Weekly Health Update: August 2009

Sunday, August 30, 2009

Irritable Bowel Syndrome (IBS), Diet & Fiber

Health Report:

Irritable Bowel Syndrome (IBS), Diet & Fiber

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Updated: 08/30/2009

The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.

IRRITABLE BOWEL SYNDROME (IBS), DIET & FIBER

An estimated 10 to 20 percent of the population suffers from a complex of gastrointestinal symptoms that are collectively referred to as irritable bowel syndrome (IBS). Irritable bowel syndrome affects women three times more commonly than men, and has historically been considered a “wastebasket” diagnosis for patients with functional gastrointestinal (GI) complaints when no other specific diagnosis can be found.

While the precise mechanisms underlying IBS are not well understood at this time, various theories have been proposed. These include abnormal responses to infections of the GI tract, abnormal hormonal and neurologic function of the intestines, hypersensitivity to certain types of foods, abnormal motility of the colon, a “hyper-awareness” of bodily functions, and certain psychiatric conditions, in addition to other hypotheses. (It is almost certain, however, that there is more than one cause for IBS.)

There are a variety of symptoms that have been associated with IBS, and the incidence, severity and frequency of each of these symptoms varies considerably from one IBS patient to another. Typically, however, IBS-associated symptoms include bloating, crampy abdominal pain, diarrhea alternating with periods of constipation, and the passage of clear or white mucus from the rectum. In many cases, IBS symptoms are more pronounced after eating, and patients with IBS often experience a powerful urge to move their bowels after meals. IBS symptoms are also more frequent and more severe during times of stress. In women with IBS, these distressing symptoms may become more intense around the time of patients’ menstrual periods. Other symptoms that have been commonly observed in patients with IBS include frequent heartburn, nausea and vomiting.

Because the true causes of IBS are poorly understood, there have been a wide range of treatments recommended for this syndrome. For example, exercise and other stress-reducing activities may be helpful for some IBS sufferers. Giving up tobacco, and reducing or eliminating alcohol consumption may also help to reduce IBS symptoms, while promoting improved overall health at the same time. Keeping a food diary can also help to identify foods that tend to provoke or worsen IBS symptoms in many patients. Finally, dietary fiber supplementation has been almost universally advocated by most IBS experts. Unfortunately, these and other recommended treatments for IBS are often ineffective in reducing the troubling GI symptoms of irritable bowel syndrome for many patients. Moreover, there have been only a handful of small, prospective, randomized clinical research studies, to date, looking at dietary interventions for IBS. Now, a newly published prospective, randomized, placebo-controlled fiber supplement study offers some helpful new clinical data regarding the treatment of IBS, and this data offers some hope for IBS sufferers.

This new clinical study, just published in the British Medical Journal, enrolled 275 adult patients with IBS. Patients were then randomized to one of three different groups within this study. A control group was given rice flour, which is a starch and contains no significant fiber. A second group of patients were given supplements of indigestible (insoluble) fiber in the form of bran. The third group received digestible (soluble) supplementation with psyllium powder (Metamucil). The type of supplement received by each patient wasn’t revealed until the end of the study.

Following 12 weeks of fiber (or placebo) treatment, the participants in this study were reassessed for the severity of their symptoms. Among the three treatment groups in this IBS fiber supplementation study, only supplementation with psyllium significantly improved IBS-related symptoms. When compared to the placebo group, IBS patients who had been randomized to receive psyllium were 22 percent more likely to report improved IBS symptoms. In comparison, there was no statistically significant improvement in IBS symptoms with bran fiber supplementation when compared to placebo, and, in fact, many IBS patients in this group actually dropped out of this clinical study because their IBS symptoms worsened while taking bran fiber supplements.

It should be noted there were two significant limitations of this study. First of all, nearly 40 percent of the patients who volunteered for this trial dropped out prematurely. However, this is a rather common phenomenon in clinical studies where the treatments are unpleasant, or when the response to such treatments is not immediate or dramatic. A second limitation is that, despite the researchers’ efforts to “blind” the patients as to which supplement they were actually receiving, three-fourths of the patients were still able to accurately guess the supplement that they had been randomized to receive. This finding, of course, introduces the possibility of bias in the perceptions and responses of these patients at the conclusion of the study. Moreover, to complicate matters further, and as prior studies have also shown, 35 percent of the control group of patients also reported an improvement in their IBS symptoms with a placebo supplement.

While there are significant limitations inherent in this study, it still represents one of only a very few existing prospective, randomized, placebo-controlled clinical research studies of fiber supplementation as a treatment for IBS. Based upon the findings of this study, despite its limitations, dietary supplementation with soluble (digestible) fiber appears to be a prudent and potentially helpful intervention for patients suffering from IBS-related symptoms; while insoluble (indigestible) fiber supplements, like bran, may actually worsen the symptoms of IBS.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

Dr. Wascher's Biography

Links to Other Health & Wellness Sites

http://doctorwascher.com/

Robert A. Wascher, MD, FACS

Dr. Wascher's Archives:

8-23-2009: Update on Prostate Cancer and Cryotherapy

8-16-2009: Exercise Improves Lymphedema Symptoms in Breast Cancer Survivors

8-9-2009: Breast Cancer Recurrence, Death & Vitamin D

8-2-2009: Honesty, Dishonesty & Brain Function

7-26-2009: Coronary Artery CT Scans & Cancer Risk

7-19-2009: Hormone Replacement Therapy (HRT) & Ovarian Cancer

7-12-2009: Breast Cancer & Metformin (Glucophage)

7-5-2009: Prostate Cancer & Green Tea

6-28-2009: Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

6-21-2009: Red Yeast Rice, Statins & Cholesterol

6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)

6-7-2009: Diet, Soy & Breast Cancer Risk

5-31-2009: Diet and Prostate Cancer Risk

5-24-2009: Diabetes, Glucose Control & Death

5-17-2009: Drug Company Marketing & Physician Prescribing Bias

5-10-2009: Hemorrhoids & Surgery

5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)

4-26-2009: Are We Really Losing the War on Cancer?

4-19-2009: Exercise in Middle Age & Risk of Death

4-12-2009: Can Chronic Stress Harm Your Heart?

4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?

3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease

3-15-2009: Depression, Stress, Anger & Heart Disease

3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children

3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children

2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer

2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones

2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum

2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence

1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?

1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors

1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure

1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood

12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps

12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome

12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival

11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?

11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level

11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008: Smoking & Quality of Life

10-19-2008: Agent Orange & Prostate Cancer

10-12-2008: Pomegranate Juice & Prostate Cancer

10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function

4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)

3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity

3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?

2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium

1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality

12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Dr. Wascher's Home Page

Saturday, August 22, 2009

Update on Prostate Cancer and Cryotherapy

Health Report:

Update on Prostate Cancer and Cryotherapy

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Updated: 08/23/2009

UPDATE ON PROSTATE CANCER AND CRYOTHERAPY

The prostate gland is a walnut-sized gland that is attached to the bottom of the bladder deep in the male pelvis. The prostate gland wraps around the male urethra as it arises from the bladder, and several ducts that run between the prostate gland and the urethra allow the prostatic secretions to be expelled into the urethra at the time of ejaculation. These prostatic secretions, which constitute about 20 percent of the volume of semen, help to create the optimal chemical environment for sperm to thrive and migrate within the female genital tract, thereby enhancing sperm function.

Prostate cancer is the most common non-skin cancer that occurs in men, and the second most common cause of cancer death in men. In 2009, an estimated 192,000 new cases of prostate cancer will be diagnosed, and approximately 27,000 men will die of this disease. Prostate cancer afflicts 1 out of every 6 American men during their lifetimes, and accounts for 25 percent of all cancer diagnoses in men (similar to the percentage of breast cancer cases among all cancer cases diagnosed in women). As with the great majority of breast cancer cases, most prostate cancers appear to be stimulated to grow and spread by sex hormones produced by the gonads (and, specifically, by testosterone and other androgens produced by the testes, and by other tissues in the body).

Almost exactly a year ago, I wrote about the emergence of cryoablation as a treatment for prostate cancer (Cryoablation and Prostate Cancer). Cryoablation uses slender probes to freeze tumors and surrounding normal tissue, and has been proposed as an alternative to surgery or radiation therapy for the treatment of prostate cancer. In July of 2008, I noted that, in most respects, cryoablation appeared to compare favorably with surgery and radiation therapy, although the incidence of impotence appeared to be much higher with cryoablation than with standard prostate cancer treatments. I also noted, at the time, that there was no prospective, randomized clinical research data available with which to make a credible and direct comparison between cryoablation and other more established treatments for prostate cancer. Now, a new prospective, randomized clinical research trial comparing cryoablation with radiation therapy has reported its early results in the journal Cancer.

In this Canadian study, 244 men with newly diagnosed prostate cancer localized to the prostate gland were randomly assigned to undergo either standard external beam radiation treatment or cyroablation. These volunteers with prostate cancer were then followed for 3 years after completing their treatment. Because it is still too early to draw conclusions about cancer recurrence and survival in this group of prostate cancer patients, this preliminary report addresses quality-of-life issues related to these two forms of cancer therapy.

The men who underwent cryoablation reported more difficulties with urination than the men who were treated with radiation early after treatment, although these symptoms resolved over time. The cryotherapy group also reported significantly higher rates of long-term impotence when compared with the men who received radiation therapy. In fact, 3 years after treatment, there was a 13 percent greater incidence of moderate-to-severe sexual dysfunction among the cryotherapy group of men when compared to the radiation therapy group.

The preliminary results of this prospective, randomized clinical research trial suggest that the main long-term quality-of-life difference between cryotherapy and radiation therapy is a significantly greater incidence of long-term sexual dysfunction following cryotherapy.

As I concluded in my last update of cryotherapy for prostate cancer treatment, one year ago, the long-term benefits and risks of this form of treatment are not fully understood at this time, as we lack mature long-term prospective, randomized clinical research data with which to make prudent decisions about this treatment modality. Aside from a higher incidence of sexual dysfunction following cryotherapy, it is still too soon to tell if the long-term survival outcomes with cryotherapy will compare favorably with radiation therapy and surgery. Therefore, for now, I can only recommend cryotherapy for prostate cancer if it is performed within an approved clinical research trial. Stay tuned for further updates on this topic as they become available.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

Dr. Wascher's Biography

Links to Other Health & Wellness Sites

http://doctorwascher.com/

Robert A. Wascher, MD, FACS

Dr. Wascher's Archives:

8-16-2009: Exercise Improves Lymphedema Symptoms in Breast Cancer Survivors

8-9-2009: Breast Cancer Recurrence, Death & Vitamin D

8-2-2009: Honesty, Dishonesty & Brain Function

7-26-2009: Coronary Artery CT Scans & Cancer Risk

7-19-2009: Hormone Replacement Therapy (HRT) & Ovarian Cancer

7-12-2009: Breast Cancer & Metformin (Glucophage)

7-5-2009: Prostate Cancer & Green Tea

6-28-2009: Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

6-21-2009: Red Yeast Rice, Statins & Cholesterol

6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)

6-7-2009: Diet, Soy & Breast Cancer Risk

5-31-2009: Diet and Prostate Cancer Risk

5-24-2009: Diabetes, Glucose Control & Death

5-17-2009: Drug Company Marketing & Physician Prescribing Bias

5-10-2009: Hemorrhoids & Surgery

5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)

4-26-2009: Are We Really Losing the War on Cancer?

4-19-2009: Exercise in Middle Age & Risk of Death

4-12-2009: Can Chronic Stress Harm Your Heart?

4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?

3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease

3-15-2009: Depression, Stress, Anger & Heart Disease

3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children

3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children

2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer

2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones

2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum

2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence

1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?

1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors

1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure

1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood

12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps

12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome

12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival

11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?

11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level

11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008: Smoking & Quality of Life

10-19-2008: Agent Orange & Prostate Cancer

10-12-2008: Pomegranate Juice & Prostate Cancer

10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity

3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?

2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium

1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Dr. Wascher's Home Page

Saturday, August 15, 2009

Exercise Improves Lymphedema Symptoms in Breast Cancer Survivors

Health Report:

Exercise Improves Lymphedema Symptoms in Breast Cancer Survivors

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Updated: 08/16/2009

EXERCISE IMPROVES LYMPHEDEMA SYMPTOMS IN BREAST CANCER SURVIVORS

Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following treatment for breast cancer. When the lymphatic drainage network in the arm has been disrupted by the surgical removal of armpit lymph nodes by the surgeon, or by radiation therapy to the armpit area (or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can result in chronic swelling of the hand and arm. Patients with significant lymphedema of the arm following breast cancer treatment may experience considerable swelling (edema), heaviness, stiffness and discomfort of the affected hand and arm.

Physicians caring for breast cancer patients have traditionally advised against heavy lifting following breast cancer surgery, for fear that doing so might increase arm lymphedema. However, a new prospective randomized clinical research study calls into question the traditional advice against vigorous exercise involving the upper extremities, including lifting weights as a strengthening exercise.

This new study, which appears in the New England Journal of Medicine, included 141 breast cancer survivors with chronic lymphedema. These women were divided into two groups, with a “treatment” group randomized to twice-weekly progressive weight training and a “control” group of women who were randomized to no weight training. All of the women participating in this study were followed for one year, at the end of which the degree of arm lymphedema was reassessed. Of note, all of the women who were randomized to the weight training group were required to wear custom-fitted compression garments when they were lifting weights.

Not surprisingly, the women who participated in regular weight training reported significant improvement in upper and lower body strength during the course of this research study. Moreover, at the end of one year, both the patients and a certified lymphedema specialist reported a significant decrease in the severity and frequency of lymphedema symptoms among the patients who were randomized to the weight-lifting group. At the same time, twice weekly weightlifting sessions had no significant effect on the extent of arm and hand swelling among these women with chronic lymphedema.

The results of this clinical study are good news for breast cancer survivors with chronic lymphedema. Physicians who care for such patients should all be made aware of the results of this research study, and they should begin encouraging their lymphedema patients to engage in regular weight training (provided, of course, that there are no health issues that preclude lifting weights). Not only does regular weight training appear to decrease the severity and frequency of lymphedema symptoms (based upon the findings of this study), but the added health advantages of such training also include increased strength and a decreased risk of osteoporosis as well.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

Dr. Wascher's Biography

Links to Other Health & Wellness Sites

http://doctorwascher.com/

Robert A. Wascher, MD, FACS

Dr. Wascher's Archives:

8-9-2009: Breast Cancer Recurrence, Death & Vitamin D

8-2-2009: Honesty, Dishonesty & Brain Function

7-26-2009: Coronary Artery CT Scans & Cancer Risk

7-19-2009: Hormone Replacement Therapy (HRT) & Ovarian Cancer

7-12-2009: Breast Cancer & Metformin (Glucophage)

7-5-2009: Prostate Cancer & Green Tea

6-28-2009: Air Pollution & the Risk of Deep Venous Thrombosis (DVT)

6-21-2009: Red Yeast Rice, Statins & Cholesterol

6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)

6-7-2009: Diet, Soy & Breast Cancer Risk

5-31-2009: Diet and Prostate Cancer Risk

5-24-2009: Diabetes, Glucose Control & Death

5-17-2009: Drug Company Marketing & Physician Prescribing Bias

5-10-2009: Hemorrhoids & Surgery

5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)

4-26-2009: Are We Really Losing the War on Cancer?

4-19-2009: Exercise in Middle Age & Risk of Death

4-12-2009: Can Chronic Stress Harm Your Heart?

4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?

3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease

3-15-2009: Depression, Stress, Anger & Heart Disease

3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children

3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children

2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer

2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones

2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum

2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence

1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?

1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors

1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure

1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood

12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps

12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection

12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome

12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival

11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk

11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk

11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?

11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level

11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk

10-26-2008: Smoking & Quality of Life

10-19-2008: Agent Orange & Prostate Cancer

10-12-2008: Pomegranate Juice & Prostate Cancer

10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer

9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?

9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?

9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke

8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles

8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration

8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients

7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer

7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer

7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins

6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer

6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer

6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort

6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer

6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut

5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely

5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers

5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease

5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room

4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke

4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention

3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria

3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children

3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer

3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity

3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death

2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis

2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps

2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?

2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer

1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium

1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly

1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer

1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations

12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?

12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease

12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease

12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer

Dr. Wascher's Home Page

Saturday, August 8, 2009

Breast Cancer Recurrence, Death & Vitamin D

Health Report:

Breast Cancer Recurrence, Death & Vitamin D

"A critical weekly review of important new research findings for health-conscious readers..."

By, Robert A. Wascher, MD, FACS

Updated: 08/09/2009

BREAST CANCER RECURRENCE, DEATH & VITAMIN D

Based upon recent clinical research findings, Vitamin D is the only remaining vitamin that may have significant cancer and cardiovascular disease prevention properties. Recent large-scale prospective randomized clinical research trials have not only failed to identify a cancer prevention role (beyond a healthy balanced diet) for Vitamin E, Vitamin C, folate, and beta-carotene (a member of the Vitamin A family) supplements, but data from these trials have strongly suggested an increased risk of adverse health outcomes, at least in some sub-groups of patients, with supplements of several of these vitamins.

Alas, as is typically the case with public health studies, the clinical data regarding Vitamin D is not without inconsistency, and the data on Vitamin D and cancer incidence has not been uniformly positive, either. However, multiple recent epidemiological and prospective clinical research studies have at least suggested that low levels of Vitamin D in our bodies may, in fact, be associated with a higher risk of developing certain cancers (look for a more comprehensive review of the data on Vitamin D and cancer prevention in my forthcoming book, “A Cancer Prevention Guide for the Human Race”). Moreover, decreased blood levels of Vitamin D also appear to be linked to an increased risk of cardiovascular disease as well.

Now, a newly published prospective clinical research trial suggests that decreased levels of Vitamin D in the blood appears to be associated with an increased risk of breast cancer recurrence, and death due to breast cancer, in women previously diagnosed with early stage breast cancer. In this study, which has just been published in the Journal of Clinical Oncology, 512 women with early-stage breast cancer, diagnosed between 1989 and 1996, were prospectively followed for an average of nearly 12 years. Blood was routinely collected from all women following their diagnosis of breast cancer, as a part of this clinical research trial. The women were then closely followed for recurrence of their breast cancer, and for death due to breast cancer and other causes.

As with other similar studies, a surprisingly large number of these otherwise healthy women were discovered to have decreased levels of Vitamin D in their blood. In 38 percent of these women, Vitamin D levels were significantly below normal levels, while another 39 percent of these women had mildly decreased levels of circulating Vitamin D. Among these 512 women, 116 experienced metastatic recurrence of their breast cancer during the course of this prospective clinical study, while 87 women died with evidence of recurrent breast cancer.

The results of this prospective clinical study were rather compelling. The 10-year survival rates for these women with early-stage breast cancer varied significantly according to the level of Vitamin D in their blood. Survival at 10 years following breast cancer diagnosis was 74 percent, 85 percent, and 85 percent for women with significantly deficient, mildly deficient, and normal Vitamin D levels, respectively. Based upon the analysis of all of the data from this study, breast cancer patients with a significant deficiency of Vitamin D were observed to be almost twice as likely (71 percent increased risk) to experience a recurrence of their breast cancer, and they were 60 percent more likely to die, when compared to the patients who had normal levels of Vitamin D in their blood.

Although this clinical study included relatively few patients, it does, nonetheless, raise the possibility that a significant deficiency of Vitamin D may be associated with a worse prognosis in patients with early-stage breast cancer. Another related finding in this study was that very low levels of Vitamin D also appeared to be associated with breast tumors with more aggressive features when examined under the microscope, which is consistent with other studies that have suggested a link between “high grade” breast tumors and decreased blood levels of Vitamin D. At the same time, as I have already mentioned, the available data regarding Vitamin D levels (and the use of Vitamin D supplements) has not been consistent, and other clinical studies have failed to identify a link between Vitamin D and breast cancer risk. There is also some experimental data available suggesting that very high levels of Vitamin D in the blood may also be associated with poorer outcomes in women with breast cancer (similar findings have also been reported for excessive Vitamin D levels and cardiovascular disease outcomes). Taken together, the data from these various studies strongly suggest that there may be a fairly narrow “optimal range” of Vitamin D levels in the blood that are associated with a decreased risk of breast cancer, a decreased risk of breast cancer recurrence (and death), and a decreased risk of cardiovascular disease; and that excessively high or low levels of this vitamin may have adverse health effects in these areas.

The next obvious step is to conduct larger prospective clinical research trials that secretly randomize patient volunteers to receive various doses of Vitamin D, versus placebo (sugar) pills. There are several such studies already underway (or about to start), involving both cancer patients and patients without cancers. However, it will likely take another 10 years for mature data to emerge from these ongoing studies. Meanwhile, my advice is to eat a healthy and well-balanced diet. If you are a breast or prostate or colorectal cancer survivor, or if you have one or more risk factors for these cancers (or for cardiovascular disease), then you may also want to ask your physician to measure the level of active Vitamin D in your blood. If you are significantly deficient in Vitamin D, then your physician might consider the possibility of Vitamin D supplementation in conjunction with careful serial monitoring of your Vitamin D levels.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a widely published author, and a Surgical Oncologist at the Kaiser Permanente healthcare system in Orange County, California

(Anticipated Publication Date: March 2010)

(Click above image for TV36 interview of Dr. Wascher)

Send your feedback to Dr. Wascher at:

rwascher@doctorwascher.net

Dr. Wascher's Biography

Links to Other Health & Wellness Sites

http://doctorwascher.com/

Robert A. Wascher, MD, FACS

Dr. Wascher's Archives:

8-2-2009: Honesty, Dishonesty & Brain Function

7-26-2009: Coronary Artery CT Scans & Cancer Risk

7-19-2009: Hormone Replacement Therapy (HRT) & Ovarian Cancer