Saturday, July 25, 2009

Coronary Artery CT Scans & Cancer Risk


Health Report:

Coronary Artery CT Scans & Cancer Risk





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



Photo of Dr. Wascher



By, Robert A. Wascher, MD, FACS


Updated: 07/26/2009






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.






CORONARY ARTERY CT SCANS & CANCER RISK


It has been estimated by experts that up to 2 percent of all cancer cases are caused by exposure to medical x-ray tests. Although it is believed that there is no completely safe level of exposure to x-rays, it is well known that exposure to increasing doses of x-rays, as well as undergoing repeated x-ray examinations, increases the risk of cancer formation.


The increasing use of CT scanners (which can expose patients to significant doses of radiation) to screen asymptomatic patients for coronary artery disease has been a source of growing concern among many cancer experts. While the detection of coronary artery calcifications and coronary artery narrowing (stenosis) on multi-detector CT scanners are powerful predictors of future cardiac disease events, it remains unclear, at this time, whether or not this approach to coronary artery disease screening offers any significant clinical benefits to otherwise asymptomatic patients.


A newly published clinical research study, which appears in the current issue of the Annals of Internal Medicine, further quantifies the potential cancer risk associated with the use CT scans to screen for coronary artery disease.


Because there are no nationally standardized protocols for CT scan cardiac screening examinations, the authors of this study considered several commonly used CT scan protocols, and then calculated the actual dose of radiation delivered to patients with each of these scan protocols. Using long-term data derived from Japanese atomic bomb survivors, the researchers then estimated the added cancer risk to patients receiving coronary artery screening CT scans.


One important (and concerning) finding from this study is that radiation doses delivered to patients vary by more than 10-fold among the different CT scan protocols in common use throughout the United States.


Based upon existing screening recommendations, the authors calculated the added cancer risk associated with adult patients undergoing coronary artery screening CT scans every 5 years between the ages of 45 and 75 years for men, and every 5 years between the ages of 55 and 75 years for women. Using the very conservative assumption that all patients are exposed to a dose of radiation equivalent to the average of all commonly used CT scan protocols, the authors calculated that the lifetime increased incidence of cancer was 4.2 new cases of cancer per 10,000 men, and 6.2 new cases of cancer per 10,000 women. Based upon the known effects of radiation to the organs contained in the chest area, approximately 71 percent of the cancer cases caused by CT scans of the heart would be in the form of lung cancer, while 20 percent of these “excess” cancers would be breast cancers induced in women. Another 12 percent of these radiation-induced cancers would be in the form of leukemia in men, while 4 percent of these otherwise preventable cancers would manifest as leukemia in women.


Unfortunately, there is currently no scientific consensus regarding the clinical benefit, if any, of using CT scanners to detect coronary artery disease in asymptomatic patients, as there is no high level clinical research data available to prove that this screening approach reduces cardiac disease events, or cardiac-associated deaths. Therefore, all that can be confidently said, at this time, about the routine use of CT scans to screen for coronary artery disease is that it is, undoubtedly, associated with a small but not insignificant risk of otherwise preventable cancers. Moreover, when you consider that the authors of this study used very conservative estimates regarding absorbed radiation doses in patients undergoing coronary artery screening, the actual cancer risk associated with many of cardiac screening CT scan protocols in current use is probably significantly higher than what this study predicts.


In my own case, I underwent two separate CT scans, to assess for both coronary artery calcifications and coronary artery narrowing (stenosis), as part of a “VIP Physical” in 2006. At the time, there was great enthusiasm for the routine use of CT scanners for this purpose. However, based upon the available data (including the data from this study), I have recently decided that I will not undergo any additional heart screening CT scans until and unless compelling clinical data comes along to suggest that the benefit from such scans outweighs their potential risks. If you have been considering undergoing a routine cardiac screening CT scan, my advice is to first discuss the data contained in this clinical study with your Internist or Cardiologist, and ask them to clarify both the potential risks and benefits, in your particular case, of undergoing a coronary artery screening CT scan.


Meanwhile more research is needed to clarify what, if any, health benefits can be reasonably claimed for routine coronary artery screening CT scans in asymptomatic patients. Finally, in view of the immense variation in radiation doses associated with the various CT scanning protocols in common use today, professional radiology societies and boards should quickly work to reach a consensus on standardizing these protocols in such a way that unnecessary radiation exposure is minimized.








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







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







'


(Anticipated Publication Date: March 2010)



Link to TV36 Interview with Dr. Wascher


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









Send your feedback to Dr. Wascher at:


rwascher@doctorwascher.net







Dr. Wascher's Biography







Links to Other Health & Wellness Sites







http://doctorwascher.com/






Copyright 2009



Robert A. Wascher, MD, FACS



All rights reserved






Dr. Wascher's Archives:


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


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


7-5-2009: Prostate Cancer & Green Tea


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


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


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


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


5-31-2009: Diet and Prostate Cancer Risk


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


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


5-10-2009: Hemorrhoids & Surgery


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


10-26-2008: Smoking & Quality of Life


10-19-2008: Agent Orange & Prostate Cancer


10-12-2008: Pomegranate Juice & Prostate Cancer


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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







Sunday, July 19, 2009

Hormone Replacement Therapy (HRT) & Ovarian Cancer



Health Report:


Hormone Replacement Therapy (HRT) & Ovarian Cancer







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



Photo of Dr. Wascher


By, Robert A. Wascher, MD, FACS


Updated: 07/19/2009






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) & OVARIAN CANCER

By now, regular readers of this column already know that combination hormone replacement therapy (HRT) drugs, which have been taken by millions of postmenopausal women since World War II, have been unequivocally linked to a significant increase in the risk of breast cancer and heart disease (see my other columns on this topic, if you are not yet aware of these findings from the seminal Women’s Health Initiative Study). Now, a new prospective public health study from Denmark, which has just been published in the Journal of the American Medical Association, strongly suggests that the risk of ovarian cancer may also be significantly increased by chronic HRT use.


In this newly published study, all Danish women between the ages of 50 and 79 years were followed between 1995 and 2005, using prospective public health databases. Altogether, a whopping 909,946 women were included in this study’s analysis.


After an average follow-up duration of 8 years, 3,068 new cases of ovarian cancer were diagnosed. Using a national pharmacy registry, the researchers conducting this study were able to review all of the medications previously and currently taken by the nearly 1 million women who were included in this public health study.


When compared to women who had never used HRT, current users of HRT experienced a 38 percent increase in the incidence of ovarian cancer. Among women who had previously used HRT, the risk of developing ovarian cancer decreased with each passing year after discontinuing HRT. Within two years of discontinuing HRT, the risk of developing ovarian cancer had returned to the same level that was observed among women in the general population who had never used HRT. Interestingly, unlike the current data linking combination HRT with breast cancer, the increased risk of developing ovarian cancer with HRT use was associated with both combination HRT and with estrogen-only HRT.


Ovarian cancer is a relatively rare form of cancer, with approximately 22,000 cases diagnosed each year in the United States. Therefore, ovarian cancer accounts for fewer that 1.5 percent of all diagnosed cancers, overall, and approximately 3 percent of all cancers occurring in women. However, ovarian cancer is a fairly lethal disease, with a nearly 70 percent mortality rate based upon 2009 statistics from the American Cancer Society. Thus, even a relatively modest increase in the risk of developing ovarian cancer translates into a potentially significant number of deaths from this disease. (The authors of this study calculated that one woman would go on to develop a preventable case of ovarian cancer for every year of HRT taken within a group of 8,330 women.) When the researchers applied these findings to the incidence of ovarian cancer in Denmark, they concluded that approximately 5 percent of the total number of cases of ovarian cancer in Denmark could be linked to the use of HRT.


Another finding of particular interest in this study was that the use of estrogen skin patches (transdermal HRT) and vaginal estrogen creams were also associated with a mild increase in the risk of developing ovarian cancer. I point this finding out, as there are advocates of these alternative forms of HRT who claim that they are not associated with any known cancer risk, unlike the more common oral forms of HRT.


Thus, this enormous prospective public health study strongly suggests that HRT use, of any type, is associated with a small but potentially significant increase in the risk of developing ovarian cancer (unlike, I might add, low-dose oral contraceptive medications, which have been linked to a lower risk of developing ovarian cancer). On the other hand, the increased risk of ovarian cancer associated with HRT appears to essentially disappear approximately two years after discontinuation of HRT.


This is not the first clinical research study linking HRT to an increased risk of ovarian cancer, and the findings of this huge study further underscore the potentially adverse effects of HRT on a woman’s health. (Although this was not a randomized placebo-controlled clinical trial, the huge number of patients included in this study adds considerable statistical power to its findings.) Indeed, since the ominous findings of the prematurely terminated Women’s Health Initiative Study were first revealed in 2002, I have counseled my own patients to avoid HRT if at all possible.


(Note: The post-World War II marketing history for HRT is a fascinating but disturbing story of drug company hubris and the collective complicity of much of the mainstream medical profession, and it is a cautionary tale that I will be telling in a new book, due to be published at the end of 2010.)






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




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





'


(Anticipated Publication Date: March 2010)



Link to TV36 Interview with Dr. Wascher


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








Send your feedback to Dr. Wascher at:


rwascher@doctorwascher.net






Dr. Wascher's Biography






Links to Other Health & Wellness Sites






http://doctorwascher.com/







Copyright 2009



Robert A. Wascher, MD, FACS



All rights reserved








Dr. Wascher's Archives:



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


7-5-2009: Prostate Cancer & Green Tea


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


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


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


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


5-31-2009: Diet and Prostate Cancer Risk


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


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


5-10-2009: Hemorrhoids & Surgery


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


10-26-2008: Smoking & Quality of Life


10-19-2008: Agent Orange & Prostate Cancer


10-12-2008: Pomegranate Juice & Prostate Cancer


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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






Dr. Wascher's Home Page





Sunday, July 12, 2009

Breast Cancer & Metformin (Glucophage)



Health Report:



Breast Cancer & Metformin (Glucophage)





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



By, Robert A. Wascher, MD, FACS


Photo of Dr. Wascher


Last Updated: 07/12/2009





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.





Breast Cancer & Metformin (Glucophage)

Patients with diabetes are thought to be at increased risk of developing certain types of cancer, as well as being at an increased risk of developing a recurrence of previously diagnosed cancers. For example, an increased risk of recurrent breast cancer has, specifically, been linked to obesity and diabetes in women. Among other possible explanations, elevated levels of insulin are thought to act as a stimulus for cancer cells to
grow and divide. Other diabetes-associated molecules also appear to cause increased cancer cell proliferation, or growth, including insulin-like growth factor (IGF).

Metformin, also known as Glucophage, has become the most commonly prescribed oral medication for the treatment of diabetes. Previous laboratory and public health studies have suggested that metformin may also be able to suppress cancer cell proliferation, and to reduce the risk of death due to cancer. However, thus far, there has been very little direct clinical research evidence available to support this hypothesis.

A new clinical research study, just published in the Journal of Clinical Oncology, sheds further light on the potential role of metformin as a possible new treatment for breast cancer. In this retrospective clinical study from the M.D. Anderson Cancer Center, the
medical records of 2,529 patients who received chemotherapy as initial treatment
(neoadjuvant chemotherapy) for their early stage breast cancers, between 1990 and 2007, were reviewed. This group of breast cancer patients included 68 diabetic patients who were taking metformin, 87 diabetic patients who were not taking metformin, and
2,374 nondiabetic patients. All 2,529 patients subsequently went on to have surgery for their breast cancers, and the researchers then assessed the response of each woman’s breast cancer to their initial chemotherapy.

A pathological complete response to chemotherapy occurs when the pathologist can no longer find any evidence of residual cancer after surgical removal of the original cancer site. (In general, a pathological complete response to neoadjuvant chemotherapy is associated with a better prognosis.) The incidence of pathological complete response to neoadjuvant chemotherapy was then evaluated in each of the three groups of women involved in this clinical study.

In this study, the diabetic women who were taking metformin were found to have three times the rate of pathological complete response to neoadjuvant chemotherapy when compared to the diabetic women who were not taking metformin (there was no statistically significant difference between the diabetic women taking metformin and the nondiabetic women, although there was still a trend towards improved pathological complete response in the metformin group).

While the retrospective nature of this study, and the relatively small numbers of diabetic women included in the study, significantly limits the conclusions that can be drawn, these results are consistent with other previous research findings. Taken together, this data strongly suggests that metformin may be able to, at a minimum, counteract the
proliferative effects of diabetes on breast cancer cells. This finding raises the question as to whether or not diabetic women who are diagnosed with breast cancer should be routinely placed on metformin as part of their overall cancer treatment program. Since this clinical study also detected a non-significant improvement in pathological complete response rates among diabetic women taking metformin, when compared to nondiabetic women, larger prospective clinical research studies may also help us to understand whether or not metformin might be clinically useful in treating breast cancer in women who do not have diabetes, as well.

Currently, there are several prospective clinical research trials underway, looking at the role of metformin in the management of breast cancer (and at least one such clinical trial for prostate cancer, as well). Hopefully, one or more of these prospective clinical research trials will help us to better understand the role, if any, for metformin as a potential breast cancer therapy in diabetic women (and, perhaps, in nondiabetic women as well). Meanwhile, if you are a breast cancer survivor with diabetes, and you are not taking metformin, you might be well advised to discuss this data with your Oncologist.



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




'


(Anticipated Publication Date: March 2010)




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