COLON CANCER: STRATEGIES FOR PREVENTION AND DETECTION

A new report shows that what you eat really can be preventive

More than 130,000 men and women are told they have colon or rectal cancer every year, making it the third most commonly diagnosed cancer, according to the American Cancer Society.

But a new report from the American Institute for Cancer Research and the World Cancer Research Fund provides new evidence that the right eating and exercise plan can really help lower your risk of developing the disease.

In the report, researchers analyzed 99 studies with data on 29 million people.

“The findings are clear that diet and lifestyle play a major role,” says lead author Edward L. Giovannucci, M.D., Sc.D., professor of nutrition and epidemiology at the Harvard TH Chan School of Public Health. “Despite its prevalence, colorectal cancer is a highly preventable disease.”

Foods To Eat More Of

It’s long been suspected that eating more whole grains will reduce your risk of colon cancer, but this is the first time that it has been confirmed.

“Until recently, there had not been many studies that directly examined whole grain intake and subsequent colorectal cancer risk in large populations,” says Giovannucci. “But now we have enough research to say the link has strong evidence.”

In fact, eating about three servings of whole grains a day can lower colorectal cancer risk by 17 percent. (One serving is equal to 1 cup of ready-to-eat cereal, a slice of bread, or ½ cup of cooked rice or pasta.)

Why do whole grains help?

“Fiber is one of the keys to prevention of colon cancer,” says Michael A. Valente, M.D., a colorectal surgeon at the Cleveland Clinic, who was not involved in the AICR/WCRF report. “But we suspect that it’s really the thousands of nutrients, minerals, and other natural chemical compounds present in foods that are high in fiber—such as whole grains and fruits and vegetables—that are helping to prevent cancer, not just the fiber itself.”

Many of these compounds have what the report called “plausible anti-carcinogenic properties.” Which is why, in addition to eating more whole grains, it’s smart to increase consumption of fiber-rich fruits and vegetables as well.

Foods To Cut Back On

The researchers found that eating a lot of red meat (such as beef and pork) and processed meat (such as bacon, cold cuts, and sausage) were potentially harmful.

Every 1.8 ounces a day of processed meat increased risk by as much as 16 percent, while eating more than about 17½ ounces of red meat a week was labeled a “probable cause” of colorectal cancer.

One theory as to why these meats increase colon cancer risk is that they have high levels of iron derived from blood, which has been shown to promote the growth of colorectal tumors.

The connection between alcohol and colorectal cancer was also “convincing,” according to the report, and was especially strong for those who drink more than 30 grams per day (the equivalent of about two glasses of wine, or two cocktails or two beers).

“If you do consume alcohol, keep your intake moderate,” recommends Giovannucci.

Other Steps You Can Take

Getting more whole grains and veggies, and less meat may have another risk-reducing benefit: helping you to maintain a healthy weight. According to the report, there is strong, convincing evidence that people who are overweight are more likely to develop colon cancer.

All types of physical activity—not just formal exercise—was protective, too, with the most active people having about 20 percent lower risk of colon (but not rectal) cancer than the least active.

The report did not cover screening for colon cancer, but it’s a preventive move that deserves mention, and detailed below. Colorectal cancer usually develops over 10 to 15 years without causing symptoms. Most cases start as noncancerous polyps in the lining of the large intestine or the rectum. Detecting and removing polyps prevents them from developing into cancer.

You should have a colonoscopy every five to 10 years staring at age 50.

And if you have a close relative who had colorectal cancer, you should be even more vigilant about changing your lifestyle and getting regular screenings.

“Having a first-degree relative (mother, father, sibling) with the disease increases your risk by nearly 100 percent compared to the average person,” says N. Jewel Samadder, M.D., a gastroenterologist at the Mayo Clinic and expert with the American Gastroenterological Association.

If that’s you, experts recommend that, in addition to improving your diet, weight, and activity level, you start getting colonoscopies at age 40.

Can a Daily Aspirin add to Prevention of Colon Cancer?

New guidelines suggest aspirin can prevent some forms of cancer, but taking one isn’t a good idea for everyone

A recent analysis by the U.S. Preventive Services Task Force suggests that aspirin might lower your risk of certain cancers, especially colon cancer if it’s taken long term. But you shouldn’t take aspirin for cancer prevention alone. That’s because the drug also poses risks—in particular the risk of dangerous bleeding in the stomach and brain—that may outweigh its possible protective effect against cancer.

But if you and your doctor decide that taking a daily, low-dose aspirin (81 mg, or a “baby aspirin”) is a good way to reduce your risk of heart disease, then think of a reduced risk of colon cancer as a bonus.

Considerable research going back decades shows that taking low-dose aspirin can help prevent heart attacks and ischemic strokes (the kind caused by blood clots) in people at high risk for cardiovascular disease. Now, researchers at the Preventive Services Task Force, an independent, volunteer panel of experts in prevention and evidenced-based medicine, have looked back at those studies to see what effect aspirin might have had on the risk of cancer. Combined data from three large studies involving 47,464 people suggested that, compared to people who didn’t take aspirin, those who did reduced their risk of colon cancer by about 40 percent, but only 10 to 19 years after they started taking the drug.

Uncertain Benefits vs. Known Harms

Encouraging results make a compelling case for ongoing, high-quality research looking at various cancers, but current evidence doesn’t support taking aspirin solely to prevent colon cancer. The evidence to date has to be interpreted cautiously, because it comes largely from a small set of older trials on cardiovascular disease prevention that were not set up to study the effect of aspirin on cancer. As a result, one cannot issue a blanket recommendation for the use of aspirin specifically for prevention of any cancers.

 EARLY DETECTION OF CANCER: WHAT YOU NEED TO KNOW

Been putting off that colonoscopy? A new review evaluates the other screening options.

Colonoscopy has long been touted as the gold standard for colon cancer screening, recommended for all adults starting at age 50. With colon cancer expected to kill more than 49,000 Americans this year, getting a colonoscopy is currently the best way to reduce your risk. But, many people avoid colonoscopy because it includes an unpleasant 12-hour prep that includes drinking copious amounts of laxative and many trips to the bathroom, followed by the procedure itself, which costly and typically requires anesthesia.

Instead, consumers may want to opt for one of the two at-home colon-cancer screening tests available by prescription.

A new review published in JAMA by David Lieberman, M.D., professor of medicine and chief of gastroenterology at Oregon Health and Science University in Portland, concludes that home tests may be a decent first-step screener—although patients still need a colonoscopy if the kits find a worrisome result. What’s more, the kits can miss polyps, including precancerous growths that a doctor can spot and remove at the time of the colonoscopy.

                AT-HOME KITS

     FIT Test (Fecal Immunochemical Test)

The second most commonly prescribed colon-cancer screening test in the U.S. after colonoscopies, FIT tests have been in use for about 10 years.

The FIT test requires sending a single small fecal sample to a lab, which is then tested for blood. It’s a test that should be repeated annually, unlike colonoscopy, which is typically required just once every 10 years.

A person may have a cancer that isn’t bleeding at the time of the test, but that same tumor may bleed and be detected when the person is retested the following year. Research shows that this type of test detects cancer with 79 percent accuracy. But about five percent of tests deliver “false positive” results—which result in patients having to go for follow-up colonoscopies.

       Multitarget Stool DNA Test

This test goes by the brand name Cologuard. It requires shipping an entire bowel movement to the lab. In addition to testing for blood, Cologuard looks for DNA from cancer cells scraped from the intestinal wall by feces as it passes through.

Studies have shown that this type of test detects cancer with 92 percent accuracy. However, 14 percent of tests deliver false positive results—far higher than the FIT test.

Another concern with this test is its sheer newness. Because Cologuard only received Food and Drug Administration approval in 2014, there are no studies showing that people who choose this screening method avoid dying of colon cancer in the long-term.

Studies also have not yet established the appropriate interval between testing, though the U.S. Preventive Services Task Force (USPSTF), an independent panel of health experts that advises the government, recommends repeating the test every one or three years.

           BOTTOM LINE FOR SCREENING

If you have a personal or family history of colon cancer, then regular colonoscopies clearly are the best choice. For the rest of us, the best approach is less clear, but until more research data are available, colonoscopy (sadly) is still the safest route.

Sorry to disappoint!

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VALUE OF FRUIT AND VEGETABLE CONSUMPTION: MORE IMPORTANT NEWS

A recent large study assessed the correlation between food intake and cardiovascular disease and deaths in the Middle East, South America, Africa, or south Asia. A link was brought to light between increased fruit, vegetable, and legume consumption with a lower risk of cardiovascular and total mortality. Maximum benefits could be derived for total mortality at three to four servings of any of these components per day (equivalent to 12 to 17 ounces per day) .

This study evaluated 135,335 individuals aged 35 to 70 years without cardiovascular disease. Enrollees were selected from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. Their diet involved country-specific food frequency questionnaires at baseline. The data contained demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease.

The main outcomes were cardiovascular diseases of all types, cardiovascular mortality, non-cardiovascular mortality, and total mortality. They assessed the correlations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality.

The study covered 10 years beginning in 2003, and was concluded at the end of March, 2017. Combined mean fruit, vegetable and legume intake averaged 3.9 servings per day. During a median 7.4 years of follow-up, the following events were reported: 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths.

Higher total fruit, vegetable, and legume intake displayed an inverse correlation with major cardiovascular diseases and total mortality in the models adjusted for age, sex, and random effects. The overall hazard ratio for total mortality was lowest for three to four servings per day compared with the groups taking substantially less.  Interestingly, there was no additional decrease in hazards with higher consumption.

Fruit intake was related to lower risk of cardiovascular, non-cardiovascular, and total mortality.

Legume intake was also inversely linked with non-cardiovascular death and total mortality.

For vegetables, raw vegetable intake strongly correlated with a lower risk of total mortality.  In contrast, cooked vegetable intake exhibited a modest benefit against mortality. 

                 Conclusion

This study adds further support for what we have recommending for many years. In general, dietary patterns in the U.S. have been trending in this direction, but for many, obesity seems to be nullifying much potential benefit. I was a bit surprised by the suggestion that raw vegetables might be better than their raw counterparts, but any firm conclusions will await further study.

Although the study did not detail the causes for reductions of non-cardiovascular mortality, from what we already know, it is likely that various cancers were likely prevented as well.

 

 

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UNNEEDED MEDICAL CARE: A CONTRIBUTOR TO HIGH COSTS

Unnecessary medical care is common in the United States, and a fear of malpractice seems to be an important driver for ordering unneeded tests and treatments, a new survey found.  Other factors include patient demand and doctors’ desire to boost profits, the researchers said.

“Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American,” said study senior author Dr. Martin Makary, professor of surgery and health policy at Johns Hopkins University School of Medicine in Baltimore.

Unneeded medical care accounts for a large chunk of wasted health care resources and costs in the United States and leads to about $210 billion in extra spending each year, according to the National Academy of Medicine.

The researchers surveyed more than 2,000 U.S. doctors in a wide variety of specialties and found that most believed 15 to 30 percent of medical care is not needed, including 22 percent of prescription medications, 25 percent of medical tests, 11 percent of procedures and 21 percent of overall medical care.

Leading reasons cited by the doctors for overuse of medical resources were fear of malpractice (85 percent), patient pressure/request (59 percent), difficulty accessing prior medical records (38 percent), and profit (17 percent).

Specialists and doctors with at least 10 years of experience after residency were more likely to believe that doctors perform unnecessary procedures when they stand to profit, according to the study.

“Interestingly, but not surprisingly, physicians implicated their colleagues [more so than themselves] in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level so that individual providers can see where they might improve,” said study co-author Dr. Daniel Brotman, a professor of medicine at Hopkins.

The respondents said the best ways to reduce unneeded care include training medical residents on appropriateness criteria for care (55 percent), easy access to outside health records (52 percent), and more evidence-based practice guidelines (51.5 percent).

“Most doctors do the right thing and always try to, however, today ‘too much medical care’ has become an endemic problem in some areas of medicine. A new physician-led focus on appropriateness is a promising homegrown strategy to address the problem,” Makary said in a university news release.

WHAT CAN THE INDIVIDUAL PATIENT DO?

These data suggest some appropriate responses for individual patients: First, when any test such as an X-ray of the back, neck, or elsewhere, is recommended, one should question its need. Furthermore, can the test be done at a later date and how much will any given result affect the resulting treatment? Many suspected ailments will subside with time and render any testing unnecessary. Will the management be altered regardless of the test’s outcome? If not, maybe it can be avoided altogether. Moreover, don’t insist on a given test or procedure if the physician believes it is unnecessary or can wait until later—even if you have insurance that with cover much of the cost. Before any prescription is given, ask whether cheaper alternatives—especially generics—are just as effective. Even more important, perhaps a given prescription can be avoided altogether without any consequences to health.

These are some of the tips that can empower patients to participate in reduction of overall costs of healthcare in this entire nation.

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NUTS: DESPITE THE NAME, THEY MAY BE A PANACEA

Eating almonds on a regular basis may help boost levels of the good (HDL) cholesterol while simultaneously improving the way it removes cholesterol from the body. According to researchers, who, in a recent study, compared the levels and function of high–density lipoprotein (HDL cholesterol) in people who ate almonds every day, to comparable levels of the same group of people when they ate a muffin instead. The researchers found that while participants were on the almond diet, their HDL levels and functionality improved. The study, published in the Journal of Nutrition, builds on previous research on the effects of almonds on cholesterol–lowering diets. The researchers wanted to see if almonds could not just increase the HDL levels but also improve the function of this component, which works by gathering cholesterol from tissues, like the arteries, and helping to transport it out of the body.
HDL is very small when it gets released into circulation, and acts like a garbage bag that slowly gets bigger and more spherical as it gathers cholesterol from cells and tissues before depositing them in the liver to be broken down.
Depending on how much cholesterol it has collected, HDL cholesterol is categorized into various subpopulations, which range from the very small to the larger, more mature forms. The researchers hoped that eating almonds would result in more larger particles, which would signal improved HDL function.
In a controlled–feeding study, 48 men and women with elevated LDL cholesterol participated in two six–week diet periods. In both, their diets were identical except for the daily snack. On the almond diet, participants received 43 grams — about a handful — of almonds a day. During the control period, they received a banana muffin instead. The researchers found that, compared to the control diet, the almond diet increased HDL particles to their largest size and most mature stage — by 19 percent. They were able to show that there were more larger particles in response to consuming the almonds compared to not consuming almonds, which would translate to the smaller particles doing what they’re supposed to be doing. They’re going to tissues and pulling out cholesterol, getting bigger, and taking that cholesterol to the liver for removal from the body. An increase in this particular HDL subpopulation is meaningful, because the particles have been shown to decrease overall risk of cardiovascular disease.
If people incorporate almonds into their diet, they should expect multiple benefits, including ones that can improve heart health. Obviously, they’re not a cure–all, but when eaten in moderation – and especially when eaten instead of a food of lower nutritional value – they’re a great addition to an already healthy diet. Other nuts may provide similar benefits, but they have not been studied in this fashion. Nevertheless, they may provide other benefits as well, such as in cancer prevention, as we present below.

A recent study showed that nut and peanut butter consumption can reduce the risk of esophageal and gastric cancer. Previous studies had suggested that nut consumption has been associated with decreased risk of colorectal, endometrial, lung, and pancreatic cancers. Polyphenols, fiber, vitamins, and minerals in nuts may confer this observed protective effect. Up to now, no prospective study has evaluated the effect of nut consumption on esophageal and gastric cancers. The objective was to evaluate the associations between nut and peanut butter consumption and the risk of esophageal and gastric cancers and their different subtypes. The most recent study used data from the NIH-AARP Diet and Health Study, which enrolled 566,407 persons who were 50–71 years old at baseline (1995–1996). The median follow-up time was 15.5 years. Intakes of nuts and peanut butter were assessed through the use of a validated food-frequency questionnaire. Statistical models estimated risks for esophageal and gastric cancers. Compared with those who did not consume nuts or peanut butter [lowest category of consumption], participants in the highest category of nut consumption had a lower risk of developing the most common type of stomach cancer  The same association was also seen for peanut butter consumption.

This information is added to what we already know about nuts in general. Almost all nuts provide good sources of caloric energy, primarily from unsaturated fats (oils), they are useful also for lowering cholesterol. Moreover, the essential amino acids contained in nuts are vital for constructing protein, i.e., the building blocks for our muscles and other tissues. Although each type of nut does not supply, in itself, a complete source of these amino acids, consuming a variety of nuts will provide a complete complement of the various necessary (essential) components. Other nutritional elements provided by nuts include folic acid, vitamin E, potassium, magnesium, and calcium. Especially noteworthy is their uniformly low sodium content, a highly desirable feature (provided that no salt is added). They also contain polyphenols, bioactive constituents that seem to be beneficial to heart health that extends beyond other dietary constituents.

During the past 20 years, mounting evidence indicates that consuming all nuts (including peanuts and peanut butter) at least twice weekly provides substantial protection from cardiovascular disease and overall death rates as compared to those consuming them only rarely or not at all. These desirable results seem to share the stage with almonds, as noted above, primarily through the rearranging of cholesterol components, and despite a substantial caloric content, nuts have less tendency to promote obesity, probably because of their prominent satiating effect. For unknown reasons, nuts also appear to prevent diabetes, another contributor to cardiovascular disease. Research studies have also indicated that, if the “Mediterranean” diet, which, in itself is healthy, is supplemented by extra mixed nuts (one ounce daily) and extra virgin olive oil (one quart total per week), substantial additional reductions of cardiovascular disease and stroke can be accomplished.

The bottom line? Forget the junk food and opt for any kind of nuts, whether with meals or as free-standing snacks!

 

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