Are there lifestyle changes that can help my cancer recovery?

Posted July 03, 2013, 2:00 am

I’m a cancer survivor. Should I be following special guidelines for diet and exercise?

Advances in cancer treatment and earlier detection are allowing more people to live longer after a cancer diagnosis. Today, more than 12 million Americans are cancer survivors. And many of them look to diet and exercise to help prevent cancer recurrence, live longer or just feel better.

Recently, the American Cancer Society (ACS) reviewed and summarized the scientific evidence about the role of diet and exercise for cancer survivors. They found that the same things that prevent cancer from developing in the first place also help keep it from coming back. The ACS published its findings in a report called “Nutrition and Physical Activity Guidelines for Cancer Survivors.”

The ACS found that to reduce the chance of cancer returning and increase the chance of surviving, cancer-free, after a cancer diagnosis, survivors should:

Achieve and maintain a healthy weight;Get enough physical activity (at least 150 minutes per week);Eat a healthy diet that emphasizes vegetables, fruits and whole grains;

The ACS also provided specific advice for survivors of a variety of major cancers. I’ve put a summary of the guidelines below.

The ACS also advised:

Cancer survivors should work with a registered dietitian who has special certification in cancer care. He or she can provide specific, evidence-based advice.Many cancer survivors have trouble taking in enough calories each day. Eating smaller and more frequent meals can help. Or try special fortified or nutrient-dense foods.Use dietary supplements cautiously. Taking more than the recommended daily amounts (RDA) of vitamins and minerals does not improve treatment outcomes or long-term survival. In fact, it can interfere with some cancer treatments. For example, taking a beta-carotene supplement may encourage the growth of lung cancer.Exercise can help fight fatigue, keep you functioning and improve your quality of life. Discuss when to start exercising, and how much, with your doctor.Obesity appears to increase the risk of breast (and possibly other) cancer recurrence. Losing weight and keeping it off can help improve survival.

When some of my patients hear advice like the ACS has given, they are skeptical. To them, cancer is a powerful force, and it seems unlikely that a healthy lifestyle could do much to tame it. I tell them that the advice is supported by large and well-done scientific studies. There is little doubt from those studies, for example, that survivors of breast cancer who are overweight have a worse prognosis than those of normal weight. Or that those who exercise regularly have a better prognosis than those who don’t.

We even are beginning to understand why. A research study was published recently which showed regular exercise leads to hormonal changes that discourage the growth of breast cancer cells. It’s not anecdotal: It’s science.

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Fish Habit May Reduce Breast Cancer Risk, Study Suggests

Researchers found that higher fatty acid intake cut chances of disease by 14 percent

By Kathleen Doheny

HealthDay Reporter

THURSDAY, June 27 (HealthDay News) -- Regularly eating oily fish such as salmon, tuna or sardines may help reduce the risk of breast cancer, a new report suggests.

These fish contain a type of fatty acid known as n-3 polyunsaturated fatty acids (PUFAs).

"Increased n-3 PUFA intake has a protective effect for breast cancer," said researcher Duo Li, a professor of nutrition at Zhejiang University in Hangzhou, China.

Li and his team reviewed 21 different studies that looked at the intake of fish and PUFAs. The previously published research included more than 800,000 women in the United States, Europe and Asia, and 20,000 cases of breast cancer. The follow-up time varied, from four years to 20.

The new report is published online June 27 in the journal BMJ..

Fish include several types of PUFAs that are involved in chemical messaging in the brain, helping to regulate both blood vessel activity and the immune system. The fatty acids also have been linked with other health benefits, such as lower risk of heart problems.

Earlier studies have shown conflicting results about the protective effects of PUFAs that are found in fish and breast cancer risk. So Li decided to pool the results of the 21 studies and reanalyze them.

In his analysis, consumption of most types of PUFAs -- but not fish itself -- was linked with a lower risk. Women with a high intake of PUFAs had a 14 percent reduction in breast cancer risk. For every 0.1-gram-per-day increase in the intake of the fatty acids, there was a 5 percent lower risk of breast cancer, the study found.

So how much fish should you eat? "One to two servings of oily fish per person per week is suggested," Li said.

Li said he can't explain with certainty the association between PUFAs and lowered breast cancer risk. Among other possibilities, he speculated that the fatty acids may help regulate the activities of molecules involved in cell growth and in the spread of cancer cells.

Two U.S. experts who reviewed the new findings saw pros and cons to the report.

Although the number of women studied was large, the link found between fatty acid intake and breast cancer risk reduction "is not necessarily cause-and-effect," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.

Dr. Joanne Mortimer, director of women's cancer programs at the City of Hope Comprehensive Cancer Center in Duarte, Calif., agreed. "My take on this is it may be more than just what they eat" that helps reduce breast cancer risk, she said. "To make an assumption that the lower risk is due entirely to diet may be a false one."

The women with a high intake of PUFAs also may be more apt to exercise and follow other healthy habits, Mortimer said.

Both Mortimer and Bernik cautioned against focusing too much on fish for risk reduction or on eating too much of it. "It's no cure-all," Bernik said. And, if eaten in excess, the mercury content of some fish can be unhealthy, she added.

Besides eating oily fish, Bernik tells patients to exercise regularly, eat plenty of fruits and vegetables, and not smoke to reduce the risk of breast and other cancers.

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FDA Approves New Drug to Fight Advanced Prostate Cancer

Xofigo was fast-tracked for approval and is meant for tumors that have spread to the bones

By EJ Mundell

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- The U.S. Food and Drug Administration announced Wednesday that it has approved a drug to help men with advanced prostate cancer whose disease has spread to the bones.

The drug, Xofigo, is targeted to patients with late-stage, metastatic disease that has spread to the bones but not to other organs, the FDA said in a news release. It is meant for patients who have already undergone surgery and/or drug therapies such as hormone-based treatments.

The FDA said Xofigo was approved more than three months ahead of the original August 2013 deadline the agency had set for a complete review. Instead, the drug was reviewed under the agency's "priority" review program, designated for medicines that appear safe and effective in a context where no good alternative therapy exists.

"Xofigo binds with minerals in the bone to deliver radiation directly to bone tumors, limiting the damage to the surrounding normal tissues," Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, explained in the news release.

In a clinical trial involving more than 800 men with symptomatic prostate cancer that was resistant to hormonal therapy and had spread to the bones, men on Xofigo survived a median of 14 months compared to a little over 11 months for men taking a placebo. Side effects from Xofigo included nausea, diarrhea, vomiting and swelling of the legs and feet. Low levels of red and white blood cells, as well as platelets, were also reported among some patients taking Xofigo, the FDA said.

Pazdur noted that "Xofigo is the second prostate cancer drug approved by the FDA in the past year that demonstrates an ability to extend the survival of men with metastatic prostate cancer." The other drug, Xtandi, was approved by the FDA last August for men with hormone treatment-resistant prostate cancers that have spread or recurred, and who had previously been treated with the drug docetaxel.

According to the American Cancer Society, prostate cancer remains the leading cancer type among men outside of skin cancer, and about one man in every six will develop the illness during his lifetime. Caught early, it is often curable. About 239,000 new cases of prostate cancer are diagnosed among American men each year, and nearly 30,000 men die from the disease annually.

Xofigo is co-marketed in the US by Wayne, N.J.-based Bayer Pharmaceuticals and Algeta US of Cambridge, Mass.

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Cancer Patients May Face Higher Bankruptcy Odds

By Barbara Bronson Gray
HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- People diagnosed with cancer are almost three times more likely to declare bankruptcy than are those without the disease, a large new study suggests.

And younger people with cancer have up to five times higher bankruptcy rates compared to older patients with the disease, the researchers found.

Of almost 200,000 people with cancer in the study based in Washington state, about 2 percent filed for bankruptcy protection after being diagnosed. Of those who were not diagnosed with cancer, 1 percent filed.

Although the risk of bankruptcy for those with cancer is still relatively low, researchers said it is significant.

"Bankruptcy is such an extreme measure of financial distress, and we didn't include the other forms of financial difficulties people encounter," said Catherine Fedorenko, a study co-author and technical project coordinator at the Fred Hutchinson Cancer Research Center, in Seattle.

Whether people suffer substantial debt or have to go so far as to declare bankruptcy, their financial problems are likely to be stressful, said Karma Kreizenbeck, a study co-author and project director at the Hutchinson Institute for Cancer Outcomes Research.

"This paper shows how medical debt associated with a cancer diagnosis could be more likely to lead to a bankruptcy," Kreizenbeck said. "But it could also mean people have to take second jobs, end up with lower credit scores or have to make other decisions."

Celeste Smith, 63, was diagnosed five years ago with breast cancer. A Seattle realtor who was just starting to do well in a new job, she found she had to stop working when she was faced with months of radiation and chemotherapy. Despite the fact that she had health insurance, her mortgage and car payment bills began to mount. "It's a horrible circle trying to get over cancer and deal with all the financial stress," she said. Smith ended up filing for bankruptcy and moving from her foreclosed house to affordable living for seniors.

Researchers have noted before that the financial burden on people with cancer can be substantial. Data from the Medical Expenditure Panel Survey in 2004 showed that 6.5 percent of the $20.1 billion spent on cancer care by those not yet on Medicare each year comes directly from the patients themselves, according to study background information.

A small study presented last year at an American Society of Clinical Oncology meeting showed that four of every five cancer patients and their spouses or caregivers said they had concerns about meeting medical costs and suffered associated financial and mental stress.

The new research, published online May 15 and in the June print issue of Health Affairs, is based on data taken from a registry of people 21 and older who lived in Washington and were diagnosed with cancer from 1995 through 2009. They were compared to a randomly sampled population of people without cancer, matched by age, gender and ZIP code. Cancer cases were identified using a cancer registry based at the Fred Hutchinson Cancer Research Center, part of a U.S. National Cancer Institute epidemiology database.

Key findings of the new study include the following:

Cancer patients were 2.65 times more likely than people without cancer to go bankrupt.Those cancer patients who filed for bankruptcy were more likely to be younger, female and nonwhite than were cancer patients who didn't file. The youngest age groups had up to 10 times the bankruptcy rate compared to the older age groups. The youngest groups in the study were diagnosed at a time when their debt was typically high and their income was not, the study noted. Bankruptcy filings went up as time went by. While the proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, it went up to 1.7 percent after five years. Bankruptcy rates were highest for people with the diagnosis of thyroid and lung cancer, and lowest for melanoma, breast and prostate cancer. The authors suggested that the higher rate of bankruptcy associated with thyroid cancer was likely due to the fact that it affects younger women more often than do other cancers.

The study, based on data from 1995 to 2009, did not take into account the potential impact of the implementation of the Affordable Care Act (ACA) in 2010, an expert pointed out.

"The problem of bankruptcy was one thing the ACA was designed to address," said Peter Cunningham, a senior fellow and director of quantitative research at the Center for Studying Health System Change, in Washington, D.C.

Cunningham expressed concern that the researchers didn't note whether the cancer patients or the control participants had health insurance. "So we don't know how much of a difference having health insurance makes in terms of avoiding bankruptcy," he said. "It would have been nice to see what the impact of health insurance coverage is in being able to prevent bankruptcy and how many people lost their health insurance coverage because of their cancer diagnosis."

What should people do to avoid the stress of money troubles when faced with a serious disease? "The study points to the value of having health insurance," Cunningham said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Catherine Fedorenko, technical project coordinator, Fred Hutchinson Cancer Research Center, Seattle; Karma Kreizenbeck, project director, Hutchinson Institute for Cancer Outcomes Research, Seattle; Peter J. Cunningham, Ph.D., senior fellow and director of quantitative research, Center for Studying Health System Change, Washington, D.C.; Celeste Smith, Seattle; June 2013, Health Affairs

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Fitness in Middle Age May Help Shield Men From Cancer Later

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 16 (HealthDay News) -- Men who are physically fit in middle age have a lower risk of developing and dying from certain cancers, new research indicates.

"Fitness is a huge predictor of [cancer] risk," said Dr. Susan Lakoski, an assistant professor of internal medicine at the University of Vermont, in Burlington. "You need to be fit to protect yourself against a cancer diagnosis in older age."

Men who were fit in their 40s, 50s and 60s were less likely decades later to get lung or colorectal cancer, she found. Those who were fit were also less likely to die from prostate, lung or colorectal cancers.

She is scheduled to present her research, supported by the U.S. National Cancer Institute, on June 2 at the American Society of Clinical Oncology annual meeting in Chicago.

While other studies have found physical activity protects against certain cancers, Lakoski said fewer studies have looked at the importance of fitness to predict whether men would develop or die from cancers.

For the study, Lakoski and her colleagues evaluated more than 17,000 men who had a single cardiovascular fitness assessment as part of a preventive health checkup at the Cooper Clinic, in Dallas, when they were 50, on average.

The men walked on a treadmill under a regimen of changing speed and incline. Their results were categorized into five groups, from lowest fitness level to highest.

Later on, the researchers analyzed Medicare claims data to identify the participants who had developed three common cancers among U.S. men -- lung, colorectal or prostate.

The average follow-up period was 20 to 25 years. During that time, 2,332 men developed prostate cancer, 276 developed colorectal cancer and 277 developed lung cancer.

During the follow up, 769 men died -- 347 of cancer, 159 of heart disease and 263 of other causes.

The men who were most fit on the treadmill test, when compared to the least, had a 68 percent lower risk of lung cancer and a 38 percent lower risk of colorectal cancer. Their prostate cancer risk didn't decline with increasing fitness, but the risk of death from it did.

Even a small improvement in fitness helped, the researchers found. For instance, a 50-year-old man who increased fitness so he could last three more minutes on the treadmill, Lakoski said, could reduce cancer death risk by 14 percent and heart disease death risk by 23 percent.

Low fitness levels increased the risk of cancer and heart disease even in men who weren't obese, the researchers found.

They also took into account other factors that could increase risk, such as age and smoking habits.

The good news, Lakoski said, is that, "You don't have to be highly fit to get protection." The most protection against cancer and heart disease was found in moving out of the least fit group.

And how unfit were those men? The men in the least fit group who were 40 to 49 when they took the test could walk on the treadmill less than 13.5 minutes. Those who were 50 to 59 lasted less than 11 minutes. Those 60 and older in the least fit group only lasted less than 7.5 minutes.

The findings make sense, said Colleen Doyle, director of nutrition and physical activity for the American Cancer Society.

"While you can't tell just how much activity these guys were doing over time, it makes sense that the most fit would have better cancer-related outcomes -- because they are likely the most active." While the new research did not find a link between fitness levels and a diagnosis of prostate cancer, a recent review of other published studies did show a modest reduction in that risk, Doyle said.

Lakoski can't explain the protective effects of fitness for sure, but can speculate. "We know that fitness modulates several important pathways also related to cancer risk," she said. These include, among other pathways, reducing inflammation and oxidative damage in the cells, she said.

Doyle agreed that many mechanisms are probably at work. Activity can improve immune function, for instance, and help control weight, and that in turn can decrease inflammation, she said.

To achieve cardiovascular fitness and reduce cancer risk, be moderately active 150 minutes a week or vigorously active for 75 minutes, or some combination, Doyle advised.

Because this study is being presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Lakoski found a link between fitness and cancer protection, not cause and effect. She also can't say whether the findings would apply to women. She hopes to study that next.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Susan Lakoski, M.D., assistant professor, internal medicine, University of Vermont, Burlington; Colleen Doyle, M.S., R.D., director, nutrition and physical activity, American Cancer Society; June 2, 2013, presentation, American Society of Clinical Oncology annual meeting, Chicago

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Some Types of Skin Cancer Linked to Lower Chances of Alzheimer's

A weak immune response might allow skin cancer but protect brain from inflammation, expert suggests

By Barbara Bronson Gray

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- There's some good news for people who have had certain kinds of skin cancer: A new study suggests that their odds of developing Alzheimer's disease may be significantly lower than it is for others.

People who had non-melanoma skin cancer were nearly 80 percent less likely to develop Alzheimer's disease than people who did not. The association was not found with other types of dementia.

To understand the possible association between skin cancer and Alzheimer's, it is important to know that people have a combination of cells that are multiplying and others that are dying, explained study author Dr. Richard Lipton, a professor of neurology, epidemiology and population health at the Albert Einstein College of Medicine in New York City. The research was published online May 15 in the journal Neurology.

"When cell division gets out of control, we call that cancer. And when specific populations of brain cells die, we call that Alzheimer's," Lipton said. "So, there is a balance between cell division [growth] and cell death. If you have an individual with an increased risk of cell division over cell death, that may be linked to a decreased risk of Alzheimer's."

The finding was intriguing to one expert.

"It's fascinating that we can get clues about what's going on in the brain by looking at the periphery [skin]," said Terrence Town, a professor in the physiology and biophysics department at the Keck School of Medicine at the University of Southern California.

Non-melanoma skin cancer is the most common cancer in the United States; there were more than 2 million new cases in 2012, according to the U.S. National Cancer Institute.

What could be causing the possible association between skin cancer and a reduced risk of Alzheimer's?

"Either developing skin cancer is a marker for some biological process that protects against Alzheimer's or environmental factors may play a role," Lipton said. Genetics could be a factor, as could lots of outdoor physical activity and exercise, although Lipton cautioned people to avoid too much sun exposure and wear sunscreen.

Others think the link may be directly related to how the lowered immune response of skin cells in skin cancer corresponds to a similar immune response in the brain.

"This research is another piece of evidence that tells us that peripheral inflammation [in the skin] is very important in Alzheimer's disease," Town said. He thinks that people who develop non-melanoma skin cancers don't have an immune response in their skin, and thus develop skin cancers, because an immune response may be critical to fighting skin cancer. But that benefits them when it comes to developing Alzheimer's disease.

"This reduced inflammatory response that was permissive to the skin cancer was perhaps beneficial in the brain," said Town.

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Socializing May Ease Pain of Breast Cancer

THURSDAY, May 9 (HealthDay News) -- Having fun with family and friends can help relieve breast cancer patients' pain and improve their quality of life, a new study indicates.

The study included more than 3,100 women in California who were diagnosed with breast cancer between 2006 and 2011. Within about two months of their diagnosis, they completed questionnaires on their social networks, the kinds of support they received, their emotional and physical quality of life, and their physical symptoms from breast cancer.

Women with the largest social networks were most likely to report the best overall quality of life during breast cancer treatment. Higher levels of social support were also linked with better emotional quality of life, according to the Kaiser Permanente researchers.

Having family and friends to do fun things with (positive social interaction) was the most important predictor of good physical quality of life. Patients with little or no positive social interaction were three times more likely to report a low quality of life and more physical symptoms, the investigators found.

The study also found that the benefits of tangible support from others -- such as doing household chores, bringing food or providing transportation to the doctor -- were strongest among women with late-stage breast cancer. Those with low levels of tangible support were nearly three times more likely to have a lower-than-average quality of life.

The study was published May 9 in the journal Breast Cancer Research and Treatment.

"This study provides research-based evidence that social support helps with physical symptoms," study author Candyce Kroenke, a staff scientist with the Kaiser Permanente division of research, said in a Kaiser news release. "Social support mechanisms matter in terms of physical outcomes."

Each year in the United States, about 230,000 women are diagnosed with invasive breast cancer and, in 2012, there were about 2.9 million breast cancer survivors. The fact that more women are being cured of breast cancer increases the importance of quality of life after diagnosis, Kroenke said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Kaiser Permanente, news release, May 8, 2013

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Agent Orange Tied to Lethal Prostate Cancer

Findings from U.S. veterans should raise awareness of chemical warfare's hazards, researcher says

By Robert Preidt

HealthDay Reporter

MONDAY, May 13 (HealthDay News) -- A link exists between exposure to Agent Orange and deadly forms of prostate cancer in U.S. veterans, according to a new study.

Agent Orange was a chemical spray that was heavily used during the Vietnam War era. It was often contaminated with dioxin, a potentially cancer-causing chemical. Previous research suggests that exposure to Agent Orange increases the risk of prostate cancer, but it wasn't known if it specifically increases the risk of more dangerous forms of the disease.

In this study, researchers looked at more than 2,700 U.S. veterans who underwent a prostate biopsy. Prostate cancer was diagnosed in 33 percent of the veterans, including 17 percent with high-grade disease, according to the study, which was published online May 13 in the journal Cancer.

Exposure to Agent Orange was linked with a 52 percent increase in overall prostate cancer risk, a 75 percent increased risk of high-grade prostate cancer and a more than doubled risk of the deadliest forms of the disease.

The findings suggest that determining veterans' exposure to Agent Orange can help identify those who may be at increased risk for prostate cancer, leading to earlier detection and treatment, said Dr. Mark Garzotto, of the Portland Veterans Administration Medical Center and Oregon Health & Science University, and colleagues.

"It also should raise awareness about potential harms of chemical contaminants in biologic agents used in warfare and the risks associated with waste handling and other chemical processes that generate dioxin or dioxin-related compounds," Garzotto said in a journal news release.

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Aspirin's Anti-Colon Cancer Effect May Depend on Genes

Tumors with a key mutation seemed unaffected by daily use of the drug, study found

By Robert Preidt

HealthDay Reporter

TUESDAY, June 25 (HealthDay News) -- Numerous studies have found that daily low-dose aspirin might help shield against colon cancer. But new research suggests that gene mutations found in different colon tumors may influence that relationship.

This study of data from more than 127,000 people in the Nurses' Health Study and the Health Professionals Follow-Up Study in the United States found that the benefits of aspirin used were affected by mutation of a gene called BRAF.

Specifically, regular aspirin use was associated with a lower risk of colorectal cancers characterized by the "typical" form of BRAF, but not with the risk of colon cancers with mutated forms of BRAF.

These findings suggest that BRAF-mutant colon tumor cells may be less sensitive to the effects of aspirin, according to the study in the June 26 issue of the Journal of the American Medical Association.

The researchers also found that taking a higher number of aspirin tablets a week -- more than 14 tablets -- was associated with a lower risk of colorectal cancer with typical BRAF, but this was not seen with BRAF-mutated cancers, according to a journal news release.

The research was led by Reiko Nishihara of the Dana-Farber Cancer Institute in Boston.

Importantly, regular aspirin use after a diagnosis of either type of colorectal cancer did not improve patients' survival, the team said.

"This suggests that the potential protective effect of aspirin may differ by BRAF status in the early phase of tumor evolution before clinical detection but not during later phases of tumor progression," the study authors wrote.

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Cholesterol Drugs Might Boost Kidney Cancer Survival

Study finds statin medications tied to lower death risk after nearly 4 years of follow-up

By Robert Preidt

HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- Cholesterol-lowering statin drugs that are taken by millions of Americans might also improve survival from a type of kidney cancer called renal cell carcinoma, a new study suggests.

Statins -- drugs such as Crestor, Lipitor, Pravachol and Zocor -- have anti-inflammatory and cell self-destruction properties, and previous research has shown that these drugs may lower the risk of developing some types of cancer. The new research, presented Tuesday at the annual meeting of the American Urological Association in San Diego, suggests that the drugs might fight kidney cancer.

"Given that one in four Americans over 45 years of age take a statin and renal cell carcinoma occurs most often in men ages 50 to 70, it may be prudent to prospectively evaluate if statins protect against [cancer] progression," study author Dr. Scott Eggener, an associate professor of urologic oncology at the University of Chicago, said in a meeting press release.

One expert not connected to the study wasn't surprised by the findings.

"The use of statins has shown promise in previous studies with reducing overall cancer-related mortality," said Dr. Michael Palese, an associate professor of urology at the Icahn School of Medicine at Mount Sinai, in New York City. He added that certain characteristics of renal cell carcinomas might render statins "beneficial" for patients.

In the study, Eggener's team reviewed data from more than 900 patients who had surgery for renal cell carcinoma between 1995 and 2010. After an average follow-up period approaching four years, statin use was associated with a reduced risk of cancer progression, the team reported.

Over three years, 10 percent of the patients who took statins died of their cancer, compared with 17 percent of those who did not take this type of drug.

After accounting for other factors, the researchers concluded that statin use was independently associated with both improved overall survival and disease-specific survival.

Another expert said the finding echoes those seen in other studies involving cancer patients.

"Last year in a study published in the New England Journal of Medicine, Danish researchers studied 13 different cancers and found that in all types, the use of statins was associated with longer cancer specific survival," said Dr. Manish Vira, director of the fellowship program in urologic oncology at North Shore-LIJ's Arthur Smith Institute for Urology in Lake Success, N.Y.

But he stressed that the data so far come from observational trials, which can prove an association but not a cause-and-effect relationship between statin use and improved survival.

"Given the current data and known cardiovascular protective effects of statins, certainly it seems prudent to design clinical trials to study the potential of statin therapy in breast, colon, prostate and now kidney cancer treatment," Vira said.

Studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

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Cholesterol Drugs Might Boost Kidney Cancer Survival

TUESDAY, May 7 (HealthDay News) -- Cholesterol-lowering statin drugs that are taken by millions of Americans might also improve survival from a type of kidney cancer called renal cell carcinoma, a new study suggests.

Statins -- drugs such as Crestor, Lipitor, Pravachol and Zocor -- have anti-inflammatory and cell self-destruction properties, and previous research has shown that these drugs may lower the risk of developing some types of cancer. The new research, presented Tuesday at the annual meeting of the American Urological Association in San Diego, suggests that the drugs might fight kidney cancer.

"Given that one in four Americans over 45 years of age take a statin and renal cell carcinoma occurs most often in men ages 50 to 70, it may be prudent to prospectively evaluate if statins protect against [cancer] progression," study author Dr. Scott Eggener, an associate professor of urologic oncology at the University of Chicago, said in a meeting press release.

One expert not connected to the study wasn't surprised by the findings.

"The use of statins has shown promise in previous studies with reducing overall cancer-related mortality," said Dr. Michael Palese, an associate professor of urology at the Icahn School of Medicine at Mount Sinai, in New York City. He added that certain characteristics of renal cell carcinomas might render statins "beneficial" for patients.

In the study, Eggener's team reviewed data from more than 900 patients who had surgery for renal cell carcinoma between 1995 and 2010. After an average follow-up period approaching four years, statin use was associated with a reduced risk of cancer progression, the team reported.

Over three years, 10 percent of the patients who took statins died of their cancer, compared with 17 percent of those who did not take this type of drug.

After accounting for other factors, the researchers concluded that statin use was independently associated with both improved overall survival and disease-specific survival.

Another expert said the finding echoes those seen in other studies involving cancer patients.

"Last year in a study published in the New England Journal of Medicine, Danish researchers studied 13 different cancers and found that in all types, the use of statins was associated with longer cancer specific survival," said Dr. Manish Vira, director of the fellowship program in urologic oncology at North Shore-LIJ's Arthur Smith Institute for Urology in Lake Success, N.Y.

But he stressed that the data so far come from observational trials, which can prove an association but not a cause-and-effect relationship between statin use and improved survival.

"Given the current data and known cardiovascular protective effects of statins, certainly it seems prudent to design clinical trials to study the potential of statin therapy in breast, colon, prostate and now kidney cancer treatment," Vira said.

Studies presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Michael Palese, M.D., associate professor, urology, Icahn School of Medicine at Mount Sinai, New York City; Manish A. Vira, M.D, director, fellowship program in urologic oncology, North Shore-LIJ Arthur Smith Institute for Urology, Lake Success, N.Y.; American Urological Association, news release, May 7, 2013

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Prostate Cancer May Be Deadlier for the Uninsured

Study found they were more likely to have a higher PSA test score, advanced disease and shorter survival

By Kathleen Doheny

HealthDay Reporter

TUESDAY, May 7 (HealthDay News) -- Men who are uninsured or underinsured get advanced prostate cancer at nearly four times the national average and don't survive as long as other men with advanced disease, a new study says.

"We've identified a group of advanced prostate cancer patients who do not do well," said Dr. Jeffrey Reese, a clinical professor (affiliated) at Stanford University School of Medicine. He's also chief of urology at the Santa Clara Valley Medical Center, a county hospital serving a large underinsured population in San Jose, Calif.

"They come in invariably because they [are] having symptoms of metastatic disease," he said, which is when the cancer has spread to other parts of the body.

Of all men diagnosed with prostate cancer at the medical center from 1998 through 2008, Reese found 71 men, or more than 14 percent, had advanced prostate cancer. That's more than three times the national average of 4 percent who have advanced cancer at the time of diagnosis.

Even though the men were offered all available treatments, their five-year survival rate was also well below the national average, Reese found.

He is due to present the findings Tuesday at the annual meeting of the American Urological Association (AUA), in San Diego.

Testing for PSA measures the blood level of PSA, thought to be a key marker for prostate cancer. "A PSA of 4 is sort of the cutoff" before doctors begin doing other tests, Reese said. Some begin testing, such as a biopsy, even sooner, at 2.5 nanograms per milliliter (ng/mL).

In the study, the 71 men with advanced cancer all had prostate specific antigen (PSA) levels above 100 ng/mL. The median PSA in the men was nearly 400.

None of the 71 men -- whose average age was 66 -- had been tested for PSA before at the Santa Clara hospital, and Reese said he suspects most or all had never had a PSA test anywhere.

Under new, less stringent guidelines issued at the meeting, the AUA suggests PSA testing be discussed by men and their doctors, especially those aged 55 to 69, weighing the pros and cons of screening. The association says the best evidence of benefit from screening is among those men aged 55 to 69 screened every two to four years.

Survival of the men in the study was lower than the national average for men with advanced prostate cancer, Reese also found. The median survival was 18 months -- half of the men lived longer -- and less than 10 percent lived three years past the diagnosis.

In comparison, 29 percent of men with advanced disease, overall, live at least five years after diagnosis, Reese said.

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At-Home Drug Errors Common for Kids With Cancer, Research Shows

Study author says parents need more support, better awareness

By Steven Reinberg

HealthDay Reporter

FRIDAY, May 3 (HealthDay News) -- Children with cancer often have complex medication regimens -- sometimes as many as 20 drugs a day -- that they take at home, and mistakes are common, a new study finds.

Errors often occur when parents don't understand how to give the drugs, but mislabeled bottles and wrong prescriptions are also to blame, researchers say.

"Parents of children with cancer make many mistakes giving their children critical medicines, including chemotherapy at home," said lead researcher Dr. Kathleen Walsh, of the departments of pediatrics and medicine at the University of Massachusetts School of Medicine in Worcester.

Injuries were often related to under-dosing pain medication, which was causing pain for the children, she said. "Sometimes parents wouldn't fill prescriptions, or give the proper dose," Walsh said.

"One thing that was surprising was the high rate of errors that go on," she added. "This high rate of errors calls us to remind doctors and parents that they need to be aware that home medication use is fraught with error, so they need to give the medicines exactly as they are told to do."

That's not to blame parents, Walsh noted. "Usually parents weren't aware they were making mistakes. They weren't aware that what they were doing could be dangerous or could decrease the effectiveness of the medications they were using," she said.

Parental "workarounds" to get kids to take medicines could make them less effective.

For example, one child wouldn't take a chemotherapy drug, so the parent sprinkled it on his dinner not realizing the drug doesn't work when taken with food, Walsh said.

"Another parent wasn't using a pill cutter, but using a knife to cut the medication and so the chemotherapy was crumbling and much of it was left on the table," she explained. "Parents didn't realize this was a mistake."

Walsh thinks parents need more support in how they use medications at home. "Parents need to understand you need to give medications exactly as prescribed and if you are going to change that in any way you need to tell the doctor," she said.

The report was published in the May print issue of Pediatrics.

Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, said that "when you are caught in the middle of the chaos and sadness of a sick child, it's not uncommon to see significant mistakes made when [parents are] giving medications to their children."

Many of the parents in the study were college educated, but no matter how well-educated the parents there are still many gaps in understanding how to administer chemotherapy at home, he said.

Lichtenfeld noted that these errors weren't always the parent's fault. "There were discrepancies between the labels on the drug and what the parents were supposed to do," he said. It's possible that the doctor changed the dose, but it was not reflected in the label from the pharmacy. This problem could be solved by better labeling, he added.

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Testicular Cancer on Rise in U.S., Especially Among Hispanic Men

By Kathleen Doheny
HealthDay Reporter

FRIDAY, May 3 (HealthDay News) -- The number of testicular cancer cases continues to climb slowly but steadily in the United States, according to new research.

While the cancer is still most common among white males, the greatest increase is among Hispanic men, according to Dr. Scott Eggener, an associate professor of surgery at the University of Chicago.

Eggener tracked the statistics on testicular cancer from 1992 through 2009, looking at data from a nationwide epidemiology database.

"The incidence of testicular cancer appears to be increasing very slowly but steadily among virtually all groups that we studied," he said. "The novel finding is that the most dramatic increase is in Hispanic men."

Eggener can't explain the increase. He is due to present his findings Monday at the annual meeting of the American Urological Association, in San Diego. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases supported the study.

Testicular cancer is known as a young man's cancer, as half of the cases affect men aged 20 to 34, according to the American Cancer Society. However, older men can also be affected.

This year, the American Cancer Society expects 7,920 new cases of testicular cancer in the United States. About 370 men are expected to die of it.

"It still remains an uncommon cancer," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. He reviewed the new findings. "It's important that we become aware of the situation [of rising numbers of cases], but not become alarmed by it." Hispanic men, he noted, still have a lower rate of the cancer than do white men.

In his study, Eggener found that the incidence of testicular cancer rose from 1992 through 2009. In 1992, for instance, 5.7 of every 100,000 men had testicular cancer. By 2009, that number had risen to 6.8 men for every 100,000.

Hispanic men had the largest annual percentage increase. In 1992, four of every 100,000 Hispanic men were affected. By 2009, it was 6.3 men of every 100,000, the investigators found.

For men affected, the outlook is generally good, experts agreed. "It has the highest survival rate of any solid tumor," Eggener said. The overall five-year survival rate, he noted, is 95 percent or higher.

Symptoms can include a painless lump on a testicle, an enlarged testicle or an achy feeling in the lower belly.

Few risk factors have been identified. One known risk factor is having an undescended testicle -- one that does not move down into the scrotum at birth. In the United States, those born with an undescended testicle commonly have corrective surgery, Eggener said.

Currently, the U.S. Preventive Services Task Force, a national panel of experts, does not recommend routine testicular self-exams. It concludes that screenings performed by health care providers or men ''are unlikely to provide meaningful health benefits because of the low incidence and high survival rate of testicular cancer, even when it is detected at symptomatic stages."

Nor does the cancer society recommend routine monthly self-exams, Lichtenfeld said. "Clearly the task force has looked at this very carefully and they recommend not doing testicular self-exam or any form of screening for testicular cancer.''

According to the cancer society, testicular exam should be part of a routine exam by a health care provider, Lichtenfeld said.

It's important for men to pay attention to any changes in their testicles, he said.

"If a man notices a lump or a change, he should go see his doctor," Lichtenfeld said. "We have had a significant improvement in the treatment of this cancer."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Scott Eggener, M.D., associate professor of surgery, University of Chicago; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; May 6, 2013, presentation, American Urological Association annual meeting, San Diego

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Look Beyond the Sun for Skin Cancer Culprits, Doctors Warn

Tanning beds, organ transplants and smoking among additional risk factors

By Serena Gordon

HealthDay Reporter

FRIDAY, June 21 (HealthDay News) -- Think "skin cancer" and blame immediately goes to the sun. Justifiably so -- though not totally, skin doctors say.

"Hands down, sun exposure is the biggest risk factor for skin cancer," said Dr. Sherrif Ibrahim, an assistant professor of dermatology at the University of Rochester Medical Center in New York. "And it's a cumulative risk. The more exposure you've gotten, the bigger the risk. The skin doesn't know if you're out one time for an hour or 12 times for 5 minutes at a time. Your skin keeps a running meter."

That's important to know as summer officially begins, according to skin health experts at the American Academy of Dermatology.

Each year, more than 3.5 million basal and squamous cell skin cancers, known as non-melanoma cancers, are diagnosed in the United States, according to the American Cancer Society. These types of skin cancer aren't as deadly as melanoma, which affects about 75,000 U.S. residents annually. About 9,000 people die from melanomas and 2,000 from non-melanoma skin cancers each year, according to the society.

However, the sun isn't the only thing that can be problematic. Tattoos, certain chemicals, other diseases and possibly even those better-for-the-environment light bulbs all have been linked to skin cancer.

And people who think tanning beds are safer than soaking up the sun should think again, Ibrahim suggested.

"There's an unquestionable link between tanning booths and skin cancer," Ibrahim said. "There's been an enormous surge in the popularity of tanning booths, and with it the average age of people with melanomas is much lower. I had a 22-year-old patient just the other day."

This is because it doesn't matter if the ultraviolet light comes from the sun or from an artificial source. Dr. Alan Fleischer, a dermatology professor at Wake Forest Baptist Medical Center in Winston-Salem, N.C., explained that "the kind of light produced by tanning beds isn't better or worse than natural sunshine, but people may get more and longer exposure, especially in areas where outside, they might display more modesty."

Even getting a manicure can expose you to ultraviolet light.

"Ultraviolet nail treatment units do produce UV light, but the risk is quite small," said Fleischer. The lights are used to help gel or regular polishes set or harden.

Despite the low risk, the American Academy of Dermatology still recommends putting sunscreen on your hands before you get a manicure.

Even things that seem unrelated to UV light -- such as getting an organ transplant or a tattoo, or having an autoimmune disease -- have been linked to skin cancer diagnoses.

People who've had an organ transplant have an extremely elevated risk for skin cancer -- up to 200 times higher than others, according to Ibrahim.

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Testicular Cancer on Rise in U.S., Especially Among Hispanic Men

Study finds slow, steady increase, but experts say condition remains uncommon

By Kathleen Doheny

HealthDay Reporter

FRIDAY, May 3 (HealthDay News) -- The number of testicular cancer cases continues to climb slowly but steadily in the United States, according to new research.

While the cancer is still most common among white males, the greatest increase is among Hispanic men, according to Dr. Scott Eggener, an associate professor of surgery at the University of Chicago.

Eggener tracked the statistics on testicular cancer from 1992 through 2009, looking at data from a nationwide epidemiology database.

"The incidence of testicular cancer appears to be increasing very slowly but steadily among virtually all groups that we studied," he said. "The novel finding is that the most dramatic increase is in Hispanic men."

Eggener can't explain the increase. He is due to present his findings Monday at the annual meeting of the American Urological Association, in San Diego. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases supported the study.

Testicular cancer is known as a young man's cancer, as half of the cases affect men aged 20 to 34, according to the American Cancer Society. However, older men can also be affected.

This year, the American Cancer Society expects 7,920 new cases of testicular cancer in the United States. About 370 men are expected to die of it.

"It still remains an uncommon cancer," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. He reviewed the new findings. "It's important that we become aware of the situation [of rising numbers of cases], but not become alarmed by it." Hispanic men, he noted, still have a lower rate of the cancer than do white men.

In his study, Eggener found that the incidence of testicular cancer rose from 1992 through 2009. In 1992, for instance, 5.7 of every 100,000 men had testicular cancer. By 2009, that number had risen to 6.8 men for every 100,000.

Hispanic men had the largest annual percentage increase. In 1992, four of every 100,000 Hispanic men were affected. By 2009, it was 6.3 men of every 100,000, the investigators found.

For men affected, the outlook is generally good, experts agreed. "It has the highest survival rate of any solid tumor," Eggener said. The overall five-year survival rate, he noted, is 95 percent or higher.

Symptoms can include a painless lump on a testicle, an enlarged testicle or an achy feeling in the lower belly.

Few risk factors have been identified. One known risk factor is having an undescended testicle -- one that does not move down into the scrotum at birth. In the United States, those born with an undescended testicle commonly have corrective surgery, Eggener said.

View the original article here

Some Infertile Men Show Higher Cancer Risk, Study Suggests

Factors that contribute to lack of sperm may also raise odds for tumors, researchers say

By Amy Norton

HealthDay Reporter

FRIDAY, June 21 (HealthDay News) -- Men who are infertile because they produce no sperm may have a higher-than-average risk of developing cancer, a new study finds.

Researchers found that of more than 2,000 men with fertility problems, those with no sperm production had an increased risk of developing cancer over the next six years.

The men were young going into the study (about age 36, on average), so few did develop cancer. Among men with no sperm -- what doctors call azoospermia -- just over 2 percent were diagnosed with cancer.

Still, their risk was three times higher than that of the average man their age.

"They have the cancer risk of a man about 10 years older," said lead researcher Dr. Michael Eisenberg, an assistant professor of urology at Stanford University School of Medicine.

About 15 percent of infertile men are azoospermic, according to the study, which was published June 20 in the journal Fertility and Sterility.

This isn't the first work to connect male infertility to cancer risk, but it suggests the link may be concentrated among men with the most severe type of infertility.

"This suggests that it's not male infertility in general, but azoospermia in particular," Eisenberg said.

That's an important piece of information, said a male-infertility expert not involved in the study. If the link between male infertility and cancer is real, you would expect that more severe infertility would be tied to a greater cancer risk, said Dr. Thomas Walsh, of the University of Washington in Seattle.

"This reinforces the idea that this is a real relationship," Walsh said.

He said he doubts anyone would say that infertility is causing cancer. But he and Eisenberg said it's possible that some common genetic factors contribute to both azoospermia and a greater vulnerability to cancer.

"When we see a man with azoospermia, we usually assume there's a genetic cause," Eisenberg said. There are certain gene mutations already tied to the condition, but a minority of azoospermic men turn out to have one of them when they are tested. That means there are likely other, as yet unknown, gene defects involved in azoospermia, Eisenberg said.

And some of those genetic flaws might be involved in cancer susceptibility, he said.

Another infertility expert was cautious about interpreting the findings because of the small numbers: only 10 cases of cancer among the 451 men with azoospermia, and 19 cases among nearly 1,800 men with other types of infertility.

The idea that genetic abnormalities might underlie both azoospermia and cancer risk has merit, said Dr. Frederick Licciardi of NYU Langone Medical Center in New York City. But, he said, "while this is important reasoning and is based in basic science studies, I do not feel they have enough evidence in this paper to bolster this theory."

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Gene-Based Blood Test for Colon Cancer Shows Promise

Early trial supports accuracy of the screening, which could be a boon in preventing the disease

By Robert Preidt

HealthDay Reporter

WEDNESDAY, June 19 (HealthDay News) -- Could screening for colon cancer someday be as easy as having a blood test? Researchers say just such a test is showing early promise in trials.

The screening checks for levels of miR-21 -- a piece of DNA known as microRNA. Researchers in the gastrointestinal cancer research lab at the Baylor Research Institute in Dallas studied several hundred patients with either colorectal polyps (noncancerous growths that often precede cancer) or full-blown cancer.

They found that measuring levels of miR-21 in the blood accurately spotted up to 92 percent of patients with colorectal cancer.

The test also accurately identified up to 82 percent of patients with advanced colorectal polyps -- growths that put people at high risk of developing colorectal cancer.

The study was published June 19 in the Journal of the National Cancer Institute.

"This blood-based test could be transformative in how we screen patients for colorectal cancer; it would save lives and could result in major savings of health care dollars," Dr. Michael Ramsay, president of Baylor Research Institute, said in an institute news release.

Other experts were cautiously optimistic.

"These results are very promising for the future of cancer screening and treatment," said Dr. Jerald Wishner, director of colorectal surgery at Northern Westchester Hospital in Mount Kisco, N.Y.

"Colonoscopy screening is the current gold standard to detect colon cancer. However, less than 50 percent of Americans who should be screened get screened," Wishner said. "The blood test is a less invasive screening method that will eliminate barriers to colonoscopies, including embarrassment and possible discomfort in preparation for the test."

Dr. David Robbins, associate chief of endoscopy at Lenox Hill Hospital in New York City, agreed that it is "only a matter of time before we can screen for the most common, and most lethal, cancers using a simple blood test."

"This well-designed study brings us one step closer to the holy grail of colon cancer eradication by identifying those at high risk for developing colon cancer by measuring a pretty straightforward genetic signature," Robbins said.

According to the American Cancer Society, colon cancer is the second leading cancer killer, after lung cancer. More than 102,000 new cases of the disease will be diagnosed among Americans this year, and almost 51,000 people will die from the disease in 2013.

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Obesity Linked to Prostate Cancer, Study Finds

TUESDAY, April 23 (HealthDay News) -- Obese men are more likely to have precancerous changes detected in benign prostate biopsies and are at increased risk for eventually developing prostate cancer, new research suggests.

For the study, researchers examined data from nearly 500 men who were followed for 14 years after undergoing an initial prostate biopsy that was found to be noncancerous, or benign.

Prostate abnormalities were detected in 11 percent of the patients, and these abnormalities were strongly associated with obesity, said study author Andrew Rundle, an associate professor of epidemiology at Columbia University Mailman School of Public Health in New York City.

After taking into account factors including family history of prostate cancer, the researchers concluded that obesity at the time of the initial biopsy was associated with a 57 percent increased risk of developing prostate cancer during the 14 years of follow-up.

This association, however, was seen only for prostate cancer that occurred earlier in the follow-up period, according to the study, which was published in the April 23 issue of the journal Cancer Epidemiology, Biomarkers & Prevention.

"We don't absolutely know what the true biology is," Rundle said in a news release from the American Association for Cancer Research. "In some ways, this reflects the association between the body size and larger prostate size, which is thought to reduce the sensitivity of the needle biopsy. It is possible that the tumors missed by initial biopsy grew and were detected in a follow-up biopsy."

The association found in this study does not prove cause and effect.

Rundle noted that previous studies "have attempted to determine if there are subpopulations of men diagnosed with benign conditions that may be at a greater risk for developing prostate cancer. This is one of the first studies to assess the association between obesity and precancerous abnormalities."

These findings indicate that obesity "should be considered a factor for more intensive follow-up after a benign prostate biopsy," Rundle said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Association for Cancer Research, news release, April 23, 2013

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Scientists Spot Cancer Metabolism Changes

SUNDAY, April 21 (HealthDay News) -- Hundreds of potential targets for new cancer drugs that could starve tumors have been identified by scientists who analyzed gene expression data from 22 types of malignancies.

The study revealed a number of cancer-associated changes in the metabolism of cells. To support their uncontrolled growth, cancer cells need to reprogram and "supercharge" a cell's normal metabolism, the researchers explained.

Pinpointing these metabolic changes could prove important in efforts to develop drugs that interfere with cancer metabolism, according to the study, which was published online April 21 in the journal Nature Biotechnology.

"The importance of this new study is its scope," lead investigator Dennis Vitkup, an associate professor of biomedical informatics at Columbia University Medical Center, said in a center news release. "So far, people have focused mainly on a few genes involved in major metabolic processes. Our study provides a comprehensive, global view of diverse metabolic alterations at the level of gene expression."

One of the major findings was that cancer-induced changes in metabolism are significantly different in various types of tumors.

"Our study clearly demonstrates that there are no single and universal changes in cancer metabolism," study co-author Dr. Matthew Vander Heiden, an assistant professor at MIT, said in the news release. "That means that to understand transformation in cancer metabolism, researchers will need to consider how different tumor types adapt their metabolism to meet their specific needs."

Targeting metabolism may be a way to strike cancer at its roots, according to Vitkup.

"You can knock out one, but the cells will usually find another pathway to turn on proliferation. Targeting metabolism may be more powerful, because if you starve a cell of energy or materials, it has nowhere to go," he explained.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Columbia University Medical Center, news release, April 21, 2013

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