Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

OCTOBER IS NATIONAL BREAST CANCER

AWARENESS MONTH

HORMONE REPLACEMENT THERAPY (HRT)

AND BREAST CANCER RISK

The rising incidence of breast cancer, year-after-year, over the past 50 years in the United States (and in many other industrialized countries) has been attributed to a variety of factors, including environmental contaminants, rising obesity levels, and increased compliance with annual screening mammograms, among others.  However, one factor that has been given inadequate attention, in my view, is that of hormone replacement therapy (HRT), despite nearly a century of data showing a strong linkage between lifetime exposure to the female hormones estrogen and progesterone and the risk of developing breast cancer.

In 2002, the enormous, randomized, prospective, blinded Women’s Health Initiative (WHI) study published its preliminary results, and prematurely terminated its combination HRT study because of an alarming increase in the incidence of breast cancer in the group of women who had been secretly randomized to receive combination HRT medications for menopausal symptoms.

Despite subsequent updates from the WHI, which have shown, essentially, a doubling of breast cancer risk after more than 5 years of HRT use, there was initially a great deal of resistance to the WHI’s findings (and the findings of other similar clinical research trials) linking HRT use with an increased risk of developing breast cancer.

Now, a new national Canadian public health study offers additional powerful clinical research data linking HRT use with breast cancer risk, and reveals the equally strong link between declining HRT use and the declining breast cancer incidence in Canada.  This study appears in the current issue of the Journal of the National Cancer Institute.

In this study, 1,200 women between the ages of 50 and 69 participated in the National Population Health Survey between 1996 and 2006.  Just prior to the 2002 release of the WHI study’s results, 13 percent of these women regularly used combination HRT.  By December 2004, only 5 percent of the postmenopausal women participating in this study were still taking HRT medications.  During this same period, the incidence of breast cancer in this large group of Canadian women decreased by about 10 percent.  (Importantly, compliances rates with screening mammograms did not change during the course of this clinical research study.)

Thus, between 2002 and 2004, when HRT use significantly declined, the incidence of breast cancer decreased by about 10 percent in Canada.  Moreover, this significant decrease in breast cancer incidence occurred without any change in mammogram rates.

This study, as with other recent studies, adds to the overwhelming research data linking HRT use with an increased risk of developing breast cancer.  As I tell my own patients who are approaching menopause, it is best to avoid HRT altogether.  If you are already taking HRT medications, then ask your doctor to help you in weaning yourself off of these medications.

In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer.  There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure.  Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition!  There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in! 

For a deeper evidence-based discussion of the links between HRT and breast cancer risk, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

OCTOBER IS NATIONAL BREAST CANCER

AWARENESS MONTH

MAMMOGRAMS BETWEEN 40 AND 49 YEARS OF AGE

Both patients and their physicians were stunned last year when the U.S. Department of Health and Human Services’ U.S. Preventive Services Task Force (USPSTF) recommended against routine annual screening mammograms in women between the age of40 and 49 years (as has been the standard recommendation in the United States, and in most countries around the world, for many years).  The USPSTF’s recommendations quickly set off a firestorm of debate regarding the calculations and public health considerations used by the USPSTF to arrive at this surprising recommendation.  Since the USPSTF released its recommendations in the fall of 2009, most breast cancer specialists and breast cancer advocacy groups have continued to recommend that women who are at average risk of developing breast cancer begin routine annual screening mammograms at age 40. 

As I extensively discuss in my new book, A Cancer Prevention Guide for the Human Race, there is ample available clinical research data showing that screening mammograms detect breast cancer at an earlier stage than other commonly available screening methods, and that survival is improved in women in whom breast cancer is first detected by a mammogram (as opposed to the detection of a palpable or visible breast mass).

Now, a newly published large-scale public health study from Sweden, which appears in the current issue of the journal Cancer, offers further important evidence that the routine use of annual screening mammograms among women between 40 and 49 years of age significantly reduces the risk of dying from breast cancer.

In this enormous study, women between the ages of 40 and 49 years were separated into two groups, depending upon whether or not they underwent annual screening mammograms between 1986 and 2005 (the average duration of patient follow-up in this study was a very impressive 16 years).  In this very powerful research study, young women who underwent annual mammograms accounted for 7.3 million “person-years” of observation, while the young women who did not undergo mammograms accounted for a similarly astonishing 8.8 million “person-years” of observation within this landmark public health study. 

When the number of breast cancer deaths were assessed in both of these huge groups of young women, the women who underwent routine annual mammograms were found to be 29 percent less likely to die of breast cancer when compared to the young women who did not undergo annual mammograms!  (In public health terms, this 29 percent observed reduction in the death rate due to breast cancer is highly clinically significant!)

This public health study, which encompassed the entire country of Sweden, is the largest mammography study of its kind, and its findings are both powerful and persuasive in defense of beginning routine annual screening mammograms at the age of 40 in women who are at average risk of developing breast cancer.  It is my hope that the dramatic findings of this huge clinical study will now lay to rest any lingering doubts regarding the effectiveness of screening mammograms, beginning at 40 years of age, in reducing the risk of death due to breast cancer.

In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer.  There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure.  Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition!  There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in! 

For an evidence-based discussion of the critical importance of breast cancer screening, including mammograms, in a cancer prevention lifestyle, order your copy of my new landmark book, “A Cancer Prevention Guide for the Human Race,” from Amazon or Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores! 

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

http://www.youtube.com/watch?v=7-Tdv7XW0qg

I and the staff of Weekly Health Update would like to take this opportunity to thank the more than 100,000 new and returning readers who visit our premier global health information website every month.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers” 

IMPORTANT NEW ADVANCE IN BREAST CANCER TREATMENT:

INTRAOPERATIVE RADIATION THERAPY

The surgical management of breast cancer has undergone several very important revolutions over the past 20 years.  When I began medical school, there was essentially only one treatment available to women newly diagnosed with breast cancer.  Irrespective of how small or how large the tumor, every woman was advised to undergo complete removal of her breast (mastectomy).  Likewise, a radical removal of the lymph nodes in the armpit area, on the same side as the breast cancer, was also considered mandatory back then, even if there were no clinically enlarged lymph nodes detected prior to surgery.

Thanks to a landmark prospective clinical research study, conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) cancer study group, we know that radical mastectomy offers no improvement in breast cancer survival when compared to simply removing the breast tumor with a margin of normal surrounding breast tissue (partial mastectomy, also known as “lumpectomy”).  The NSABP B-04 study, which was initiated in 1971, has now reached an average duration of patient follow-up of nearly 30 years, and the compelling findings of this study have made it possible for hundreds of thousands of women with breast cancer to preserve their breasts.

More recently, the application of the sentinel lymph node (SLN) concept has enabled surgeons to locate the one, or a couple, of lymph nodes most likely to contain breast cancer cells.  By removing a very small number of SLNs, the complications associated with removal of the armpit (axillary) lymph nodes can be reduced by ten-fold when compared to removal of most of the lymph nodes in the axilla.  Since 60 to 65 percent of all breast cancer patients will not have their SLNs involved with breast cancer cells, the vast majority of these women are now able to avoid a complete axillary lymph node dissection, and its associated 30 to 35 percent incidence of complications, including chronic swelling of the arm (lymphedema), numbness or chronic discomfort the arm, and decreased shoulder mobility and strength.  (Unfortunately, at the present time, women with “positive” SLNs are still advised to have their remaining armpit lymph nodes surgically removed.)

For most women, “breast-conserving” surgery carries an additional price, though.  Radiation treatments are administered to the breast after all other treatment has been completed, as this has been shown to cut the risk of recurrence of cancer within the same breast in half.  For most patients, conventional “external beam” radiation therapy lasts approximately 5 weeks.  Although these treatments are given on an outpatient basis (Monday through Friday, typically), this somewhat prolonged duration of treatment is enough of an inconvenience to some breast cancer patients that they, ultimately, decide to undergo mastectomy instead of lumpectomy combined with radiation.

A number of techniques have been devised to speed up the process of radiation therapy for breast cancer patients.  These approved methods of accelerated breast irradiation include the use of more frequent treatment sessions, using a standard “external beam” radiation machine, as well as various forms of radiation treatments collectively referred to as brachytherapy.  Unlike external beam irradiation, where beams of radiation pass from a machine, and through space, before entering the breast from outside the body, brachytherapy techniques all involve placing a device inside the breast (within the lumpectomy cavity).  These catheter-based brachytherapy devices are then loaded with radioactive seeds that emit therapeutic radiation to the inside of the breast.  Based upon recent research data, brachytherapy appears to be just as effective as conventional external beam irradiation in reducing the risk of breast cancer local recurrence.  However, both brachytherapy and other forms of accelerated breast irradiation still require 1 to 2 weeks of treatment.

One potential alternative to standard accelerated breast irradiation methods has been the use of a one-time treatment of the lumpectomy cavity with radiation at the same time that the patient undergoes lumpectomy in the operating room.  Intraoperative radiation therapy has been utilized for other types of cancer, primarily within the abdomen, but its usefulness in treating breast cancer has been less clear.  Now, a newly published prospective, multi-institutional clinical study, just published in the journal Lancet, offers hope that a single application of radiation, administered while the patient is still under anesthesia at the time of her lumpectomy, might be able to replace the more cumbersome and time-consuming radiation therapy modalities currently in use.

This clinical trial was started in 2000, and enrolled 2232 women with newly diagnosed breast cancer.  Half of these women underwent conventional external beam radiation therapy, while the other half of these volunteers underwent a single episode of intraoperative radiation treatment at the time of their breast cancer surgery (it should be noted that 14 percent of the women who were randomized to receive intraoperative radiation therapy also subsequently received external beam irradiation as well).

After an average follow-up duration of 4 years, there was no significant difference in the incidence of local breast cancer recurrence between these two groups of women.  Moreover, the incidence of complications associated with radiation therapy was significantly lower in the group of patients who underwent a single intraoperative treatment with radiation when compared to the conventional external beam radiation therapy group.

While the 4-year follow-up of this group of breast cancer patients is too brief to definitively conclude that a single dose of intraoperative radiation provides equivalent long-term protection against local breast cancer recurrence when compared to external beam irradiation and brachytherapy, this study still offers the hope of yet another significant advancement in the treatment of breast cancer.  If intraoperative radiation therapy appears to be as effective as conventional breast irradiation after at least 10 years of patient follow-up, then I predict that eligible breast cancer patients will, someday, be routinely treated in this manner.  Ultimately, this approach to breast cancer treatment has the potential to significantly increase the efficiency and speed of patient care while simultaneously decreasing the overall cost of such care.  It will also improve the quality of the lives of millions of women, over time, and free them to move on with their lives more quickly after receiving the diagnosis of breast cancer.

To learn more about the prevention of breast cancer, and other cancers, look for the publication of my new landmark book, “A Cancer Prevention Guide for the Human Race,” in the summer of this year.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers” 

CHEMOTHERAPY FOR BREAST CANCER & MEMORY LOSS

“Chemo Brain” is a term often used by breast cancer patients to describe the decreased memory, and other cognitive dysfunctions, associated with chemotherapy for this common form of cancer.  However, there has been very little prospective, objective clinical research into this phenomenon.  Furthermore, what little research that has been done in this area, to date, has primarily focused upon subjective self-assessments, by breast cancer patients, of their own level of cognitive function following chemotherapy.  Moreover, until recently, the complaints of breast cancer patients regarding their self-perceived memory loss following chemotherapy were often dismissed by many physicians. 

Now, a newly published prospective clinical research study from the M.D. Anderson Cancer Center suggests that physicians may have vastly underestimated the frequency, severity, and duration of cognitive dysfunction following standard breast cancer chemotherapy.  This clinical study, which appears in the current issue of the journal Cancer, prospectively enrolled 42 women with newly diagnosed breast cancer.  All of these women then underwent standardized neuropsychological evaluation before, during, and after chemotherapy.  Importantly, this study not only tested these breast cancer patients in the early period after they completed their chemotherapy, but also one year after their chemotherapy had ended.  The findings from this small study strikingly illustrate just how common, and how enduring, memory loss and other forms of cognitive dysfunction are following chemotherapy for breast cancer.

Prior to beginning chemotherapy, 21 percent of these patients had some detectable degree of cognitive dysfunction.  By the end of their chemotherapy treatments, a whopping 65 percent of these 42 patients displayed measurable declines in memory function, organizational ability, and cognitive processing speed.  One year later, 61 percent of these women continued to display measurable declines in cognitive function.  Worse yet, among this group of women with persistent cognitive dysfunction one year after completion of their chemotherapy, 71 percent continued to display progressively worsening of cognitive function when compared to their level of function immediately after finishing chemotherapy.  Finally, the remaining 29 percent of this group of women with long-term evidence of cognitive dysfunction actually displayed a delayed-onset of cognitive decline when they were tested one year after chemotherapy (i.e., when compared to the results of their neuropsychological testing immediately after chemotherapy).

Although this clinical research study enrolled a small cohort of patients, its prospective nature, and its use of validated neuropsychological tests, make it a powerful research study for its size.  The findings of this study also fit well with previous laboratory research studies that have shown both acute and delayed changes in the actual structure of the brains of animals treated, proportionately, with the same chemotherapy drugs commonly used to treat breast cancer in humans.  Whether or not the significant declines in cognitive function that were observed, one year after chemotherapy in the 61 percent of women who participated in this study, will eventually stabilize, improve or worsen is unknown at this time.  Longer follow-up of these 42 breast cancer patients will have to be performed to answer this important question.  However, this small prospective study clearly indicates that the majority of women who undergo standard chemotherapy for breast cancer appear to experience significant and prolonged declines in their level of cognitive function, including memory loss, decreased organizational skills, and a general slowing of their cognitive processing speed, and that these adverse changes persist for at least a year after completion of chemotherapy.

The findings of this study should spur additional research into the precise cause(s) of this chemotherapy-associated impairment in cognitive function, as well as strategies to reduce the severity and duration of these adverse health effects following chemotherapy for breast cancer.  Meanwhile, it is important for me to stress that chemotherapy unquestionably extends survival, and saves lives, among women who are appropriately advised to undergo such treatment for breast cancer.  In my opinion, no patient should read this column, and then go on to refuse chemotherapy that has been appropriately recommended because of the findings of this clinical research study.  

To learn more about the prevention, screening, diagnosis and treatment of breast cancer, look for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in the summer of this year.

Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

http://www.youtube.com/watch?v=7-Tdv7XW0qg

http://www.redcross.org/

http://www.imcworldwide.org/haiti 

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers” 

CRUCIFEROUS VEGETABLES, SOY & BREAST CANCER RISK

The role of soybean-derived isoflavones in cancer prevention is not entirely clear at this time.  However, there has been intense interest in tofu, and other soy-derived foods, as potential breast cancer prevention agents.  At the same time, because genistein, and other soy isoflavones, are known to variably act as both inhibitors and mimics of estrogen (the primary female sex hormone), cancer experts remain divided regarding the safety of regularly consuming soy isoflavones by women who are at an increased risk of developing breast cancer (chronic estrogen stimulation of the breast is a known risk factor for breast cancer).  Meanwhile, the high level of tofu consumption among women in the Far East, coupled with the much lower incidence of breast cancer in those countries when compared to the United States and other western countries, has fuelled speculation that tofu and other soy-derived foods may actually be associated with a reduced risk of breast cancer. 

In addition to soy isoflavones, there is also research data available suggesting that the frequent consumption of cruciferous vegetables, like broccoli and cauliflower, may also be associated with a decreased risk of at least some types of cancer, including breast cancer.

A newly published public health study from Singapore evaluated the impact of the regular intake of vegetables, fruit, and soy-derived foods on the risk of breast cancer within the large Chinese population in that country.  This enormous prospective epidemiological study, which began in 1993, and which appears in the current issue of the American Journal of Clinical Nutrition, included more than 34,000 women volunteers.  All of the 34,018 women in this study underwent detailed evaluation of their diets when they entered into this prospective public health study.  Among this very large group of women, 629 new cases of breast cancer were diagnosed during the course of this ongoing study. 

Based upon their self-reported dietary patterns, the women participating in this large epidemiological study were divided into two groups.  The first group consisted of women who regularly consumed cruciferous vegetables, fruit, and tofu.  The second group of women generally favored meat and starchy foods (such as dim sum), and consumed far fewer portions of vegetables, fruit, and tofu when compared to the first group.

The results of this study indicated that increasing levels of vegetable, fruit and tofu intake were associated with a significant decrease in breast cancer risk in postmenopausal women.   Among the women reporting the highest levels of intake of these foods, there was, on average, a 30 percent reduction in the risk of breast cancer when compared to the women who rarely ate these healthy foods.  Moreover, among the postmenopausal women who frequently consumed vegetables, fruit, and tofu, and who were observed for 5 or more years in this study, the apparent reduction in the risk of breast cancer grew even stronger, and these women were found to be 43 percent less likely to develop breast cancer when compared to women who rarely consumed vegetables, fruit, and tofu in their diets.

Therefore, in this large diet survey-based, prospective public health study,  a diet rich in vegetables (and cruciferous vegetables, such as broccoli and cauliflower, in particular), fruit, and tofu was strongly associated with a significant reduction in breast cancer risk in postmenopausal Chinese women living in Singapore.

Although there remains some concern that soy isoflavones may, under some conditions, actually stimulate the growth of either new or previous breast cancers (or cancers of the ovary or uterus), this public health study’s favorable findings are additive to a growing body of research data suggesting that both cruciferous vegetables and soy-derived isoflavones may be associated with a substantial decrease in the risk of breast cancer in women. 

To learn more about the potential role of cruciferous vegetables and soy isoflavones as part of a cancer prevention lifestyle, look for the publication of my new landmark evidence-based book, “A Cancer Prevention Guide for the Human Race,” in the summer of this year.

Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author

http://www.youtube.com/watch?v=7-Tdv7XW0qg

In view of the extreme devastation and human misery brought about in Haiti and Chile by the recent earthquakes, Weekly Health Update asks our tens of thousands of caring readers to give generously to established charities that are currently working in those countries to assist the injured, the ill, and the homeless.  There are many such legitimate charities, including the following two:

http://www.redcross.org/

http://www.imcworldwide.org/haiti 

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers” 

ASPIRIN & BREAST CANCER SURVIVAL

Breast cancer tumors, like many other types of cancer, produce increased amounts of chemicals called prostaglandins.  As with many other types of cancer, prostaglandins are thought to play an important role in the growth and spread of breast cancer. 

Aspirin belongs to a class of drugs known as NSAIDs (non-steroidal anti-inflammatory drugs).  Like other NSAIDs, aspirin is able to block the activity of the prostaglandin-producing enzyme cyclooxygenase (COX).  Moreover, previous research has indicated that, in addition to decreasing prostaglandin production in the body, aspirin also reduces the levels of estrogen in the body (approximately 90 percent of breast cancers are stimulated to grow in the presence of estrogen).

Previous research on aspirin as a breast cancer prevention drug has resulted in contradictory findings (although aspirin and other NSAIDs have clearly been shown to reduce the incidence of colorectal polyps and colorectal cancer, and other cancers as well).  However, a newly published study, in the Journal of Clinical Oncology, adds weight to prior evidence that the regular intake of aspirin may significantly decrease the risk of breast cancer recurrence, and the risk of death due to recurrent breast cancer.

The enormous Nurses’ Health Study is a prospective public health research study that began in 1976 with more than 120,000 female nurses in the United States.  Every 2 years, this huge cohort of women completes detailed personal questionnaires regarding diet and lifestyle factors related to cardiovascular disease and cancer.  Between 1976 and 2002, more than 4,000 nurses participating in this study were newly diagnosed with breast cancer.  The researchers conducting this landmark study then analyzed the incidence of breast cancer recurrence, and the risk of death, among these 4,164 breast cancer patients as a function of their aspirin intake.  (Other cancer-associated diet and lifestyle risk factors were also analyzed, as well.)

In this huge prospective public health trial, regular aspirin intake was found to significantly reduce the risk of death due to breast cancer.  Taking aspirin 2 to 5 times per week was associated with a 71 percent reduction in the relative risk of death due to breast cancer, while 6 to 7 days of aspirin use per week was associated with a 64 percent reduction in the relative risk of cancer-associated death.  Importantly, this apparent aspirin-associated reduction in the risk of death due to breast cancer recurrence was observed in women with both early-stage and more advanced breast cancers, in both premenopausal and postmenopausal women, in both obese and non-obese women, and in women with estrogen-sensitive and estrogen-resistant tumors. 

While this study’s primary weakness is that (like most epidemiological studies) the collected data was primarily based upon patient questionnaires, the Nurses’ Health Study continues to be a carefully conducted prospective study with very stringent data quality controls in place.   

To summarize the important findings of this study:  Among women previously diagnosed with breast cancer, taking aspirin for 2 or more days per week was associated with a significant reduction in the risk of both breast cancer recurrence and death due to breast cancer.  (As always, I recommend that you discuss the potential risks and benefits of regularly taking aspirin, or any other new medication, with your doctor before making such changes.)

To learn more about the potential role of NSAIDs in cancer risk reduction, look for the publication of my new landmark book, “A Cancer Prevention Guide for the Human Race,” in the spring/summer of this year.

http://www.youtube.com/watch?v=7-Tdv7XW0qg

http://www.redcross.org/

http://www.imcworldwide.org/haiti

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

BREAST CANCER, PHYSICAL THERAPY &

LYMPHEDEMA

Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following treatment for breast cancer.  When the lymphatic drainage network in the arm and hand has been disrupted by the surgical removal of axillary (armpit) lymph nodes, or by radiation therapy to the axilla (or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can then result in chronic swelling of the hand and arm.  Patients with significant lymphedema of the arm following breast cancer treatment may experience considerable swelling (edema), heaviness, stiffness and discomfort of the affected hand and arm.

Unfortunately, there are no known effective methods available to prevent lymphedema, and once significant lymphedema does develop, compression sleeves and soft tissue massage are the primary treatment modalities currently available.  Unfortunately, currently available lymphedema treatments are often not highly effective for many patients, and there is no known cure for lymphedema once it develops.

Now, a newly published research study, in the British Medical Journal, suggests that physical therapy, when initiated early after breast cancer surgery, can significantly decrease the risk of arm and hand lymphedema.  In this prospective randomized clinical research study, 120 women who underwent removal of their axillary lymph nodes for breast cancer were randomized to one of two groups.  Women assigned to the experimental group underwent physical therapy 3 times per week, for a total of 3 weeks.  Physical therapy techniques used in this group included manual lymph drainage and soft tissue massage techniques, as well as progressive shoulder exercises.  Both groups of women also underwent the same lymphedema management educational course, but the control group of women did not receive any physical therapy interventions.

Among the 116 women who completed at least one year of follow-up, 18 women (16 percent) went on to develop lymphedema.  Fourteen of the women who developed lymphedema were in the control group, while the remaining 4 women were in the experimental group.  Thus, in this clinical study, early physical therapy following axillary lymph node dissection (ALND) was associated with a very significant 72 percent reduction in the risk of developing lymphedema, at least within the first year following breast cancer surgery.

Whether or not the use of early postoperative physical therapy can reduce the incidence of arm lymphedema over periods longer than one year is unknown at this time, and additional follow-up of the patients who participated in this clinical research study will be required to answer this very important question.  However, this is one of the very few studies available that suggests a role for physical therapy in the actual prevention of arm and hand lymphedema following ALND for breast cancer.  If additional, mature follow-up of these patients confirms a long-term benefit from early postoperative physical therapy in preventing arm lymphedema, then a strong case could be made for the routine use of early physical therapy in women who undergo ALND, and perhaps, as well, women who undergo sentinel lymph node biopsy with subsequent radiation therapy to the breast and armpit (axilla) area.

For additional information and resources related to cancer-associated lymphedema, please click on the links below:

http://www.cancersupportivecare.com/Abstracts/asbdpbtps.html

http://meeting.ascopubs.org/cgi/content/abstract/23/16_suppl/8185

http://www.annalssurgicaloncology.org/cgi/content/abstract/15/7/1996

http://www.cancerlynx.com/sln.html

http://doctorwascher.com/Archives/11-23-08.htm

http://doctorwascher.com/Archives/8-16-09.htm

For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

Welcome to Weekly Health Update

“A critical weekly review of important new research findings for health-conscious readers”

SOY ISOFLAVONES REDUCE BREAST CANCER

RECURRENCE RISK

Regular readers of this column are already aware of the controversy surrounding soy isoflavone intake and breast cancer risk.  As happens frequently in clinical research (unfortunately), contradictory research findings have made it difficult to understand the true relationship between dietary soy intake and breast cancer risk (if one exists).  There is, for example, both laboratory and clinical data suggesting that a diet rich in soybean-derived products may be associated with a lower risk of developing breast cancer.  At the same time, because genistein and other dietary isoflavones are known to weakly mimic the effects of estrogen, there has been some concern that a diet rich in isoflavone “phytoestrogens” may increase both the risk of developing a new breast cancer and the risk of developing a recurrence of a previous breast cancer.  (In fact, there is data from laboratory research studies showing that genistein can indeed fuel the growth of human breast cancer cells growing in culture dishes, when exposed to high concentrations of this soy-derived isoflavone.)

A growing body of public health research, primarily from Asian countries where tofu and other soy-based foods are frequently consumed, appears to link increased soy consumption with a decreased lifetime breast cancer risk, particularly when soy-based foods are consumed during adolescence, during the time when development of the female breast is most active (Soy & Breast Cancer Risk).  (Interestingly, there is also recent research suggesting that soy products might also reduce the risk of prostate cancer, which is another hormonally driven cancer:   Genistein & Prostate Cancer Cells, Dietary Soy & Prostate Cancer Risk.)

Although epidemiological research is, increasingly, suggesting that a diet rich in soybean-derived foods might lower a woman’s lifetime risk of developing breast cancer, many breast cancer experts have remained apprehensive regarding dietary isoflavone intake in women with a prior history of breast cancer, in view of the estrogen-like effects of these “phytoestrogens.”  As I have already noted, there is considerable research data available to suggest that soy-derived isoflavones can, at least under certain laboratory conditions, stimulate estrogen-sensitive breast cancer cells to grow and divide.  These research findings have left many oncologists feeling uncomfortable in recommending soy-based foods to their breast cancer patients.  Now, a newly publish public health study in the Journal of the American Medical Association suggests that soy-based foods may actually reduce the risk of breast cancer recurrence, and death due to any cause, in women who have previously been diagnosed with this very common form of cancer.

In this study, which was performed in Shanghai, China, 5,042 female breast cancer survivors (ages 20 to 75 years) were followed for an average of almost 4 years.  All of these patient volunteers underwent detailed surveys regarding their lifestyle habits, including their diets.  These patients, who were originally diagnosed with breast cancer between 2002 and 2006, were surveyed at 6, 18, 36 and 60 months following their original diagnosis with breast cancer.  

The results of this study indicate that the breast cancer survivors who consumed the greatest amount of soy-based foods in their daily diets were 32 percent less likely to experience a recurrence of their breast cancer when compared to the women who consumed the least amount of soy-based isoflavones.  Moreover, the women who consumed the greatest amount of soy were also 29 percent less likely to die, from any cause, when compared to the women who consumed the least amount of soy-derived foods.

A particularly interesting and unexpected finding of this study was that both women with estrogen sensitive breast cancers and women with tumors that were not sensitive to estrogen appeared to experience a significantly decreased risk of breast cancer recurrence if they frequently consumed soy products.  Another important finding of this study was that women who were taking the estrogen-blocking cancer treatment drug tamoxifen also appeared to enjoy a reduced risk of breast cancer recurrence with higher levels of dietary soy intake.  Additionally, the researchers noted that high levels of soy intake appeared to be about as effective in reducing the risk of breast cancer recurrence as the breast cancer prevention drug tamoxifen, alone.

The results of this very important study mirror the findings of the only other prospective clinical study that has looked at the impact of soy-based foods on breast cancer recurrence (the “Life After Cancer Epidemiology,” or “LACE,” study).  The LACE study, which was performed in the United States, followed nearly 2,000 breast cancer survivors for, on average, more than 6 years.  In the LACE study, women who were taking tamoxifen, and who also consumed the highest amount of soy-based dietary isoflavones, were 50 percent less likely to develop a recurrence of their breast cancer when compared to women who reported the lowest consumption of soy-derived foods.

As I have pointed out previously, epidemiological research studies based upon dietary surveys are susceptible to several types of bias which, in turn, can cause researchers to draw the wrong conclusions.  In this case, however, there are now two large prospective cohort studies that have reached essentially the same conclusions (albeit with a rather limited duration of patient follow-up).  Both studies strongly suggest that high levels of soy-based isoflavones in the diet may be able to significantly reduce the risk of breast cancer recurrence.  Based upon the findings of this large Chinese study, the apparent cancer risk reduction effect associated with high levels of soy intake also appears to benefit premenopausal and postmenopausal women, as well as women who are taking the estrogen-blocking drug tamoxifen, women with estrogen-sensitive tumors, and women with (counter-intuitively) estrogen-resistant tumors.

In view of the limited duration of patient follow-up in both of these clinical breast cancer studies, as well as the limitations of survey-based epidemiological research in general, I would like to see updated data from both of these studies after at least 10 years of patient observation before I would be willing to tell my breast cancer patients that they should significantly increase their dietary soy intake.  On the other hand, the rather compelling data presented by both of these clinical research studies will also make me less anxious when any of my breast cancer patients decide, of their own accord, to increase their intake of soy-derived isoflavones.

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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity