level of pain 12 months after surgery, and factors associated with pain included chronic preoperative pain, chemotherapy, preoperative depression and pain in the area to be operated, according to a study appearing in the January 1 issue of JAMA.

The Study: Tuomo J. Meretoja, M.D., Ph.D., of Helsinki University Central Hospital, Helsinki, Finland, and colleagues examined the prevalence and severity and factors associated with chronic pain after breast cancer surgery and treatments. The study included 860 patients younger than 75 years with nonmetastasized breast cancer treated at the Helsinki University Central Hospital in 2006-2010. A questionnaire was sent to patients 12 months after surgery, with assessments of presence and intensity of pain.

Results: At 12 months after surgery, 35 percent of the patients reported no pain, 50 percent mild pain, 12 percent moderate pain, and 4 percent severe pain. The factors associated with pain at 12 months were chronic preoperative pain, preoperative pain in the area to be operated, axillary lymph node dissection, preoperative depression, chemotherapy and radiotherapy.

“These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed,” the authors write.

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: The JAMA Network Journals (2013, December 31). Study identifies factors associated with pain one year after breast cancer surgery.ScienceDaily. Retrieved January 6, 2014, from http://www.sciencedaily.com­/releases/2013/12/131231163923.htm; Tuomo J. Meretoja, Marjut H. K. Leidenius, Tiina Tasmuth, Reetta Sipilä, Eija Kalso. Pain at 12 Months After Surgery for Breast CancerJAMA, 2014; 311 (1): 90 DOI:10.1001/jama.2013.278795

Exercise May Reduce Future Risk of Depression

women walking exercise

Activities such as running or walking can help you shake off depression. Now, a new study in the American Journal of Preventive Medicine suggests that exercise may prevent the disorder later in life.

Researchers at the University of Toronto analyzed 26 years’ worth of studies and concluded that even low levels of movement — walking or gardening for 20 or 30 minutes a day — show promise of warding off depression in people of all ages.

The analysis included 30 studies. Of these, 25 suggested exercise influenced depression risk. People who did little to no activity were more likely to show signs of depression or be diagnosed with the disorder years later, while those who exercised were less likely to become depressed as they got older, according to George Mammen, Ph.D. candidate and co-author of the study.

Because small amounts (20 to 30 minutes a day) of low-intensity activity were associated with lowering depression risk, Dr. Mammen concludes that current activity guidelines for physical health appear appropriate for mental health as well. The Centers for Disease Control and Prevention recommend 150 minutes per week of moderate exercise (brisk walking) or 75 minutes of high-intensity activity (running).

“If you’re not physically active, you should start,” says Mammem. “We usually think of exercise in terms of weight and how we look, but it’s also a way to maintain mental health far into the future.”

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.

Calcium Supplements May Not Prevent Bone Loss in Women With Breast Cancer

broken bone

Background: Women undergoing treatment for breast cancer are often prescribed calcium and vitamin D supplements to prevent and manage osteoporosis, an unwanted side effect of breast cancer management.

The Study: The authors reviewed data from clinical trials that evaluated the effect of antiresorptive drugs on BMD and used the “before-after” data from the comparison group to assess change in BMD in pre- and in post-menopausal women. Overall, the results from 16 trials indicate that 500-1500 mg calcium and 200-1000 IU vitamin D, the doses commonly recommended, do not prevent loss of BMD in women with breast cancer. Despite supplementation, women lost BMD in virtually every clinical trial reviewed.

My Take: Breast cancer patients lose bone mineral density at a higher rate than their healthier counterparts, increasing their risk of fractures (which are associated with significant declines in function and health-related quality of life, and in higher mortality rates). In the clinical trials reviewed, BMD in the women was measured at the beginning and end of the studies, one author said, “so if the supplementation worked to prevent BMD loss, you should be able to see that in the data, and we clearly didn’t.”

Maybe the bone loss would have been worse without the supplements, but this study is concerning as : 1) we do a poor job of slowing or stopping bone loss; and 2) there is growing evidence of a link between calcium supplements and the risk of a stroke or heart attack. (As an aside, I think that if you do take calcium supplements, it might be wise to divide the dosing; for example, take half in the morning and half in the evening, rather than all at once (bolus effect.)  For now, we don’t have good data to guide patients with breast cancer when it comes to calcium and vitamin D. Certainly, a bit of weight-bearing exercise is a good idea for most of us.

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.

Ambien Emergencies on the Rise

insomnia sleep woman in bedAmbien-related emergencies are on the rise. The number of of emergency room visits in the USA has increased dramatically. In 2005, there were 6,000 emergency room cases involving Ambien and other medications containing the hypnotic drug zolpidem; by 2010, the number recorded was 19,000. Nearly half of the visits were initiated after individuals mixed the sedative with other drugs (anti-anxiety drugs; narcotics).

My take: Caveat emptor: The US Food and Drug Administration (FDA) has ordered that dosage levels for women be cut in half, and recommended that doses for men be cut too. Personally, I must say that this is not my favorite sleep medicine for use for my patients with insomnia. And certainly don’t mix it with alcohol consumption. Narcotics and Ambien do not appear to be a great mix either, in my opinion. 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 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Physical Activity Reduces Cancer Treatment Side Effects

ImageIf you had asked me, during much of the 20th century, whether exercise was an important component of cancer treatment, I would have answered no. In fact, we physicians thought that exertion should be avoided during cancer treatment. Then, a randomized trial for patients with Stage II breast cancer began to change our views. This study showed that 10 weeks of aerobic exercise decreased chemotherapy-induced nausea, while improving functional capacity and body composition.

Subsequent studies have shown benefits of exercise for patients undergoing chemotherapy or radiation therapy for several types of cancer. This improvement can occur even with elderly patients, with improvements in memory, self-reported health measures, fatigue, and shortness of breath.

Exercise has also been shown to help with sexual dysfunction among some men undergoing androgen deprivation therapy for advanced prostate cancer.

MacVicar MG, et al. Nurs Res 1989;38:348-51.

Winningham ML, et al. Oncol Nurs Forum 1988;15:447-50.

Sprod LK, et al. J Geriatr Oncol 2013;3:90-97.

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.