November 5, 2007

Attitude Change: A Positive Outlook Does Not Beat Cancer?

Many believe that a positive attitude will increase one’s lifespan, specifically for someone who encounters an illness or disease such as cancer. However, a new study claims that this belief is ill-conceived. Researchers from the University of Pennsylvania analyzed the emotional states of about 1,100 patients diagnosed with head and neck cancer, as pictured on the left. Conclusions show that survival was not associated with patients’ emotions. Other factors, such as gender, disease stage, and tumor site were also taken into consideration. Even then, the link between positive emotions and cancer survival rates could not be made. Such news is unfortunate and disheartening, and, as stated by Dr. James C. Coyne from the University of Pennsylvania, “The hope that we can fight cancer by influencing emotional states appears to have been misplaced.”

This finding has inspired me to explore the blogosphere this week. I decided to comment on two very compelling posts after reading various weblogs. My comments can be found by following the links. However, for the purpose of convenience, they can be found below. The first post that I chose to comment on is from the blog The Cheerful Oncologist by Craig Hildreth, M.D., a medical oncologist. Rated as one of the world’s top bloggers on health and medicine, he discusses the study regarding emotions and cancer survival in his post “Put On a Happy Face - That’s an Order?” The second post that I comment on is published by Steven Novella, M.D., an academic clinical neurologist at Yale University School of Medicine. His post, “Mood, Cancer, and the Placebo Effect,” argues that “positive outlook does not help our bodies fight cancer” due to lack of scientific evidence to support this conclusion.

“Put On a Happy Face - That’s an Order?”

First, I would like to say that I found your post and links quite informative. It is interesting that cancer patients who have a positive outlook on life are no more likely to survive than patients who are depressed. I would have thought otherwise. The studies could not find significant evidence to link positive attitude to a better outcome in cancer survival. As you have in your post, I would also ask, “Are they telling us that all this ‘keep your head up’ advice given to cancer patients is worthless?” I believe that staying positive will benefit a cancer patient mentally and physically. In general, maintaining a good attitude helps everyone. I would like to point out that the information presented in the study conducted by James C. Coyne, Ph.D. and colleagues is exclusively representative of patients with head and neck cancer. Therefore, patients diagnosed with other cancers, such as breast and prostate cancer, may benefit from having a positive attitude. As stated in the referenced article “Emotions Don’t Play a Role in Cancer Survival,” the role of endocrine factors associated with breast and prostate cancer may yield varying results. Do you believe that the outcome would differ for patients with breast and prostate cancer in comparison to those with head and neck cancer? As a future physician, I would also “strongly support the sowing of hope and joy in the lives of my patients.” Since multiple studies “[do not] suggest that they will live a longer life with such an attitude,” patients have to know that they will just live a “better one” as you concluded. Are there any studies which oppose the notion that positive emotions do not play a role in cancer survival outcomes?

“Mood, Cancer, and the Placebo Effect”

Your post offers a valid explanation for the reason why positive moods do not necessarily lead to better health outcomes and survival rates. The belief that emotions play a key role in cancer survival is one that many, including myself, share (see image to the right). After reading “Mood, Cancer, and the Placebo Effect,” I understand that one can not generalize or assume outcomes without scientific evidence. Speaking with a couple of cancer survivors, however, it became clear that they attribute their favorable prognosis to a positive outlook, among other factors. I then would ask why they make this connection so passionately. This question can be partly answered with your statement “Just being distracted [with good moods] will decrease a person’s perception of their pain.” The claim that you make regarding “rigorous effective clinical thinking” is an important point in your post. Humans tend to “oversimplify” and it is not “a legitimate or effective intellectual strategy.” Overall, I commend you on a well written post regarding the topic of emotions and health outcomes. You presented points that explain the misleading notion of treatment generalizations that “lie outside the bounds of scientific medicine.” I noticed that alternative medicine is incorporated in your discussion and I wanted to know if that included herbal remedies. Lastly, it is important that people understand that positive moods do help with other health problems like heart disease as you stated. The clarification of this statement is necessary since “we don’t want to hastily generalize in the other direction.” Do you think there will be future studies which will refute the arguments made in the aforementioned study?

October 29, 2007

An Unexpected Finding: Smoking Is Not Associated with Advanced Breast Cancer?

Most people know that smoking causes cancer, emphysema, and heart disease. It can shorten a smoker’s life by up to ten years; moreover, the habit can cost the smoker (as seen in the image to the left) thousands of dollars a year. Nonetheless, investigators have found no difference in the breast cancer death rate among smokers and non-smokers, a fact that only few know. At Fox Chase Cancer Center in Philadelphia, researchers analyzed data on 6,162 women with breast cancer who were evaluated at the facility between 1970 and 2006. When they were first seen, 9% of breast cancer patients were smokers. One of the researchers at the center, Dr. Matthew Abramowitz, claimed, “For patients who developed breast cancer, there did not appear to be a difference in the cancers that they presented with based on whether or not they had ever smoked.” Most had expected a more advanced stage in the tumor among smokers. Although this was not the case, the tobacco industry should not take the finding as good news.

Another study was recently published in the British Journal of Cancer. This case-control study looked at Swedish-born women aged 50-74 years whose invasive breast cancers were identified between October 1993 and March 1995. Examination of the patient’s smoking habits included the smoking time period, duration or intensity, and frequency. Other health factors such as family and genetic background, and obesity were also observed. Despite the consideration of all these aspects, the association between smoking and advanced breast cancer could not be made. Nevertheless, those who conducted this study did discover a greater risk in breast cancer for women who consume alcohol (refer to the image on the right). Cancer specialist Wendy Y. Chen stated, “The more alcohol consumed on a regular basis, the greater the risk.” Statistically speaking, “one drink a day raises the figure to 9.4 cases per 100.” The reason is that alcohol is responsible for changing the way in which the body metabolizes estrogen, and because the majority of breast cancers are “fueled by the hormone estrogen,” higher consumption of alcohol contributes to higher blood estrogen levels. It should be noted that the relationship between smokers and the intake of alcohol is that smokers tend to drink more than nonsmokers. Since the level of alcohol is significant, the risk of the disease is higher.

The discovery that smoking does not have a considerable risk for breast cancer (though some researchers disagree) is an important yet surprising one. After much effort and time, anti-tobacco measures even gave up on the pursuit to link smoking with breast cancer. Is this good news for the tobacco industry? Not necessarily. Smoking does initiate the development of several other illnesses and diseases, including lung cancer, heart disease, and stroke. “Lung cancer has overtaken breast cancer as the leading cause of cancer deaths in women,” said Irma H. Russo, from Fox Chase Cancer Center. More importantly, heart disease is the number one cause of death among Americans. The discussion of the research in this post, therefore, does not justify the habit of smoking. Physicians will continue to warn their patients against unhealthy habits, especially when studies show that the association between smoking and breast cancer is “still somewhat controversial.” Even so, it will be interesting to see whether or not research will again disprove the current findings associated with smokers and advanced breast cancer in the future.

October 23, 2007

Chemotherapy and the Risk for Heart Disease: For Better or Worse?

The cure to one disease may be the catalyst to another. This is evident in chemotherapy, which is one of many life-saving cancer therapies. Unfortunately, this type of therapy contributes to the long term risk of cardiovascular disease. Since chemotherapy is a common treatment for breast cancer, damage to the heart is a typical side effect. On October 9, 2007, the Journal of the American College of Cardiology (JACC) published an article on this subject in which Dr. Pamela Douglas, a Duke University cardiologist, stated that long-term effects of chemotherapy should be the focus of doctors. If followed, her advice could help the physician monitor patients in order to minimize the future risk of heart disease, and in consequence a more comprehensive treatment plan would be offered.

Millions of American women live with breast cancer (the most common type of cancer among females), and they are joined by approximately 200,000 new cases that arise each year. However, due to emerging therapies and prevention treatments, breast cancer death rates have decreased over the past few years. While this allows for more women to live longer, the possible risk of obtaining cardiovascular disease needs to be considered. Dr. Alan Campbell, medical director of oncology for Spectrum Health, says “it's a known fact that chemotherapy, used to fight cancer cells, can also weaken the heart muscle.” By carefully monitoring his patients for heart disease (as seen in the image to the left), Dr. Campbell is able to prescribe the proper treatment. This attentiveness is essential, because altering the treatment dosage is necessary at times to ensure that the incidents of heart failure do not increase. Campbell further notes that there is “relatively little damage to the heart but it's the women who have aggressive or reoccurring breast cancer that are most at risk.” This is for the reason that recurrent breast cancer is often fatal. During the ongoing treatment process, it is judicious to consider the possibility of developing cardiovascular disease, which is not typically life-ending and can be cured with existing medications.

Despite the availability of medications to treat heart disease, many other factors play a role as the cardiac culprit. A majority of older women have age-related risk factors for cardiovascular disease, such as high blood pressure. In some cases, physical inactivity, obesity, chest radiation, and stress during treatment further the incidence of heart failure and breast cancer (refer to the image on the lower right). Dr. Douglas, claims that during “the process of curing their breast cancer, we've exposed them to some pretty nasty things. And it's not just one nasty thing, it's a sequence of nasty things." Currently there is much debate on whether treatments of chemotherapy should be abandoned, which would require a reassessment of the treatment guidelines by the government and health officials.

As I had discussed in a previous post, current breast cancer treatments have led to a decline in death rates. By taking this into consideration, will the elimination of treatments such as chemotherapy help rather than hinder patients? What are the possible positive and negative outcomes associated with this issue? These are questions to consider, especially when current cancer therapies have contributed to the survival of many patients. The answers to these inquiries are worth pondering, for there are various remedies that cure certain diseases, but more than a few are also implicated as the reason for the development of another sickness. Even though there are new medications being created to prevent heart damage, how can clients rest assured that these treatments will be promising? Doctors cannot guarantee the success of prospective procedures and health care consumers will have to understand that heart disease may be the next condition they battle after recovering from breast cancer. This is a reality for only about 4% of breast cancer patients, but it is pertinent that physicians take precaution and monitor for any change in the heart. Patients should also be required to get a formal heart risk assessment before receiving the final breast cancer treatment. Doing so will signal the need for extra care.

October 8, 2007

Prostate Cancer: Survival Rates Vary According To Season

A current study on prostate cancer conducted by a team of American and Norwegian researchers revealed that the season of prostate cancer diagnosis is linked to the survival rate. Researchers analyzed the data of 46,205 Norwegian men who were diagnosed with prostate cancer from 1964 to 1992. They were divided into four different groups according to the seasons (image to the right). The overall findings suggested that men who were identified with having prostate cancer in the summer and fall have better survival than those who were diagnosed in the winter and spring. More specifically, those diagnosed in the winter and spring are 20 percent more likely to die within three years then those who are diagnosed in the summer and fall.

Each of the four seasons vary in their daily temperatures and weather patterns. The summer and autumn months, defined from June to November, have higher levels of calcidiol, an intermediate metabolite of vitamin D (see chemical structure to the bottom left), through ultraviolet exposure—a vitamin whose exposure is not as prevalent during the winter and spring seasons. The study, published in the journal, The Prostate, did not prove that vitamin D is the determining factor. However, study co-author Dr. Tomasz Beer, director of the prostate cancer program at the Oregon Health & Science University Cancer Institute, suggested that further research should be conducted on this possibility. Vitamin D has been shown to regulate cell differentiation and help sustain the immune system. Most importantly, this fat soluble vitamin is also known to slow down cancer growth. Alternate factors associated with vitamin D included age, food intake high in vitamin D, vacations in sunny southern areas, and the location of residency in Norway, were also examined to determine whether survivability was affected. Of all the variables examined, age is the risk factor that influences the chances of being diagnosed with prostate cancer because younger males readily produce more vitamin D than older males. As mentioned by the researchers “the capacity of skin to produce vitamin D when exposed to sunshine is about 40 percent lower in men 75 and older than in men 60 and younger” and therefore younger men had a slightly better rate of survival.

In this study, a relationship between the varying seasons and survival rates of prostate cancer has been proven to exist. Despite these findings, additional factors that could potentially affect the study include the type of treatments administered and the stage of the disease at the time of diagnosis. The older patients normally have a more advanced diagnosis of prostate cancer and are subjected to different treatments. This may have an overall effect on the survival rate. Furthermore, the skin color of these patients is another risk factor to consider in such a study. Dark-skinned people require more sun exposure to make vitamin D. This is due to the thickness of the skin layer called the stratum corneum, which alters the amount of absorbed ultraviolet radiation.

There are several factors to consider when conducting a study such as the one discussed in this post. The physical attributes, life style, environmental surroundings, and genetics are a few that need to be measured for a thorough research study. The discovery that certain seasons contribute to a better outcome in survival rates among men with prostate cancer seems promising for future treatments. However, since the study was conducted with Norwegian men, not all factors may be applicable to the general population of those who are diagnosed with prostate cancer. The importance of integrating vitamin D in our life style, especially prostate cancer patients, can help reduce the development of cancer. Researchers as early as 1936 were aware that skin cancer patients have reduced rates of other cancers when exposed to UV light even though excessive sun exposure may give rise to skin cancer. Prostate cancer patients and the general population need to be advised that moderation is the key in the intake of vitamin D and ultraviolet exposure as it is for other healthy lifestyle habits.

October 1, 2007

Good News: A Look Into Why Breast Cancer Death Rates Have Declined

The month of October, also known to many as National Breast Cancer Awareness Month, is dedicated towards increasing breast cancer consciousness through education and providing mammograms to those in need. The pink ribbon, as seen on the left, has been the international symbol of breast cancer awareness for over fifteen years. During Pink October, current updates and reports are also released about this disease.

On September 25, 2007, HealthDay discussed the findings of a report published by the American Cancer Society, which announced that breast cancer death rates continue to decline more than two percent annually. This is good news for many people as well as for the American Healthcare System. These findings prove that existing treatments and methods used to prevent or cure breast cancer have been successful for breast cancer patients. According to the American Cancer Society, the trend of declining breast cancer death rates “can be traced to early detection and better treatments.” With the improvement of treatment strategies and medical diagnostic tools used for early detection, it is inevitable that breast cancer rates decrease over the years. However, this was not nearly as evident for black women in comparison to white and Hispanic women, as mentioned in the report.

The claim made in Breast Cancer Facts & Figures 2007-2008 (image on the right) about the decline in breast cancer death rates being greater among white and Hispanic women than black women is considered troubling news. The explanation to such information is due to the lack of access to health care, as stated by Dr. Eric P. Winer, the director of the breast oncology center at Dana-Farber Cancer Institute in Boston. In order to combat this problem, it is important that all Americans are granted the access to health care. Once this has been completed, the gap in breast cancer rates between white and black women will decrease. Additionally, patients will have the ability to detect the disease at an earlier stage where it will be more preventable and curable. This will ultimately “save lives and reduce suffering” as affirmed by Dr. Winer. Since breast cancer is the most frequently diagnosed cancer among women, access to health care will also reduce the statistical fact that more than one in four malignancies are detected in women. Although many associate this disease with women, there have been reported breast cancer cases with men.

Even with the small number of men diagnosed with breast cancer, the report listed a finding that discussed the statistical significance of male breast cancer. The incidence in males is quite rare, however, this rate increased by one percent a year between 1975 and 2004. The report further states that the cause to the increase in male breast cancer is unknown. Upon conducting research about this issue, three risk factors associated with male breast cancer may be considered. First, the diagnosis of cancer in men is different from women since the detection of cancer in men is found at a later stage than it is for women. The cancer would have metastasized throughout the body as a result of late detection. Second, those who are diagnosed with prostate cancer are in need of estrogen therapy. Such therapy requires an added amount of estrogen to the body which means that there is a higher risk to acquire breast cancer. Obesity is the third risk factor linked with this disease since the testosterone level decreases and is replaced with high levels of estrogen. The regulation of diet and exercise is needed in both men and women to reduce the risk for getting breast cancer.

In order to continue decreasing breast cancer death rates, it is important to maintain a healthy lifestyle. Take preventative measures such as mammography screening (image on the left), especially since there has been a reported decrease in the usage of mammography screening. This causes fewer cancers to be identified. Also, begin screening early on if health records indicate a family history of breast cancer. Consider drinking no more than one alcoholic beverage a day and maintain weight by exercising. Decrease the use of hormone replacement therapy if possible since it is linked to breast cancer and many other health risks. Most importantly, grant all Americans the access to universal health coverage to decrease the health disparities found throughout the United States.

September 24, 2007

Mobile Phones: Is There a Link to Cancer?

For several years now, there has been a constant concern of whether or not mobile phones, are associated with the development of cancer, specifically brain cancer (image on the right). Many have heard that the more you utilize cellular phones, the more likely it is that brain cancer will develop. Is this another myth or can this be another health issue people need to be aware of? With this question in mind, I have decided to do some research this week by utilizing and exploring the blogosphere. There were two posts that I decided to comment on which can be seen in the following two paragraphs. The first post that I commented on is titled “Did you know…” written by Sasha. Sasha brings up the issue of cellular phones causing cancer. However, her post is mainly concerned with presenting a recent study revealing that mobile phones may cause a slowing of brain activity. The second post that I commented on is titled “Cell phones cause cancer?” written by family physician, Dr. A. He explains that the study is pretty insignificant and the risk of developing cancer from the use of cell phones is a rumor. With my overall findings, research has not been clearly able to confirm the linkage between mobile phones and cancer.

“Did you know…”
First of all, I would like to say that your blog presents an interesting issue concerned with mobile phones and brain activity. The study that was conducted by researchers in Australia, England and the Netherlands concluded similar study conclusions to the recent report that was released by Mobile Telecommunications and Health Research Programme (MTHR). This report by MTHR stated that there is not a significant risk between mobile phones and cancer. However, this can not be a definite conclusion since it was a short-term study rather than a long-term study. The study that you present in your blog states the same thing. Martijn Arns predicts that “a longer-term study would show more severe effects.” I believe that there is a possibility that long-term studies might present clearer conclusions. On the other hand, I would argue that people want to obtain certain results and, as a consequence, will prolong this study in order to affirm those results if such findings can be conclusive. I may add that this study seems to be quite insignificant due to the small study sample collected over a short period of time. Since the researchers do plan on expanding the study over a longer period of time with a larger sample, I believe the results of the future study will be a bit more significant.

"Cell phones cause cancer?”
I would like to say that I strongly agree with your statement “research is a funny business in that if you don't like the result, you either extend out the time of the study until you get the result that you want.” I find this to be very true within our present society. People do want to confirm that cellular phones do cause cancer, just as many had stated that plastic bottles cause cancer as well! Both are myths; however people never seem to be satisfied with the research results that are primarily conducted by these higher institutions. I can understand how they do not want to make a definite conclusion since previous studies associated with lung cancer and smoking did not appear until ten years later. However, it is interesting to note that a team found “slight excess reporting of brain and ear cancer” that were on the “borderline of statistical significance.” Again, I agree with your translation of this statement which basically means “no statistical significance.” It is great to know that a physician is able to justify and clarify these concerning recent issues since they are so relevant in our American health care system.

September 17, 2007

Fact or Fiction: The Insight on Whether or Not Plastics Cause Cancer

Circulating emails entitled “Cancer Updates From John Hopkins” have made their way through innumerable inboxes having many inclined to wonder whether drinking water out of plastic bottles will lead to the development of cancer. Upon receiving a persuasive yet deceitful email discussing a current research finding at Johns Hopkins University, a majority of people believed the addressing issue of a harmful toxin, known as dioxin, being released into the water after freezing the plastic bottle. Furthermore, the email addressed the appearance of the Wellness Program Manager at Castle Hospital, Dr. Edward Fujimoto, on a TV program explaining this health hazard which furthered the plausibility of the false warning. He talked about the dangers of dioxin and how heating food with plastic is not a safe method since it does contribute to the release of these cancer-causing toxins. In exception to the discussion Dr. Edward Fujimoto had on television, the email was filled with misinformation.

Due to this notice that was supposedly sent out by Johns Hopkins University, confirmation from the university itself was needed to verify the validity of the significant finding. In response to this email, assistant professor, Rolf Halden, PhD, PE, in the Department of Environmental Health Sciences and the Center for Water and Health at Johns Hopkins University discredited this hoax email. The Office of Communications and Public Affairs at the university conversed with Rolf Halden about the issue of dioxins released from plastic bottles as well as the use of plastic cookware. Halden clarified the issue and stated that dioxins are not present in plastics and freezing plastic bottles does not contribute to the release of this chemical. Moreover, he explained that: “Chemicals do not diffuse as readily in cold temperatures, which would limit chemical release if there were dioxins in plastic, and we don’t think there are.” It is important to note however that heating and cooking with plastics does increase the possibility of chemicals being released into the food substance according to Halden. Consequently, Dr. Edward Fujimoto’s statement on heating foods in plastic, as found in the email, is not an inaccurate statement. Rather, understanding the context as a whole can be misinterpreted by many who did receive the email.

Though present-day technology allowed for an immediate distribution of the email regarding the recent research on dioxin, the hoax was quickly identified and detested by researchers at Johns Hopkins University. It is important that society is immediately warned about all possible health risks associated with the usage of plastic ware. For example, many people probably would not have known that some drinking straws have been labeled “not for hot beverages” simply because the chemicals from the straw are being extracted into one’s beverage according to Halden. Most would usually have the initial understanding that one might be burned by using the straw.

Moreover, generating a scare towards drinking water from plastic bottles through a false email contributes to an unrest society. The release and distribution of such pertinent health related information throughout the internet needs to be monitored and certified in a specific manner. I, myself being a previous recipient of such a bogus email, further looked into the issue of dioxins and discovered the falsification attached with the email message. Additionally, the validity of such a message would have not been only claimed online, but through the use of mass media. Today is the age of a well informed society. Nevertheless, I say thank you for the recommendation of using heat-resistant glass, stainless steel, or ceramics when cooking in order to avoid the increased risk of cancer. No thank you to the unnecessary scare that left many wondering what the next everyday essential (like water bottles) will be warned against as a possible risk of developing cancer.
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