By TARA PARKER-POPE
A group of experts advising the nation’s premier cancer research institution has recommended changing the definition of cancer and eliminating the word from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment.
The recommendations, from a working group of the National Cancer Institute, were published on Monday in The Journal of the American Medical Association. They say, for instance, that some premalignant conditions, like one that affects the breast called ductal carcinoma in situ, which many doctors agree is not cancer, should be renamed to exclude the word carcinoma so that patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments that can include the surgical removal of the breast.
The group, which includes some of the top scientists in cancer research, also suggested that many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”
While it is clear that some or all of the changes may not happen for years, if it all, and that some cancer experts will profoundly disagree with the group’s views, the report from such a prominent group of scientists who have the backing of the National Cancer Institute brings the discussion to a higher level and will most likely change the national conversation about cancer, its definition, its treatment and future research.
“We need a 21st-century definition of cancer instead of a 19th-century definition of cancer, which is what we’ve been using,” said Dr. Otis W. Brawley, the chief medical officer for the American Cancer Society, who was not directly involved in the report.
The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm.
The advent of highly sensitive screening technology in recent years has increased the likelihood of finding these so-called incidentalomas — the name given to incidental findings detected during medical scans that most likely would never cause a problem. However, once doctors and patients are aware a lesion exists, they typically feel compelled to biopsy, treat and remove it, often at great physical and psychological pain and risk to the patient. The issue is often referred to as overdiagnosis, and the resulting unnecessary procedures to which patients are subjected are called overtreatment.
Cancer researchers warned about the risk of overdiagnosis and overtreatment as a result of new recommendations from a government panel that heavy smokers be given an annual CT scan. While the policy change, announced on Monday but not yet made final, has the potential to save 20,000 lives a year, some doctors warned about the cumulative radiation risk of repeat scans as well as worries that broader use of the scans will lead to more risky and invasive medical procedures.
Officials at the National Cancer Institute say overdiagnosis is a major public health concern and a priority of the agency. “We’re still having trouble convincing people that the things that get found as a consequence of mammography and P.S.A. testing and other screening devices are not always malignancies in the classical sense that will kill you,” said Dr. Harold E. Varmus, the Nobel Prize-winning director of the National Cancer Institute. “Just as the general public is catching up to this idea, there are scientists who are catching up, too.”
One way to address the issue is to change the language used to describe lesions found through screening, said Dr. Laura J. Esserman, the lead author of the report in The Journal of the American Medical Association and the director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco. In the report, Dr. Esserman and her colleagues said they would like to see a multidisciplinary panel convened to address the issue, led by pathologists, with input from surgeons, oncologists and radiologists, among others.
“Ductal carcinoma in situ is not cancer, so why are we calling it cancer?” said Dr. Esserman, who is a professor of surgery and radiology at the University of California, San Francisco.
Such proposals will not be universally embraced. Dr. Larry Norton, the medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, said the larger problem is that doctors cannot tell patients with certainty which cancers will not progress and which cancers will kill them, and changing terminology does not solve that problem.
“Which cases of D.C.I.S. will turn into an aggressive cancer and which ones won’t?” he said, referring to ductal carcinoma in situ. “I wish we knew that. We don’t have very accurate ways of looking at tissue and looking at tumors under the microscope and knowing with great certainty that it is a slow-growing cancer.”
Dr. Norton, who was not part of the report, agreed that doctors do need to focus on better communication with patients about precancerous and cancerous conditions. He said he often tells patients that even though ductal carcinoma in situ may look like cancer, it will not necessarily act like cancer — just as someone who is “dressed like a criminal” is not actually a criminal until that person breaks the law.
“The terminology is just a descriptive term, and there’s no question that has to be explained,” Dr. Norton said. “But you can’t go back and change hundreds of years of literature by suddenly changing terminology.”
But proponents of downgrading cancerous conditions with a simple name change say there is precedent for doing so. The report’s authors note that in 1998, the World Health Organization changed the name of an early-stage urinary tract tumor, removing the word “carcinoma” and calling it “papillary urothelial neoplasia of low malignant potential.” When a common Pap smear finding called “cervical intraepithelial neoplasia” was reclassified as a low-grade lesion rather than a malignancy, women were more willing to submit to observation rather than demanding treatment, Dr. Esserman said.
“Changing the language we use to diagnose various lesions is essential to give patients confidence that they don’t have to aggressively treat every finding in a scan,” she said. “The problem for the public is you hear the word cancer, and you think you will die unless you get treated. We should reserve this term, ‘cancer,’ for those things that are highly likely to cause a problem.”
The concern, however, is that since doctors do not yet have a clear way to tell the difference between benign or slow-growing tumors and aggressive diseases with many of these conditions, they treat everything as if it might become aggressive. As a result, doctors are finding and treating scores of seemingly precancerous lesions and early-stage cancers — like ductal carcinoma in situ, a condition called Barrett’s esophagus, small thyroid tumors and early prostate cancer.
But even after years of aggressively treating those conditions, there has not been a commensurate reduction in invasive cancer, suggesting that overdiagnosis and overtreatment are occurring on a large scale.
The National Cancer Institute working group also called for a greater focus on research to identify both benign and slow-growing tumors and aggressive diseases, including the creation of patient registries to learn more about lesions that appear unlikely to become cancer.
Some of that research is already under way at the National Cancer Institute. Since becoming director of the institute three years ago, Dr. Varmus has set up a list of “provocative questions” aimed at encouraging scientists to focus on critical areas, including the issue of overdiagnosis and molecular tests to distinguish between slow-growing and aggressive tumors.
Another National Cancer Institute program, the Barrett’s Esophagus Translational Research Network, or Betrnet, is focused on changes in the esophageal lining that for years have been viewed as a precursor to esophageal cancer. Although patients with Barrett’s are regularly screened and sometimes treated by burning off the esophageal lining, data now increasingly suggest that most of the time, Barrett’s is benign and probably does not need to be treated at all. Researchers from various academic centers are now working together and pooling tissue samples to spur research that will determine when Barrett’s is most likely to become cancerous.
“Our investigators are not just looking for ways to detect cancer early, they are thinking about this question of when you find a cancer, what are the factors that might determine how aggressively it will behave,” Dr. Varmus said. “This is a long way from the thinking 20 years ago, when you found a cancer cell and felt you had a tremendous risk of dying.”
Category: Health
Related to health issues
Supplements are not food!
Supplements are not food! There is no reason to eat them. Eat the right food to get your vitamins. The right food is a whole food plant based diet.
Are supplements a quick health fix or can vitamins actually be bad for you?Vitamin pills are big business – from chewable ones for children and tablets especially tailored for women going through the menopause to essential oils for dodgy joints and high-dose vitamin C to pep up your immune system, there’s a supplement for everyone.
But can vitamins actually be bad for your health?
It seems that your daily pill can do more harm than good. Indeed, last week saw the revelation that fish oil capsules have been linked to high levels of prostate cancer – a shock for the millions who take fish oils or omega-3 fatty acids every day in the quest to ease joint pain, improve heart health and fight mental decline.
A study of more than 2,000 men found that those with the highest levels of omega-3 in their blood were 71 per cent more likely to develop the most lethal form of prostate cancer, and 44 per cent more likely to develop low-grade prostate cancer.
And it’s not just omega-3 that is under scrutiny. According to Dr Alan Kristal, who led the study at the Fred Hutchinson Cancer Research Centre in Seattle, there is surprisingly little evidence that any vitamin or mineral pills prevent disease – unless people are suffering from a nutrient deficiency.
‘As we do more and more of these studies, we find high doses of supplements have no effect or increase the risk of the disease you are trying to prevent,’ he says. Yet millions of busy Britons take vitamins to compensate for a poor diet.
One in three of us takes a supplement, and we spend about £209 million a year on vitamin pills. The message last week from experts was not to panic. Dr Michele Sadler, the HFMA’s scientific adviser, said: ‘This type of evidence can indicate an association, but does not demonstrate cause and effect’
For most people, taking multivitamin and mineral supplements at the recommended dose is safe.
So amid all this confusing and sometimes contradictory advice, which supplements work and, more importantly, which ones are safe?
MULTIVITAMINS
Big business: One in three of us takes a supplement – but is it worth it?While they might be the most wide-ranging supplement in the UK – providing 100 per cent of our daily allowance of everything from vitamin B to copper – there is little evidence that they do any good.
In 2010, French researchers followed 8,000 volunteers who had taken either a multivitamin or a dummy placebo pill for six years.
They found that those who popped the vitamin pill were just as likely to suffer heart disease or cancer as those taking the placebo.
That work followed a 2008 major review of 67 studies – involving 230,000 people – which found no evidence that multivitamins prolonged life.
Some studies have even suggested that high doses could do more harm than good.
In 2011, the Iowa Women’s Health Study looked at the health of more than 38,000 older women and found that women who regularly took multivitamins were 2.4 per cent more likely to die over the 19 years of the study.
Their research also showed that use of vitamin B6 increased the risk of death during the study by 4.1 per cent, folic acid by 5.9 per cent, iron by 3.9 per cent, magnesium by 3.6 per cent, zinc by 3 per cent and copper by 18 per cent.
However, the study didn’t take into account the fact that many people start taking heavy doses of vitamins only when they develop serious diseases such as cancer.
But Dr Kristal says: ‘Dozens of studies of multivitamins show that they do absolutely nothing at the recommended doses.’
So if your diet contains plenty of fresh food and your five-a-day, it’s unlikely a multivitamin pill is essential.
VITAMIN C
Doctors have known since the 1750s, when British sailors were first issued with limes, that vitamin C is essential for health. It helps to heal wounds, strengthens the body’s connective tissues and keeps cells healthy.
But despite the many health claims made about vitamin C, there is little evidence that it does much good as a supplement.
While it does appear to shorten the duration of colds, there is little real proof that it staves off illness, Dr Kristal says.
And the high doses recommended by some supporters of alternative medicine may do more harm than good.
Danger: Fish oil capsules have been linked to high levels of prostate cancerIn February, an 11-year study of more than 23,000 men found that those who took high doses of the supplement – typically 1,000 mg – were twice as likely to develop kidney stones compared to men who took no pills.
A 2002 study showed that 1g doses of vitamin C and vitamin E almost trebled the risk of premature death among postmenopausal women in any year.
The Department of Health says adults need 40 mg a day but doses up to 1,000 mg a day are unlikely to cause harm. Anyone worried about their intake should decide whether they are exceeding their safe daily dose.
‘For example, the effervescent vitamin drink Berocca contains 476 mg. Two doses would take you close the recommended limit.’
VITAMIN E
Found in nuts, germs, wheat and oils, vitamin E is vital for healthy cells. According to the Department of Health, most adults need between 3 mg and 4 mg a day.
Brain boostVitamin B supplements can help stave off Alzheimer’s disease because they reduce brain shrinkage, claims a study by Oxford University
Studies have shown that foods rich in vitamin E may protect against heart disease. But there is little evidence that vitamin E pills do the same – and some that say they may do harm.
In 2011, U.S. researchers at Cleveland Clinic found that men who took a ‘high strength’ 268 mg vitamin E pill each day during the seven year study were 17 per cent more likely to develop prostate cancer than men who did not take the supplement.
And, in 2005, a seven-year study of 4,000 people found it increased the risk of heart failure by 13 per cent.
While the Department of Health says taking 540 mg or less a day is unlikely to do harm, the prostate cancer study published by Dr Kristal also looked at the effect of daily 400 mg vitamin E doses.
Dr Kristal says: ‘It increased the risk of prostate cancer by 17 per cent. We don’t know why. But one thing to remember is that, unlike vitamin C, it is soluble in fat and so levels build up in the body over time.’
Experts say that one egg or 28 g of almonds a day should provide all the vitamin E you need – making it unlikely that any of us need a supplement.
Enough: A glass of milk and a yoghurt meets our daily calcium limitCALCIUM
Calcium is often taken by middle-aged and older people to protect their bones. There is also evidence that it can prevent the recurrence of bowel polyps – growths that may develop into cancer.
However, calcium supplements could increase the risk of heart disease in men, according to a study in February from the U.S. National Cancer Institute.
A study of 388,000 people found that men who took more than 1,000 mg, or 1 g, a day in supplements were at greater risk of heart problems – and had a 20 per cent higher risk of death.
Women were not at greater risk, the Journal of the American Medical Association found. Scientists believe that high calcium levels harden the arteries, increasing the risk of cardiovascular disease.
The Food Standards Agency recommends adults have 700 mg of calcium a day. One yoghurt and a 300 ml glass of milk would meet your daily calcium limit, so it’s unlikely you would need a supplement.
SELENIUM
Selenium is a trace mineral found in seafood, meat and grains. It is essential in small doses and selenium deficiency is linked to mental decline, impaired immune systems and premature death.
But although it is commonly recommended to help prevent heart disease, too much can be harmful. The Department of Health says men need 0.075 mg a day, and women 0.06mg, in their diet. But after looking at data from 20,000 adults, Warwick Medical School researchers found that it did little to lower the incidence of heart disease in people with a good diet.
High doses were linked to type 2 diabetes, the authors reported in the Cochrane Library journal.
BETA CAROTENE
Beta carotene is a pigment that gives yellow and orange plants colour. The body converts beta carotene to vitamin A, which we need for good vision, healthy skin and a strong immune system.
Beta carotene is a natural antioxidant and is usually taken to prevent cancer. But there is no evidence it works, and plenty to show that high doses can be harmful.
In 1994, researchers found that smokers who regularly took a large 20 mg dose of beta carotene a day were 8 per cent more likely to die from lung cancer than people who did not take the supplement.
As well as all this, beta carotene can also give white skin an orange tint, and can trigger upset stomachs, joint pain and dizziness.
Eggs Harmful to Health
| BREAKING MEDICAL NEWS | May 15, 2013 |
Eggs Harmful to Health
May 15, 2013
Eggs increase the risk for heart disease and diabetes, according to a new meta-analysis published in Atherosclerosis. Researchers reviewed 14 studies and found that those who consumed the most eggs had a 19 and 68 percent increased risk for developing cardiovascular disease and diabetes, respectively, compared with those who ate the fewest eggs. For those who already had diabetes, the risk for developing heart disease from eating the most eggs jumped by 83 percent.
Li Y, Zhou C, Zhou X, Li L. Egg consumption and risk of cardiovascular diseases and diabetes: A meta-analysis. Atherosclerosis. Published ahead of print April 17, 2013.
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Breaking Medical News is a service of the Physicians Committee for Responsible Medicine, 5100 Wisconsin Ave., Ste. 400, Washington, DC 20016, 202-686-2210. Join PCRM and receive the quarterly magazine,Good Medicine.
Jamie-oliver-campaign-makes-mcdonalds-change-recipe
Chef Jamie Oliver won a battle against one of the largest fast food chains in the world. After Oliver showed how McDonald’s hamburgers are made, the franchise announced it will change its recipe.
According to Oliver, the fatty parts of beef are “washed” in ammonium hydroxide and used in the filling of the burger. Before this process, according to the presenter, the food is deemed unfit for human consumption.
According to the chef and presenter, Jamie Oliver, who has undertaken a war against the fast food industry: “Basically, we’re taking a product that would be sold in the cheapest way for dogs, and after this process, is being given to human beings.”
Besides the low quality of the meat, the ammonium hydroxide is harmful to health. Oliver calls it “the pink slime process.”
“Why would any sensible human being put meat filled with ammonia in the mouths of their children?” asked the chef, who wages a war against the fast food industry.
In one of his initiatives, Oliver demonstrates to children how nuggets are made. After selecting the best parts of the chicken, the remains (fat, skin and internal organs) are processed for these fried foods.
The company, Arcos Dorados, the franchise manager in Latin America, said such a procedure is not practiced in the region. The same applies to the product in Ireland and the UK, where they use meat from local suppliers.
In the United States, Burger King and Taco Bell had already abandoned the use of ammonia in their products. The food industry uses ammonium hydroxide as an anti-microbial agent in meats, which has allowed McDonald’s to use otherwise “inedible meat.”
Even more disturbing is that because ammonium hydroxide is considered part of the “component in a production procedure” by the USDA, consumers may not know when the chemical is in their food.
On the official website of McDonald’s, the company claims that their meat is cheap because, while serving many people every day, they are able to buy from their suppliers at a lower price, and offer the best quality products.
In addition, the franchise denied that the decision to change the recipe is related to Jamie Oliver’s campaign. On the site, McDonald’s has admitted that they have abandoned the beef filler from its burger patties.
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Boy-recovers-from-autism-by-removing-dairy
Autism rates around the planet are rising and many are asking questions about how they can best treat or remedy symptoms to increase quality of life overall.
Ethan Fox began showing strong signs of Autism recovery when his diet was changed to no longer include gluten and dairy. Ethan’s parents acted on the advice of Dr. Kenneth Bock who is an autism specialist and author of ‘Healing The New Childhood Epidemics. Autism, ADHD, Asthma and Allergies.’ It is believed that changing an autistic child’s diet to no longer include gluten and dairy can assist 60% of children with the disorder.
There is much concern that the rise in autism is directly linked to the rise in vaccines since the early 1990′s. While this theory has been debunked on several occasions by mainstream health, many independent studies are confirming the link, suggesting that mainstream health has a vested benefit in the continuation of their practices. Many researchers in the field strongly believe the current vaccine schedule is unsafe and health professionals are turning a blind eye to the real and factual results. Many arguments against the mainstream approach to this research is that they have not properly studied or tested the link between autism and vaccines and therefore are irresponsibly drawing conclusions.
Autism in the U.S. alone has increased by over 2700 percent since 1991. It was at that point that vaccines for children doubled, and even today we still see an increase in the number of immunizations. Before 1991, 1 in 2500 children were diagnosed with autism whereas now 1 in 91 children are diagnosed.
Although research by Epidemiologist Tom Verstraeten and Dr. Richard Johnston, an immunologist and pediatrician from the University of Colorado, both determined that thimerosal was responsible for the sudden rise in cases of autism, their findings were quickly dismissed by the CDC.
The graph illustrates the link between the MMR vaccine and the rise in autism
Further research on the link between a gluten free diet having positive results for autistic children is furthered by the a study focused solely on dietary therapy for children with autism. I have included a link to the study in the sources, below is an excerpt from the study’s abstract.
‘We report the history of a child with autism and epilepsy who, after limited response to other interventions following her regression into autism, was placed on a gluten-free, casein-free diet, after which she showed marked improvement in autistic and medical symptoms. Subsequently, following pubertal onset of seizures and after failing to achieve full seizure control pharmacologically she was advanced to a ketogenic diet that was customized to continue the gluten-free, casein-free regimen.’
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The Protein Myth
The Protein Myth
In the past, some people believed one could never get too much protein. In the early 1900s, Americans were told to eat well over 100 grams of protein a day. And as recently as the 1950s, health-conscious people were encouraged to boost their protein intake. Today, some diet books encourage high-protein intake for weight loss, although Americans tend to take in twice the amount of protein they need already. And while individuals following such a diet have sometimes had short-term success in losing weight, they are often unaware of the health risks associated with a high-protein diet. Excess protein has been linked with osteoporosis, kidney disease, calcium stones in the urinary tract, and some cancers.
The Building Blocks of Life
People build muscle and other body proteins from amino acids, which come from the proteins they eat. A varied diet of beans, lentils, grains, and vegetables contains all of the essential amino acids. It was once thought that various plant foods had to be eaten together to get their full protein value, but current research suggests this is not the case. Many nutrition authorities, including the American Dietetic Association, believe protein needs can easily be met by consuming a variety of plant protein sources over an entire day. To get the best benefit from the protein you consume, it is important to eat enough calories to meet your energy needs.
The Trouble with Too Much Protein
The average American diet contains meat and dairy products. As a result, it is often too high in protein. This can lead to a number of serious health problems:
- Kidney Disease: When people eat too much protein, they take in more nitrogen than they need. This places a strain on the kidneys, which must expel the extra nitrogen through urine. People with kidney disease are encouraged to eat low-protein diets. Such a diet reduces the excess levels of nitrogen and can also help prevent kidney disease.
- Cancer: Although fat is the dietary substance most often singled out for increasing cancer risk, protein also plays a role. Populations who eat meat regularly are at increased risk for colon cancer, and researchers believe that the fat, protein, natural carcinogens, and absence of fiber in meat all play roles. The 1997 report of the World Cancer Research Fund and American Institute for Cancer Research, Food, Nutrition, and the Prevention of Cancer, noted that meaty, high-protein diets were linked with some types of cancer.
- Osteoporosis and Kidney Stones: Diets that are rich in animal protein cause people to excrete more calcium than normal through their kidneys and increase the risk of osteoporosis. Countries with lower-protein diets have lower rates of osteoporosis and hip fractures.
Increased calcium excretion increases risk for kidney stones. Researchers in England found that when people added about 5 ounces of fish (about 34 grams of protein) to a normal diet, the risk of forming urinary tract stones increased by as much as 250 percent.
For a long time it was thought that athletes needed much more protein than other people. The truth is that athletes, even those who strength-train, need only slightly more protein, which is easily obtained in the larger servings athletes require for their higher caloric intake. Vegetarian diets are great for athletes.
To consume a diet that contains enough, but not too much, protein, simply replace animal products with grains, vegetables, legumes (peas, beans, and lentils), and fruits. As long as one is eating a variety of plant foods in sufficient quantity to maintain one’s weight, the body gets plenty of protein.
Pink Slime Aside, Meat is Not Safe
By Neal Barnard, M.D. | Posted on April 4, 2012
The recent uproar over “lean beef trimmings”—also known as “pink slime”—has led the maker of this ammonia-treated meat to suspend operations at all but one plant. Beef Products, Inc., acknowledged that the company has taken a huge hit since social media exploded with concerns about this disturbingly unhealthful, chemically-treated substance going into school lunch lines.
The U.S. Department of Agriculture is considering removing pink slime from schools, and fast-food companies have even taken the slime out of their burger recipes. The pink slime pandemonium has inspired bloggers to expose the long list of other unlabeled chemicals that end up in almost all industrial meat. Without any labeling requirement, meat processors can lace meat with chemicals used to bleach fabric, disinfect pools and hot tubs, and bleach wood pulp, just to name a few.
These revelations have consumers fuming. Some are calling for more labeling, and less processing of meat. The meat industry is claiming that these chemically treated products are safe—maybe even safer than beef not treated with chemicals.
But ultimately there is no such thing as safe meat. Meat is loaded with cholesterol and saturated fat, not to mention E. coli and other pathogens that can cause serious illnesses. If treated with chemicals, it then contains substances that may increase the risk of cancer and other health problems.
Beef Products, Inc., is desperately trying to rebuild business, taking out a full-page Wall Street Journal ad and launching a website that proclaims that “Beef is Beef.”
The company has that right. From ground beef to sirloin steak to rump roast, every cut of beef contributes to more deadly illnesses than the chemicals in pink slime will likely ever cause. Whether it’s pink slime or organic, grass-fed beef, it all leads to obesity, heart disease, type 2 diabetes, and other life-threatening illnesses.
The pink slime victory shows just how powerful consumers are when they come together to fight an unsafe product. But it’s hardly the end of the battle: It’s time to face up to the consequences of our meaty diets and move to more healthful ways of eating.
As originally published on PCRM.org
Too Much Breast-Cancer Treatment?
Every few months, another study reports that many breast cancers are being “overdiagnosed”—that is, detected and treated even though they would never cause problems if they were left alone. In one article, epidemiologists in Norway estimated that 15% to 25% of breast cancers found by mammograms were being treated unnecessarily.
A study in Norway fuels the debate over whether breast cancer can be overtreated. Melinda Beck on The News Hub discusses the debate over the concept of too much breast-cancer treatment. Photo: Bloomberg.
The study in the Annals of Internal Medicine in April calculated that for every 2,500 women offered mammograms over 10 years, one breast-cancer death was averted, but six to 10 women were subjected to surgery, radiation and/or chemotherapy unnecessarily.
The researchers in Norway compared breast-cancer rates in counties where a government mammogram program had begun with those without such screening, as well as with past years. They found that detecting and treating many early-stage breast cancers reduced the number of late-stage cancers and deaths only slightly, prompting them to conclude that much of the treatment was unnecessary—in some cases because the cancers wouldn’t have progressed, and in some cases because they were fatal despite being treated early. Other studies have estimated that the overdiagnosis rate falls in a wide range, anywhere from 2% to 52%.
There is currently no way to tell which patients diagnosed with breast cancer—200,000 a year in the U.S.—could safely forgo treatment, breast-cancer specialists say. “When you can tell me which cancers need to be treated and which don’t, then I will consider this argument” about overdiagnosis, says Clifford Hudis, chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City.
Clinicians say leaving breast cancer untreated is a gamble they can’t take. “I don’t know anyone who offers women the option of doing nothing,” says Eric Winer, director of the breast cancer program at Dana-Farber Cancer Institute in Boston. “On the one hand, we are aware of the overtreatment, all of us. On the other hand, there are still 40,000 women every year who die of breast cancer.”
Otis Brawley, an epidemiologist and breast-cancer specialist who heads the American Cancer Society, notes such estimates are all statistical presumptions. “Even if we overdiagnose 1 in 5, we have numerous studies showing that by treating all these women, we save a bunch of lives,” he says.
A 2011 Cochrane review of seven trials in which 600,000 women were randomly assigned to get mammograms or not estimated that while 30% were overdiagnosed, breast cancer deaths were reduced by 15%.
Even in the precancerous stage, called ductal carcinoma in situ (DCIS) when abnormal cells are confined to a milk duct, physicians almost always advise women to have a lumpectomy or mastectomy along with radiation, because about 20% of the 65,000 cases of DCIS found every year in the U.S. become invasive cancer.
A few women do opt to monitor their DCIS to see if it progresses. A study in the journal The Breast last year of 14 such women, who took hormone-blocking drugs, found that after two years, eight decided to have surgery, with five of them having progressed to stage 1 invasive breast cancer. Six remained on active surveillance with no evidence their DCIS had worsened.
The authors, from the University of California, San Francisco, noted that even when DCIS becomes an invasive cancer, it’s treatable when found at an early stage: The odds that a 60-year old woman with a 7 millimeter breast tumor, would die from it in the next 10 years are less than 3%, half the risk she faces of dying from another cause during that time.
Physicians say it would be far riskier to leave invasive breast cancers untreated. “At this point, any breast cancer does need to be removed,” says Bhuvaneswari Ramaswamy, a breast cancer researcher at the Ohio State University Comprehensive Cancer Center in Columbus, Ohio. “We do more than we need to because we don’t know how to do less.”
Scientists have made progress in analyzing individual breast cancers and tailoring treatment accordingly. About two-thirds of tumors have estrogen receptors that make them vulnerable to hormone-blocking medications. About one-third test positive for a protein called HER2 that makes cancers particularly aggressive, but susceptible to the drug Herceptin.
A new wave of tests can predict how tumors will behave based on their genetic profile. The most commonly used test is Oncotype DX, which analyzes 21 genes. Cells from about half the breast tumors in the U.S. are now sent to Genomic Health Inc. in Redwood City, Calif., which developed the test. The company’s technicians determine how likely the cancer is to recur in 10 years and whether the patient would benefit from chemotherapy as well as radiation and surgery. Company officials say the test has reduced the number of U.S. breast-cancer patients on chemotherapy by 20% since it became available in 2004.
A new Oncotype DX test can predict whether a patient with DCIS would benefit from radiation in addition to surgery. But there is no test that can determine whether a breast tumor can be left untreated. “That’s a dream that we would all have for the future,” says Steven Shak, co-founder of Genomic Health, who led the development of Herceptin.
The company is testing a version of Oncotype DX that may be able to tell which prostate cancers don’t need treatment. More than 60% of prostate cancers are thought to be so slow-growing that they would never be life-threatening, but as of now, there is no way to tell those apart from the fast-growing ones that kill 28,000 men in the U.S. every year. About 20% of prostate cancer patients opt for “active surveillance” rather than immediate treatment—in part because the side effects of radiation and surgery can be severe, including impotence and incontinence.
Biostatisticians argue that fewer mammograms would reduce the number of small, early cancers found, as well as the rate of false positives that require additional scans and biopsies. That’s the rationale the U.S. Preventive Service Task Force used in 2009 when it recommended that women get mammograms every two years starting at age 50, instead of annually starting at age 40.
“I’m certainly not asking anyone to stop getting mammograms. I am asking my profession to tell women the truth about the [overdiagnosis] deal,” says H. Gilbert Welch, professor of medicine at Dartmouth Institute for Health Policy & Clinical Practice.
Patients are seldom even told about the overdiagnosis issue and there is very little data on the long-term side effects of cancer treatments, which can include chronic pain, debilitating fatigue, “chemo brain” or foggy thinking, and additional cancers linked to radiation treatments, says Fran Visco, president of the National Breast Cancer Coalition, a nonprofit advocacy group. “We shouldn’t not tell them the truth because we are worried they’ll be confused.”
Many physicians who treat breast cancer patients are loath to stop looking so hard for cancer, and hope for additional tests that can better predict which breast tumors will stay harmless. Meanwhile, says Memorial Sloan-Kettering’s Dr. Hudis, “we are quibbling over whether everyone benefits or only some people. Let’s not lose sight of the fact that we are saving lives.”
A look at data about the disease in the U.S. and the typical treatments.
•Estimated new cases in 2012: 226,870 women; 2,190 men
•Estimated deaths in 2012: 39,510 women; 410 men
•Percentage diagnosed as Stage IV (metastasized): 5%
•Five-year survival by stage: local 98%; regional 83%; metastasized 23%
•Five year survival overall: 89%
•Diagnosed in lifetime with breast cancer: 1 in 8 women
Sources: NCI/SEER data from 2005-2009; National Cancer Institute
•Stage 0 (noninvasive DCIS): lumpectomy or mastectomy and radiation, sometimes hormone therapy
•Stage I or II: lumpectomy or mastectomy, radiation and often chemotherapy
•Stage III: chemotherapy and radiation before or after mastectomy, underam lymph nodes removed, often targeted therapy
•Stage IV and recurrent: surgery (depending on where cancer has spread), chemotherapy, radiation, hormone, other therapies
Low fat and Skim Milk Linked to Increased Prostate Cancer Risk
While total calcium and vitamin D intake does not appear to impact the risk of prostate cancer, consuming your 3-a-day of dairy in the form of low fat or skim milk may actually increase the risk of malignancy, according to two studies recently published in the American Journal of Epidemiology …
Past research had indicated a potential link between dietary calcium and dairy product intake and prostate cancer, though the supporting evidence was not clear. In order to explore this topic further, these two large studies were launched.
The first was led by Dr. Song-Yi Park, from the University of Hawaii in Honolulu. His group conducted a Multiethnic Cohort Study of 82,483 men between the ages of 45 and 75, from 1993 to 2002. During that time, 4,404 of the men developed prostate cancer. No association was found between calcium and vitamin D and prostate cancer, regardless of if the source was via supplements or dietary intake. However, consumption of low fat and nonfat milk was related to an increased risk, while whole milk correlated with a decreased risk of total prostate cancer. The study does suggest that an association with milk consumption may vary by fat content, particularly for early forms of this cancer.
Another study, led by Dr. Yikyung Park, from the National Cancer Institute at the National Institutes of Health (NIH) in Bethesda, Maryland, produced similar results. Their research was conducted between 1995 and 2001, following 293,888 men.
Similar to the findings out of the University of Hawaii, skim milk was linked with advanced prostate cancer. In contrast, calcium intake from non-dairy foods was actually tied to a reduced risk of non-advanced prostate cancer.
If you aren’t interested in increasing your fat and calorie intake, but have concerns of prostate cancer risk, then perhaps green tea would be the best beverage of choice. A third study published in December, found that men who drank five or more cups a day may cut their risk of developing advanced prostate cancer in half, when compared to those men who drank less than one cup a day.
Further studies will be required to solidify any of these possible connections.
SOURCES:
American Journal of Epidemiology, December 1, 2008.
Reuters: Nonfat Milk Linked to Prostate Cancer
Non-Dairy Calcium: Milk, Calcium King or Jester?
According to the enormous 12-year Harvard study of 77,761 female nurses, as published in the American Journal of Public Health (1997, volume 87): “…women consuming greater amounts of calcium from dairy foods had significantly increased risks of hip fractures, while no increase in fracture risk was observed for the same levels of calcium from nondairy sources.”
Wait a minute, dairy products could actually be a cause of hip fractures from osteoporosis? This landmark study has risen more than a few eyebrows in the medical community. Although this is a giant study in its own right, it certainly does not stand alone in the evidence for a dairy-free lifestyle.
In a review of 34 published studies in 16 different countries, researchers at Yale University discovered that the countries with the highest rates of osteoporosis, including the United States, England, Sweden, and Finland, were coincidentally also the highest consumers of dairy products. As further proof, countries with historically low rates of osteoporosis and hip fracture, such as China, are seeing a proportionate increase in the incidence of osteoporosis with the adoption of Westernized dietary habits.
But, how can this be…according to the USDA, milk is one of our major food groups? The answer is not completely clear, but there are a couple of strong theories circulating in the scientific community. High dairy intake provides a high level of animal protein, which in turn is high in sulfur-containing amino acids. The body buffers the effects of these amino acids by releasing calcium from the bones, and excreting it from the body. In addition, animal foods, particularly milk, contain very high levels of phosphorous, which may interfere with calcium absorption.
The tides are turning on the osteoporosis front. Keeping strong bones may depend more on preventing calcium loss than on increasing calcium intake. For this reason, many renowned researchers are changing their calcium vote from milk to plant sources such as vegetables, fruits, and nuts.
The Way To Eat 