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.

Can Aspirin Reduce the Risk of Melanoma Among Postmenopausal White Women?

Tanning beds substantially raise risks of skin...
Tanning beds substantially raise risks of skin cancer, including melanoma. (Photo credit: Wikipedia)

While previous studies demonstrated no reduction in melanoma skin cancer risk associated with aspirin use. Now comes an intriguing report that aspirin may reduce the probability of melanoma among postmenopausal Caucasian women.

The study: The authors looked at data from the Women’s Health Initiative Observational Study (WHI OS). Half of the patients were followed for over 12 years.

The results: The melanoma incident rate was 21% lower among aspirin users compared to those taking non-aspirin NSAIDs or not taking NSAIDs. Among women taking aspirin for 5 or more years, the melanoma risk was 30% lower. Acetaminophen (Tylenol) had no such benefit.

Limitations of the study: Medication use was self-reported. There was no information about risk factors such as hair and eye color. (The study did include information on skin type, sun exposure and sun protection habits) The study is large, has long follow-up, and a large number of confirmed melanomas.

My take: The study is provocative. But do these observations hold true for per- and perimenopausal women, other ethnic groups? Men? And what about the downsides of aspirin, including bleeding from the gut? We also known that low-dose aspirin can lower the risk of colorectal cancer among patients (those with something known as Lynch syndrome) at high risk for the disease. And it can lower the risk of cardiovascular events such as heart attacks and stroke. For me, unless my patient has a reason not to take it, I think it is not unreasonable to incorporate a baby aspirin into your daily routine, especially if you are over the age of 50. For you, make sure you check in with your primary care provider before making the decision.

And you know the rest: Sunscreen (don’t forget to re-apply), hats, sunglasses, no tanning beds, and limit the time in the sun. 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!

Food Supplement Linked to Lower PSA in Prostate Cancer

broccoli
Broccoli (Photo credit: Wikipedia)

A commercially available food supplement that contains pomegranate, broccoli, green tea, and tumeric significantly lowers prorate-specific antigen (PSA) levels (compared with a placebo) among patients with prostate cancer. The study results were presented at the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO). The polyphenol-rich supplement, known as Pomi-T sold out within hours.

The study: Double-blind, placebo-controlled randomized trial. The study enrolled 203 men (average age, 74 years) who had sustained a recurrence (as defined by PSA) of their cancer following treatment with surgery or radiation therapy. The men were randomized to receive either the supplement three times per day for 6 months, or the supplement.

Results: At 6 months, the median increase in PSA was 64% lower in the supplement group (15% versus 78.5%). Not surprisingly, more men proceeded to treatment in the placebo group. In the supplement group, 7.4% went on to treatment, compared to 26% in the supplement group.

Supplement downsides: More men experienced non-significant bloating or diarrhea, but 15% had beneficial effects such as better digestion and improvement in urination.

The science: In the lab, polyphenols reduce cell proliferation, block blood vessel growth, mage cells more sticky to one another (less likely to break loose and travel), and promote cell suicide (apoptosis). These agents have no hormonal effects.

Bottom line: While more data is needed regarding this particular supplement, it adds to growing evidence that lifestyle matters: A balanced diet (including cruciferous vegetables may avoidance of obesity, physical activity may all reduce the risk of prostate 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!

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!