Poor adolescent diet associated with premenopausal breast cancer

“During adolescence and early adulthood, when the mammary gland is rapidly developing and is therefore particularly susceptible to lifestyle factors, it is important to consume a diet rich in vegetables, fruit, whole grains, nuts, seeds, and legumes and to avoid soda consumption and a high intake of sugar, refined carbohydrates, and red and processed meats.”

– lead author Karin B. Michels, ScD, PhD, professor and chair of the Department of Epidemiology at the UCLA Fielding School of Public Health, Los Angeles

Key points: Women who consumed a diet associated with chronic inflammation  as adolescents or young adults appear to have a higher risk of developing premenopausal breast cancer, as compared with those who had a diet not linked to inflammation.

Background: Researchers used data from 45,204 women in the Nurses’ Health Study II who had completed a food frequency questionnaire in 1998, when they were ages 33 to 52, about their diet during high School. The investigators then assed adult diet by first using a food frequency questionnaire in 1991, when participants were ages 27 to 44, and then every 4 years thereafter. They gave each woman’s diet an inflammatory score using a previously method that links diet with inflammatory markers in the blood.

During 22 years of follow-up, 870 of the women who completed the high school food frequency questionnaire were diagnosed with premenopausal breast cancer and 490 were diagnosed with postmenopausal breast cancer. When women were divided into five groups based on the inflammatory score of their adolescent diet, those in the highest score group had a 35 percent higher risk for premenopausal breast cancer relative to those in the lowest score group. When the same analysis was done based on early adulthood diet, those in the highest inflammatory score group had a 41 percent higher risk for premenopausal breast cancer relative to those in the lowest score group.

I’m Michael Hunter, the Breast Cancer Doctor.

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    

Light-emitting e-readers Before Bedtime Adversely Impact Sleep

What You Need to Know: Use of a light-emitting electronic device (LE-eBook) in the hours before bedtime can adversely impact overall health, alertness, and the circadian clock which synchronizes the daily rhythm of sleep to external environmental time cues.

“We found the body’s natural circadian rhythms were interrupted by the short-wavelength enriched light, otherwise known as blue light, from these electronic devices,” said Anne-Marie Chang, PhD, corresponding author. “Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock and reduced next-morning alertness than when reading a printed book.”

Background: Previous research has shown that blue light suppresses melatonin, impacts the circadian clock and increase alertness, but little was known about the effects of this popular technology on sleep. The use of light emitting devices immediately before bedtime is a concern because of the extremely powerful effect that light has on the body’s natural sleep/wake pattern, and may thereby play a role in perpetuating sleep deficiency.

The Study: During the two-week inpatient study, twelve participants read LE-e-Books on an iPad for four hours before bedtime each night for five consecutive nights. This was repeated with printed books. The order was randomized with some reading the iPad first and others reading the printed book first.

  • IPad readers took longer to fall asleep, were less sleepy in the evening, and spent less time in REM sleep. IPad readers had reduced secretion of melatonin, a hormone which normally rises in the evening and plays a role in inducing sleepiness.
  • IPad readers had a delayed circadian rhythm, indicated by melatonin levels, of more than an hour. Participants who read from the iPad were less sleepy before bedtime, but sleepier and less alert the following morning after eight hours of sleep.

Although iPads were used in this study, BWH researchers also measured other eReaders, laptops, cell phones, LED monitors, and other electronic devices, all emitting blue light.

“In the past 50 years, there has been a decline in average sleep duration and quality,” stated Charles Czeisler, PhD, MD, FRCP, chief, BWH Division of Sleep and Circadian Disorders. “Since more people are choosing electronic devices for reading, communication and entertainment, particularly children and adolescents who already experience significant sleep loss, epidemiological research evaluating the long-term consequences of these devices on health and safety is urgently needed.”

My Take: These findings are important and should be considered, given recent evidence linking chronic suppression of melatonin secretion by nocturnal light exposure with the increased risk of breast cancer, colorectal cancer and prostate cancer. I’m Dr. Michael Hunter, and I no longer use any blue light-emitting devices in the hour before bedtime.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Journal References

  • Anne-Marie Chang, Daniel Aeschbach, Jeanne F. Duffy, and Charles A. Czeisler. Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS, December 22, 2014 DOI: 10.1073/pnas.1418490112
  • Brigham and Women’s Hospital (Harvard). “Light-emitting e-readers before bedtime can adversely impact sleep.” ScienceDaily. ScienceDaily, 22 December 2014. <www.sciencedaily.com/releases/2014/12/141222131348.htm>.

The Pill Linked to Breast Cancer Risk

What You Need to Know

  • Recent use of some oral contraceptives is associated with an increased risk of breast cancer.
  • Risk varies with formulation of the contraceptives, and those with low-dose estrogen were not associated with cancer.

The Study:  In a nested case-control study, women (ages 20-49) who had used birth control pills within the previous year had a 1.5x increase in the risk of disease, compared with those who had never or formerly used the drugs, according to Elisabeth Beaber, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues.

But the risk varied with formulation of the contraceptives; some types — notably those with low-dose estrogen — were not associated with cancer, Beaber and colleagues reported in the Aug. 1 issue of Cancer Research.

Many women ask about oral contraceptives and breast cancer,” and the benefits and risks need to be clearly understood, commented Holly Pederson, MD, of the Cleveland Clinic.

In women under 50, she told MedPage Today, “their absolute risk of breast cancer is less than 2%.”

But while that risk “raises red flags,” the main concern is not oral contraceptives, she said, but familial and genetic predispositions, such as mutations in the BRCA genes. Those factors, she noted, were not analyzed in the study.

Pederson added that it’s “important to reinforce to our patients that the most commonly used birth control pill — low-dose [estrogen] monophasic — was even in this study not associated with an increased risk.”

The issue is not a new one, Beaber and colleagues noted: a 1996 pooled analysis of more than 150,000 women, a third of them with breast cancer, showed a slight increase in risk associated with oral contraceptives.

Since then, two major studies have reached differing conclusions. The Nurses’ Health Study II found an excess breast cancer risk associated with current oral contraceptive use and with one specific formulation, while the Women’s Contraceptive and Reproductive Experiences Study found no such risks.

But most such studies have relied on participant recall, lacked data on current contraceptive formulations, and didn’t stratify breast cancer risk by estrogen receptor status, they noted.

To help fill the gap, Beaber and colleagues turned to the records of the Group Health Cooperative, an integrated health care delivery system in the Seattle-Puget Sound area.

They obtained information on estrogen receptor status from the Surveillance, Epidemiology, and End Results (SEER) database.

Other findings related to recent use of oral contraceptives included:

  • High-dose estrogen was associated with an odds ratio for cancer of 2.7
  • Ethynodiol diacetate was associated with an odds ratio of 2.
  • Triphasic dosing with an average of 0.75 milligrams of norethindrone was associated with an odds ratio of 3.1
  • Other types, including low-dose estrogen oral contraceptives, were not linked to an increased risk, they reported.

The odds ratio for estrogen receptor–positive disease was 1.7 (with a 95% confidence interval from 1.3 to 2.1), while for estrogen receptor-negative disease it was 1.2, with a 95% confidence interval from 0.8 to 1.8. The difference between the two was not significantly different, Beaber and colleagues reported.

“Our results suggest that use of contemporary oral contraceptives in the past year is associated with an increased breast cancer risk relative to never or former oral contraceptive use,” Beaber said in a statement, adding the risk “may vary by oral contraceptive formulation.”

Beaber cautioned that the results need confirmation and “should be interpreted cautiously.” She noted that breast cancer remains rare in young women and that oral contraceptives have “numerous established health benefits” that need to be considered as well by doctors and patients.

Those benefits include reproductive planning, menses regulation, decreased dysmenorrhea, and decreased risk of benign breast conditions, she and colleagues concluded.

My Take: Fortunately, the overall risk of breast cancer is quite low in this age group, so even though a 1.5x increase seems extraordinarily large (and I would note that the study numbers are remarkably low (at least for women on the pill for over 6 months), it represents only a small increase in absolute risk. And remember, low-dose estrogen pills were not associated with increased risk. I do think that those with a strong family history of breast cancer may wish to proceed with more caution. 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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Primary reference: Beaber E, et al “Recent oral contraceptive use by formulation and Breast cancer risk among women 20 to 49 years of age” Cancer Res 2014; 74; 4078–89.

Secondary reference: http://www.medpagetoday.com/HematologyOncology/BreastCancer/47024

Breast Cancer Risk Increases as Red Meat Intake Increases

Fresh raw beef on cutting board red meat

What You Need to Know: Higher red meat intake in early adulthood might be associated with an increased risk of breast cancer, and women who eat more legumes — such as peas, beans and lentils — poultry, nuts and fish might be at lower risk in later life, suggests a paper.

Background: Studies have suggested no significant association between red meat intake and breast cancer. However, most have been based on diet during midlife and later, and many lines of evidence suggest that some exposures, potentially including dietary factors, may have greater effects on the development of breast cancer during early adulthood.

The Evidence: A team of US researchers investigated the association between dietary protein sources in early adulthood and risk of breast cancer. They analyzed data from 88,803 premenopausal women (aged 26 to 45) taking part in the Nurses’ Health Study II who completed a questionnaire on diet in 1991.

  • Red meat items included unprocessed red meat (beef, pork, or lamb and hamburger) and processed red meat (such as hot dogs, bacon and sausage); poultry included chicken and turkey; fish included tuna, salmon, mackerel, sardines; legumes included beans, lentils and peas; and nuts.
  • Nine categories of intake frequency were recorded from “never or less than once per month” to “six or more per day.”
  • Factors such as age, height, weight, race, family history of breast cancer, history of benign breast disease, smoking, menopausal status, hormone and oral contraceptive use were taken into account. Adolescent food intake was also measured and included foods that were commonly eaten from 1960 to 1980, when these women would have been in high school.

Medical records identified 2,830 cases of breast cancer during 20 years of follow-up. Putting these real life data into a statistical model allowed the researchers to estimate breast cancer risks for women with different diets. They estimated that, for each step-by-step increase in the women’s consumption of red meat, there was a step-by-step increase in the risk of getting breast cancer over the 20 year study period.

Specifically, the statistical model worked out the number of cases of breast cancer during the total years of follow up for all the women in the study (rate/person years).

For example, the model estimated that there would be 493 cases of breast cancer over 306,298 person years among women with the lowest intake of red meat. This compared with 553 cases per 31,169 person years among women with the highest intake.

  • Higher intake of red meat was associated with a 22% increased risk of breast cancer overall. Each additional serving per day of red meat was associated with a 13% increase in risk of breast cancer (12% in premenopausal and 8% in postmenopausal women).
  • In contrast, estimates showed a lower risk of breast cancer in postmenopausal women with higher consumption of poultry. Substituting one serving per day of poultry for one serving per day of red meat was associated with a 17% lower risk of breast cancer overall and a 24% lower risk of postmenopausal breast cancer.
  • Furthermore, substituting one serving per day of combined legumes, nuts, poultry, and fish for one serving per day of red meat was associated with a 14% lower risk of breast cancer overall and premenopausal breast cancer.

The authors conclude that higher red meat intake in early adulthood “may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer.” Further study of the relation between diet in early adulthood and risk of breast cancer is needed, they add.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References:

  • M. S. Farvid, E. Cho, W. Y. Chen, A. H. Eliassen, W. C. Willett. Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study. BMJ, 2014; 348 (jun10 3): g3437 DOI: 10.1136/bmj.g3437
  • BMJ-British Medical Journal. “Estimated risk of breast cancer increases as red meat intake increases, study suggests.” ScienceDaily. ScienceDaily, 10 June 2014. <www.sciencedaily.com/releases/2014/06/140610205257.htm>.

Sleep Patterns and Cancer: New Evidence

woman sleeping

I recently enjoyed a short essay by Cary Peasant, and want to share it with you.

Sleep disorders are common in both men and women. The body needs adequate sleep. Recent evidence shows the value of sleep to the body is to clean out waste molecules in the brain, allowing us to function better. This observation was even listed in Science as one of the most important scientific observations of 2013.

I found recent basic science and referenced clinical studies very important. Hakim and coworkers (Cancer Research 2014, volume 74, page 1329) studied mice which had experimental tumors TC-1 or 3LLC. If the mice were subjected to sleep disruption (using a mechanical sweeper during daylight hours to fragment the sleep patterns of the mice), the cancers grew faster and became larger. Also, these tumors in sleep deprived mice were more invasive into normal muscle and subcutaneous tissues of the mice. The reason for the accelerated cancer growth and invasiveness was increased tumor macrophages. The authors identified the TLR4, MYD88 and TRIG pathways to be controlling the macrophages, which may prompt new cancer treatments if pathway modulating drugs can be developed.

But are sleep disorders associated with cancers in people? Yes , and more than you might think. Short sleep duration increased the incidence of breast cancer (S. Pinheiro, Cancer Res 2006; 66: 5521). Since colon polyps are more frequent in patients with sleep disorders (C. Thompson, Cancer 2011; 117: 841), it is not surprising that colon cancer is also more frequent (L Jiao and coworkers, Br J Cancer 2013; 108: 213). Even liver cancer is increased in sleep deprived J. Liang, Sleep Med 2012; 13; 869).

I suggest that this basic and clinical data should prompt us to review sleep patterns in our patients and if they are deficient, to refer those patients to sleep specialists for evaluation and treatment. This should be associated with reduction of fatigue and sleepiness, as well as possible improving tumor control.

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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: http://boards.medscape.com/forums/?128@@.2a5c927d!comment=1

Hormone Replacement Therapy, Genetic Changes, and Breast Cancer

hormone magnifying glass estrogen

What You Need to Know: Hormone replacement therapy – for women struggling with symptoms related to menopause – has been linked to an increased risk of breast cancer. But, does this mean that all forms of hormones confer an equal risk? The answer may be no.

Researchers have measured activity of genes associated with breast cancer in women before and while, they took different types of hormone replacement therapy (HRT). They found that an HRT used in the famous Women’s Health Initiative (WHI) trial had a greater activating effect on these genes than a “natural” formulation applied via an estrogen gel applied to the skin in combination with oral progesterone. This shows that varying the HRT and the way it is taken can have very significant effects on the genes associated with breast cancer.

What’s New? The type of HRT a woman takes, and the way it is taken, can have a significantly different effect on genes associated with breast cancer. This finding opens the way to identify which forms of HRT have minimal effect on breast cancer. It also gives the long-term possibility of personalising HRT according to the genes which a woman expresses.

Background: Since the publication of the Women’s Health Initiative report on HRT in 2002, many women have been worried about the effect of HRT on breast cancer. The International Menopause Society states that the increase in breast cancer is small, but that recommends that HRT be individually prescribed, depending on a woman’s family and medical history. However, at a deeper level the problem has been; how do we know what HRT actually does to the breast at a genetic level?

The Evidence: For the study, researchers from the Karolinska Institutet in Sweden, recruited a group of 30 healthy women, and took two samples of breast tissue from each, using a needle biopsy. Each tissue sample was then tested to measure the activity of 16 genes known to be associated with a greater risk of breast cancer. The women were then divided into two groups, and given HRT for 2 cycles of 28 days.

15 women took oral HRT, using CEE/MPA (this is a synthetic conjugated equine estrogen, plus medroxyprogesterone acetate, which was used in the WHI trial). The other 15 were given E2/P, which is estradiol gel plus oral micronised progesterone. Estradiol is a type of estrogen found in the body, so can be considered more “natural” than the CEE/MPA formulation. The estrogen (E2) was applied to the skin in a gel. The progesterone was micronised (i.e. put into very small particles) and taken orally.

At the end of the HRT cycles, the women then underwent the second breast biopsy. As lead researcher, Professor Gunnar Soderqvist said: “30 patients is quite a high number of patients for this type of analysis. The assessment of all genes both before and during treatment for the change in gene expression means that each woman was her own control, which adds to the strength of the study.”

Results: The researchers used PCR analysis to confirm that the CEE/MPA HRT changed the expression of 8 out of 16 genes (50%), whereas only 4 out of 16 genes (25%) were expressed differently in women taking the E2/P HRT. This difference was shown to be highly statistically significant.

What does this mean? Professor Gunnar Soderqvist continued: “Until now, it has not been possible to assess breast gene regulation in healthy women in vivo. This is the first study ever describing effects in healthy women during these HRT treatments and shows very important differences mostly in favour of “natural” treatment with the gel containing estradiol/ oral micronised progesterone when compared with “synthetic “oral CEE/MPA.

The study does not show that either HRT formulation “causes cancer,” but it does show that the type of HRT and perhaps the route of administration will cause differences in genes associated with breast cancer. We can conclude by saying that natural treatment with the estrogen gel and oral progesterone affects gene regulation and surrogate markers for breast cancer risk (such as mammographic density and breast cell proliferation) considerably less than the conventional synthetic treatment which stopped the WHI study.”

Incoming International Menopause Society President, Professor Rod Baber (Sydney) said: “This very important study show that use of HRT combining a transdermal estradiol preparation with oral micronised progesterone causes significantly less expression of genes associated with breast cell proliferation and breast cancer than the more traditional HRT combination of conjugated estrogens plus medroxyprogesterone.

The basic science from this study supports the evidence we have from clinical trials such as the French E3N trial, which shows that the choice so estrogen and progestogen and the mode of delivery is important in reducing any risk of breast cancer possibly associated with long term HRT.

My personal rule is this: Don’t use HRT to reduce your risk of heart attack, stroke, or dementia. If you need HRT to deal with symptoms such as severe hot flashes (and relatively non-toxic interventions such as acupuncture don’t work), choose the lowest dose of HRT that helps, and use it for as short a time as needed. 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.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: International Menopause Society. “For the first time, proof of what hormone replacement therapy does to genes involved in breast cancer.” ScienceDaily. ScienceDaily, 2 May 2014. <www.sciencedaily.com/releases/2014/05/140502172035.htm>.