Aspirin and Cancer

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A low dose aspirin regimen may

  • Reduce the risk of heart attack
  • For persons over 50, reduce the risk of certain types of cancer including colorectal.

The risk associated with daily aspirin use is internal bleeding. Thus, for example, its not recommended for people with stomach ulcers. The bleeding risk increases with age, so some doctors are reluctant to recommend an aspirin regimen for people over age 60. A task force has recommended that use over age 60 be left to the individual, and be based on whether an individual is more concerned about the bleed risk or the potential benefits with regard to cancer and heart disease.


Soources:

  1. Arefa Cassoobhoy, MD, MPH, “Aspirin to Prevent Cancer: What to Tell Patients,” Medscape, 14 April 2017. http://www.medscape.com/viewarticle/878567?nlid=114187_1521&src=WNL_mdplsfeat_170418_mscpedit_wir&uac=153634BV&spon=17&impID=1330937&faf=1
  2. Mayo Clinic, “Daily aspirin therapy: Understand the benefits and risks.” http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/ART-20046797

 

Flame retardants, household dust, and thyroid cancer

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A new report from Duke University finds an explanation for increases in the frequencyth of thyroid cancer in household dust.

“Thyroid cancer is the fastest increasing cancer in the U.S., with most of the increase in new cases being papillary thyroid cancer” [PTC], said the study’s lead investigator, Julie Ann Sosa, M.D., MA, professor of surgery and medicine at Duke University School of Medicine in Durham, N.C. “Recent studies suggest that environmental factors may, in part, be responsible for this increase.” (1)

Prior studies have shown that some flame retardants used in the home and in vehicles have a similar chemical structure to thyroid hormones and can disrupt thyroid function.

The study measured the content of household dust as well as the incidence of chemicals in blood samples taken from occupants.  The study used a post facto experimental design with test and control groups.  All of the 140 participants lived in their homes for more than 11 years.

This study established that these flame retardants

  1. Appear in household dust in measurable quantities, where they can be inhaled by occupants and
  2. The level of two of them found in dust and blood samples are associated with the probability of having PTC.

The two problem chemicals identified in the study as elevating cancer risk belong to a class of chemicals, polybrominated diphenyl ethers (PBDEs).

  • Decabromodiphenyl ether (BDE-209). This is the most commonly used retardant, and appears to double the risk for thyroid cancer.
  • Tris(2-chloroethyl) phosphate (TCEP).

Participants with high levels of TCEP in their house dust were more than four times as likely to have larger, more aggressive tumors that extended beyond the thyroid, according to the study.

Participants with high levels of BDE-209 in their blood were 14 times more likely to have a version of the cancer that tends to be more aggressive.

Why should you care?  These chemicals are used as flame retardants in plastics (including TV cabinets), furniture, drapery backing, some carpets and in consumer electronics, both in home and in automobiles.  Both exposure to these chemicals and the prevalence of thyroid cancer are increasing.

Note:  This research was funded by Fred and Alice Stanback, the Duke Cancer Institute, and the Nicholas School of the Environment at Duke University, and not by industry sources.

What you need to consider:

  • Do you have a home air purification system? Not something that makes the air smell nice, but something that removes dust and other particles from what you breath. Maybe it’s time to invest or upgrade.
  • Read the labels on what you buy.

 


Sources:

  1. The Endocrine Society. “Exposure to common flame retardants may raise the risk of papillary thyroid cancer.” ScienceDaily. ScienceDaily, 2 April 2017. <www.sciencedaily.com/releases/2017/04/170402111311.htm>.
  2. US Environmental Protection Agency, “Technical Fact Sheet — Polybrominated Diphenyl Ethers (PBDEs) and Polybrominated Bophenyls (PBBs),” January 2014.
  3. Wikipedia, “Decabromodiphenyl ether.” https://en.wikipedia.org/wiki/Decabromodiphenyl_ether

Lung Cancer and Women

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Media attention doesn’t necessarily reflect what’s most important to you.  Consider this comparison, based on 2016 statistics from the American Cancer Society and the National Cancer Institute:

Cancer type               Estimated number of new cases         Estimated number of deaths

Breast cancer                               252,710                                                 40,610

Lung cancer                                 222,500                                                155,870  (1)

Lung cancer accounts for just over 9% of deaths from all types of cancers.

Which should worry you more?

Understand that you don’t have to be female to contract breast cancer, and you don’t have to be a smoker to contract lung cancer.  Pollution is sufficient.

Early detection is best for both types of cancers. For breast cancer, you look for a lump. The test is easy. If you have a cat or dog, the animal may even paw at the area of the lump. You just need to look.

For lung cancer, the only early sign is a persistent dry cough — something that just doesn’t go away in a week or two, the way the cough associated with a cold should.  If the cough brings up blood, that’s a red flag, but the persistent cough by itself should prompt a visit to the doctor — sometimes visits to multiple doctors to get the diagnosis right.

Unfortunately, the dry cough is easy to ignore, and that’s when people get into trouble. By the time other symptoms appear, the cancer may have spread and be much more difficult to treat successfully. The five-year survival rate for Stage IV lung cancer is less than 10%. When one friend of mine finally was diagnosed, he lasted only a few months.

Listen to your body.


Sources:

  1. National Cancer Institute, “Common Cancer Types.” https://www.cancer.gov/types/common-cancers
  2. Centers for Disease Control and Prevention, “Statistics for Different Kinds of Cancers.” https://www.cdc.gov/cancer/dcpc/data/types.htm
  3. Amy Marturana, “The one very subtle symptom of lung cancer you need to know,” Self, 20 May 2017. https://www.aol.com/article/lifestyle/2017/03/20/subtle-symptom-lung-cancer/21903320/
  4. LungCancer.org, “Symptoms of Lung Cancer.” http://www.lungcancer.org/find_information/publications/163-lung_cancer_101/266-symptoms

Cervical Cancer, Race and Poverty

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A re-examination of cancer data shows that cervical cancer is more common than originally thought, and that it is more deadly among minority and poor women.

Sometimes, you just have to reconsider the assumptions made in data analysis.  That’s what happened here.  The originally analysis looked at rates among all adult women.  The revision excludes women who have had a hysterectomy, for whom cervical cancer is no longer a possibility.

  • The adjustment took the rate for white women from 3.2 per 100,000 women to 4.7.
  • The adjustment took the rate for black women from 5.7 to 10.1 per 100,000 women.

Overall, there are about 4,000 new cases of cervical cancer per year.

The kicker is that while cervical cancer is treatable (my wife had an advanced case of it over 30 years ago), there are still people dying from it.  Routine screening is essential:

“A recent study in the journal Gynecologic Oncology that looked at 15,194 patients with advanced cervical cancer found that more than half did not receive treatment considered to be standard of care, and that those patients were more likely to be black and poor.

“According to the analysis published Monday, the hysterectomy-corrected mortality rates put black American women on par with women living in some underdeveloped countries in Latin America, Asia and Africa, particularly in sub-Saharan Africa.” [NY Times, see sources below]

One doctor interviewed for the article recalled recently having to outfit a 25-year-old female with a colostomy bag as a result of late detection.  Most patients with advanced cervical cancer never had a PAP Smear.

Access to healthcare and screening was one of the cardinal elements of the Affordable Care Act.  Current revisions will make this less accessible and more costly.  That means more deaths.


Sources:

 

 

 

 

 

 

 

The Radiation Legacy of WWII

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Radiation is a part of American life.  Everyone gets some.  A few “lucky” ones get a lot  more.

North St. Louis County, Missouri, is peppered with sites identified by the US Army Corp of Engineers as radioactive.  It’s the legacy of uranium processing for nuclear arms programs in World War II.  Uranium waste was dumped into a landfill near the St. Louis airport (Lambert Field).  However, the area is subject to flooding by Coldwater Creek, and that has spread radioactive material to parks and yards across North County.

The result: North County has been turned into a cancer hotspot, and shown in the map below.  Some of the cancers seen in this area are extraordinarily cancer_cases_1242rare.

Coldwater Creek drains into the Missouri River above the juncture with the Mississippi River, and just above the intake for drinking water for the City of St. Louis.

There have been a number of law suits file over the last 6 years, with some thrown out by various judges and some still active.

OK, that’s known, at least to local residents.  Whether it has had an impact on tourism or on convention traffic isn’t known.

However, St. Louis was only one processing center,  There were five others:

  • Tanawanda, New York (on the Niagara River upstream from Niagara Falls)
  • Deepwater, New Jersey (on the Delaware River across from Wilmington, Delaware)
  • Canonsburg, Pennsylvania (south of Pittsburgh)
  • Oak Ridge, Tennessee (near Knoxville)
  • Cleveland, Ohio (on Lake Erie)

There are radiation issues in all of these communities.  In many cases, the coverage is old enough that current residents may not even be aware of the problem.  A 2006 article labeled Canonsburg as “the most radioactive town in America.”

That said, some level of radioactivity exists in all areas of the US.  The map below is from a civilian volunteer monitoring program (the Radiation Network).  Unfortunately, none of the civilian volunteers appear to be focusing on historical problem sites.

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Take-aways

Knowledge is safety.  The more you know about where you live and where your kids play, the better you can try to protect yourself and them.


Sources:

 

 

 

The Unexpected Cost of Beating Cancer (Part 2)

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This illustrates the challenges that diligent physicians have in keeping up with new developments in their field.

Yesterday, I posted on the side effects of immunotherapy treatment for cancer.

Today, we have an article from researchers at UPenn on the use of an existing drug (a class of drugs known as JAK inhibitors) to reduce the risk of these side effects.

Some doctors use combinations of immunotherapy drugs to assure effectiveness against the target cancer.  However, the combinations seem to increase the risk of major side effects.

Use of the JAK inhibitor with a single immunotherapy drug can be as effective as use of the combination of drugs, without the increased risk of side effects.

Each day, there’s something new.  Is your doctor keeping up with his homework?

That’s the major reason you always need second opinions for anything important.


Sources:

 

 

The Unexpected Costs of Beating Cancer

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Cancer is a scary word for most people.  The C-word — some refuse to say its name — in the past has meant lengthy treatment with poisons and uncertain results.  If identified later in development, its often a death sentence.  The side effects of treatment (radiation and chemotherapy) are at best unpleasant.

We have a new class of drugs to treat cancer.  The class is called hypnotherapy, and it works by enabling the body’s own immune system to attack and destroy cancer cells.  Immune system cells (T-cells) see cancer cells as “normal.”  Immunotherapy changes the system by which T-cells identify alien cells to attack, allowing them to go after cancer cells.  For a lot of patients, this can be very effective in eliminating cancer.

The problem, as discussed in a New York Times story today, is that changing how T-cells identify targets can also allow them to attack cells that are truly normal and useful to the body — cells that make up the liver, lungs, pancreas and heart.  For some of the new drugs in this class, side effects can occur between 30% and 50% of the time and can range from mild to lethal.

Typical side effects can include:

  • Fatigue
  • Chills
  • Nausea
  • Reaction at the infusion site

More advanced reactions can include:

  • Pneumonitis (inflammation of the lungs resulting in cough and difficulty breathing)
  • Colitis (inflammation of the large bowel leading to diarrhea)
  • Hepatitis and pancreatitis
  • Skin rashes
  • Endocrine disorders including thyroid abnormalities and adrenal insufficiency (1)

People who survive the treatment have been known to develop a late-life version of Type I diabetes, requiring daily administration of insulin.  In one clinical trial, five health individuals who received the immunotherapy drug died.

The risk is greater for patients outside major urban medical research centers.  Doctors in these areas are unlikely to have seen the side effects from these drugs and may misdiagnose or delay treatment — and that can be life threatening.  Because some of the symptoms resemble flu, it can be easy for inexperienced doctors to fail to recognize either the urgency or the required treatment.  (Inexperienced in this can can refer to veteran doctors who simply have limited or no experience with these drugs and their side effects.)

Bottom line:

  1. With any cancer therapy, the patient needs to understand that there may be impacts on quality of life and make a conscious choice as to how much risk/impact he or she is willing to accept.
  2. The best course of action is behavioral change and early detection.  That means looking at diet and exercise and learning the early warning signs and how to self-examine.
    • One oncologist I know swears by a concoction that he drinks once per day made up of 2 cups of kale or spinach, a one-inch slice of pineapple and one green apple (e.g., granny smith).  There are other docs with other suggestions.
    • Pets have been known to sense cancer in owners.  If you pet changes behavior, and starts nuzzling part of your body, it’s worth exploring why.
    • Regular doctor visits and screenings.

Anything can be relatively quick and easy to beat at Stage 1.  The length of treatment, cost, and potential for a bad outcome rise with each Stage.

If you’re not going to take care of yourself, then make sure you have your will done.  No reason to create problems for your heirs.


Sources:

  1. Dana Farber Cancer Center, “What Are the Side Effects of Immunotherapy?”, 8 March 2016.  http://blog.dana-farber.org/insight/2016/02/what-are-the-side-effects-of-immunotherapy/
  2. Hackethal, Veronica, MD, “How to Treat Side Effects of New Cancer Immunotherapies”, Medscape, 6 May 2015.  http://www.medscape.com/viewarticle/844264
  3. National Cancer Institute, “Immunotherapy”.  https://www.cancer.gov/about-cancer/treatment/types/immunotherapy
  4. Richtel, Matt, “Immune System, Unleashed by Cancer Therapies, Can Attack Organs”, The New York Times, 3 December 2016.  http://www.nytimes.com/2016/12/03/health/immunotherapy-cancer.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0