Health Report:
Health Differences Between Americans & Europeans
Lycopene & Prostate Cancer
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Last Updated: 02/22/2009
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.
HEALTH DIFFERENCES BETWEEN AMERICANS & EUROPEANS
I have commented before about the striking discordance between the amount of money that we spend on health care in the United States and the health outcomes that we achieve with all of those dollars. At more than $2 trillion dollars per year, or more than $7,000 per citizen per year, the U.S. spends more on health care than virtually every other country in the world. One would, therefore, assume that all of those trillions of health care dollars would translate into a globally unsurpassed level of health and wellbeing in America. However, one would actually be mistaken in this assumption, as the United States lags behind many other countries of the world, including a few relatively underdeveloped countries, in several very important public health benchmarks. As if this were not bad enough, the world’s richest nation has an estimated 47 million uninsured citizens, with millions more possessing utterly inadequate health insurance coverage (millions of us in this country are just one serious illness away from financial ruin).
Health care reform in the United States continues to be a political “third rail,” although virtually all stakeholders are in agreement that our healthcare system is dysfunctional and inefficient, and that it offers the American people very poor value for their money. However, there is considerable disagreement regarding the root causes that underlie the acknowledged deficiencies in our health care system, which means that there is also pervasive disagreement regarding the best interventions to undertake. Amidst the worst economic downturn since the Great Depression, and with no end in sight to the ongoing Not-Quite-As-Great-Depression, it is unclear whether or not the fledgling Obama Administration will be able to assemble the political capital and the will to wade into the treacherous waters of health care reform within the foreseeable future.
A new research study, just published in the American Journal of Public Health, provides a rather stark comparison between the health status of rich and poor adults in the United States and Europe. In this study, more than 17,000 adults between the ages of 50 and 74 years were interviewed from among 10 European countries. Nearly 7,000 Americans of similar age were also interviewed for this study. The researchers assessed these 24,000 middle-aged and elderly adults for 6 chronic illnesses that are commonly accepted as indicators of the overall health of a society.
In general, the American adults reported poorer overall health than their European counterparts. While the differences in health between the two groups of adults were, not surprisingly, more pronounced among poorer patients, even the wealthier Americans reported more problems with their health when compared to wealthy Europeans. At the same time, the gap in health status between rich and poor was much smaller among Europeans than was observed among the American patients who participated in this study. (As a striking example of the health disparities between Americans and Europeans, heart disease, the number one cause of death in most developed countries, was present in 18 percent of Americans, but in only 11 percent of Europeans, in this study.)
This study puts some important numbers on health trends that have become increasingly obvious over the past few decades. When comparing health outcomes between two populations of patients that live in similarly modern, industrialized, and western societies, the United States fares very poorly, indeed.
Our nation’s focus on disease prevention is haphazard and poorly executed, resulting in unacceptably high rates of preventable diseases and disease-related complications. Rather than investing our nation’s wealth in disease prevention and screening programs, we, instead, backload our inefficient and byzantine health care system with trillions of dollars, every year, to treat the complications of diseases that are, in many cases, almost entirely preventable. European countries spend, on average, only 50 to 60 percent as much on health care, per capita, as we do here in the United States, and yet their health outcomes frequently exceed ours in multiple critical areas of public health.
While we may not all agree on every detail, almost all of us agree that our health care system is fundamentally broken, and that we cannot go on with “business as usual” any longer. Despite the ongoing implosion of the economy, we must somehow find the will and the foresight to overhaul our current fractured and wasteful health care system, including a much greater emphasis on promoting healthful lifestyle habits, and improved disease prevention and screening programs. As the average age of our population continues to rise, our ongoing failure to step up to the plate and fix our dysfunctional health care system will, increasingly, cost our nation dearly.
LYCOPENE & PROSTATE CANCER
As regular readers of this column already know, recent research data has been quite unkind to many vitamins and other dietary supplements that were previously thought to have a potential role in disease prevention. While the vitamin and supplements industry remains a multi-billion dollar business, large prospective clinical research trials in recent years have, repeatedly, shown no health benefits from taking vitamin supplements, and in some cases, certain vitamin supplements appear to actually worsen health.
As in so many other cases, laboratory research studies using cancer cells growing in Petrie dishes have previously suggested that lycopene, a member of the Vitamin A family, might be toxic to prostate cancer cells. This, predictably, has spurred tens of thousands of men to take lycopene supplements in hopes of preventing prostate cancer. However, a small new prospective clinical and laboratory research trial, just published in the Journal of Urology, suggests that lycopene may not offer any clinical benefit as a treatment adjunct in men with advanced prostate cancer.
In this small pilot study, 17 adult patients with prostate cancer refractory to other treatments were given 15 milligrams of lycopene per day for 6 months. During the course of this study, both the clinical progression of these patients’ prostate cancers and the level of prostate specific antigen (PSA) in their blood were monitored. Unfortunately, there was no clinically detectable benefit of lycopene on the progression of prostate cancer in these men.
While this was a very small pilot study, with limited statistical power, its results are nonetheless disappointing. Previous studies of lycopene and prostate cancer have largely relied upon so-called “in vitro” research on prostate cancer cells growing in a laboratory dish, or on dietary surveys in epidemiology studies. These are popular methodologies of cancer prevention and treatment research because they are quick and inexpensive to perform. But the vast majority of the findings of these types of lower-level research studies are, unfortunately, never confirmed by high-level prospective, randomized clinical research trials.
Given the very small number of patients enrolled in this pilot trial, and the relatively short duration of follow-up, a larger, placebo-controlled, prospective, randomized clinical trial with lycopene should be undertaken. The men in this small pilot study also had advanced prostate cancer that had become resistant to current treatments, and so it might be helpful to perform a larger clinical trial with men who have intermediate-stage prostate cancer, in the hope that a more modest benefit from lycopene, if it exists, might be identified. For now, however, the clinical evidence remains extremely weak that lycopene has any useful role to play in either the prevention or treatment of prostate cancer (indeed, I stopped taking lycopene, myself, several years ago, when I concluded that the available clinical data did not support its use as a cancer prevention agent).
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
Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net
Dr. Wascher's Biography
Links to Other Health & Wellness Sites
http://doctorwascher.com
Copyright 2009
Robert A. Wascher, MD, FACS
All rights reserved
Dr. Wascher's Archives:
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
Home Page
Saturday, February 21, 2009
Sunday, February 15, 2009
Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
Health Report:
Statin Drugs & Death Rates
Physical Activity, Breast Cancer & Sex Hormones
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Last Updated: 02/15/2009
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.
STATIN DRUGS AND DEATH RATES
As I’ve mentioned in previous columns, the statin class of cholesterol-lowering drugs have revolutionized the treatment of elevated cholesterol levels, and have been shown, by multiple clinical studies, to decrease the incidence of cardiovascular events, including fatal heart attacks (myocardial infarction), in susceptible patients. While their value in reducing non-cardiovascular disease events (such as cancer, for example) continues to be debated, there is no question but that statin drugs can significantly drive down the risk of coronary artery disease in patients with elevated cholesterol levels, as well as in patients with high-normal levels of LDL (the “bad cholesterol”).
A new clinical study assessing statin drugs and death rates has just been published in the Archives of Internal Medicine. Nearly 230,000 adult patients (average age was about 58 years) enrolled in an HMO were retrospectively assessed in this huge public health study, which was performed in Israel; and all of these patients were started on statin medications between 1998 and 2006. Two general groups of patients were included in this study. The first group included patients who were prescribed statin drugs to prevent coronary artery disease, and who had no clinical evidence of coronary artery disease at the time they started receiving statins. The second group consisted of patients who were prescribed statin drugs because they already had been diagnosed with coronary artery disease. In this study, the researchers were able to determine the level of compliance of each patient with their statin medications, based upon the HMO’s pharmacy refill data.
After an average follow-up of about 5 years, the death rates among the compliant and noncompliant patients were then compared. The patients who were at least 90 percent compliant with their statin prescriptions experienced a whopping 45 percent reduction in their risk of death, from any cause, when compared to the patients who were less than 10 percent compliant with their statin medications! Furthermore, this dramatic difference in survival was observed in both the prevention group and in the coronary artery disease group.
The research data also revealed that the greatest reduction in the risk of death was observed in patients with very high baseline LDL levels, and in patients treated with more potent statin drugs. These latter two observations are especially important, because the retrospective nature of this study increases the risk that undetected biases might have influenced the researchers’ conclusions. (For example, patients who were noncompliant with their statin drugs may have also engaged in other risky health behaviors that, independent of not taking their statin drugs, might also have increased their risk of death.)
The 45 percent reduction in all-cause mortality that was associated, in this study, with a greater than 90 percent patient compliance rate with statin prescriptions is significantly greater than has been observed in most prospective randomized clinical research studies, to date. Given the retrospective nature of this study, it is not clear if the much greater mortality benefit of statin drug compliance observed in this study is entirely valid or not, but the enormous population of HMO patients included in this study, and the moderately long duration of their follow-up (albeit retrospective in nature), suggests that this study’s conclusions are probably reasonable.
If you have significant risk factors for coronary artery disease, or if you already have coronary artery disease, and your doctor has prescribed a statin drug for you, then the results of this study suggest that you can markedly reduce your risk of death by taking your medications as prescribed.
PHYSICAL ACTIVITY, BREAST CANCER & SEX HORMONES
There is considerable research evidence showing that regular exercise decreases the risk of several different types of cancer, including breast cancer. In the case of breast cancer, given that 85 to 90 percent of breast cancer cases appear to be linked in some way to exposure to estrogen and progesterone (the “female sex hormones”), most experts have assumed that increased levels of regular physical activity must somehow affect circulating sex hormone levels in the blood, but the research data in this area has been unclear. However, a new clinical research study, published in the journal Cancer Epidemiology Biomarkers & Prevention, now appears to provide evidence of a direct link between exercise and circulating sex hormone levels in the blood.
In this study, more than 800 postmenopausal women who participated in a large European public health study, the EPIC study, were evaluated. Physical activity data for these women was obtained by the use of patient questionnaires, and blood was drawn from all study participants and tested for levels of both female and male sex hormones.
The investigators soon discovered that increasing levels of physical activity resulted in decreasing levels of estrogen in the blood, as well as increased levels of a protein in the blood that binds up circulating sex hormones (sex hormone binding globulin). Furthermore, high levels of physical activity, as occurs with vigorous exercise, also increased blood levels of the male sex hormone dehydroepiandrosterone (DHEA) in these postmenopausal women.
The results of this study offer at least one potential explanation for the inverse relationship between levels of physical activity and breast cancer risk that has been identified in previous clinical studies. Irrespective of the precise mechanism(s) involved, there is ample evidence that 4 to 5 thirty-minute periods of moderate-to-vigorous exercise each week can significantly reduce a woman’s risk of developing breast cancer, and that this exercise-related risk reduction is present irrespective of whether a woman is overweight or not. Also, as we all know, exercise is good for both the heart and mind, 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
Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net
Dr. Wascher's Biography
Links to Other Health & Wellness Sites
http://doctorwascher.com
Copyright 2009
Robert A. Wascher, MD, FACS
All rights reserved
Dr. Wascher's Archives:
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
Home Page
Statin Drugs & Death Rates
Physical Activity, Breast Cancer & Sex Hormones
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Last Updated: 02/15/2009
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.
STATIN DRUGS AND DEATH RATES
As I’ve mentioned in previous columns, the statin class of cholesterol-lowering drugs have revolutionized the treatment of elevated cholesterol levels, and have been shown, by multiple clinical studies, to decrease the incidence of cardiovascular events, including fatal heart attacks (myocardial infarction), in susceptible patients. While their value in reducing non-cardiovascular disease events (such as cancer, for example) continues to be debated, there is no question but that statin drugs can significantly drive down the risk of coronary artery disease in patients with elevated cholesterol levels, as well as in patients with high-normal levels of LDL (the “bad cholesterol”).
A new clinical study assessing statin drugs and death rates has just been published in the Archives of Internal Medicine. Nearly 230,000 adult patients (average age was about 58 years) enrolled in an HMO were retrospectively assessed in this huge public health study, which was performed in Israel; and all of these patients were started on statin medications between 1998 and 2006. Two general groups of patients were included in this study. The first group included patients who were prescribed statin drugs to prevent coronary artery disease, and who had no clinical evidence of coronary artery disease at the time they started receiving statins. The second group consisted of patients who were prescribed statin drugs because they already had been diagnosed with coronary artery disease. In this study, the researchers were able to determine the level of compliance of each patient with their statin medications, based upon the HMO’s pharmacy refill data.
After an average follow-up of about 5 years, the death rates among the compliant and noncompliant patients were then compared. The patients who were at least 90 percent compliant with their statin prescriptions experienced a whopping 45 percent reduction in their risk of death, from any cause, when compared to the patients who were less than 10 percent compliant with their statin medications! Furthermore, this dramatic difference in survival was observed in both the prevention group and in the coronary artery disease group.
The research data also revealed that the greatest reduction in the risk of death was observed in patients with very high baseline LDL levels, and in patients treated with more potent statin drugs. These latter two observations are especially important, because the retrospective nature of this study increases the risk that undetected biases might have influenced the researchers’ conclusions. (For example, patients who were noncompliant with their statin drugs may have also engaged in other risky health behaviors that, independent of not taking their statin drugs, might also have increased their risk of death.)
The 45 percent reduction in all-cause mortality that was associated, in this study, with a greater than 90 percent patient compliance rate with statin prescriptions is significantly greater than has been observed in most prospective randomized clinical research studies, to date. Given the retrospective nature of this study, it is not clear if the much greater mortality benefit of statin drug compliance observed in this study is entirely valid or not, but the enormous population of HMO patients included in this study, and the moderately long duration of their follow-up (albeit retrospective in nature), suggests that this study’s conclusions are probably reasonable.
If you have significant risk factors for coronary artery disease, or if you already have coronary artery disease, and your doctor has prescribed a statin drug for you, then the results of this study suggest that you can markedly reduce your risk of death by taking your medications as prescribed.
PHYSICAL ACTIVITY, BREAST CANCER & SEX HORMONES
There is considerable research evidence showing that regular exercise decreases the risk of several different types of cancer, including breast cancer. In the case of breast cancer, given that 85 to 90 percent of breast cancer cases appear to be linked in some way to exposure to estrogen and progesterone (the “female sex hormones”), most experts have assumed that increased levels of regular physical activity must somehow affect circulating sex hormone levels in the blood, but the research data in this area has been unclear. However, a new clinical research study, published in the journal Cancer Epidemiology Biomarkers & Prevention, now appears to provide evidence of a direct link between exercise and circulating sex hormone levels in the blood.
In this study, more than 800 postmenopausal women who participated in a large European public health study, the EPIC study, were evaluated. Physical activity data for these women was obtained by the use of patient questionnaires, and blood was drawn from all study participants and tested for levels of both female and male sex hormones.
The investigators soon discovered that increasing levels of physical activity resulted in decreasing levels of estrogen in the blood, as well as increased levels of a protein in the blood that binds up circulating sex hormones (sex hormone binding globulin). Furthermore, high levels of physical activity, as occurs with vigorous exercise, also increased blood levels of the male sex hormone dehydroepiandrosterone (DHEA) in these postmenopausal women.
The results of this study offer at least one potential explanation for the inverse relationship between levels of physical activity and breast cancer risk that has been identified in previous clinical studies. Irrespective of the precise mechanism(s) involved, there is ample evidence that 4 to 5 thirty-minute periods of moderate-to-vigorous exercise each week can significantly reduce a woman’s risk of developing breast cancer, and that this exercise-related risk reduction is present irrespective of whether a woman is overweight or not. Also, as we all know, exercise is good for both the heart and mind, 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
Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net
Dr. Wascher's Biography
Links to Other Health & Wellness Sites
http://doctorwascher.com
Copyright 2009
Robert A. Wascher, MD, FACS
All rights reserved
Dr. Wascher's Archives:
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
Home Page
Sunday, February 8, 2009
Health Report:
Hormone Replacement Therapy (HRT) & Breast Cancer
Stool DNA Testing & Cancer of the Colon & Rectum
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Last Updated: 02/08/2009
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.
HORMONE REPLACEMENT THERAPY (HRT) & BREAST CANCER
Hormone replacement therapy (HRT) came of age during the sexual revolution in the United States in the 1960s. During this revolution, premenopausal women not only finally gained control over their reproductive systems with the advent of oral contraceptives, but postmenopausal women could also effectively alleviate the symptoms of menopause by taking HRT pills. However, despite a recent avalanche of clinical research data linking the most commonly prescribed form of HRT with an increased risk of breast cancer, diehard supporters of HRT continue to cling to alternative explanations for the lock-step rise and fall of breast cancer cases relative to the number of HRT prescriptions filled in the United States (and around the world). While the cloak of obfuscation and overstated benefits that has obscured the risks of HRT finally began to be peeled away with the 2002 publication of the preliminary results of the enormous Women’s Health Initiative Study, entrenched proponents of HRT are not going down without a fight. Recently, persistent HRT advocates have attempted to link a modest and recent decrease in the incidence of screening mammograms with the recent and historical decline in the number of breast cancer cases diagnosed in the United States, despite highly compelling research evidence that breast cancer rates are falling as a direct consequence of declining HRT use by women. Now, a new study, just published in the New England Journal of Medicine, substantially adds to the findings of other recent studies in debunking this alternate hypothesis.
In this new study, the Women’s Health Initiative (WHI) study researchers have gone back and reviewed their data on the nearly 17,000 women who volunteered for this pivotal women’s health study (the average duration of follow-up in this prospective, randomized, placebo-controlled study has already exceeded 12 years, rendering it an exceedingly powerful clinical research study). In particular, the significant increase in breast cancer incidence that was observed among the WHI study women who had received HRT pills for an average of almost 6 years was then compared to the subsequent decline in breast cancer rates in this same group of women after the premature termination of the combination HRT portion of the WHI study in 2002.
Among the group of women randomized to receive HRT pills, the incidence of new breast cancer cases after 5.6 years of HRT was almost twice as high as was observed in the “control group” of women that received only placebo pills. However, within two years of discontinuing HRT, following the premature termination of the WHI study in 2002, the breast cancer rate rapidly declined in the original HRT group of women. During this phase of the WHI study, there was no significant difference in the incidence of screening mammograms between the two groups of women. Thus, the incidence of breast cancer rose dramatically over a 5 to 6 year period among women randomized to receive standard combination HRT, and then fell just as dramatically among this same group of women as fewer and fewer women in this group continued to use HRT. As this “experimental group” of women were confirmed to have utilized mammograms to the same degree as the “control group” of women did during this prolonged phase of the WHI study, the potential impact, if any, of declining mammogram rates on the incidence of breast cancer among these nearly 17,000 postmenopausal women is automatically eliminated with respect to the seminal findings of the WHI study.
The history of the dramatic rise of HRT after World War II, and its gradual and still ongoing decline, is a fascinating (and disturbing) story of hubris, bias, and ignorance; as well as the crass commercial exploitation of momentous cultural shifts in the United States (and around much of the world) for financial gain. Look for a new book on this unsettling medical drama from me in the coming year or two.
STOOL DNA TESTING & CANCER OF THE COLON & RECTUM
Depending upon your age and your risk profile for colorectal cancer, you may be advised to undergo colonoscopy every 5 to 10 years. Although there are several available options for colorectal cancer screening, colonoscopy remains the “gold standard” screening test, as it allows for evaluation of the entire colon and rectum. Unlike other methods of screening, colonoscopy also allows physicians to biopsy or remove suspicious lesions identified during the screening examination. Let’s face it, though, undergoing colonoscopy is no picnic. For most people (myself included), the “prep” is the worst part of the experience.
On the day before colonoscopy, powerful purgatives are used to flush out the colon. Although there are several different types of “bowel prep” solutions available, all of them result in some degree of abdominal cramps and nausea, and they all produce the same “end result.” Hours spent sitting on the toilet, with profuse diarrhea throughout the day, make for a miserable day, indeed. At the end of the prep day, most people feel rather spent and hungry from a day of purging and consuming only liquids. In most cases, colonoscopy is performed with intravenous sedation and, fortunately, most patients have little or no recall of the actual procedure.
While thousands of colonoscopies are safely performed every day, colonoscopy is an invasive procedure, and there is a very small (but not completely insignificant) risk of complications, including bleeding and bowel perforation.
Because of the negative aspects of colonoscopy, alternative colorectal cancer screening methods are always being evaluated. “Virtual colonoscopy,” using computed tomography (CT) scans, is still undergoing evaluation, but many experts have already noted that patients still have to purge their colons before CT-colonography, and any polyps or other abnormalities that are detected during CT-colonography will still require that a separate colonoscopy be performed. There is also the issue of being exposed to not inconsequential doses of radiation each time a patient undergoes CT-colonography.
Given the unpleasantness associated with conventional colonoscopy, studying the stool for signs of premalignant or malignant polyps or tumors is an attractive option. In fact, various tests that detect tiny amounts of shed blood in the stool have been used for decades as colorectal cancer screening tests. Unfortunately, fecal occult blood testing is not sensitive or specific enough to rely upon as a single screening method for cancers, or precancerous lesions, of the colon and rectum. (There are multiple non-cancer causes of occult blood loss into the stool, and not all precancerous polyps, or even small colon or rectal cancers, will consistently shed enough blood into the stool to be detected by fecal occult blood testing.)
Recently, a new approach to screening the stool for signs of precancerous and cancerous lesions has been developed. Unlike fecal occult blood testing, which detects a substance in the stool (e.g., traces of blood) that is not specific to cancer, the most recent generation of stool studies detect genetic material specific to malignant or premalignant cells that are also shed into the stool. Of particular interest, currently, are stool DNA studies. In this method of colorectal cancer screening, DNA is extracted from stool samples and, using a powerful DNA amplification test (polymerase chain reaction, or PCR), DNA mutations specific to cancer cells can often be detected. However, these stool DNA tests currently miss about half of all colorectal cancers, and they are largely incapable of detecting the precancerous polyps that can easily be detected and removed during colonoscopy. However, a new study, just published in the journal Gastroenterology, reveals a potentially important advance in stool DNA testing for colorectal cancer screening.
In this new study, PCR was combined with another test known as digital melt curve analysis. Adding digital melt curve analysis further increases the already exquisite sensitivity of PCR in detecting tiny traces of mutated DNA that are shed into the stool by colorectal cancers, and by many premalignant polyps as well. Using this approach in patients already diagnosed with colorectal cancer, and in whom specific cancer-related DNA mutations were known to be present, evidence of tumor DNA was identified in 90 percent of the stool samples that were tested with the new DNA test. In another group of patients known to have precancerous polyps (advanced adenomas) containing a specific cancer-associated DNA mutation called KRAS, this new method of stool DNA testing was able to detect the KRAS mutation in an impressive 75 percent of patients.
The results of this small pilot study are extremely impressive, and will likely lead to a new generation of stool DNA testing that will overcome many of the limitations associated with currently available stool DNA tests. As this study evaluated only a very small number of patients, however, it will be necessary to repeat this study with larger numbers of patients before stool DNA testing can be considered equivalent to screening colonoscopy. Until then, colonoscopy, in my opinion, remains the current gold standard for colorectal cancer screening. Perhaps one day, in the near future, however, colonoscopy will only be reserved for the approximately 20 to 25 percent of patients who have colorectal polyps or other neoplastic lesions (including cancer) at the time of their periodic colorectal cancer screening exams. Fortunately, I have another four years left before I have to repeat my next colonoscopy prep. Perhaps stool DNA testing will be a reasonable colorectal cancer screening alternative for me, and for millions of other patients, by then!
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
Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net
Dr. Wascher's Biography
Links to Other Health & Wellness Sites
http://doctorwascher.com
Copyright 2009
Robert A. Wascher, MD, FACS
All rights reserved
Dr. Wascher's Archives:
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
Home Page
Hormone Replacement Therapy (HRT) & Breast Cancer
Stool DNA Testing & Cancer of the Colon & Rectum
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Last Updated: 02/08/2009
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.
HORMONE REPLACEMENT THERAPY (HRT) & BREAST CANCER
Hormone replacement therapy (HRT) came of age during the sexual revolution in the United States in the 1960s. During this revolution, premenopausal women not only finally gained control over their reproductive systems with the advent of oral contraceptives, but postmenopausal women could also effectively alleviate the symptoms of menopause by taking HRT pills. However, despite a recent avalanche of clinical research data linking the most commonly prescribed form of HRT with an increased risk of breast cancer, diehard supporters of HRT continue to cling to alternative explanations for the lock-step rise and fall of breast cancer cases relative to the number of HRT prescriptions filled in the United States (and around the world). While the cloak of obfuscation and overstated benefits that has obscured the risks of HRT finally began to be peeled away with the 2002 publication of the preliminary results of the enormous Women’s Health Initiative Study, entrenched proponents of HRT are not going down without a fight. Recently, persistent HRT advocates have attempted to link a modest and recent decrease in the incidence of screening mammograms with the recent and historical decline in the number of breast cancer cases diagnosed in the United States, despite highly compelling research evidence that breast cancer rates are falling as a direct consequence of declining HRT use by women. Now, a new study, just published in the New England Journal of Medicine, substantially adds to the findings of other recent studies in debunking this alternate hypothesis.
In this new study, the Women’s Health Initiative (WHI) study researchers have gone back and reviewed their data on the nearly 17,000 women who volunteered for this pivotal women’s health study (the average duration of follow-up in this prospective, randomized, placebo-controlled study has already exceeded 12 years, rendering it an exceedingly powerful clinical research study). In particular, the significant increase in breast cancer incidence that was observed among the WHI study women who had received HRT pills for an average of almost 6 years was then compared to the subsequent decline in breast cancer rates in this same group of women after the premature termination of the combination HRT portion of the WHI study in 2002.
Among the group of women randomized to receive HRT pills, the incidence of new breast cancer cases after 5.6 years of HRT was almost twice as high as was observed in the “control group” of women that received only placebo pills. However, within two years of discontinuing HRT, following the premature termination of the WHI study in 2002, the breast cancer rate rapidly declined in the original HRT group of women. During this phase of the WHI study, there was no significant difference in the incidence of screening mammograms between the two groups of women. Thus, the incidence of breast cancer rose dramatically over a 5 to 6 year period among women randomized to receive standard combination HRT, and then fell just as dramatically among this same group of women as fewer and fewer women in this group continued to use HRT. As this “experimental group” of women were confirmed to have utilized mammograms to the same degree as the “control group” of women did during this prolonged phase of the WHI study, the potential impact, if any, of declining mammogram rates on the incidence of breast cancer among these nearly 17,000 postmenopausal women is automatically eliminated with respect to the seminal findings of the WHI study.
The history of the dramatic rise of HRT after World War II, and its gradual and still ongoing decline, is a fascinating (and disturbing) story of hubris, bias, and ignorance; as well as the crass commercial exploitation of momentous cultural shifts in the United States (and around much of the world) for financial gain. Look for a new book on this unsettling medical drama from me in the coming year or two.
STOOL DNA TESTING & CANCER OF THE COLON & RECTUM
Depending upon your age and your risk profile for colorectal cancer, you may be advised to undergo colonoscopy every 5 to 10 years. Although there are several available options for colorectal cancer screening, colonoscopy remains the “gold standard” screening test, as it allows for evaluation of the entire colon and rectum. Unlike other methods of screening, colonoscopy also allows physicians to biopsy or remove suspicious lesions identified during the screening examination. Let’s face it, though, undergoing colonoscopy is no picnic. For most people (myself included), the “prep” is the worst part of the experience.
On the day before colonoscopy, powerful purgatives are used to flush out the colon. Although there are several different types of “bowel prep” solutions available, all of them result in some degree of abdominal cramps and nausea, and they all produce the same “end result.” Hours spent sitting on the toilet, with profuse diarrhea throughout the day, make for a miserable day, indeed. At the end of the prep day, most people feel rather spent and hungry from a day of purging and consuming only liquids. In most cases, colonoscopy is performed with intravenous sedation and, fortunately, most patients have little or no recall of the actual procedure.
While thousands of colonoscopies are safely performed every day, colonoscopy is an invasive procedure, and there is a very small (but not completely insignificant) risk of complications, including bleeding and bowel perforation.
Because of the negative aspects of colonoscopy, alternative colorectal cancer screening methods are always being evaluated. “Virtual colonoscopy,” using computed tomography (CT) scans, is still undergoing evaluation, but many experts have already noted that patients still have to purge their colons before CT-colonography, and any polyps or other abnormalities that are detected during CT-colonography will still require that a separate colonoscopy be performed. There is also the issue of being exposed to not inconsequential doses of radiation each time a patient undergoes CT-colonography.
Given the unpleasantness associated with conventional colonoscopy, studying the stool for signs of premalignant or malignant polyps or tumors is an attractive option. In fact, various tests that detect tiny amounts of shed blood in the stool have been used for decades as colorectal cancer screening tests. Unfortunately, fecal occult blood testing is not sensitive or specific enough to rely upon as a single screening method for cancers, or precancerous lesions, of the colon and rectum. (There are multiple non-cancer causes of occult blood loss into the stool, and not all precancerous polyps, or even small colon or rectal cancers, will consistently shed enough blood into the stool to be detected by fecal occult blood testing.)
Recently, a new approach to screening the stool for signs of precancerous and cancerous lesions has been developed. Unlike fecal occult blood testing, which detects a substance in the stool (e.g., traces of blood) that is not specific to cancer, the most recent generation of stool studies detect genetic material specific to malignant or premalignant cells that are also shed into the stool. Of particular interest, currently, are stool DNA studies. In this method of colorectal cancer screening, DNA is extracted from stool samples and, using a powerful DNA amplification test (polymerase chain reaction, or PCR), DNA mutations specific to cancer cells can often be detected. However, these stool DNA tests currently miss about half of all colorectal cancers, and they are largely incapable of detecting the precancerous polyps that can easily be detected and removed during colonoscopy. However, a new study, just published in the journal Gastroenterology, reveals a potentially important advance in stool DNA testing for colorectal cancer screening.
In this new study, PCR was combined with another test known as digital melt curve analysis. Adding digital melt curve analysis further increases the already exquisite sensitivity of PCR in detecting tiny traces of mutated DNA that are shed into the stool by colorectal cancers, and by many premalignant polyps as well. Using this approach in patients already diagnosed with colorectal cancer, and in whom specific cancer-related DNA mutations were known to be present, evidence of tumor DNA was identified in 90 percent of the stool samples that were tested with the new DNA test. In another group of patients known to have precancerous polyps (advanced adenomas) containing a specific cancer-associated DNA mutation called KRAS, this new method of stool DNA testing was able to detect the KRAS mutation in an impressive 75 percent of patients.
The results of this small pilot study are extremely impressive, and will likely lead to a new generation of stool DNA testing that will overcome many of the limitations associated with currently available stool DNA tests. As this study evaluated only a very small number of patients, however, it will be necessary to repeat this study with larger numbers of patients before stool DNA testing can be considered equivalent to screening colonoscopy. Until then, colonoscopy, in my opinion, remains the current gold standard for colorectal cancer screening. Perhaps one day, in the near future, however, colonoscopy will only be reserved for the approximately 20 to 25 percent of patients who have colorectal polyps or other neoplastic lesions (including cancer) at the time of their periodic colorectal cancer screening exams. Fortunately, I have another four years left before I have to repeat my next colonoscopy prep. Perhaps stool DNA testing will be a reasonable colorectal cancer screening alternative for me, and for millions of other patients, by then!
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
Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net
Dr. Wascher's Biography
Links to Other Health & Wellness Sites
http://doctorwascher.com
Copyright 2009
Robert A. Wascher, MD, FACS
All rights reserved
Dr. Wascher's Archives:
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
Home Page
Sunday, February 1, 2009
Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
Health Report:
Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding)
Obesity, Weight Loss & Urinary Incontinence
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Last Updated: 02/01/2009
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.
OBESITY AND THE COMPLICATIONS OF DIVERTICULOSIS (DIVERTICULITIS & BLEEDING)
Diverticulosis is an acquired condition that results in the formation of small pouches along the wall of the colon with advancing age. Diverticulosis is known to be much more common among populations that consume western diets, which generally lack significant daily fiber intake. In less developed countries where highly processed and refined foods are not frequently consumed, and where a large percent of the diet is in the form of fresh fruits and vegetables, diverticulosis of the colon is far less common. Most patients with diverticulosis will have no symptoms of this condition. However, there are two potentially life-threatening complications that can occur when diverticulosis is present.
Diverticulosis can result in significant bleeding from the colon within a diverticulum (the small colonic pouch that causes diverticulosis). In severe cases of diverticular bleeding, blood transfusions, and even emergency surgery, may be required (in some cases, radiologists may be able to identify the site of bleeding using angiography, and may also be able to inject material into the offending artery to stop the bleeding).
A second serious complication of diverticulosis is inflammation of a diverticulum, also known as diverticulitis. Mild cases of diverticulosis frequently respond to a 10 to 14 day course of oral antibiotics, while more severe cases of diverticulitis may cause perforation of the colon and abscess formation, or even diffuse peritonitis.
As previously mentioned, a low-fiber diet is thought to be the most important mechanism underlying the formation of diverticuli in the colon (and, most commonly, in the left side of the colon). However, other risk factors may also be involved in the development of diverticulosis, as well as the complications of diverticulosis.
A new prospective clinical study, just published in the journal Gastroenterology, evaluated more than 47,000 adult male physicians between the ages of 40 and 75 years, and followed them for an average of 18 years, making this a very high-powered study. The patient volunteers in this very large prospective clinical study were closely followed through detailed health surveys that were conducted every two years. During these biennial surveys, waste circumference, hip circumference, and body weight were measured and recorded.
In this very large cohort of study volunteers, there were 801 cases of diverticulitis and 383 cases of diverticular bleeding documented during the nearly 20 year duration of this study. After evaluating the resulting clinical data, the researchers found that being obese (BMI ≥ 30 kg/meter-squared) was associated with nearly twice the risk of developing diverticulitis as was observed among men who were of normal weight (BMI ≤ 21 kg/meter-squared). Similarly, the obese men in this enormous study population experienced more than 3 times the risk of diverticular bleeding when compared to the men who were of normal weight.
When the researchers looked at waist-to-hip circumference ratio, the resulting findings were similar. Men with a high waist-to-hip ratio (or, so-called “central obesity”) were approximately twice as likely to develop diverticulitis or diverticular bleeding when compared to men with a very low waist-to-hip ratio. Even simple measurements of waist circumference revealed the same findings, as men with larger waists were found to be about twice as likely to experience diverticular bleeding and diverticulitis when compared to their counterparts with narrower waists.
As if there weren’t already enough reasons to maintain your weight within a healthy range, this huge prospective clinical study strongly suggests that obesity (as measured by BMI, weight, waist-to-hip ratio, or waist circumference) is a significant risk factor for diverticulosis and its two major complications. Although this type of study was not designed to identify the mechanism(s) whereby obesity increases the risk of diverticular complications, it is very likely that the highly-refined, high-energy diets favored by obese people plays an important role in the development of diverticulosis (and its complications) in overweight people.
So, in addition to protecting your cardiovascular system and your joints (as well as reducing your risk of cancer), maintaining a healthy weight, and eating a diet rich in fruits and vegetables and whole grains, will probably do your colon a lot of good as well!
OBESITY, WEIGHT LOSS & URINARY INCONTINENCE
Urinary incontinence is a common affliction, particularly in older women. Urinary incontinence causes varying degrees of unintended urine leakage, especially when coughing or otherwise straining. Patients with urinary incontinence often must wear special water-proof undergarments to contain leaking urine. Hysterectomy and menopause are both well-known risk factors for urinary incontinence, which explains why this condition is much more common in women than in men. Obesity has long been known to increase the risk of developing urinary incontinence as well, most likely as a result of the increased pressures that arise within the abdomen with increasing levels of obesity. However, there has been very little prospective clinical research data available to suggest that losing excess weight can, in turn, reduce the severity of urinary incontinence symptoms in women.
Now, a new study published in the current issue of the New England Journal of Medicine provides compelling evidence that weight loss in overweight and obese women can indeed significantly reduce the severity of bothersome and often embarrassing urinary incontinence symptoms.
In this prospective randomized clinical research study, 338 middle-aged overweight and obese women were randomly assigned to either an intensive 6-month weight loss program (including diet, exercise, and behavior modification) or to a structured weight loss education program. Weekly measurements of body mass index (BMI) and the number of incontinence events were then recorded for all study participants over the course of 6 months.
The women who were assigned to the intensive 6-month weight loss program lost an average of 17 pounds (or about 8 percent of their initial body weight), while the women who were randomized to the weight loss education program only lost an average of about 3 pounds (or 1.6 percent of their initial body weight). Among the women who were assigned to the intensive exercise program, there was an impressive 47 percent reduction in the number of weekly incontinence episodes! However, even the women in the diet education group, despite their rather modest weight loss, appeared to benefit, and experienced a 28 percent decrease in weekly incontinence episodes.
While the significant decline in the number of weekly incontinence episodes reported by the women randomized to diet education classes suggests that there might be a placebo effect, or other factors not directly related to weight loss, involved in the improvements observed in this study, the women who participated in the intensive exercise program, and who lost 8 percent of their initial body weight, experienced a 68 percent greater reduction in the number of incontinence episodes when compared to the “education-only” group of women.
So… keeping one’s weight in a healthy range not only reduces the risk of cardiovascular disease, arthritis, cancer, and both benign and malignant diseases of the colon, but it may also sharply reduce the distressing symptoms of urinary incontinence 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 the Physician-in-Chief for Surgical Oncology at the Kaiser Permanente healthcare system in Orange County, California
Send your feedback to Dr. Wascher at:
rwascher@doctorwascher.net
Links to Other Health & Wellness Sites
Copyright 2009
Robert A. Wascher, MD, FACS
All rights reserved
Dr. Wascher's Archives:
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
Home Page
Subscribe to:
Posts (Atom)
Posts
