Partners of patients with HPV-related head and neck cancer not at increased risk

Partners of patients with HPV (human papilloma virus)-related oropharyngeal cancer do not have increased levels of oral HPV infection. The risk of a partner developing HPV-related of the oropharynx (back of the mouth, including the base of tongue) is low.

– American Society of Clinical Oncology, 49th Annual Meeting (2013)

Pregnancy after a breast cancer diagnosis does not affect prognosis

pregnant woman

Young women who have completed treatment for invasive breast cancer often ask if a pregnancy will increase their chances of recurrence (cancer return). The question seems appropriate to me, especially given the fact that hormon receptor positive breast cancer is fueled by estrogen. It should be comforting to these women that a new study suggests that a pregnancy after treatment for early stage, estrogen receptor (ER-positive breast cancer does not affect the recurrence rate (Journal of Clinical Oncology 2013;31:73-79). Researchers in Brussels, Belgium aimed to compared the disease free survival (DFS) in pateitns with ER-positive breast cancer both with and without a subsequent pregnancy.  The authors also looked at a number of other outcomes, including disease free survival among ER-negative patients.

The retrospective review found no difference in DFS between the pregnancy and non-pregnancy groups in the ER-positive group. Perhaps surprisingly, the patients who became pregnant less than 2 years after diagnosis had a better disease free survival compared to their matched controls. This last observation may be due to selection bias, I think. The bottom line? This study provides good evidence that a woman who desires a biological child after breast cancer diagnosis will not have their prognosis adversely affected by pregnancy. The study is not without flaws however, including the fact that 80% of patients had no information about a critical marker known as HER-2.

A big question is what to do if you want to become pregnant, but have not completed a recommended course of anti-estrogen therapy such as tamoxifen. Researchers are beginning to investigate the impact of a break from tamoxifen on results. I hope you have found this blog informative, and look forward to offering an e-book on breast cancer (for IPad) within weeks. I’m Dr. Michael Hunter, and I thank you for visiting with me.

Heartburn raises cancer risk … but antacids may reduce risk


Gastric reflux, more commonly known as heartburn, can increase the risk of cancer of the throat area (laryngopharyngeal squamous cell carcinoma). Now the good news, reported online May 23, 2013 in Cancer Epidemiology Biomarkers & Prevention. Individuals without a history of heavy tobacco or alcohol consumption who have a history of frequent heartburn have a 1.8 times greater risk. This risk remained, even when the researchers adjusted for age, sex, race, smoking, alcohol consumption, presence of human papilloma virus (HPV), educations, and body mass index. For those with a history of heartburn, the use of antacids only to relieve symptoms was associated with a big drop in the risk of larynx cancer (by two-thirds!) or laryngopharyngeal cancer (by about a third). In addition, there was the suggestion of a lower risk of cancers of the pharynx. While these findings are provocative, we still need more studies to clarify a potential role for antacids as a cancer risk reduction agent. I’m Dr. Michael Hunter.

Small print: Remember, the information provided here is for general use only. We do not provide medical advice for individuals, and recommend that you check in with a valued health care provider.

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We have proof! Sunscreen reduces skin aging


We all knew it intuitively, but now we have data that sunscreen does more than simply protect your skin from cancer and sunburns. A new study shows that sunscreen can protect against wrinkling, spotting, and loss of elasticity caused by exposure to ultraviolet radiation. Australian researchers followed 900 patients for 4 years. Some were told to use sunscreen daily, and instructed in its proper use (including re-applying after being outside for a few hours, after going in water, or profuse sweating). Other participants were given no instructions regarding the use of sunscreen. The investigators then used a technique called micro topography: They made sensitive silicone impressions on the back of each participant’s hand. Skin surface patterns reflect the severity of damage to deeper skin layers, including the collagen and elastic fibers. So, if you spend time outside during the day, you should use sunscreen. And remember, SPF is not a marker for how long you can stay out in the sun. An SPF 15 sunscreen blocks about 93% of UV-B rays, while SPF 30 blocks 97%. You want a sunscreen that protects against both UV-A and UV-B, and has an SPF of 50 or below. The Envoironmental Working Group  prefers  sunscreens free of oxybenzone and retinal palmitate (a form of vitamin A). I’m Dr. Michael Hunter The fine print: The material contained herein is for general use, and may not apply to you as an individual. As such, it is not intended to be medical advice for an individual, and you should check with a valued health provider with any questions or concerns.

No Cancer Rise from Japan’s Nuclear Disaster


As you know, our Japanese friends suffered a magnitude 9 earthquake (and subsequent tsunami) on March 11, 2011. Nearly 19,000 people died, and the Fukushima Daiichi nuclear plant was devastated, spewing radiation and leading to the evacuation of 160,000 from their homes. Now, the United Nations offers tat evacuation and sheltering significantly reduced the exposure to radioactive substances. The chair of the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) explained that while a few individuals received extraordinarily high doses of radiation, there were no radiation-related deaths of acute effects among nearly 25,000 workers. Unlike Fukushima, people close to the then-Soviet plant were exposed to radioactive iodine in milk. The thyroid is the most exposed organ, as radioactive iodine concentrated there (children are especially vulnerable). For the Japanese, the UN committee offers that “the radiation dose levels were so low, that we don’t expect to see any increase in cancer in the future in the population.” Good news for the Japanese people, and for the world. I’m Dr. Michael Hunter.

The small print: Anything stated here is for general use only, and should not be construed as medical advice for an individual. Please check with your health care provider with any questions or concerns.

What are BRCA mutations?


Angelina Jolie has put personalized medicine in the spotlight. Her mother died at age 56 following a 10 year battle with cancer. Jolie recently published a powerful New York Times op ed piece revealing her personal journey after testing positive for a BRCA mutation and her subsequent decision to have risk-reducing removal of her breasts and ovaries. In today’s blog, we turn to the basics of BRCA mutations. What are they, and what are the risks they pose?

BRCA stands for BReast CAncer susceptibility gene. We have BRCA1 and BRCA2, initially discovered by Dr. Claire King at the University of Washington, Seattle. You and I have BRCA genes; in fact we all do. They are tumor suppressor genes that help to keep your cells’ genetic material stable and to prevent cells from growing uncontrollably.

Among women, BRCA mutations (changes) have been associated with a marked increase in the risk of breast and ovarian cancer, often at an early age. On average, the risk of breast cancer increases from 12% (for the average woman in the USA) to about 60% or more among those with a BRCA mutation. The lifetime risk for ovarian cancer increases too, from about 1.4% in the general population to as much as 40%.

Unfortunately, there is more. BRCA1 mutations also increase the risk of cervix, uterus, colon, and pancreas cancer. And BRCA2 mutations also increase the risk of stomach, gallbladder, pancreas, and bile duct tumors as well as melanoma. Among men, BRCA mutations can increase the risk of male breast cancer, with BRCA1 mutations also associated with a higher risk of testicular cancer, and BRCA2 mutations increasing the risk for prostate cancer.

Genetic counseling can be remarkably informative. We will discuss who should consider BRCA testing in a future blog. Thank you. I’m Dr. Michael Hunter.

The small print: Anything stated here is for general use only, and should not be construed as medical advice for an individual. Please check with your health care provider with any questions or concerns.

Hot flashes in Cancer: Neutraceuticals for Treatment


Over several blogs, I look forward to reviewing the biology of hot flashes, causes, and management tools. Today, let’s take a moment to look at neutraceutical medicines. Neutraceuticals include herbal medicines such as black cohosh and homeopathic herbs. The category also includes vitamins, and phytoestrogens (including soy and flaxseed). Historically, studies have been challenged by lack of standardization for the interventions. Let’s turn to some of these potential remedies for hotflashes.

Black cohosh: This herb is derived from the North American periwinkle plant, and has been well-studied for hot flashes among women with breast cancer, but not very much for symptoms linked to prostate cancer management. It acts on serotonin receptors, but does not have estrogen-like actions. While some historic trials showed effectiveness, modern trials do not show it to work among women without cancer. Some studies show it helps women who are on tamoxifen, but check with your doctor before you considering using it.

St. Johns’ wort: My review leads me to believe that this intervention does not work well. In addition, it can interact with some specific medicines.

Homeopathic herbs: While some observational trials have shown benefit, two randomized, controlled trials have not found homeopathic herbs to be effective against hot flashes, compared to placebo. We do not have high level evidence to suggest you should use this approach.

Vitamins: Vitamin E is one of the most investigated vitamins used to reduce hot flashes. First of all, some women should take caution: Heart disease, high blood pressure, and high blood pressure can present problems. There is some concern about inducing cancer, too. My read: Vitamin E may reduce hot flash incidence by 1 or 2 per day. Folic acid may help alleviate hot flashes, but more studies are needed.

Flax Seed: This rich source of lignans (a class of phytoestrogens) has been investigated in 3 prospective, randomized trials. There appears to be no benefit for women, and no good data for men.

Red clover: A randomized trial showed no benefit among women. No good data for men.

Soy isoflavones: A systematic review of 19 randomized studies (meta-analysis) suggests that soy may reduce hot flashes more than a placebo for women. The median dose was 54 mg per day. We don’t have much data about prostate cancer-related hot flashes and soy among men, but what is available is a bit conflicting.

Well, that’s it for today. Going forward, we’ll turn to other potential interventions. For now, I suggest exercise, and looking for triggers (for example, caffeine, heat, stress, alcohol, and spicy foods). I’m Dr. Michael Hunter.