Gum Disease and Cancer Risk

dental exam oral cavity white male head and neck oropharynx

New data supports the need to further investigate an association between periodontal disease and cancer risk.

Background: Previous studies have found periodontal disease is a risk factor for breast, oral, and esophageal cancers. Case-control studies have shown a link between tooth loss and the risk for esophagus and stomach cancers.

The Study: Investigators examined periodontal disease information in 65,869 women ages 54 to 86 at 40 centers in the USA. Mean age 68 years. Most were non-Hispanic whites with some college education. Participants answered this question: “Has a dentist or dental hygienist ever told you that you had periodontal or gum disease?”

The Results: This large prospective cohort study shows that postmenopausal women with a history of periodontal disease, including those who have never smoked, are at significantly increased overall risk for cancer as well as site-specific cancers, including lung, breast, esophageal, gall bladder, and melanoma skin cancers.Although periodontal disease and cancer share important risk factors (such as increased risk with increasing age and increased in smokers), this study showed that after adjustment for age, the risk of periodontal disease history and cancer persists regardless of smoking history.

My Take: This study adds to a growing body of evidence from smaller studies that link periodontal disease to total cancer risk. Oral hygiene is important not only in preventing tooth loss, but may have important implications for prevention of systemic diseases, including cancer. I’m Dr. Michael Hunter.

Cancer Epidemiol Biomark Prev. Published online 01 Aug 2017.

Available Today: Your Breast Cancer app on Android (in Search, type Michael Hunter Your Breast Cancer … and voila!)

Curious About Menopause? Read This.

menopause woman sweats hot flashes

Summary: Vasomotor and vaginal symptoms are cardinal symptoms of menopause. Vasomotor symptoms can be particularly troubling to women and are the most commonly reported menopausal symptoms, with a reported prevalence of 50-82% among U.S. women who experience natural menopause (1, 2). The occurrence of vasomotor symptoms increases during the transition to menopause and peaks approximately 1 year after the final menstrual period (3-5).

Today’s New York Times has an interesting take on menopause. Here it is:

In the-better-late-than-never department, the American College of Obstetricians and Gynecologists has revised its guidelines for effective treatment of the symptoms of menopause. Published as a practice bulletin for doctors called “Management of Menopausal Symptoms,” the new guidelines recognize that up to three-fourths of women in the United States experience troublesome side effects when their bodies stop producing estrogen as a result of natural or medically induced menopause. The document addresses the most common distressing consequences: hot flushes and vaginal atrophy.

  • Hot flushes can last for months or even decades, but vaginal problems, if untreated, persist for the remainder of a woman’s life.
  • Hot flushes can cause drenching, sometimes embarrassing sweating, and seriously disrupt sleep night after night. Vaginal atrophy and the loss of lubrication and elasticity can make sexual encounters painful, depress libido and cause irritation and bleeding during exercise.

You might think the standard treatment would be to administer the hormones that menopausal women are losing. Indeed, supplementation with estrogen was a common practice for decades, and not just for curbing menopausal symptoms. Estrogen was widely promoted as a way to protect women’s health and to keep looking and feeling young well into old age.

But in 2002, a large clinical trial called the Women’s Health Initiative found that the most popular form of hormone replacement, a pill that combined estrogen and synthetic progesterone called Prempro, increased a woman’s risk of heart disease, breast cancer, stroke and blood clots .

The highly publicized results tainted hormone therapy with a broad brush. Although the Women’s Health Initiative was designed primarily to test the popular premise that hormone replacement after menopause protected women’s hearts, the unexpected findings prompted millions of middle-aged and older women to stop using the hormones and kept many millions more from starting them. Even though the vast majority of the 16,608 participants in the study were older women well past menopause, the findings were widely interpreted to apply to all women going through menopause, even younger women just approaching the end of their fertile years.

Somewhat frenetic experimentation ensued as physicians, drug companies and women themselves searched for effective alternatives to hormone replacement. Various nonhormonal remedies were promoted, from soy foods and black cohosh to exercise and acupuncture. Each had its advocates, but all lacked rigorous scientific evidence for effectiveness.

Those promoting soy-based foods and supplements, for example, cited the low reported rates of menopausal symptoms among Asian women, whose diets are especially rich in soy, which has estrogenic effects. An authoritative review of placebo-controlled studies of plant-based estrogens, however, found no convincing evidence that they were helpful in curbing menopausal hot flushes. (One exception was genistein, a substance in soy, which the researchers said warranted further study.)

The new bulletin, prepared by Dr. Clarisa R. Gracia, an associate professor of obstetrics and gynecology at the University of Pennsylvania, examines the various claims and scores of studies. It offers treatment recommendations based on the best available evidence for preserving the health and well-being of women experiencing menopausal symptoms.

In an interview, Dr. Gracia acknowledged that “there’s a strong placebo effect” when women try one or another suggested remedy for menopausal distress. She admitted that “it’s all for the better” if an innocuous placebo, like a food or supplement, brings relief to some women.

But most women do best when their physicians offer remedies that have been shown to be effective in well-designed studies. And as you might guess, estrogen alone, or in combination with a natural or synthetic progesterone (progestin) for women who still have a uterus, is the “most effective therapy” for curbing hot flushes, the report found.

  • Data do not support the use of progestin-only medications, testosterone or compounded bioidentical hormones,” the report also said.
  • Estrogen with or without progestin can be administered orally or through the skin with a patch, gel or spray. The transdermal route is considered safer: When absorbed through the skin, the hormones bypass the liver, which would otherwise create substances that might raise the risk of heart attack or cancer.
  • The report emphasizes that treatment with hormones must be individualized and that doctors should prescribe the lowest effective dose for the shortest time needed to relieve hot flushes. But because some women may need hormone therapy to control hot flushes even in their Medicare years, the guidelines recommend “against routine discontinuation of systemic estrogen at age 65.”
  • Hormone replacement can be risky for some women, especially those who have had breast cancer. Alternatives that have proved helpful include low doses of antidepressants known as selective serotonin reuptake inhibitors (S.S.R.I.’s), like Paxil, and serotonin-norepinephrine reuptake inhibitors (S.N.R.I.’s), like Pristiq. Clonidine, a blood pressure medication, and gabapentin, an anticonvulsant, may also be helpful, though neither is approved by the Food and Drug Administration for menopausal treatment.
  • The report found little or no data to support the use of herbal remedies, vitamins, phytoestrogens (like isoflavones, soy and red clover) or acupuncture to relieve hot flushes. It did recommend “common sense lifestyle solutions” like dressing in layers, lowering room temperatures, consuming cool drinks, and avoiding alcohol and caffeine. For overweight and obese women, weight loss can also help.
  • As with hot flushes, vaginal symptoms respond best to estrogen therapy, which can be administered through the mouth or skin or locally via a cream, tablet or ring. Even a low-dose vaginal tablet containing 10 micrograms of estradiol improves symptoms, the report noted.
  • Low-dose vaginal treatments are administered daily for a week or two at first, then once or twice a week indefinitely as maintenance therapy.

Because small amounts of estrogen used vaginally can enter general circulation, women who have had hormone-sensitive breast cancer are advised to try nonhormonal remedies first.

Many women experience relief of symptoms with lubricants and moisturizers prepared with water or silicone. Lubricants, applied just before intercourse, can reduce friction and pain caused by dryness. Moisturizers are used routinely to relieve dryness, itching, irritation and pain, and to improve elasticity.

Last year, the Food and Drug Administration approved Osphena (ospemifene) to treat vaginal atrophy related to menopause. The drug, taken orally once a day, is a selective estrogen receptor modulator that has estrogenlike effects in the vagina. But Osphena, too, can promote endometrial growth. It is not recommended for women who have had breast cancer, and it is not intended for long-term use.

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.

Triple-Negative Breast Cancer: Risk Factors

breast cancer in female body diagram

Breast cancer growth may be driven by the so-called female hormones, estrogen and progesterone, or by HER2. But some breast cancers are not driven by any of these; the ER/PR/HER2 negative cancers are sometimes referred to as “triple negative,” and represent among the most aggressive breast cancers. So why do these cancers occur? What are the risk factors for triple negative breast cancer?

Two of the largest studies to date look at triple-negative breast cancer, and have found some reproductive factors (pregnancy and multiple childbirth), obesity, and lack of physical activity to increase risk.

The Research: Both studies used data from more than 155000 women enrolled in the Women’s Health Initiative. Of the group, 307 developed triple-negative breast cancer after a follow-up of 8 years, and 2610 were found to have estrogen-receptor-positive (ER+) breast cancer.  Let’s look at each of these studies:

  1. In the first study, investigators found that obese women had a 35% higher risk (they were 1.35x more likely) for triple-negative breast cancer, as compared to women with the lowest body mass index (BMI).
  2. In the second study, the number of births affected risk for triple negative breast cancer: Women who had given birth to 3 or more children were at higher risk than women who had given birth to one child (hazard ratio 1.46).

My Take: Triple negative breast cancer appears to be a very different disease, compared to the other breast caner subtypes. While the hormonal changes of pregnancy makes the breast less susceptible to ER-positive breasy cancer, these mechanisms do not reduce the risk for triple-negative disease. The link between pregnancy and increased risk for triple-negative breast cancer may be due to an abnormal response of the breast to pregnancy. Obesity and physical inactivity, on the other hand, might increase risk bu affecting insulin-like growth factors or inflammatory changes in the breast. 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: Cancer Epidemiol Biomarkers Prev. Published online March 1, 2011. Abstract; J Natl Cancer Inst. Published online February 23, 2011. Abstract; Medscape Medical News, 2011 WbeMD LLC.

Height Linked to Cancer Risk – Again

Deja vu all over again.

Among a large prospective cohort of postmenopausal women, investigators found a modest association between height and the risk of cancer (including melanoma, multiple myeloma, and cancers of the thyroid, ovary, colon, rectum, and endometrium.

Dr. Geoffrey Kabat and colleagues (Albert Einstein College of Medicine of Yeshiva University in New York City) looked for a link between height and cancer at 19 body sites among 144,701 women measured at enrollment for the Women’s Health Initiative study. At a median follow-up of 12 years, 20,928 cancers were identified.

For every 10cm increase in height, there was a 13% increase in the risk of developing any cancer, after adjustment for potential confounders such as age, weight, education, smoking habits, alcohol consumption, and hormone therapy.

My take: We have seen this association in several other studies. And we men don’t escape the link (full disclosure: This author is height-challenged). Why might height be linked to an increase in cancer risk? Perhaps improved nutrition in childhood, with more calorie-dense foods and milk – may increase levels of a hormone known as insulin-like growth factor (IGF-1), and with increased linear growth and greater height. IGF-1 promotes cell proliferation, which can contribute to cancer.

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 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: Cancer Epidemiol Biomarkers Prev. Published online 25 July 2013. Abstract.