The Gossip Test & Francis Crick

Francis Crick in his office. Behind him is a m...
             Francis Crick in his office. (Photo credit: Wikipedia)

Did you know?

Francis Crick joined James Watson, Rosalind Franklin,  New Zealand-born physicist Maurice Wilkins, and others to discover the structure of DNA. But did you know that after earning a degree in physics from University College in London, Crick had his pathway remarkably altered by the breakout of World War II. Instead of proceeding to a graduate degree in physics, he took a civilian job at the British Admiralty Research Laboratory. There he helped develop radar and magnetic mines. One of these mine designs was effective against German minesweepers. After the war, he was intellectually restless and decided to change careers. Here’s what he said about how he chose the next chapter of his life:

“I had discovered the gossip test – what you are really interested in is what you gossip about. Without hesitation, I applied it to my recent conversations. Quickly I narrowed down my interests to two main areas: the borderline between the living and the nonliving, and the workings of the brain.” (Francis Crick, in his book What Mad Pursuit)

In 1953, he and Watson published their findings on the double-helix structure for DNA in the British scientific weekly Nature. And the rest is history. And now you know.

I’m Dr. Michael Hunter.

Genomic Analysis Lends Insight to Prostate Cancer

Gleason grade Lower grades are associated with...
Gleason grade Lower grades are associated with small, closely packed glands. Cells spread out and lose glandular architecture as grade increases. Gleason score is calculated from grade as described in the text. (Photo credit: Wikipedia)

Under the headline “Cool!” researchers at Mayo Clinic (USA) used next-generation gene analysis to determine that some of the more aggressive prostate cancer tumors have similar genetic origins. This may help in predicting who will have progression of cancer.

Background: This study is the first of its kind: It used next-generation genomic sequencing in adjacent Gleason patterns, allowing us to correlate genome changes and what we see under the microscope (grade). The standard method for evaluating prostate biopsy tissue is a numeric system called Gleason grading. A pathologist looks at the tumor under the microscope, and gives it a Gleason score based on the pattern of its cells. As many prostate cancer samples have more than one pattern, the two most prominent patterns are added together to give a Gleason score. The highest Gleason scores represent the most aggressive, potentially life-threatening cancer.

The study: The study looked at Gleason score 7 tumors, a score linked to a higher risk of progression (compared to low grade tumors, many of which don’t need any treatment). The tumors all appeared to have a common genetiv origin. These DNA changes in the aggressive cancers were also seen in lower Gleason pattern tumors, suggesting that the gene analysis could identify which cancers might be aggressive (before the pathologist could by looking under the microscope). In fact, the Gleason pattern 3 tumors had more gene alterations in common with its corresponding Gleason pattern 4 tumor (than they did when compared to Gleason pattern 3 tumors from other patients).

My take: This is just what the doctor ordered. Many prostate cancers never needed to be diagnosed! And yet 10s of thousands die every year of the disease. So how do we know which cancers to ignore and which to treat? We need more guidance, and this study points the way to a future when care can be far more individualized than it is today.

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. Thanks!

Estrogen Receptor Negative Breast Cancer: Can Coffee Reduce Risk?

cups of coffee panoramic

Recent research demonstrates that coffee consumption may reduce your risk of cancer; more specifically, this study (published in the open access journal Breast Cancer Research) shows that drinking coffee specifically reduces the risk of cancer not driven by “female” hormones, or estrogen-receptor (ER)-negative breast cancer.

The study: Swedish researchers compared lifestyle factors and coffee consumption among women with breast cancer, and age-matched women without the disease. Several lifestyle factors influenced risk, including age at menopause, exercise, weight, education, and a family history of breast cancer. Coffee drinkers had a lower incidence of breast cancer than women who rarely drank coffee. But when  adjusted for factors such as age, the protective effect of coffee on breast cancer were only measurable for ER-neagative breast cancer.


Results: The authors compared lifestyle factors and coffee consumption between women with breast cancer and age-matched women without. They found that coffee drinkers had a lower incidence of breast cancer than women who rarely drank coffee. However they also found that several lifestyle factors affected breast cancer rates, such as age. Once they had adjusted their data to account for these other factors they found that the protective effect of coffee on breast cancer was only measurable for ER-negative breast cancer.
My take: There are often conflicting results regarding the beneficial effects of coffee. This study is helpful in that it broke out the coffee effect by the type of breast cancer (ER positive versus ER negative). Now we have the suggestion that coffee may lower the risk of ER-negative breast cancer. Oh, and it tastes good too! (Full disclosure: I live in the Seattle area.) It seemed that the more the coffee, the lower the risk. But take heed: Once you get up to 4+ cups, you may introduce other problems such as cardiac ones.
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. Thanks!

Do high-fat dairy foods raise breast cancer death risk?

whole-milk-gallon
Whole milk (Photo credit: David Guo’s Master)

Individuals completing breast cancer treatment often query me about the role of diet in reducing the risk of recurrence (the cancer coming back). Unfortunately, we do not have high level evidence to provide guidance with confidence. Now we have a new study that provides insight into the association of  high-fat dairy foods and risk.

According to a new study of 1,893 breast cancer survivors, those who average as little as one serving of high-fat dairy foods have a 1.5x higher risk of dying from breast cancer (as compared to those who eat little or no high-fat daily).

“Specifically, women consuming one or more servings per day of high-fat dairy had a 64 percent higher risk of dying from any cause and a 49 percent increased risk of dying from their breast cancer during the follow-up period,” said the author Candyce Kroenke, ScD, MPH. The category of high-fat dairy products researchers tracked included cream, whole milk, condensed or evaporated milk, pudding, ice cream, custard, flan, and also cheeses and yogurts that were not low-fat or non-fat. In general, the women studied reported that they consumed low-fat milk and butter most often, and they consumed relatively limited amounts of low-fat dairy desserts, low-fat cheese and high-fat yogurt. Overall, low-fat dairy intake was greater (median 0.8 servings per day) than high-fat dairy (median 0.5 servings per day).

My take: Many previous studies have struggled to definitively find a link between dairy and breast cancer risk. This study is especially helpful in that the authors looked at the type of fat. The study found an association between high-fat dairy and breast cancer mortality, but no association with low-fat dairy products and breast cancer outcomes. This research was part of the Life After Cancer Epidemiology (LACE) study, one of several efforts by investigators with the Kaiser Permanente Division of Research to consider the role of lifestyle factors such as nutrition, exercise and social support on long-term breast cancer survival and recurrence.

While hundreds of studies have examined the role of lifestyle factors in cancer risk and prevention, this study is one of a small but growing number that focus on the role of lifestyle factors after a breast cancer diagnosis. Now, when patients ask me what to do to potentially lower their risk, I answer: 1) Be physically active, aiming for 150 minutes per week of the equivalent of a vigorous walk (30 minutes, 5 days/week); 2) Achieve and maintain a body mass index (BMI) of 20-25; 3) Be prudent about alcohol; 4) If you are taking an anti-estrogen drug, be careful not to miss doses. And now, I can add: Watch those high-fat dairy products (but this doesn’t mean you can’t occasionally cheat!). 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!  

About the author: 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. Thank you.

Journal of the National Cancer Institute, 2013

Cells Play “Tag” to Determine Direction of Movement

English: Europe 1916 by Boardman Robinson. Ant...
Europe 1916 by Boardman Robinson. Anti-war cartoon depicting Death enticing an emaciated donkey towards a precipice with a carrot labeled “Victory.” (Photo credit: Wikipedia)

Today, I want to report the findings of researchers in Barcelona and London, as they may have implications for future cancer management.

The study: Investigators looked at cells in the neural crest, a very mobile embryonic structure in vertebrates that gives rise to most of the peripheral system (and other cell types, including in the cardiovascular system, pigment cells in the skin, and some bones, cartilage, and connective tissue in the head.

How cool is this? When cells in our bodies move collectively, they do so in a fashion similar to the game of “tag.” This allows them to coordinate their movement in a particular direction. Researchers saw that during development, these neural crest cells chase other types of cells – so-called placodal cells that give rise to sensory organs – which dash away when approached. The cell sheet is thus propelled in a certain direction.

My take: The cells behave like a donkey chasing a carrot. It chases, but never quite reaches the target. This gives us insights about cell migration, a critical process in development and wound healing. But what if this better understanding of why cells move the way they do led to valuable insights into how cancers develop and spread?

I’m Dr. Michael Hunter.

About the author: 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. Thanks!

Dark Chocolate & Cardiac Health: Good News

chocolate splash

I have to confess that I am awfully fond of dark chocolate. But could my weakness for the good stuff translate into better health? Today, we will take a little detour away from cancer and examine the relationship between modest consumption of dark chocolate and cardiovascular health.

Inside chocolate: Dark chocolate is packed with flavonoids, a group of phytochemicals that act as antioxidants. Consuming chocolate increases the antioxidants in our blood. How does that translate into something actionable? A couple of small squares of dark chocolate can reduce your risk of death from heart attack by nearly half in some cases. This is the conclusion of Diane Becker, MPH, ScD of Johns Hopkins University School of Medicine.

How the heck does that work? Becker found that blood platelets clotted more slowly among individuals who had earn chocolate as compared to those who had not. Remember: When platelets clump, a clot can form and block a blood vessel. This can lead to a myocardial infarction (heart attack). You have the flavanoids in cocoa to thank for these positive effects. Harvard researchers added that chocolate may lower the risk of heart attack by lowering blood pressure, anti-inflammatory actions, and decreasing low density lipoprotein (LDL) oxidation.

A review of the literature suggests other mechanisms, too. In a separate study, healthy men who consumed dark chocolate had improved flow of blood in their arteries; the walls of the blood vessels literally relaxed. And our friends in Italy found that insulin resistance (a risk factor for diabetes) improved with chocolate consumption. Blood pressure went down too (at least the systolic blood pressure, or the first number in the blood pressure reading lowered).

What type of chocolate is the most flavonoid-rich? The highest levels are in natural cocoa powder (not Dutch cocoa, though, because itis alkalized). The type second highest in flavonoids is unsweetened baking chocolate. Dark chocolate and semisweet chocolate chips rank third, with milk chocolate and chocolate syrup having the least.

cacao bean on tree chocolate

     But you write a cancer blog: Indeed. But I so love dark chocolate (in moderation). And for this, you must suffer a bit today, hearing about the magic elixir!

My take: Two to three small squares of dark chocolate (70% or higher) may help to improve your cardiovascular health. But wait! There’s more! In a future blog, we will look at recent studies about potential reductions in risk of cancer associated with our dark chocolate. Suffice it to say that while we need more evidence, the available literature hints at reductions in cancer risk due to the antioxidant effects of dark cholocate. That it is a pleasurable eating experience is a bit of an added bonus. You now know what you need to do. And enjoy! (My favorite is Green & Black brand.) 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!  

About the author: 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. Thanks!

Breast cancer: Aromatase Inhibitors and Bone and Muscle Symptoms

English: Arimidex (Australian packaging)
Arimidex (Australian packaging) (Photo credit: Wikipedia)

The study: A recent study by Lintermans and colleagues examines the relationship between aromatase inhibitor drugs and arthralgia. Their carefully conducted study used MRI (hands/wrists) and a careful physical examination, with measures of self-reported morning stiffness and grip strength measurements. The study was too small to demonstrate differences between the various types of aromatase inhibitor drugs.

Results: Between months 6 and 24, the fluid in the joints increased among users of aromatase inhibitor drugs (but not in a control group that received an alternative anti-estrogen drug, tamoxifen). Grip strength decreased in both the aromatase inhibitor and tamoxifen groups. At the 24 month mark, more than a third of the aromatase inhibitor users had morning stiffness. The symptoms did not seem to improve over time.

My take: Muscle and joint achiness are common with the use of the AI drugs. Some researchers have found fewer symptoms among those who take calcium/biphosphanate. Others have correlated these symptoms with lower bone mineral density. We know that all patients considering management with AIs should have an evaluation for bone strength before beginning an aromatase inhibitor. The bottom line? While the aromatase inhibitor drugs can be valuable, they are commonly associated with discomfort in the joints and muscles. 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!

Lintermans A, et al. Ann Oncol 2013;24:350-355.