In Prostate Cancer, Regular Walking May Boost Quality of Life

What You Need to Know: Engaging in a regular walking regimen can improve well-being for men with prostate cancer.

The Study: In the new study, a team led by Siobhan Phillips, Ph.D., of the Northwestern University Feinberg School of Medicine in Chicago, tracked outcomes for 51,529 early-stage prostate cancer survivors in the United States, who completed a survey about their quality of life.

  • Many of the men reported having urinary and bowel problems, erectile dysfunction, and other sexual function problems, as well as weight gain, fatigue, and depression.
  • The men also provided information about the average amount of time per week they spent walking, jogging, running, cycling, swimming, and playing sports.

Results: Three hours of “casual” walking per week boosted the men’s health-related quality of life by reducing fatigue, depression, and weight issues. Walking at a faster pace for 90 minutes a week provided similar benefits, the team found.

My Take: You don’t have to engage in high-impact, vigorous activities to improve your quality of life after a prostate cancer diagnosis. Just keep moving. 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.

Reference: Phillips, Siobhan M., et al. “Physical activity, sedentary behavior, and health-related quality of life in prostate cancer survivors in the health professionals follow-up study.” Journal of Cancer Survivorship. DOI: 10.1007/s11764-015-0426-2. April 16, 2015.

Lethal Metastatic Prostate Cancer May Spread from Other Sites

What You Need to Know: Multiple targeted therapies may be needed to combat metastatic prostate cancer because metastasis may be spread from multiple tumor clones according to a new study. “{The findings} are eye-opening,” said study investigator William Isaacs, PhD, who is a professor of urology at the Johns Hopkins Brady Urological Institute and a member of The Johns Hopkins Kimmel Cancer Center in Baltimore, MD. “It emphasizes the aspects that these cancers are evolving at an almost continual rate.”

The Study: Using whole-genome sequencing, Dr. Isaacs and colleagues characterized multiple metastases arising from prostate tumors in 10 men with metastatic castration-resistant prostate cancer (mCRPC). The team analyzed the subclonal architecture of prostate cancer cells and found that:

  •  Metastasis-to-metastasis spread was found to be common through de novo monoclonal seeding of daughter metastases.
  • Researchers found a transfer of multiple tumor clones between metastatic sites in 5 of the 10 patients.

The researchers believe that a new view of mCRPC is now emerging that tumor cells share a common heritage but subclones develop metastatic potential. The data suggest clonal diversification may occur in part as a necessity to bypass androgen deprivation therapy (ADT) and subsequently drive distinct subclones onto a convergent path of therapeutic resistance.

My Take: Whole-genome sequencing on the samples showed that even though a single cell begins the metastatic process, the disease becomes very heterogeneous as it spreads throughout the body over time. These new findings support the notion that treatments for metastatic cancers should include a combination of therapies that target a variety of genetic pathways.  The idea that metastatic tumors can seed and establish other metastatic tumors in patients is different from traditional theories that the primary tumor is solely responsible for disseminating cancer cells with metastatic potential. To me, this work is beautiful, pointing to a new way to see and manage metastatic cancer. I’m Dr. Michael Hunter.

Reference: Gundem G, Van Loo P, Kremeyer B, et al. The evolutionary history of lethal metastatic prostate cancer. Nature. 2015;520(7547):353-357.

Omega-3 Fatty Acids for the Control of Breast Cancer Medicine–Induced Musculoskeletal Pain

Purpose Musculoskeletal symptoms are the most common adverse effects of aromatase inhibitors (AIs) and can result in decreased quality of life and discontinuation of therapy. Omega-3 fatty acids (O3-FAs) can be effective in decreasing arthralgia resulting from rheumatologic conditions and reducing serum triglycerides.

Patients and Methods Women with early-stage breast cancer receiving an AI who had a worst joint pain/stiffness score ≥ 5 of 10 using the Brief Pain Inventory–Short Form (BPI-SF) were randomly assigned to receive either O3-FAs 3.3 g or placebo (soybean/corn oil) daily for 24 weeks. Clinically significant change was defined as ≥ 2-point drop from baseline. Patients also completed quality-of-life (Functional Assessment of Cancer Therapy–Endocrine Symptoms) and additional pain/stiffness assessments at baseline and weeks 6, 12, and 24. Serial fasting blood was collected for lipid analysis.

Results Compared with baseline, the mean observed BPI-SF score decreased by 1.74 points at 12 weeks and 2.22 points at 24 weeks with O3-FAs and by 1.49 and 1.81 points, respectively, with placebo. Adjusting for the baseline score, osteoarthritis, and taxane use, 12-week BPI-SF scores did not differ by arm (P = .58). Triglyceride levels decreased in patients receiving O3-FA treatment and remained the same for those receiving placebo (P = .01). No between-group differences were seen for HDL, LDL, or C-reactive protein.

Conclusion There was a substantial (> 50%) and sustained improvement in AI arthralgia for both O3-FAs and placebo but no meaningful difference between the groups.

My Take: A strong illustration of the power of a placebo. 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.

Reference: Published online before print May 4, 2015, doi: 10.1200/JCO.2014.59.5595 JCO May 4, 2015 JCO.2014.59.5595                                   

 

Low Sunlight Exposure and Higher Risk for Pancreatic Cancer

What You Need to Know: People living in countries with low levels of sunlight have a substantially increased risk for pancreatic cancer, even after taking into account a number of factors associated with the disease. Researchers found that low exposure to ultraviolet B (UVB) irradiance, which is related to both latitude and the degree of cloud cover, was associated with a six-fold increased risk for pancreatic cancer.

The Study: Investigators obtained age-standardized pancreatic cancer incidence rates for 172 countries from the International Agency for Research on Cancer’s GLOBOCAN 2008 database.

  • Data on energy intake from animal sources and alcohol consumption were obtained from the United Nations Food and Agriculture Organization, and the World Health Organization provided information on the prevalence of obesity, the sex-specific smoking prevalence, and per capita health expenditure.
  • Crucially, data from the NASAs International Satellite Cloud Climatology Project, which pertain to geographical variations in solar irradiance, allowed estimated UVB irradiance levels to be corrected for percentage cloud cover, inasmuch as heavy cloud cover does not transmit UVB.

Results: Overall, there was a higher incidence rate of pancreatic cancer with lower cloud-adjusted UVB irradiance, such that residents of countries with low UVB irradiance were approximately six times more likely to have incident pancreatic cancer than those living in countries with high UVB irradiance (P < .0001 for males and females).

The associations remained significant after taking into account per capita health expenditure, the geographical distribution, and factors known to be associated with pancreatic cancer, such as diabetes, obesity, alcohol consumption, and smoking. Interestingly, consumption of animal protein was positively associated pancreatic cancer in both sexes (P = .0190 in males; P = .0156 in females).

My Take: Given the strong association between UVB irradiance and pancreatic cancer risk, what about using vitamin D in an attempt to prevent or even treat pancreatic e cancer? There are a number of ongoing studies in both animal and human models on whether pancreatic cancer can be treated with vitamin D. Moderate doses of vitamin D seem reasonable as both a potential risk-reduction agent for a dreadful disease, and for consideration among those with pancreas 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.

Reference: American Society of Breast Surgeons (ASBS) 16th Annual Meeting. Presented April 30, 2015.

Can a New Blood Test Predict Future Breast Cancer?

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What You Need to Know: By analyzing a simple blood sample, scientists have succeeded in predicting if a woman will get breast cancer within two to five years. The method — a metabolic blood profile — is still in the early stages but over time the scientists expect it could be used to predict breast cancer and more generally to predict chronic disease.

“The method is better than mammography, which can only be used when the disease has already occurred. It is not perfect, but it is truly amazing that we can predict breast cancer years into the future,” said Rasmus Bro, a professor of chemometrics in the Department of Food Science at University of Copenhagen. He stressed the method has been tested and validated only for a single population (cohort) and needs to be validated more widely before it can be used practically.

Food science showed the way

The researchers’ approach to developing the method was adopted from food science, where it is used for control of complex industrial processes. Basically, it involves handling and analysing huge amounts of biological data in a holistic and explorative way. The researchers analysed all compounds a blood sample contains instead of — as is often done in health and medical science — examining what a single biomarker means in relation to a specific disease. The model does not reveal anything about the importance of the single biomarkers in relation to breast cancer, but it does reveal the importance of a set of biomarkers and their interactions.

“No single part of the pattern is actually necessary nor sufficient. It is the whole pattern that predicts the cancer,” said Professor Dragsted.

A metabolic blood profile describes the amounts of all compounds (metabolites) in our blood. The scientists measured metabolic blood profiles for this project. When you are in a pre-cancer state, the pattern for how certain metabolites are processed apparently changes.

While a mammography can detect newly developed breast cancer with a sensitivity of 75 per cent, the new metabolic blood profile is able to predict the likelihood of a woman developing breast cancer within the next two to five years with a sensitivity of 80 per cent.

Based on population study

The research is based on a population study of 57,000 people followed by the Danish Cancer Society over 20 years. The participants were first examined in 1994-96, during which time their weight and other measurements were recorded and they answered a questionnaire. They also provided a blood sample that was stored in liquid nitrogen.

The scientists used the 20-year-old blood samples and other available data from 400 women who were healthy when they were first examined but who were diagnosed with breast cancer two to seven years after providing the first sample, and from 400 women who did not develop breast cancer.

The method was also used to test a different dataset of women examined in 1997. Predictions based on the new set of data matched the first dataset, which indicates the validity of the model.

I’m Dr. Michael Hunter, and that is your glimpse into the future.

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.

References:

  • Faculty of Science – University of Copenhagen. “New blood test can predict future breast cancer.” ScienceDaily. ScienceDaily, 15 April 2015. <www.sciencedaily.com/releases/2015/04/150415103154.htm>.
  • Rasmus Bro, Maja H. Kamstrup-Nielsen, Søren Balling Engelsen, Francesco Savorani, Morten A. Rasmussen, Louise Hansen, Anja Olsen, Anne Tjønneland, Lars Ove Dragsted. Forecasting individual breast cancer risk using plasma metabolomics and biocontours. Metabolomics, 2015; DOI: 10.1007/s11306-015-0793-8

Prostate Cancer Family History Linked to Breast Cancer Risk

What You Need to Know: Family history is a significant risk factor for breast cancer, especially in women who have first-degree relatives with the disease. That risk might be even higher if there is a first-degree relative with prostate cancer, a new study suggests.

  • In women with a family history of prostate cancer, there was a 14% increase in the relative risk of developing breast cancer. However, in women with a family history of both breast and prostate cancer, the relative risk increased to 78%.
  • In addition, the risks associated with a family history of both breast and prostate cancer was higher in black women than in white women.

“While this study is limited to largely postmenopausal women, one might expect to see a similar or stronger risk in younger women,” said first author Jennifer Beebe-Dimmer, MPH, PhD, from the Karmanos Cancer Institute and Wayne State University School of Medicine in Detroit. “We tend to see a stronger family history of breast cancer among women diagnosed at younger ages, and the same may be true for a family history of prostate cancer,” Dr Beebe-Dimmer told Medscape Medical News. We believe that physicians may want to consider family history of prostate cancer in addition to breast cancer before making recommendations about screening,” she added.

Dr Beebe-Dimmer pointed out that there is some evidence that men might have a higher risk for prostate cancer if they have first-degree relatives with breast cancer.

“We and others have shown the opposite association, particularly when female relatives are diagnosed with early-onset disease,” she said. “It has been suggested that a relatively small proportion of the prostate cancer cases diagnosed in families with breast and/or ovarian cancer are related to BRCA1/2, suggesting that there may be other genes and/or shared environmental exposures that explain the clustering.”

Multiple Relatives Increases Risk

  • The study included  78,171 women who participated in the Women’s Health Initiative Observational Study from 1993 to 1998. The women were followed for a median of 132 months from the date of enrollment, and there was a median of 60 months between enrollment and the diagnosis of breast cancer. There were 3506 cases of incident breast cancer diagnosed in the cohort up to August 31, 2009.
  • Participants with breast cancer were more likely than those without to be white non-Hispanic and college educated, and to have a history of hormone use and benign breast disease. They were also more likely to have undergone mammography screening within 2 years of the baseline examination.
  • Median age at the time of breast cancer diagnosis was 69 years (range, 50 – 90 years).
  • A positive family history of breast cancer was reported by 11,608 women in the cohort, and women with breast cancer were more likely than those without to report a family history of the disease (20.5% vs 14.6%).
  • Having a single family member with breast cancer was associated with an increase in risk of approximately 40%, after adjustment for cofounders (hazard ratio [HR], 1.42; 95% CI, 1.30 – 1.55). Having multiple family members with breast cancer increased that risk (adjusted HR [aHR], 1.66; 95% confidence interval [CI], 1.32 – 1.88).
  • Women with breast cancer were also more likely than those without to report that at least one first-degree relative had been diagnosed with prostate cancer (11.6% vs 10.1%). This family history was associated with a significant, albeit modest, increase in breast cancer risk after adjustment for confounders such as a family history of breast cancer (aHR, 1.14; 95% CI, 1.02 – 1.26).
  • The risk was highest for those with a family history of both breast and prostate cancer (aHR, 1.78; 95% CI, 1.45 – 2.19).
  • When the data were stratified by race, the risk was highest in black women who had “multiple affected first-degree family members” (aHR, 2.85; 95% CI, 1.33 – 2.08). A family history of prostate cancer was modestly predictive in both white and black women, but only reached statistical significance in white women. Although black women with a family history of both diseases appeared to be at greater risk of developing breast cancer (aHR, 2.34; 95% CI, 1.09 – 5.02), “the risk estimates were not significantly different as evidenced by the overlapping CIs,” note Dr Beebe-Dimmer and colleagues.

Reference: Cancer. Published online March 9, 2015. Abstract    

Too High levels of Vitamin D May Increasing Mortality

What You Need to Know: The level of vitamin D in our blood should neither be too high nor too low. Scientists from the University of Copenhagen are the first in the world to show that there is a connection between high levels of vitamin D and cardiovascular deaths.

The Study: Several studies have shown that too low vitamin D levels can prove detrimental to our health. However, new research from the University of Copenhagen reveals, for the first time, that too much vitamin D in our blood is connected to an increased risk of dying from a stroke or a heart attack.

“We have studied the level of vitamin D in 247,574 Danes, and so far, it constitutes the world’s largest basis for this type of study. We have also analysed their mortality rate over a seven-year period after taking the initial blood sample, and in that time 16,645 patients had died. Furthermore, we have looked at the connection between their deaths and their levels of vitamin D,” Professor at the Department of Clinical Medicine, Peter Schwarz explains.

Conclusion: Dr. Schwartz concludes: “If your vitamin D blood level is below 50 or over 100 nanomol per litre, there is an greater connection to deaths. We have looked at what caused the death of patients, and when numbers are above 100, it appears that there is an increased risk of dying from a stroke or a coronary. In other words, levels of vitamin D should not be too low, but neither should they be too high. Levels should be somewhere in between 50 and 100 nanomol per litre, and our study indicates that 70 is the most preferable level,” Peter Schwartz states.

My Take: There is a correlation between mortality rates and too low levels of vitamin D, but the new findingis that the levels of vitamin D that are too high may be linked to cardiovascular risk. As is the case with so many things, moderation may be the key. 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.

References:

  • D. Durup, H. L. Jørgensen, J. Christensen, P. Schwarz, A. M. Heegaard, B. Lind. A Reverse J-Shaped Association of All-Cause Mortality with Serum 25-Hydroxyvitamin D in General Practice: The CopD Study. The Journal of Clinical Endocrinology & Metabolism, 2012; 97 (8): 2644 DOI: 10.1210/jc.2012-1176
  • University of Copenhagen – The Faculty of Health and Medical Sciences. “High levels of vitamin D is suspected of increasing mortality rates.” ScienceDaily. ScienceDaily, 10 March 2015. <www.sciencedaily.com/releases/2015/03/150310105222.htm>.