Crash diet tied to increased gallstone risk

People who go on an extremely low calorie diet are more likely to develop gallstones than people on a moderately low calorie diet, according to a new study.

Dr. Michael Jensen, a professor of medicine at the Mayo Clinic, said dieters typically end up with similar weight loss in the long run whether they use extreme calorie restriction or more moderately restricted diets.

"You're going to end up in the same place (weight-wise), so why take the risk of ending up in the hospital with a gall bladder problem just to lose weight faster?" said Jensen, who was not part of the study.

Gallstones affect as many as 20 million people in the U.S.

Dr. Kari Johansson, the lead author of the study and a researcher at the Karolinska Institute in Sweden, said quick weight loss from very low calorie diets is thought to impact the salt and cholesterol contents of bile and the emptying of the gallbladder, both of which can contribute to gallstones.

To see how these diets affect gallstone risk in a real-world setting, Johansson and her colleagues collected information on customers' progress from a weight loss company in Sweden called Intrim.

Some of the study authors have worked for the company or serve on its scientific advisory board.

Their study included 6,640 dieters, half of whom went on a crash diet and the other half of whom went on a low calorie diet.

The crash diet involved liquid meals of just 500 calories a day for six to 10 weeks, followed by the gradual introduction of normal food, and then nine months of a weight maintenance regime of exercise and healthy eating.

The other dieters ate 1,200 to 1,500 calories a day, including two liquid meals, for three months, followed by the nine month weight maintenance period.

Health coaches at Intrim collected weight and body size information, which the researchers linked to a national health database that has records on gallstone treatments.

After three months in the weight loss program, the crash dieters lost about 30 pounds, compared to roughly 17 pounds lost among people on the low calorie diet.

One year out from the start of the diet, the extremely low calorie group had lost an average of 24.5 pounds, while the other group lost about 18 pounds.

Among those on the crash diet, 48 people developed gallstones requiring hospital treatment, and 16 people in the other group developed gallstones, Johansson and her colleagues report in the International Journal of Obesity.

They could not determine why gallstones were more common among people in the extremely low calorie group.

"One contributing factor was that they lost more weight during follow-up... another may be that they may have had a lower fat intake," Johansson said in an email to Reuters Health.

Jensen said people should have doctors supervise their health when going on a very low calorie diet, something that is recommended in the U.S.

"They should be informed about the risk/benefit tradeoff compared to using the less intensive, but also less effective, (low calorie diet) alternative," Johansson said.

Breast Cancer: Know Your Risks

Reported by Dr. Brian Lau for ABC News:

Breast cancer strikes more than 2.7 million women in the United States, according to the National Cancer Institute. One in eight women will be diagnosed with the disease at some point in their lives.

Dr. Richard Besser, chief health and medical correspondent for ABC News, hosted a tweet chat this week on breast cancer prevention to help women understand their risk factors for the disease and what steps they can take to minimize these risks.

Besser was joined by doctors from top hospitals from all over the country, as well as medical experts from the Centers for Disease Control and Prevention, the American Cancer Society and various chapters of the Susan G. Komen Breast Cancer Foundation.

 Click here for the full transcript of the chat. Read on for the highlights.

What are the risk factors for breast cancer?

Most breast cancer patients don’t have any known risk factors. However, the chance of developing the disease increases with age, obesity, increased breast density and history of previous cancer treatments.

Does Breast Size Affect Breast Cancer Risk?

A woman is also more likely to develop breast cancer if an immediate relative is diagnosed with the disease before age 50. Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk. And women who began menstruating early or go through menopause after the age of 55 may have an increased risk, possibly due to a longer lifetime exposure to the hormones estrogen and progesterone.

Overall, white women are slightly more likely to develop breast cancer than are African-American women, but African-American women are more likely to die of this cancer.

What gene mutation increased Angelina Jolie’s risk of breast cancer?

BRCA1 and BRCA2 are genes that help suppress tumors. Angelina Jolie was diagnosed with an inherited mutation of the BRCA1 gene, which increased her risk of developing breast cancer and ovarian cancer.

Not all BRCA variants are as dangerous and only about 5 to 10 percent of breast cancer cases are associated with genetic mutations. Additionally, not all children or relatives will inherit those mutations. Doctors recommend genetic testing for high-risk patients like Jolie, who has a strong family history of breast cancer.

Are pre-emptive bilateral mastectomies the only course of treatment in a high-risk situation like Jolie’s?

Jolie chose to have a prophylactic bilateral mastectomy to remove both of her breasts, which has been found to greatly reduce the risk of breast cancer. But it doesn’t entirely eliminate risk, and this isn’t the only choice for someone faced with a similar diagnosis.

Angelina Jolie’s Double Mastectomy Fuels National Debate

Two other options exist for women at high risk of developing breast cancer: They can monitor their health more frequently, alternating a mammogram and MRI of their breasts every six months. Or, they can undergo preventive chemotherapy.

The number of patients opting for prophylactic mastectomy is increasing. A 2008 study in the International Journal of Cancer found that about 36 percent of American women with a BRCA1 or BRCA2 mutations chose to have both breasts removed.

What can the average woman do to prevent breast cancer?

Maintaining a healthy lifestyle through exercise, weight control and limiting alcohol can help prevent breast cancer. For a typical woman who doesn’t have any risk factors for the illness, the American Cancer society recommends a yearly mammography screening after age 40. The U.S. Preventive  Services Task Force recommends regular mammograms every two years for all women between the age of 50 and 74.

Aspirin Taken Regularly Could Lower Colon Cancer Risk, Study Suggests

By: By Rachael Rettner, LiveScience Senior Writer
Published: 06/25/2013 04:16 PM EDT on LiveScience

Taking aspirin regularly may reduce the risk of most types of colon cancer, a new study suggests.

In the study, people who took aspirin at least twice a week were 27 percent less likely to develop colon cancer over a 28-year period, compared with those who took aspirin less frequently, or not at all.

However, this reduction in risk applied only to colon cancers that did not have a mutation in a gene called BRAF. Taking aspirin regularly did not reduce the risk of developing colon cancer with a BRAF mutation; about 10 to 15 percent of colon cancers have this mutation.

The findings agree with previous research showing a reduced risk of colon cancer among people who take regular aspirin. But the new results suggest that colon cancers with a BRAF mutation may be less sensitive to the effects of aspirin, the researchers said.

The next key question is to determine which people are more likely to develop BRAF-mutated colon cancer, said study researcher Dr. Andrew T. Chan, a gastroenterologist at Massachusetts General Hospital. People at risk for this specific colon cancer may not benefit from regularly taking aspirin, Chan said. [See 5 Interesting Facts About Aspirin].

Because the study included mainly white participants, the findings should be confirmed in a more diverse population, the researchers said.

Despite growing evidence linking regular aspirin use with a reduced risk of cancer, the drug is not generally recommended as a way to prevent cancer. Taking aspirin comes with risks, including an increased risk of gastrointestinal bleeding, and so researchers need to figure out what groups would be most likely to benefit from such a recommendation.

People interested in taking regular aspirin should speak with their doctor first, Chan said.

The study included more than 127,000 people who were followed from the 1980s until 2012. During this time, 1,226 people in the study developed colon cancer.

The rate of non-BRAF mutated cancer was 40.2 cases per 100,000 people per year among those who did not regularly take aspirin, but only 30.5 cases per 100,000 people per year among those who regularly took aspirin.

The rate of BRAF-mutated cancer was 5 cases per 100,000 people per year among those who did not regularly take aspirin and 5.7 cases per 100,000 people per year among those who took regular aspirin, a difference that may have been due to chance.

Taking aspirin more frequently was linked with a lower risk of non-BRAF mutated cancer, but not BRAF-mutated cancer. Those who took six to 12 doses of aspirin weekly were 30 percent less likely to develop non-BRAF mutated cancer than those who did not take aspirin, the study said.

For people who had been diagnosed with colon cancer, taking aspirin did not affect patient survival, regardless of cancer type, the study also found.

The study is published in the June 26 issue of the Journal of the American Medical Association. It was funded by National Institutes of Health (NIH); the Bennett Family Fund for Targeted Therapies Research; and the National Colorectal Cancer Research Alliance. Chan has previously worked as a consultant for Bayer Healthcare, which manufactures aspirin.

Follow Rachael Rettner @RachaelRettner. FollowLiveScience @livescience, Facebook & Google+. Original article on LiveScience.com.

Small lifestyle changes may have big impact on reducing stroke risk

Study Highlights:

  • Making small lifestyle changes could reduce your stroke risk.
  • Every one-point increase toward a better health score was associated with an 8 percent lower stroke risk.
  • A better health score was associated with a similar reduction in stroke risk in blacks and whites.

EMBARGOED UNTIL 3 p.m. CT/4 p.m. ET, Thursday, June 6, 2013
DALLAS, June 6, 2013 — Making small lifestyle changes could reduce your risk of having a stroke, according to a new study in the American Heart Association journal Stroke.

Researchers assessed stroke risk using the American Heart Association’s Life’s Simple 7 health factors: be active, control cholesterol, eat a healthy diet, manage blood pressure, maintain a healthy weight, control blood sugar and don’t smoke.

“We used the assessment tool to look at stroke risk and found that small differences in health status were associated with large reductions in stroke risk,” said Mary Cushman, M.D., M.Sc., senior author and professor of medicine at the University of Vermont in Burlington.

Researchers divided the Life’s Simple 7 scores into three categories: zero to four points for inadequate, five to nine points for average, and 10 to 14 points for optimum cardiovascular health.

Researchers found:

  • Every one-point increase toward a better score was associated with an 8 percent lower stroke risk.
  • Compared to those with inadequate scores, people with optimum scores had a 48 percent lower stroke risk and those with average scores had a 27 percent lower stroke risk.
  • A better score was associated with a similar reduced stroke risk in blacks and whites.

While black participants had worse Life’s Simple 7 scores than whites, the association of the Life’s Simple 7 score with stroke risk was similar in black and white participants. “This highlights the critical importance of improving these health factors since blacks have nearly twice the stroke mortality rates as whites,” Cushman said.

Cushman and colleagues reviewed information on 22,914 black and white Americans age 45 and older who are participating in a nationwide population-based study called the Reasons for Geographic and Racial Differences in Stroke (REGARDS).

Researchers collected data in 2003-07 by telephone, self-administered questionnaires and at-home exams. Participants were followed for 5 years for stroke. Many of the study participants live in the Southeast region of the United States where death rates from stroke are the highest.

During the study, 432 strokes occurred. All seven health factors in Life’s Simple 7 played an important role in predicting the risk for stroke, but having ideal blood pressure was the most important indicator of stroke risk, researchers said.

“Compared to those with poor blood pressure status, those who were ideal had a 60 percent lower risk of future stroke,” Cushman said.

Researchers also found that those who didn’t smoke or quit smoking more than one year prior to the beginning of the study had a 40 percent lower stroke risk.

Each year, about 795,000 people in the United States have a stroke — the No. 4 killer and a leading cause of long-term disability. Every four minutes, an American dies from stroke. People can check their health status at www.mylifecheck.org.

Co-authors are Ambar Kulshreshtha, M.D., M.P.H. (first author); Viola Vaccarino, M.D., Ph.D.; Suzanne Judd, Ph.D.; Virginia J. Howard, Ph.D.; William McClellan, M.D., M.P.H.; Paul Muntner, Ph.D.; Yuling Hong, M.D., Ph.D.; Monika M. Safford, M.D. and Abhinav Goyal, M.D., M.H.S. Author disclosures are on the manuscript.

REGARDS is funded by a cooperative agreement from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service.

For the latest heart and stroke news, follow @HeartNews on Twitter.

For stroke science, follow Stroke at @StrokeAHA_ASA.

Chronic Heartburn May Raise Odds for Throat Cancer: Study

THURSDAY, May 23 (HealthDay News) -- People who suffer from frequent heartburn may be at increased risk for cancers of the throat and vocal cords even if they don't smoke or drink alcohol, a new study says.

Interestingly, common over-the-counter antacids seemed to protect against these cancers while prescription medications such as Prilosec, Nexium and Prevacid didn't, the researchers said.

"There has been a controversy about whether heartburn contributes to cancers of the larynx or pharynx," said lead researcher Scott Langevin, a postdoctoral research fellow at Brown University in Providence, R.I.

"And we found out that it does elevate the risk of these cancers. There is about a 78 percent increase in the risk for cancer in people who experience heavy heartburn," he said. "This is important in figuring out who to monitor more closely."

The other finding, which Langevin called "surprising," was the protective effect of common antacids in reducing the risk of cancer.

"We didn't see that protective effect with prescription medications. But it should be noted that people who take them are those who get the worst heartburn, so we shouldn't read too much into that," he said.

Langevin added that it's hard to explain that medication finding, and other studies will be needed to see if it's really the case. "It's possible that these drugs didn't have that protective effect because these were the worst cases of heartburn," he said.

The report was published May 23 in the journal Cancer Epidemiology, Biomarkers & Prevention. And while it uncovered an association between heartburn and cancer of the throat and vocal cords, it didn't prove a cause-and-effect relationship.

Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, said "the study shows that reflux is associated with an increased incidence of cancers of the larynx and pharynx."

Lichtenfeld said the role of antacids in reducing the risk of cancer needs more study. "Researchers need to determine why antacids work and, more importantly, whether antacids make a difference in also reducing cancer of the esophagus," he said.

Why other medications didn't lower the risk isn't clear, Lichtenfeld said. And it points to one limitation of this type of study: It can't take into account all the variables.

To come to their conclusions, Langevin's group compared more than 600 patients with throat or vocal cord cancer with more than 1,300 people without a history of cancer. All the patients answered questions about their history of heartburn, smoking and drinking habits, and family history of cancer.

In addition, since some head and neck cancers are caused by the human papillomavirus (HPV), the researchers tested all the participants for antigens to the virus.

The researchers found that among those who weren't heavy smokers or drinkers, frequent heartburn increased the risk for cancers of the throat and vocal cords by 78 percent.

The researchers also found that taking antacids -- but not prescription medications or home remedies -- reduced the risk for these cancers by 41 percent. The protective effect of antacids was independent of smoking, drinking or infection with HPV, they said.

SOURCES: Scott Langevin, Ph.D., postdoctoral research fellow, Brown University, Providence, R.I.; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; May 23, 2013, Cancer Epidemiology, Biomarkers & Prevention

HealthDay

Preventing GERD and Hiatal Hernias from Turning Deadly

Our GI experts discuss why upper GI/esophageal conditions may go unrecognized, how to detect them and when to take action.

Some 25 million Americans are believed to suffer on a daily basis from gastroesophageal reflux disease (GERD) – better known as heartburn – and as much as 40% of the adult U.S. population are estimated to experience it less frequently. Some of these patients also suffer from a hiatal hernia, which is typically asymptomatic. For most patients, these conditions are a serious nuisance, but not a serious health hazard. The challenge for physicians lies in determining how to treat these common disorders before they become dangerous, without subjecting patients to unnecessary treatment.

The rise in GERD, believed related to the epidemic of obesity and other lifestyle factors, is associated with an increase in esophageal adenocarcinoma. This cancer has grown six-fold in the past 30 years, while squamous cell carcinoma  (often associated with smoking and alcohol use) has declined. Given its former obscurity, physicians trained several decades ago may be less likely to recognize the potential for chronic GERD to turn cancerous.

To manage GERD, patients should avoid alcohol, greasy foods, sodas, mints, licorice, chocolate and smoking. They should eat smaller, more frequent meals and avoid a large meal within a few hours of bedtime. Losing weight is also helpful. “Modest weight loss and a prudent diet are often sufficient to manage symptoms,” notes A. Steven Fleisher, M.D., chief, Division of Gastroenterology; and director, Interventional Gastroenterology Program at Medstar Franklin Square Medical Center.

If chronic use of over-the-counter antacids is necessary, patients should consult their primary care physician. In turn, primary care doctors should refer patients to a gastroenterologist if reflux continues for several years. While GERD medications are generally safe and effective, chronic use not only may indicate the need for further evaluation, but also may lead to osteoporosis and an increased risk of infections such as clostridium-difficile (C. diff). “Make sure the patient’s vitamin D levels are adequate so they can absorb calcium,” Dr. Fleisher advises.

Barrett’s Esophagus

Compounding the issue is the fact that patients’ heartburn symptoms may decline or disappear not only with medication but also as their disease progresses. Chronic reflux can cause the esophageal lining to be damaged so significantly that it resembles stomach lining and causes discomfort to abate at the same time that the risk of cancer increases. This condition, called Barrett’s esophagus, is a strong risk factor for esophageal adenocarcinoma. The normal progression is from the initial stage of metaplasia to low grade dysplasia, high grade dysplasia and cancer; however, a Danish study published in the October 13, 2011 issue of the New England Journal of Medicine found that the annual risk of this cancer was only 0.12%, lower than the previously assumed risk of 0.5%.

In the December 2, 2012, issue of the Annals of Internal Medicine, the American College of Physicians published guidelines for using upper endoscopy in GERD patients, as well as guidelines for screening for Barett’s (see sidebar). Patients with GERD should receive endoscopy if they also experience dysphagia,  bleeding, weight loss or recurrent vomiting,  or if they have not responded to medication after several months.

If Barrett’s is found, Dr. Fleisher advises endoscopy surveillance at least every three years for patients who have Barrett’s without dysplasia and as often as every six months for those with dysplasia.

Treatment: EMR and Ablation

Gastroenterologists often perform endoscopy to evaluate the mucosa of the esophagus for strictures and the presence of Barrett’s. Until 2007, when the Prague C & M (circumference and maximal extent) criteria were developed, consistent assessment criteria were lacking.

Dr. Fleisher says, “Our practice uses the Prague Criteria, which is becoming the accepted classification for endoscopically-suspected Barrett’s. In non-dysplastic Barrett’s, four quadrant biopsies should be obtained every two centimeters in the involved esophageal segment. Barrett’s is suspected endoscopically when the normal pearl-pink mucosal lining is replaced with a salmon-pink appearing mucosa. We also often see associated hiatal hernias. The length of the Barrett’s segment correlates with more significant cancer risk. While it’s unusual, some patients have one third to one half of their esophagus affected.”

“If any nodular components are present,” he continues, “we perform an endoscopic mucosal resection (EMR).  EMR can be a cure for very early stage Adenocarcinoma and it can be performed at the time of initial endoscopy, but often isn’t.  Endoscopic ultrasound is often performed to assess for depth of invasion, and local lymphadenopathy prior to resection of sub-centimeter lesions. If the pathology shows disease limited to the lamina propria or muscularis mucosae, in the absence of lymph node metastases, lymphovascular invasion, or poor differentiation EMR provides definitive therapy. Nevertheless, these patient need close short term endoscopic surveillance.”

Dr. Fleisher adds, “EMR involves using an endoscope with tools to suction up the affected tissue. A band is deployed around the lesion, which is then removed with a snare and electrocautery. We may inject submucosal saline to lift the lesion away to facilitate banding. When the sub mucosa is involved, medically fit patients will need esophagectomy. More extensive disease may need chemotherapy and radiation before or after surgical resection.“

Following EMR, the remaining affected tissue is ablated, typically using radiofrequency (RF) ablation. A study published in the September 2012 issue of Gastroenterology found that initial RF ablation might not be cost effective for patients with Barrett’s in the absence of dysplasia, but may be appropriate for confirmed and stable low grade dysplasia, and is superior to endoscopic surveillance in high grade dysplasia.

Dr. Fleisher notes, “RF ablation is recommended along with photodynamic therapy and EMR for eradication of Barrett’s esophagus according to a March 2011 position statement on the management of Barrett’s esophagus by the American Gastroenterological Association (AGA). In selected cases, we also perform cryoablation, a technique that is still investigational for the management of dysplasia in Barrett’s esophagus. Prospective studies that demonstrate its comparable effectiveness are not yet completed. Cryotherapy freezes the involved tissue using liquid CO2 or liquid nitrogen. We use the latter, applying it for about 20 seconds in two to three applications. Patients appear to tolerate the procedure well other than some chest discomfort.”

When to Treat Hiatal Hernias Surgically

Hiatal hernia, the most common diaphragmatic hernia, is a broad term that that covers a variety of conditions in which an anatomical structure pierces the membrane of the diaphragm. While the cause is often unclear, these hernias occur more often in women, those who are overweight, and those over age 50. Because a hiatal hernia may not create symptoms until there is an emergent situation, it is often discovered incidentally.

Hiatal hernias are classified as Type I through Type IV, with Type I denoting a sliding hiatal hernia (roughly 80% of hiatal hernias) where the gastro-esophageal (GE) junction followed by the body of the stomach protrudes through the esophageal hiatus and above the diaphragm. In the less common paraesophageal hernias (Types II – IV), the fundus is displaced into the mediastinum above the GE junction. Type IV denotes a large defect in the phrenoesophageal membrane that allows other organs, including the colon or spleen, to slip up into the chest.

Adrian E. Park, M.D., MIS/GI surgeon and department chair of Surgery at Anne Arundel Medical Center, explains, “Most hiatal hernias develop over a long period of time. Patients may have had GERD 10 to 15 years ago but then their symptoms subsided. However, if they get full quickly when they eat and have shortness of breath, they may have a hiatal hernia. The danger is that the hernia can twist suddenly and strangle the stomach, requiring urgent surgical intervention.”

“Only 1 to 2% of these hernias need surgery,” continues Dr. Park, “but it’s a challenge to determine when surgery is necessary. Data shows that if we plan surgery electively, the mortality and morbidity rate is 1/5th to 1/20th that of emergency surgery. As a result, we’ve learned to err on the side of being aggressive. The great judgment required is when to intervene with patients who are not highly symptomatic. The way I approach it is to talk with the family members about the patient’s eating habits, their activities of daily living and whether they’re losing weight.”

Dr. Park notes that many patients have lost their exercise tolerance and can’t walk around the mall or grocery store. “It happens so insidiously and slowly that patients often are worked up first for cardiac and pulmonary issues,” he comments. “Once it is determined that they have a large or paraesophageal hiatal hernia, surgery often allows them to improve their pulmonary function and, as a result, their exercise tolerance.”

Laparoscopic surgery has greatly improved surgical outcomes for hiatal hernia repair. Dr. Park declares, “If you can prevail laparoscopically, you should; patients get up much more quickly and that makes all the difference. While 98% of patients are elderly, they can go home within two days and usually spend less than two hours in the OR.”

Though not a fan of GI robotic surgery, Dr. Park says, “The camera systems and instruments used in the laparoscopic procedure are continuously improving. The interest in a single incision approach has waned and four to five incisions of 5mm are more the norm.”

Dr. Park advises, “When seeking a surgeon, referring physicians should look for a surgeon who does at least several procedures per month with good pre and peri-op education and a nurse and nutritionist on the team. Some of these procedures are extremely complex and should be concentrated in select centers. The mortality rate should be under 1% and the complication rate less than 6%.”

Unless patients are willing to make long-term adjustments to their lifestyle, the surgery may not be worthwhile. Dr. Park comments, “I tell patients that if they can’t commit to lifestyle and dietary changes, which in fact constitute a healthier way to eat and live, such as eating smaller and more frequent meals daily and chewing their food well, deep breathing and core/aerobic exercises, then they shouldn’t undergo surgery and we’ll part as friends.”

Adrian E. Park, M.D., general surgeon and department chair, Surgery, Anne Arundel Medical Center

A. Steven Fleisher, M.D., general and interventional gastroenterologist; chief, Division of Gastroenterology; and director, Interventional Gastroenterology Program at Medstar Franklin Square Medical Center.

Young Women With Breast Cancer Opting For Mastectomy

Most women diagnosed with breast cancer when they're 40 or younger are choosing rather than more limited and breast-conserving , a study of women in Massachusetts finds.

Moreover, most of those choosing mastectomy elect to have the other, noncancerous breast removed, too.

These at the American Society Clinical Oncology's annual meeting in Chicago.

The research involved 227 Massachusetts women and may not be nationally representative. But study authors say it's in line with other studies suggesting that many of today's breast cancer patients are choosing mastectomy.

Sixty-two percent of women 40 and younger in this study opted for mastectomy. One in seven breast cancer patients falls in this age group.

That's in sharp contrast to their mothers' generation, which saw the rise of lumpectomies in reaction to a belief that mastectomies were unnecessarily traumatic and disfiguring — and mounting evidence that lumpectomies resulted in equivalent survival.

The new research also documents a growing trend toward prophylactic mastectomy — removal of a noncancerous breast after discovering breast cancer in the other one.

In 1998, fewer than 2 percent of women with breast cancer chose this option. In the new study, 37 percent chose prophylactic mastectomy in the non-cancerous breast. And, considering just women who chose mastectomy at all, more than 60 percent had prophylactic removal of the noncancerous breast.

All the women in the study had been diagnosed with stage I, II and II breast cancer. The study did not look at women with a so-called stage-zero condition called , short for ductal carcinoma in situ. The study also didn't include women breast cancer affected both breasts or had metastasized to other organs.

"There's no difference in survival" between mastectomy and lumpectomy among women with stage I, II or III breast cancer," study author Shoshana Rosenberg tells Shots. "These are women who had a choice, and 62 percent chose mastectomy."

She and her colleagues at and other institutions are trying to understand why.

Some of the reasons they uncovered are clear and supported by data. Others are less so.

For instance, women who have a mutation in one of the genes called were much more likely to choose mastectomy or double mastectomy. That fits with evidence that they have a very high lifetime risk of cancer recurrence.

But women who had a mother or sister with breast cancer were no more likely to choose mastectomy.

Rosenbergsays the study didn't find younger women choosing lumpectomy because of concerns about body image. "You would expect that to bias them toward breast-conserving surgery," she says. But clearly, among women in this study, that's not the case.

"From our perspective, the most interesting finding is that role that anxiety plays in the decision,"Rosenberg says. Women who scored high on a standard test for anxiety were more likely to choose mastectomy.

This makes her worry that women anxious about the best choice "are not necessarily contextualizing their true risk – not understanding or not knowing – because there's no difference in survival, so it really shouldn't make a difference which surgery to choose."

Another clue to whether women are aware of the survival data: Those who say they made the decision themselves, rather than sharing the decision with their doctor, were more likely to choose mastectomy.

"If they're making this decision on their own, it's hard to really know if they know all the facts and interpreting the risks accurately,"Rosenberg says. "We've done some other research indicating that women overestimate their risks" of cancer recurrence or death.

The study also finds that women were more likely to choose mastectomy if they had a tumor that's , if their cancer had spread to nearby lymph nodes, if they had two or more children, and if they were leaner.

That last factor probably reflects the fact that some heavier women aren't good candidates for breast reconstruction surgery, so they're more likely to choose lumpectomy.

But the study doesn't answer other questions about mastectomy-vs.-lumpectomy that may factor into many women's decisions.

For instance, some women may be concerned that they'll get a poorer cosmetic result from lumpectomy and radiation than from mastectomy followed by reconstruction. The study doesn't address that, or concern about the side-effects or burden of weeks-long radiation treatments that usually follow lumpectomy.

The study also doesn't address economic issues — such as the cost of one procedure versus another, or whether it makes a difference if women have insurance coverage.

Rosenberg says the point isn't to question whether many younger women who choose mastectomy are misguided.

"It's a high rate of mastectomy, but we're not trying to say women who choose mastectomy are making a bad decision," she says. "We just want to make sure it's an informed decision. You want to make sure the patient understands the benefits and harms of each option."

Does drinking alcohol increase the risk of cancer?

By Susan M. Gapstur, PhD, MPH

Do you enjoy an occasional, or even a daily, glass of wine, beer, or other drink that contains alcohol? Many adults do. Indeed, 37% of adults in the U.S. report drinking low to moderate amounts, which is, on average, up to 1 drink per day if you are a woman, and 2 drinks per day if you are a man. Another 28% of adults drink more each day, which is considered heavy drinking. A drink of alcohol is generally defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Modest Benefit but Many Risks Associated with Alcohol Drinking

While low to moderate alcohol consumption is linked to a reduced risk of heart disease, drinking too much alcohol can increase risk of high blood pressure, heart failure, sudden death and stroke. Overall, alcohol consumption is one of the top 10 contributors to sickness and death from injuries, motor vehicle crashes, homicides and suicides, sexual assaults, sexually transmitted infections from unsafe sex, falls, birth defects, depression, disorders of the gastrointestinal tract, and sleep disorders.

Additionally, there is a lot of evidence that drinking alcohol increases the risk of several cancers. In 2007, a working group of experts convened by the World Health Organization's International Agency for Research on Cancer (IARC) reviewed the scientific evidence on alcohol and cancer risk for 27 different anatomic sites. They found sufficient evidence that alcohol drinking is a cause of cancers of the mouth, pharynx, larynx, esophagus, liver, colon, rectum, and female breast. And for cancers of the mouth, larynx, and esophagus, when people drink and use tobacco, the risks are combined to be greater than either tobacco use or alcohol use alone!

Importantly, it is also now well recognized that drinking even low amounts of alcohol can increase the risk of breast cancer, the most commonly diagnosed cancer among women in the U.S. and worldwide. Compared to non-drinkers, there is a 10% to 12% higher risk of female breast cancer associated with each drink per day.

The IARC working group also noted that the scientific evidence is limited for several other cancer sites and more research is needed. One cancer for which there has been considerable interest is pancreatic cancer, the fourth most common cause of cancer death among men and women in the U.S. While heavy alcohol consumption causes acute and chronic pancreatitis, it has never been linked definitively to pancreatic cancer. The lack of convincing evidence is in part due to the fact that many individual studies have been too small to tease apart the effects of alcohol from the risk due to cigarette smoking, a well-established risk factor for pancreatic cancer.

To help address this issue, epidemiologists at the American Cancer Society used data collected from the Cancer Prevention Study II (CPS-II), a large cohort of more than 1.2 million U.S. men and women who were followed for cancer death from 1982 through 2008. During that follow-up time, nearly 7,000 study participants died of pancreatic cancer. The large size of the cohort allowed investigators to examine the risk of pancreatic cancer for heavy drinkers and break out whether or not they were smokers.

In those who never smoked, there was a 36% higher risk of pancreatic cancer death among men and women who drank 3 or more alcoholic drinks a day, compared to never drinkers. However, Whereas Among in those who ever smoked, there was a 16% higher risk associated with drinking 3 or more drinks per day. (The reason that the association between drinking alcohol and pancreatic cancer risk is not as strong in those who ever smoked is because they already have higher rates of pancreatic cancer, so the difference between drinkers and non-drinkers in this category is not as strong.) Regardless, these findings strongly suggest that heavy alcohol drinking is a risk factor for pancreatic cancer.

How does alcohol cause cancer?


We don't completely understand how alcohol causes cancer. Particularly for cancers of the head, neck, and esophagus, and perhaps other cancers such as liver cancer, one reason involves acetaldehyde, a toxic chemical that the body makes when it breaks down alcohol. Acetaldehyde can directly affect normal cells by damaging DNA, which can lead to cancer. For other cancers such as colorectal (colon and/or rectal) cancer, alcohol might adversely affect the metabolism of different nutrients that might play a role in reducing cancer risk. For breast cancer, drinking alcohol can increase circulating estrogens or other hormones in the blood, and hormones play a key role in the development of many breast cancers.

Are the effects of wine, beer, and liquor different?

 

Most people want to know if drinking wine is better than drinking beer or hard liquor. The research shows that it does not matter what type of alcohol you drink, and that the risk of these cancers is elevated for all alcoholic beverage types.

How to reduce your risk from alcohol

 


Based on the information and research available to date, a recent study noted that approximately 3% (19,500) of all cancer deaths in U.S. each year can be blamed on alcohol consumption, and about 1/3 of alcohol-related deaths are among those who drink up to about 1.5 drinks per day.

Some people could reduce their risk of cancer by having less alcohol. According to the American Cancer Society's guidelines for cancer prevention, people who drink alcohol should have no more than 2 drinks per day for men and 1 drink a day for women. The recommended limit is lower for women because of their generally smaller body size and slower metabolism of alcohol. (This is the average per day and doesn't justify drinking more drinks on fewer days of the week).

People who are at particularly high risk for cancer should talk to their doctor about not drinking alcohol or limiting the amount they drink to help reduce their risk.


For more information about alcohol and cancer, visit this page.

Dr. Gapstur is vice president of epidemiology for the American Cancer Society.

Colon Cancer: Catching It Early

Colon cancer is the third leading cause of cancer-related deaths in the United States among men and women, and is expected to cause about 50,830 deaths during 2013. However, colon cancer is often highly treatable. If it’s found and treated early, while it’s small and before it has spread, the 5-year survival rate is about 90%. But because many people are not getting tested, only about 4 out of 10 are diagnosed at this early stage when treatment is most likely to be successful.

This infographic focuses on the benefits of catching colon cancer early, identifying the people at greatest risk for developing colon cancer, and the steps you can take to detect colon cancer early or even prevent it altogether.

Colon Cancer: Catching It Early

Despite substantial decreases in colon cancer death rates over the past two decades, it remains the third-deadliest cancer in the United States among men and women. If it’s found and treated early, however, the 5-year survival rate is 90%. Many more lives could be saved by understanding colon cancer risks, increasing screening rates, and making lifestyle changes.

The 5-year, survival rate is 90%, if colon cancer is found early, but only 39% of colon cancer cases are diagnosed at an early stage, partly due to low screening rate.

Stages Of Colon Cancer

  • Polyp: Most colon cancers develop from these noncancerous growths
  • In Situ: Cancer has formed, but is not yet growing inside the colon or rectum walls
  • Local: Cancer is now growing in the colon or rectum walls; nearby tissue not affected
  • Regional: Growth beyond the colon or rectum walls and into tissue or lymph nodes
  • Distant: Cancer has spread to other parts of the body such as liver or lungs 

Who Gets Colon Cancer? 

Anyone can get colon cancer, but some groups are at increased risk.

Gender: Overall, colorectal cancer incidence and mortality rates are about 35% to 40% higher in men than in women. 

Age: Incidence and death rates for colorectal cancer increase with age. Overall, 90% of new cases and 94% of deaths occur in individuals 50 and older. The incidence rate of colorectal cancer is more than 15 times higher in adults 50 years and older than in those 20 to 49 years.

Race/Ethnicity: Colorectal cancer incidence and mortality rates are highest in African American men and women; incidence rates are 20% higher and mortality rates are about 45% higher than those in whites. Incidence and mortality rates among other major racial/ethnic groups are lower than those among whites.

What Can You Do About It

Reduce risk by managing your diet, weight and physical activity. 

Diet 

  • Eat more vegetables, fruits and whole grains.
  • Get the recommended levels of calcium and vitamin D.
  • Limit intake of red and processed meats, fried foods and high-calorie fats.

Body Mass Index (BMI) 

  • Avoid obesity and weight gain around the midsection.
  • Maintain a healthy Body Mass Index (BMI) of 18-25.

Physical Activity 

  • Increase intensity and amount of physical activity.

Lifestyle 

  • Avoid Tobacco
  • Avoid excess alcohol.

If you're 50 or older, talk to your doctor about getting tested.For average-risk individuals with no symptoms, screening should begin at age 50. If you are at increased risk or are experiencing symptoms, speak to your doctor right away.

Symptoms can include: Rectal bleeding, blood in the stool, dark- or black-colored stools, change in the shape of stool, lower stomach cramping, unnecessary urge to have a bowel movement, prolonged constipation or diarrhea, and unintentional weight loss. 

Pros and Cons of Different Types of Screening Tests 

Flexible Sigmoidoscopy: Slender tube is inserted through the rectum into the colon. Provides visual exam of the rectum and lower 1/3 of the colon. 

Pros: 

  • Fairly quick and safe
  • Sedation usually not used
  • Does not require a specialist

Cons: 

  • Does not view upper 2/3 of colon
  • Can't remove all polyps
  • May be some discomfort

Colonscopy: Direct exam of the colon and rectum. Polyps removed if present. Required for abnormal results from other tests

Pros: 

  • Can usually view entire colon
  • Can biopsy and remove polyps
  • Done every 10 years

Cons: 

  • Costs more than other tests
  • Higher risk than other tests
  • Full bowel preparation needed

Double-Contrast Barium Enema: Radiological exam of the colon. Barium sulfate is introduced through the rectum and spreads throughout the colon.

Pros: 

  • Can usually view entire colon
  • Relatively safe
  • No sedation needed

Cons: 

  • Can miss small polyps
  • Can't remove polyps during test
  • Full bowel preparation needed

CT Colonography: Detailed, cross-sectional, 2D or 3D views of the colon and rectum with a x-ray machine linked to a computer

Pros: 

  • Fairly quick and safe
  • Can usually view entire colon
  • No sedation needed

Cons 

  • Still fairly new test
  • Can't remove polyps during test
  • Full bowel preparation needed

Fecal Occult Blood Test/Fecal Immunochemical Test: Can detect blood in stool caused by tumors or polyps. A kit is obtained from a health care provider. 

Pros: 

  • No direct risk to the colon
  • No bowel preparation
  • Sampling done at home

Cons: 

  • Colonscopy needed if abnormal
  • May miss some polyps/cancers
  • Should be done every year

SUPPORT THE AMERICAN CANCER SOCIETY

100 years ago, we began the fight of a lifetime. Today, you can help us finish the fight. When you support the American Cancer Society, you join millions of others who are committed to the fight to end cancer. You help save lives in your community and around the world. Thank you for supporting these lifesaving efforts that get us closer to a world with less cancer and more birthdays.

Learn More // cancer.org/colon

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Minority Cancer Awareness: Everyday Steps to Help Lower Your Risk

Every April the American Cancer Society and other organizations work together to raise awareness about cancer among minorities in honor of National Minority Health Month and National Minority Cancer Awareness Week, celebrated this year April 15-21.

Cancer affects different populations differently, and minority groups in the United States continue to bear a greater cancer burden than whites. Much of this difference is due to factors like poverty and lack of access to prevention/detection services and high-quality treatment, according to a report in Cancer Facts & Figures 2013, a yearly American Cancer Society publication. For instance, African Americans and Hispanics in the US have higher poverty rates than whites and are less likely to have health insurance, making it harder for them to get the care they need.

So far this year the American Cancer Society has awarded 18 national research grants totaling more than $17.4 million to help improve access to cancer screening and treatment as well as quit-smoking programs. In addition, the Society is striving to enroll people from diverse ethnic and racial backgrounds in its landmark Cancer Prevention Study 3, a long-term study that will shed light on how lifestyle factors affect cancer risk and help us understand what to do to help prevent cancer.

Earlier studies like this one have helped us learn about some of the things everyone can do to help reduce their cancer risk or improve their chances of beating the disease if they do get it.

1. Get regular cancer screening tests.

Regular screening tests can catch some cancers early, when they’re more treatable. With a few cancers, these tests can even prevent cancer from developing in the first place. Talk with your doctor about the tests for colon, lung, prostate, breast, and cervical cancers.

2. Control your weight.

Being overweight or obese is a risk factor for many cancers, including breast, colon, uterine, esophageal, and kidney cancer. You can control your weight by exercising regularly and eating more healthfully.

3. Exercise regularly.

Even if you’re already at a healthy weight, getting regular exercise is important. Physical activity has been shown to lower the risk of several types of cancer, including breast, colon, and advanced prostate cancer. It also reduces the risk of other serious diseases like diabetes and heart disease. The Society recommends adults get at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity each week, preferably spread throughout the week.

4. Eat healthfully.

Eat at least 2 ½ cups of vegetables (including legumes) and fruits each day. Choose whole-grain breads, pasta, and cereals over those made from refined grains. Eat less processed meat such as bacon, sausage, luncheon meats, and hot dogs. Substitute fish, poultry, or beans for red meat (beef, pork, and lamb). Bake, broil, or poach meats rather than frying or charbroiling.

5. Stop smoking.

Smoking damages nearly every organ in the human body, is linked to at least 15 different cancers, and accounts for some 30 percent of all cancer deaths. Quitting smoking is one of the best things you can do for yourself and your loved ones.

Clues to How Exercise May Lower Breast Cancer Risk

Older women who are physically active have lower levels of estrogen and its breakdown products in their bodies, according to a new study, perhaps explaining why exercise may reduce breast cancer risk.

Researchers have long linked exercise with lower breast cancer risk for women past menopause, believing it works partly by lowering their estrogen levels. Higher estrogen levels can raise breast cancer risk.

The new study provides more clues as to how the exercise may be protective, said Cher Dallal, a cancer prevention fellow at the U.S. National Cancer Institute. She is scheduled to present the findings Tuesday at the American Association for Cancer Research's annual meeting in Washington, D.C.

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

"Our aim was to try to better understand how physical activity may affect levels of estrogen," Dallal said. She evaluated 540 Polish women, aged 40 to 74, who were enrolled as healthy control patients in the NCI Polish Breast Cancer Study. None of the patients was on hormone therapy.

The women engaged in a range of physical activity. For seven days, they wore a device called an accelerometer on their waist while awake, which measured overall activity. The women also collected 12-hour urine samples.

Dallal measured the hormones estradiol and estrone, along with different estrogen breakdown products, or metabolites, in the urine. "Physical activity was associated with lower levels of the main estrogens," she said. Activity also was associated with increased metabolism of some of the breakdown products, she found.

"Increased overall activity appears to increase the metabolism of estrogen," she said. "This is the first time we have been able to assess these 15 metabolites."

Using the accelerometers gives a much more accurate picture of activity during the day than other methods, such as having women recall their exercise activity, said Leslie Bernstein, a professor and director of cancer etiology at the City of Hope Comprehensive Cancer Center, in Duarte, Calif.

Bernstein was not involved in this study, but was one of the first to study exercise as a way to reduce estrogen exposure and breast cancer risk. The new study, she said, "just adds evidence to say that this is one mechanism by which physical activity reduces your risk of breast cancer. You have less excretion [of the hormones] so it means you are producing less. [However], it's still not proven."

But, she said, "we know for breast cancer [risk], hormones are important. This is the first time we have strong evidence that measured physical activity reduces hormone levels. It helps us understand what's going on and how it's working."

It doesn't mean, however, that physical activity doesn't also reduce risk in other ways, such as improving insulin metabolism, she said. Higher insulin levels have been linked with some cancers, including breast cancers.

Exercise also helps with weight control. Most estrogen comes from fat tissue after menopause, and having more fat tissue raises estrogen levels and, in turn, breast cancer risk.

Some researchers are also looking at whether physical activity can improve your ability to repair DNA, which would perhaps explains the reduced cancer risk, Bernstein said.

The take-home message for women from the new research is to exercise, Bernstein said. Women who haven't been active should check in first with their doctor, and then, after getting the go-ahead from their doctor, engage in exercise that "puts some stress on the body," such as brisk walking, she suggested.

People With Type 1 Diabetes at Risk of Thyroid Disease

People who have type 1 diabetes are more likely than others to develop an autoimmune thyroid condition.

Though estimates vary, the rate of thyroid disease -- either under- or overactive thyroid -- may be as high as 30 percent in people with type 1 diabetes, according to Dr. Betul Hatipoglu, an endocrinologist with the Cleveland Clinic in Ohio. And the odds are especially high for women, whether they have diabetes or not, she said, noting that women are eight times more likely than men to develop thyroid disease.

"I tell my patients thyroid disease and type 1 diabetes are sister diseases, like branches of a tree," she said. "Each is different, but the root is the same. And, that root is autoimmunity, where the immune system is attacking your own healthy endocrine parts."

Hatipoglu also noted that autoimmune diseases often run in families. A grandparent may have had thyroid problems, while an offspring may develop type 1 diabetes.

"People who have one autoimmune disease are at risk for another," explained Dr. Lowell Schmeltz, an endocrinologist and assistant professor at the Oakland University-William Beaumont School of Medicine in Royal Oak, Mich.

"There's some genetic risk that links these autoimmune conditions, but we don't know what environmental triggers make them activate," he explained, adding that the antibodies from the immune system that destroy the healthy tissue are different in type 1 diabetes than in autoimmune thyroid disease.

Hatipoglu said that people with type 1 diabetes are also more prone to celiac disease, another autoimmune condition.

Type 1 diabetes occurs when the immune system mistakenly attacks the insulin-producing cells in the pancreas, destroying them. Insulin is a hormone that's necessary for the metabolism of carbohydrates in foods. Without enough insulin, blood sugar levels can skyrocket, leading to serious complications or death. People who have type 1 diabetes have to replace the lost insulin, using shots of insulin or an insulin pump with a tube inserted under the skin. Too much insulin, however, can also cause a dangerous condition called hypoglycemia, which occurs when blood sugar levels drop too low.

The thyroid is a small gland that produces thyroid hormone, which is essential for many aspects of the body's metabolism.

Most of the time, people with type 1 diabetes will develop an underactive thyroid, a condition called Hashimoto's disease. About 10 percent of the time, Schmeltz said, the thyroid issue is an overactive thyroid, called Graves' disease.

In general, people develop type 1 diabetes and then develop thyroid problems at some point in the future, said Hatipoglu. However, with more people being diagnosed with type 1 diabetes in their 30s, 40s and 50s, Schmeltz said, it's quite possible that thyroid disease can come first.

Thyroid problems are often diagnosed through routine annual blood tests, according to both experts.

Untreated thyroid problems can affect blood sugar levels in people with type 1 diabetes. "If I see someone having a lot of trouble controlling their blood sugars, it could be the thyroid," noted Hatipoglu.

"People who are diagnosed with type 1 diabetes often work very hard to control their blood sugar, but if they're not aware of an underactive thyroid, they may have a lot of unexplained low blood sugars," she said. "If someone is hyperthyroid, they may have unexplained high blood sugars."

Sometimes people with type 1 diabetes gain weight from taking insulin, but unexplained weight gain can also be due to an underactive thyroid.

"People really need to be aware that if you have one of these conditions, you're at risk of the other," Schmeltz said. "And, symptoms aren't always so obvious. Someone might be tired a lot and think it's because of diabetes, and they end up ignoring thyroid symptoms."

He said the classic symptoms of an underactive thyroid are decreased energy, hair loss, inappropriate weight gain, feeling cold, constipation, dry skin, heavy periods and difficulty concentrating. Some of the symptoms also overlap with a diagnosis of depression.

Symptoms of an overactive thyroid, which are often mistaken for other conditions, include trouble concentrating, heat intolerance, frequent bowel movements, excessive sweating, increased appetite, unexpected weight loss, restlessness, a visible lump in the throat (goiter), nervousness and irregular menstrual periods, according to the U.S. National Library of Medicine.

Autoimmune thyroid disease is usually managed with a daily pill, according to Schmeltz. Hatipoglu said it's important to try to take this pill at the same time every day and to not eat for about 45 minutes after taking it. She said she tells her patients to take the pill before breakfast, or at night before bed if they have to get out the door quickly in the morning. "Take it when you know you can take it in the same way every day," she said.

Hatipoglu also pointed out that autoimmune thyroid disease can be episodic in the beginning.

"It's like a volcano erupting," she said. "It can happen on and off as the thyroid is being damaged by the immune system. One day it will be totally destroyed, but until you come to that point, it may come and go — for how long depends on the individual. For some it's months. For some it can be decades."

SOURCES: Betul Hatipoglu, M.D., endocrinologist, Cleveland Clinic, Cleveland, Ohio; Lowell Schmeltz, M.D., endocrinologist and assistant professor, Oakland University-William Beaumont School of Medicine, Royal Oak, Mich.