Lower Your Cancer Risk by Grilling Properly

US Meat Consumption
US Meat Consumption (Photo credit: Wikipedia)

In yesterday’s blog, we examined the association of processed foods (such as cold cuts and bacon) and cancer risk. We also touched on the possible link between red meat consumption and risk of cancer (including colorectal cancer). Some speculate that the iron attachment to heme in the blood may be a culprit. So what are we to do?

Lowring risk through good grilling: I do not know of a good way to take the heme iron out of meat. Still, we have some tricks to reduce the amount of potentially hazardous herterocyclic amines (HCAs) when you hit the grill.

1. Go seafood. Without charring it, it’ll have fewer HCAs than meat or poultry.

2. Marinate. Even if you simply dip the meat in the marinade just before it hits the grill.

3. Microwave the food before cooking, as you might knock off 90% of the HCAs.

4. Flip. A lot. Take out up to over 90% of the HCAs buy keeping the surface temperature lower.

5. Bake. Or roast. Or stir-fry.

6. Boil, steam, stew, or poach. Or even microwave. As the temperature doesn’t pass the water boiling point, you won’t create HCAs.

7. Don’t eat the pan drippings. They may have more HCAs than the meat itself!

8. Your mom was right: Eat your veggies. Few or no HCAs. Extra points if you have cruciferous veggies such as broccoli or brussel sprouts, as they may help your liver detoxify HCAs.

I’m Dr. Michael Hunter, and since I’m a Seattle guy, I’m off to grill some salmon!

Nutrition Reviews 63: 158, 2005; Rev. Food Sci. Food Safety 10: 52, 2100.

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. And have a great day!

Vegetable Fat Tied to Lower Risk of Prostate Cancer Death

Got prostate cancer? Well here’s the good news: You can lower your risk of dying of the disease my increasing the amount of vegetable fat you consume. A study published in June, 2013 found prostate cancer mortality to be about half for men who consumed the most vegetable fat, as compared to those who consumed the least.

“Among men with non-metastatic prostate cancer, replacing carbohydrates and animal fat with vegetable fat may reduce the risk of death due to any cause [not just cancer].”

– Erin Richman, MD (University of California, San Francisco)

Methods: Richman and colleagues searched the database of the Health Professionals Follow-up Study. Over 51,000 male health professionals have enrolled since 1986. The investigators grouped the men into quintiles of fat intake, further separated into animal fat, vegetable fat, saturated fat, monounsaturated fat, and trans fat.

Results: Men who consumed more vegetable fat after diagnosis had a lower risk of death due to any cause (all-causemortality). Replacing 10% of calories from carbohydrates with vegetable fat was assocaited with a 26% lower risk of death. The association was stronger with animal fat was replaced with vegetable fat.

My take: Avoiding obestiy may be a key. How you should do this is not yet settled, but this study suggetsts that substituting healthy foods (vegetable fats) for unhealthy foods may have a benefit. Now the chicken or the egg question: Was the benefti due to reduced consumption of carbohydrates or greater intake of vegetables?

Cutting Your Cancer Risk through Diet

English: nitrosylheme, nitrosyl-heme, heme-NO,...
Nnitrosylheme. (Pegg & Shaidi, 2000, “The color of meat” in “Food & Nutrition, Press Inc., Trumbull, Connecticut, USA), released from NO-myoglobin by cooking cured meat (Honikel K.O., 2008, Meat Science, 78, 68-76) (Photo credit: Wikipedia)

Today, I’d like to focus on a couple of things you can do to reduce your risk of cancer. We have long known that consumption of processed meat can increase the risk of cancer.

1. Processed meats: These agents are created by nitrites used to color and preserve processed meats such as bacon, sausage, and lunch meats. These compounds have been linked to cancer in lab animals. The N-nitroso compounds are not in the meat (the food companies must add chemicals to keep it from forming), but are created in the gut in a reaction probably facilitated by bacteria. This may explain why those of us who eat processed meatus have a higher risk of colorectal, esophagus, and stomach cancer.

2. Unprocessed meats: Unprocessed red meat can also increase N-nitroso compounds in your gut. For example, the risk of colorectal cancer is higher (at least according to some studies) among individuals who consume more heme iron, a substance found in all meats, but especially in red meat). On the other hand, white meat does not appear to do so. Could it be that iron attaches to hemoglobin in the blood? The studies are insufficient to say with any degree of certainty.

3. Meat mutagens: Cooking meats to well done at high temperatures causes cancer in animal studies. For humans, the data is more mixed. In the NIH-AARP Diet and Health Study, colorectal cancer risk increased by a factor of 1.2 among those who consumed the highest levels of two key heterocyclic amines (HCA). Chicke eaters may have a lower risk, even though the levels of HCA may be high in barbecued chicken.

In our next issue, we’ll look at specific things you can do to lower risk, including improving your grilling technique. 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. And have a great day!

Breast Invasive Lobular Carcinoma: Link to HRT

Patients often wonder why they got a particular cancer. While we  cannot know with certainty why a particular individual got a cancer, we know of risk factors that increase the odds of getting it. Today, we look at the association of hormone replacement therapy (HRT) and a particular type of breast cancer, lobular carcinoma.

The observation: Post-menopausal hormone replacement therapy can significantly increase the risk of the less-common lobular form of breast cancer.

What’s lobular carcinoma? This breast cancer subtype involves the lobules, grape-like structures in the breast that contain milk-producing glands. Lobular carcinoma accounts for only about 15 percent of all invasive breast cancers, and is typically hormonally sensitive. However, lobular breast tumors also present a clinical challenge because they can be more difficult to detect both by clinical examination and by mammography (as compared to the more common ductal cancer).

English: Lobular Breast Cancer. Single file ce...
Lobular Breast Cancer. Single file cells and cell nests. (Photo credit: Wikipedia)

The data: In a study published in 2008 in Cancer Epidemiology, Biomarkers and Prevention, of more than 1,500 postmenopausal, western Washington women, my friend and colleague Christopher Li, MD found that current users of combined HRT had a 2.7-fold and 3.3-fold elevated risk of lobular and ductal-lobular cancer, respectively, regardless of tumor stage, size or number of lymph nodes involved. Only women who used combined HRT for three or more years faced an increased risk of lobular cancer. Among mixed ductal-lobular cases, hormone therapy increased the risk of tumors that were predominantly lobular but not tumors that had predominantly ductal characteristics.

Bottom Line: Postmenopausal women who take combined estrogen/progestin hormone-replacement therapy for three years or more face a fourfold increased risk of developing various forms of lobular breast 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. And have a great day!

Hernias more common after minimally invasive prostate surgery


Did you know? Based on Medicare claims data, incisional hernias after radical prostatectomy are about three-times more common with minimally invasive surgery than with an open surgical approach. The frequency of incisional hernia requiring repair in the two groups was 5.3% and 1.9%, respectively. 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. And have a great day!

3D versus 2D mammograms


Today, I want to briefly discuss the use of tomosynthesis (sometimes called 3D mammography) for breast cancer screening. This sophisticated imaging approach uses a moving X-ray source to acquire 3-Dl volume data than can be displayed as thin slices. While relatively new, tomosynthesis is becoming more popular, especially for evaluating women with dense breasts (as defined by mammograms), and for women at high risk for getting breast cancer. Still, we have fairly limited data on outcomes when tomosynthesis is used for routine screening.

The results of a manufacturer-sponsored study were recently reported. The investigation looked at Italian women at least 48 years old, and did screening with integrated 2D and 3D mammograms.Screening mammograms were then interpreted by radiologists, first using standard 2D images and subsequently using integrated 2D/ 3D mammography.

Among over 7000 women screened, 52 invasive cancers and 7 cases of ductal carcinoma in situ were detected. The rate of cancers detected per 1000 screens was 5.3 with 2D technology and 8.1 with integrated 2D plus 3D screening, a statistically significant increase in sensitivity. Of 395 false-positive screens (that is, the test suggested cancer, when there actually was none), 181 resulted from both screens, 141 resulted from 2D only, and 73 resulted from integrated screens.

Bottom line: The finding that integrated screening enhances sensitivity (th ability to find cancer) while reducing false-positive results (the test says there is cancer, when there is not) match results from an interim analysis of a Scandinavian trial.

Any downsides? 2D/3D screening roughly doubles the radiation exposure to the breast.

Going forward: We need more randomized trials comparing 2D with integrated 2D/3D screening mammograms. In my own institution, we prefer the tomosynthesis approach. 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. And have a great day!

Breast Cancer With Involved Sentinel Nodes: No More Surgery Needed?


For early breast cancer, the sentinel node procedure has been a breathtaking achievement. Historically, as a part of management, many lymph nodes were removed from the axilla (underarm area). Over time, we have learned that the number of nodes involved with regional spread of cancer is the most important prognostic factor for survival. More recently, we have discovered that the removal of axillary nodes serves this important purpose, but is not as important from a treatment perspective. Not surprisingly, we have moved from taken all of the dozens of nodes in the axilla, to 10 or 20, and now just a node or two.

The sentinel lymph node procedure involves the injection of trace amounts of radioactive material (or blue dye) around the time of surgery. A small incision is made in the underarm area, and a Geiger counter-like device brought near. The surgeon listens for the ticking node and plucks it. As cancer needs to travel through this first (sentinel) node, we can determine whether there is regional spread of cancer! Voila, lower chance of pain and arm swelling, or lymphedema. So what if the sentinel node is involved? What now? Go back and take more nodes or hope the radiation therapy that follows surgery will take of any more disease that might be left behind? We have more answers this week.

Radiotherapy is a better option than surgical dissection for women with breast cancer and a positive sentinel lymph node, according to an international multicenter phase 3 trial. In fact, axillary lymph node dissection (ALND) was associated with twice the rate of lymphedema as axillary radiotherapy, with no better locoregional control and fewer adverse effects (as compared to radiation therapy), in the European Organization for Research and Treatment of Cancer (EORTC) AMAROS (After Mapping of the Axilla: Radiotherapy or Surgery?) trial. The results were presented here at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO®).

“We shifted from mastectomy to breast conservation, and now we will shift from complete axillary dissection to axillary-conserving strategies,” study author Emiel Rutgers, MD, PhD, surgical oncologist at the Netherlands Cancer Institute in Amsterdam, said during a press conference.

Outcomes no better with additional underarm surgery: There were no significant differences between the surgery and radiotherapy groups in disease-free survival (86.9% vs 82.7%; P = .1788) or overall survival (93.3% vs 92.5%; P = .3386).

Complications worse with completion axillary dissection: 5 years after therapy, the rate of lymphedema in the surgery group was twice that of the radiotherapy group (28% vs 14%).

Questions remain: 1) Extent of radiation therapy (is less more? Should we treat only the breast (with a bit of exit dose to the lower axilla) or more comprehensively (breast and of the regional nodes, recognizing more potential side effects). 2) What if a woman is not to receive radiation therapy? Should she go back for more surgery?

Still, progress. And good news for patients who have a sentinel node involved who receive radiation therapy. Your risk of regional recurrence is remarkably low, even if you don’t have more surgery.

Coming soon: Understand Breast Cancer in 60 Minutes (an e-book for IPad)

Fine print: The material herein is not aimed at providing advice for an individual, and is only general in nature. Check with your valued healthcare provider with any questions or concerns regarding your own management.