Articles on Cancer
Monday, January 21st, 2013
A New England Journal of Medicine article casts doubt on the value of screening mammography in preventing death from breast cancer. (Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence, November 22, 2012, pp 1998-2005).
Screening mammography, or mammography performed in the absence of symptoms, has doubled the frequency of detection of early-stage breast cancer, from 112 to 234 cases per 100,000 women each year. However, the rate at which women have presented with advanced breast cancer has only slightly declined, by 8 cases per 100,000 women. This suggests that many of the cancers detected by mammography are not aggressive, and would never lead to symptomatic disease. Detection of these inactive cancers represent overdiagnosis, the discovery of cancers that would not cause illness. The authors estimate that in 2008, breast cancer was overdiagnosed in over 70,000 women, representing 31% of all diagnosed breast cancers. In the last three decades, breast cancer overdiagnosis has affected over one million women.
Wednesday, August 8th, 2012
The US Preventive Services Task Force has recommended against routine PSA screening in men for prostate cancer. The recommendation was based on the conclusion that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Large studies had revealed either no or very small increases in survival from screening in patients followed for over ten years. In a European study, results showed that in men aged 55-69, screening prevented only 7 deaths per 10,000 men followed over 9 years. In older men, screening is even less useful. Moreover, screening often leads to prostate biopsy with negative results, with complications of pain, infection and bleeding. Subsequent elevated PSA readings lead to additional biopsies with further complications. I have seen patients who had three prostate biopsies performed, all negative for cancer.
The incidence of cancer within the prostate is high, and increases with age. A 50 year-old man has about a 50% chance of having cancer in the prostate, while an 80 year-old man has an 80% chance. Many of these cancers, however, are indolent, do not metastasize, and will not cause death if untreated. Unfortunately, we have no easy way of determining early which individuals have aggressive cancer.
How will this recommendation translate into action in the real world? Will patients not want to have a PSA test? Will doctors recommend against it? Will insurance companies refuse to pay for it? Will lawsuits occur when patients who were not screened develop invasive cancer and die? I think it is unlikely that PSA screening will drop into obscurity, especially when it is compared to the ritualistic frequency of mammography screening, which the Task Force has recommended not be initiated until the age of 50, then performed every two years until the age of 75, and discontinued.
Friday, July 13th, 2012
Intravenous vitamin C has a storied past. Not at the time identified as the active therapeutic component, vitamin C in citrus fruits was demonstrated by James Lind in 1747 to prevent scurvy in sailors. Citrus fruit therapy had been inconsistently utilized for 500 years for the same purpose, but was not officially acknowledged and promoted by the British admiralty until 1785, 50 years after Lind’s great experiment. During that interval multitudes of nutritionally deprived seamen suffered and died from a preventable disease Scurvy caused gastrointestinal, skin and mucous membrane bleeding, skin rashes, loss of teeth, fatigue, depression, and poor wound healing. Oranges and limes, high in vitamin C, were the answer.
Linus Pauling, a world famous chemist and beneficiary of two Nobel prizes, began studying vitamin C in 1966, after discussions with Irwin Stone, another researcher. From his work came the recommendation of vitamin C for the common cold, an idea repudiated out of hand by the medical community. He later studied intravenous vitamin C as a treatment for lung cancer, with survival rates months longer than for patients who did not receive vitamin C. (more…)
Thursday, June 21st, 2012
After years of upset, hormone cancellations and denials, now comes more evidence that estrogen replacement therapy does NOT cause breast cancer. Estrogen may even protect against breast cancer. If you find this surprising, read on.
Published in Lancet Oncology, March 7, 2012, the study was an extended, 12-year follow-up of 7,645 women, half of whom had been treated with estrogen for an average of 6 years, the other half with placebo. All of the women had received hysterectomy. Follow-up continued for 6 years after the termination of therapy.
The risk of invasive breast cancer was LOWER (0.27% per year) in women taking estrogen than in women taking placebo, meaning no hormone (0.35% per year). In women who did develop breast cancer, those taking estrogen were less likely to die from it (6 deaths, or 0.009% per year) than women who took placebo (16 deaths, or 0.024% per year). Death from any cause was also lower in the hormone-treated group.
Wednesday, June 6th, 2012
It was found previously that low vitamin D levels increase the risk of developing breast cancer. Recently it has also been found that low vitamin D levels are associated with markers of more aggressive disease and of metastases. (Aggressive Breast Tumors Linked to Vitamin D Deficiency: April 29, 2011, at http://www.urmc.rochester.edu)
Women with vitamin D levels below 32 ng/ml had a higher percentage of hormone negative cancers, known to be more aggressive. They also had a higher Onco Dx score, a genetic test of cancer cells that predicts the likelihood of metastasis.
In other words, higher vitamin D levels not only lessen the chance of getting breast cancer, but will likely also improve survival in those who have breast cancer. (more…)
Wednesday, February 29th, 2012
The American Cancer Society has published extensive lifestyle guidelines for cancer prevention. (CA Cancer J Clin 2012;62:30-67)
There are 572,000 cancer deaths in the United States each year, one third of which are attributable to diet and physical activity habits, mainly overweight and obesity. Fully another third is a result of exposure to tobacco products.
Overweight and obesity are estimated to cause 14% to 20% of cancer-related deaths. The major cancers related to overweight are breast cancer in post-menopausal women, colon and rectal cancer, endometrial, kidney, esophageal and pancreatic cancer. Several other cancers are likely related to overweight, including liver cancer, non-Hodgkins lymphoma, multiple myeloma, cervical, ovarian and prostate cancer.
A minor reduction in caloric intake, only 50-100 calories a day, may be enough to prevent weight gain, and successful weight loss may occur with caloric reduction of 500 calories a day. Foods that aggravate the problem include fried foods, cookies, cakes, candies, and sugar-sweetened beverages. These foods should be replaced with vegetables, fruits, beans and whole grains. Most restaurants offer meals that exceed recommended serving sizes, are high in hidden fats and sugars, and low in vegetables, fruits, beans and whole grains.
The health of children, and of the teenagers and adults they will become, is closely tied to the establishment of healthy behaviors in childhood. Weight gain, poor diets, and physical inactivity during childhood and adolescence increase the later risk of cancer, cardiovascular disease, stroke, diabetes, hypertension and osteoporosis later in life. Overweight young people tend to remain overweight when they become adults.
Tuesday, February 14th, 2012
The first major quantitative study linking cigarette smoking to lung cancer was published in 1928. Forty years later, 50% of adults in the United States were still smoking cigarettes. Today the prevalence is 20% of adults.
How long does it take for important health findings to translate into practice? How long will it take for the known connection between obesity and cancer, obesity and heart disease, obesity and diabetes, obesity and premature death, to have a societal effect?
Much of the reduction in tobacco use results from legal prohibitions, the increasing cost of cigarettes, and the public unacceptability of smoking. However, as once occurred with cigarettes, there are strong forces promoting an obesity-enhancing lifestyle: cheap, tasty and easily available fast food and soft drinks, reduction of physical education in our schools, and ever-present advertising.
We have a long way to go in creating health. So does the rest of the world. There are at the current time 1 billion cigarette smokers. It is estimated that by 2050, if nothing changes, 450 million of them will die as a consequence of smoking cigarettes.
Allan Sosin MD
Tuesday, November 8th, 2011
Two years ago, an elderly woman came to the office with a mass in her right breast. It was a good-sized lump over an inch in diameter, firm and well-demarcated, non-tender, with the feel of a cancer. Mammography confirmed my suspicion, with findings definitive for breast cancer. She refused a biopsy, decided to address it nutritionally with an organic, vegan diet, her own form of positive thinking, and twice weekly injections of mistletoe, an anti-cancer plant product, for which I had referred her to a source.
She returned several months later, and detailed examination revealed no trace of the mass. It had disappeared. At her last visit a few weeks ago breast examination was again completely negative. Blood studies, including a breast cancer marker, were normal. She again declined a mammogram. The cancer seems to be gone, or at least suppressed into a long-term remission.
Conventional therapy for breast cancer is aggressive, always includes radiation after surgery, with chemotherapy added if any lymph nodes are positive. If the cancer is estrogen-receptor positive, some form of hormonal blockade is offered, usually for five years, sometimes longer.
At her advanced age, and with no family responsibilities, this patient felt free to address the cancer in her own way, using alternative approaches, and has been successful, with no toxic, painful or deforming effects of treatment.
Our practice believes that patients should be informed of their options for treatment, including statistics on survival, complications of therapy, and alternative approaches, without efforts to force them in a particular direction. We rely on patients’ intelligence, judgment, and desires to guide them in the right direction. They have the right to change their minds, and change direction, as they see fit.
Allan Sosin MD
Monday, August 16th, 2010
In animal models of ovarian cancer, researchers found that chickens supplemented with flax seed demonstrated a significant reduction in tumor size and severity and enjoyed overall improvements in health and mortality than those that were not supplemented with flax.
Source: Decreased severity of ovarian cancer and increased survival in hens fed a flaxseed-enriched diet for 1 year
Thursday, June 24th, 2010
Adequate vitamin D levels are best achieved by supplements because of the side-effects of UV exposure, says the results of a new computer simulation model from the US.
We can produce vitamin D in our skin on exposure to sunlight, but the merits of getting the supplement via sunlight or supplements is a source of ongoing debate.
In the US, where over 1.5 million people are diagnosed with skin cancer every year, experts are pushing supplements, claiming recommendations for sun exposure are “highly irresponsible”.