CAN WE PREVENT ONE OF THE DEADLIEST CANCERS?? There’s little hope for those with pancreatic cancer (although Dr. Peter Gonzalez is probably the best resource on this), but there is much we can do to prevent it. Obviously not smoking is a biggie. Possibly even more powerful is avoiding prediabetes and the resultant abdominal obesity. Prior studies have found a 400% increase in risk with those that are prediabetic. This study further confirms the link. Read More
Cancer Tips
Aggressive Prostate Cancer; How to Tell if You’re at Risk
It’s become clear that only a small portion of prostate cancers will ever become aggressive. The ultimate question is, will YOUR prostate cancer become aggressive?
The same situation applies almost exactly for breast cancer.
I have always felt that the key to cancer research is to determine which cancers will progress. We have done a poor job of spending our money in this direction, instead choosing to spend billions of research dollars on drugs that do little to extend cancer survival at an extreme cost. These “costs” are made up of dollars for treatment as well as side effects.
And so many of the treatments given are for cancers that were never going to progress anyway. How real is a “cure” when the condition was going to either resolve on its own or never progress? And what about treatments like cancer surgery, which may actually promote cancer spread due to the massive stress on the body?
My position has remained strong on this matter. It is clear that widespread cancer screenings like PSA and mammography are far more likely to identify cancers that will never progress. However, if someone does undergo testing and finds they have breast or prostate cancer, this person should be educated as much as possibly about lifestyles that will increase survival. At the same time would should be spending a greater portion of cancer research dollars on determining factors that will identify those cancers that are going to progress.
Luckily, the factors that increase survival are closely related to the factors that indicate a cancer will progress. I have covered many of the protective factors for prostate cancer in a previous article that can be read by clicking here.
This particular article begins to address the other side of the equation: what factors are associated with prostate cancer progression?
Hormones play an important role in the development of sex-specific cancers like breast, uterine and prostate, with estrogen and testosterone being on the top of the list. In the study researchers looked at several aspects of hormones in aggressive prostate cancer (stage III or IV and/or Gleason ≥7) including:
- Estrone
- Estradiol
- Thirteen breakdown products of estrogen (in the 2-, 4-, or 16-hydroxylation pathways)
- Testosterone
- Sex hormone-binding globulin
When it comes to the breakdown products of estrogen in the male body, the wrong metabolites can be quite toxic to the cells of the prostate. Specifically, the “16” and “4” pathways are considered bad, while the “2” pathway is considered friendly. The same goes for breast cancer.
With this in mind, here are the results from the study:
- The risk of aggressive prostate cancer was 73% lower in those with the highest estradiol:testosterone ratio
- On the other side of the coin, the risk was 244% higher with higher 2:16α-hydroxyestrone ratios.
To put this in English, having a higher ratio of estradiol to testosterone was incredibly protective against the development of aggressive prostate cancer. Given that this is a ratio, there are two sides to the equation. The first would be low testosterone, which should come as no surprise. Testosterone will directly stimulate the cells of the prostate to reproduce, so higher levels are not good. That is why testosterone therapy can be such a bad idea.
The other side of the equation is the estrogen one. The effects of estrogens on prostate cancer are not quite as well-known and it may be, based on the results of this study, that estrogen has some type of strong protective effect against prostate cancer.
Ironically, mainstream medicine has focused on the prostate side of this equation almost exclusively, without much success (I recently reviewed this evidence in a prior blog article that can be found by clicking here). Maybe they’ve had the right theory but the wrong approach.
The results of the 2:16α-hydroxyestrone ratio have me a wee bit more confused. As I already mentioned, the 2:16α-hydroxyestrone ratio has been shown to be protective against hormonal cancers, included breast, uterine and prostate cancer. Further, intake of cruciferous vegetables like broccoli and cauliflower increase the ratio, so the ratio goes up with lifestyle choices well-known to be good for us.
But, the results of this study find that higher ratios led to increased risk of aggressive prostate cancer.
I can’t say that I have a readily available answer that makes sense for this finding. I could postulate that anything that promotes a stronger estrogenic activity (like the 16 hyroxylation product would) is going to slow prostate cancer growth.
It could be possible that an elevated 2:16α-hydroxyestrone ratio might be protective against the development of prostate cancer, but that once prostate cancer has begun, this same elevated ratio now promotes the growth of the cancer.
For now, I am not about to recommend lower intakes of things like cruciferous veggies to keep the ratio low, but I will keep my eyes peeled for more info on this topic.
The take-home message applies to men who have been diagnosed with prostate cancer and are unsure of what to do. Knowing that there is a factor that can easily be checked in the blood stream that will increase or decrease the risk of conversion to an aggressive cancer can be critical in making a treatment decision.
Given that the decision to progress or forgo treatment could be one of the most critical in a man’s life, any information to help make a decision is welcome.
Diet and Colon Cancer
THIS DIETARY PATTERN VIRTUALLY ELIMINATES COLON CANCER. Colon cancer is among one of the more prevalent types of cancer. It is also one of the cancers that we know greatly how to prevent. In this study, a diet based on fruits and veggies lowered risk by a massive 65%, while a meat, potatoes and refined carbs pattern led to a 220% increased risk. And add in probiotics, avoidance of processed foods with nitrates (although this does depend on genetic factors like the EPOH uniqueness / SNP).
Stopping Prostate Cancer Recurrence: How to Completely Miss the Boat
Having prostate cancer at all is a bad thing, but living with the constant fear of prostate cancer recurrence can be worse.
There is no shortage of controversy over our fascination with overdiagnosis of both prostate cancer and breast cancer in medicine today. I have covered this in a previous blog article (that can be read by clicking here) so I won’t go into it the controversy in detail here.
There is also no shortage of lifestyle factors that clearly, strongly play a role in the development of prostate cancer. Dairy intake increases the risk of prostate cancer. Exercise decreases it. Smoking increases risk. A plant-based diet decreases risk.
But there is one thing that absolutely plays a role in the development of most types of cancers, with prostate cancer being no exception.
The diabetic spectrum. Whether we are talking about full-blown diabetes or somewhere along the prediabetic pathway, this absolutely, positively increases your risk of developing prostate cancer.
One of the hallmarks of being prediabetic is abnormalities of lipids like total cholesterol, HDL and LDL cholesterol, VLDL and triglycerides. Lipids are the first thing I like to look at on a patient’s blood work to see if prediabetes is a concern.
It would then make sense that one of the best ways to lower your risk of developing prostate cancer in the first place would be to live an anti-diabetic lifestyle (again—out of the scope of this article, but you can purchase my eBook on diabetes by clicking here).
But what about prediabetes and prostate cancer recurrence?
This is not exactly what researchers called it in this particular article, but that is essentially what they were looking at. They looked at the relationship between lipids abnormalities and the risk of prostate cancer recurrence in 843 radical prostatectomy.
Here’s what they found:
- Elevated triglycerides were associated with a 3% increased risk of prostate cancer recurrence FOR EVERY 10 mg/dl increase. This can add up fast.
- Total cholesterol, LDL and HDL did not affect prostate cancer recurrence risk.
- However, if the men were prediabetic with lipid problems, each 10 mg/dl increase in cholesterol up recurrence risk 9% while the same increase in HDL lowered risk a respectable 39%.
Seems to be in line with expectations. Lipid problems that indicated prediabetes clearly increased the risk of recurrence. But it was after this point in the article abstract that I found myself smacking my forehead against the computer monitor…
The authors concluded that these findings suggest that lipid levels should be explored as a modifiable risk factor for prostate cancer recurrence. In other words, we should use statins to lower the risk of prostate cancer recurrence.
Huh?
Rather than suggesting that an anti-diabetic lifestyle would be powerful for preventing prostate cancer recurrence, they just completely skirt the prediabetic / lifestyle issue and jump right to using medications to treat the surrogate end marker and hope for the best.
UGH!!
Breast Cancer Risk Factors: Surprising Way to Lower Your Risk
Quitting smoking, limit alcohol use, exercise, more fruits and veggies. We all know these risk factors for breast cancer.
Or at least I hope you know these factors and more. If you need a little refresher, feel free to check out prior blog posts on breast cancer prevention by clicking here.
Some risk factors are a little less obvious. Exposure to toxic chemicals like BPA in plastic water bottles, cooking in Teflon and phthalates from vinyls all increase your risk of breast cancer. Stress plays a role. Vitamin D plays a role.
But the gut?
Or, more specifically, the bacteria in your gut.
To understand the relationship of the bacteria in your gut to breast cancer risk, you have to better understand the way the human body breaks down estrogen. The 3 main estrogens in the body are estriol, estradiol and estrone.
Estrogens in the human body are broken down through several mechanisms. The breakdown occurs through several pathways which can be either safe or damaging and this pathway is called hyrodylation. Hydroxylation can occur down several pathways that produce different end-products. The 2 pathway is generally considered the friendly pathway. On the other hand, the 16-alpha pathway creates an estrogen that damages DNA and increases the risk of hormone related cancers like breast and uterine.
Dietary choices like broccoli and cauliflower will help your body breakdown estrogen into the safer 2 pathway. That’s why you should eat more cruciferous vegetables to lower your risk of breast cancer (never saw a poster proclaiming this during any of the Susan Komen 3-days).
But there’s another really important factor that helps to determine what pathway your body will take when breaking down estrogens, which brings us back to the gut.
The bacteria in your gut play a very large role in how estrogens get broken down. And since most of the estrogens that your body is trying to get rid of are dumped into the bile and then into the gastrointestinal and out the body from there. This means that the estrogens have a very heavy exposure to the bacteria in the gut.
In this particular study, researchers looked at how much the bacteria in the gut played a role in the breakdown of estrogens. Specifically, they looked at estrone and estradiol levels (called the parent estrogens) and compared them to the hydroxylated estrogens.
Without going into details of the study, the take home message is that the more diversity there was in the bacteria of the gut, the better the ratio between the parent estrogens and the estrogen byproducts.
So what does this mean? Anything that destroys bacterial diversity in the gut is likely to increase your risk of breast cancer.
Highest on the list for destroying the good bacteria in your gut? Antibiotics. And not just in the past week. As in EVER.
Even 2 years after a course of antibiotics bacterial diversity still has not recovered. There really hasn’t been any studies looking at how long it takes to recover diversity, but I would guess it takes decades when left alone.
You can probably shorten this time by using probiotics and eating foods that support the growth of bacteria in the gut. This includes foods like beans, whole grains and fruits. These foods contain soluble fiber that the bacteria feeds on.
Remember this info the next time your primary care or urgent care offers you a prescription for your upper respiratory viral infection.
Common Prostate Cancer Treatment Falls Short
Much like breast cancer, there has been much controversy with prostate cancer “prevention” and treatment in recent years.
Mainstream medicine as well as the public health gurus all put all their bets on the PSA card when it came to prostate cancer “prevention.” (For those non-regular-readers of the Rantings, I always surrounding the word “prevention” in quotation marks because mainstream medicine does little to prevent cancers–most of what they call prevention is really early detection.)
The research over the past few years has been leading away from using PSA as an effective means of preventing prostate cancer and saving lives. Even the discoverer of the PSA test, Dr. Richard Albin, has clearly shown his opinion about the matter, stating that the test should never have been used for the early detection of prostate cancer.
The main concern with the widespread use of the PSA test to detect prostate cancer is that there are a large number of prostate cancers detected that never would progress to anything of substance. This large chunk of men diagnosed with non-aggressive prostate cancer is pushed towards surgery, radiation and chemotherapy for a cancer that would never create harm.
You can see the problem here.
One of the common treatments given to prostate cancer patients includes a drug to block the action of testosterone, referred to as androgen-deprivation therapy or ADT. The idea is, if we block the action of testosterone on prostate cells (regardless of where they may be in the body) they will not divide as rapidly and these patients should have a longer survival time.
But, like so much else in medicine, we take an idea that may sound good on the surface and run with it long before the research is done to confirm that it’s a good idea.
And sometimes this research takes a LONG time. In the case of hormone replacement therapy for women, HRT was used for almost 50 years before the research trials found out it was a bad idea. This was, of course, after the drug companies made billions of dollars on drugs like Premarin.
As a result, ADT therapy is a common drug approach used in men with prostate cancer, despite a list of side effects like weight gain, loss of sexual libido and heart disease. Which brings us to this particular study.
In it, researchers looked at 66,717 Medicare patients 66 years or older diagnosed with prostate cancer from 1992 through 2009. They were followed for 15 years (average follow up was 110 months) and broken out into high use and low use of ADT. Here’s what they found:
- ADT was not associated with improved 15-year survival following the diagnosis of localized prostate cancer.
- Among patients with moderately differentiated cancers (more serious types of tumors), the 15-year overall survival was 20.0% in areas with high ADT use vs 20.8% in areas with low use (in other words, it made no difference).
- The 15-year prostate cancer survival was 90.6% in both high- and low-use areas.
- In poorly differentiated cancers (the worst type), the 15-year cancer-specific survival was 78.6% in high-use areas vs 78.5%, in low-use areas.
- In this same group of poorly differentiated cancer, the overall risk of dying from any cause (not just cancer) over 15 years was 8.6% in high-use areas vs 9.2% in low-use areas (in other words, the group NOT using the ADT lived slightly longer).
Keep in mind that this is a very large study. While no single study sets anything in stone, the fact that we have been using an unproven therapy for prostate cancers that might never have progressed that have significant side effects should make you wonder just how many other commonly used treatments in medicine are creating far more harm than good.
Brand New Cancer Treatment Drugs; How Good Are They?
Cancer is one of the scariest things we can and will face in our lifetimes. It’s a very emotional time and we become susceptible to hopes and infer things unsaid from our doctors.
Some cancers we do exceedingly well with treatment. Others, not so much so. And for those that we don’t have effective treatments for the immediate future continues to look bleak. We just don’t have good options for treating cancers like pancreatic, colon, advanced breast and prostate cancer. And do not mistake good outcomes promoted by various natural groups for cancers that were actually “pre-” cancerous and not likely to progress to full cancer (which happens commonly with breast and prostate cancers).
For those tougher cancers, this means that we hear hope when hope might not really be given by our cancer doctors. (A recent study looking at 102 cancer center advertisements found that most ads used emotional appeals / hope instead of information about treatments–only 2% of the ads tried to “quantify” the potential benefits or mentioned risks) Oncologists are human. It takes a pretty detached physician to look a cancer patient in the eyes, family also present, and tell them that there really are no good options for treatment.
Maybe this is why it never seems to happen. I have had patients, friends and family who have been recommended treatment for a cancer with a grim prognosis. In these situations, it should have been explained that the treatments will likely not do much to improve survival and will likely destroy any quality of life the patient would otherwise have had.
Just to illustrate how true this is, theirs was a review article looking at this very topic and the costs associated with drugs for cancer care. The results:
- In the 71 drugs licensed by the FDA for the treatment of solid tumors since 2002, the average survival benefit is 2.1 months.
- These few weeks usually come at a cost of tens of thousands of dollars and severe adverse effects.
I don’t mean to sound like the doom and gloom bringer, but society needs to take a more reality based approach to cancer treatment. If society understood just how poorly we still deal with cancer maybe we would start giving prevention the spotlight that it so rightly deserves. Further, maybe we should offer cancer patients options: (1) Expensive cancer treatment loaded with side effects that will only marginally prolonged your life or (2) tens of thousands of dollars to live the life of your dreams for the next 2-4 or 6 months. Take that cruise to the Mediterranean. Take the 2 week Hawaii vacation and helicopter over the volcanoes. And bring all your close family members. Option 2 would save countless thousands of dollars.
As the cancer patient, which memories would you rather leave your loved ones with?
Increase Breast Cancer Survival: Critical Part Often Missed
I heard a sad story from a patient today. A 50-something friend had just finished treatment for breast cancer, only to suffer a fatal heart attack.
All too often, oncologists are only thinking of a 5-year survival rate as it relates to cancer. A death that occurs that is not cancer related does not count against the statistics of cancer survival.
The problem is that dead is still dead to the cancer survior. Whether from cancer, heart disease or stroke.
We already know that there are some very close associations between all chronic diseases. Patients with heart disease are more likely to have colon cancer. Diabetic patients are at a much greater risk of pancreatic cancer. This list is pretty long.
This means that every cancer patient needs to be educated about the lifestyle changes necessary to increase survival. Cancer treatment can NOT be limited to what happens at the oncology office. Chemotherapy and radiation are only a part of the equation to ensure that you are going to outlive cancer.
This particular article drives this concept home. In it, researchers looked at 2,317 women, ages 50 to 79 years, who were diagnosed with invasive breast cancer to see what kind of an impact lifestyle had on the overall survival rates over 9.6 years. Here’s what they found:
• Women with better quality diets had a 26% lower risk of dying from any cause.
• They also had a 42% lower risk of death from non–breast cancer causes.
• Breast cancer death was 9% lower, although this was not considered significant.
• More importantly, in women with estrogen receptor positive tumors the risk of dying from any cause was an impressive 45% lower.
From this information, lifestyle clearly has an important impact on the survival of a cancer patient, even if it is not directly from the cancer itself. If we can understand that cancer treatment is incredibly harmful to the patient, then lifestyle becomes critical to protecting the cancer patient from additional damage during this time.
For those of you really interested in 12 standards that make up the “Healthy Eating Index” referred to in this study, you can find a synopsis of the details by clicking here. Overall though, these standards are not that difficult to meet, especially when your life is on the line…