You Survived
Cancer: Now Pay Attention to Your Overall Health
Cancer
survivors need to pay close attention to other aspects of their health as they
age, researchers urge.
A new study
finds that nearly half of cancer survivors die of something other than cancer,
such as heart disease or diabetes. And the further from the initial cancer
diagnosis they get, the more likely it is that their cause of death will be
something other than cancer.
The study was
to be presented Tuesday at the American Association for Cancer Research's
annual meeting in Chicago.
"After
the detection of cancer, clinicians and cancer survivors pay less attention to
the prevention and treatment of other diseases and complications," lead
researcher Dr. Yi Ning, assistant professor in the department of epidemiology
and community health at Virginia Commonwealth University in Richmond, said in
an association news release. "We shouldn't neglect other aspects of health
because we are focused on cancer and overlook other chronic conditions."
In following
1,800 cancer survivors over the course of more than 18 years, researchers found
that 776 of the patients died: 51 percent eventually died from cancer and 49
percent died from other conditions.
"We
realized that the mortality rates for some types of cancer, such as breast
cancer, had declined," said Ning, also an associate research member at VCU
Massey Cancer Center. "Cancer survivors live much longer than they did
several decades ago. So with this large group of cancer survivors, we need to
pay more attention to cancer survivors' overall health."
The patients
followed in the study survived some of the most common forms of cancer,
including breast, prostate, cervical, lung and colorectal. A large percentage
were also diagnosed with conditions other than cancer, including high blood
pressure and diabetes.
The more time
that passed after the initial cancer diagnosis, the more likely cancer
survivors were to die from another illness. Among those who died from a
condition other than cancer during the study period, 33 percent had been
diagnosed with cancer within the previous five years and 63 percent had been
diagnosed 20 years earlier.
Because this
study was presented at a medical meeting, the data and conclusions should be
viewed as preliminary until published in a peer-reviewed journal.
More
information
(SOURCE:
American Association for Cancer Research, news release, April 3, 2012)
Veggies Like Broccoli, Cabbage May Help
Fight Breast Cancer: Study
High intake of cruciferous vegetables associated with lower
death rate, researchers say.
Eating broccoli, one of the
top "super foods," and other cruciferous vegetables may improve your
odds for breast cancer survival, a new study suggests.
In a study of women in
China diagnosed with breast cancer, researchers found that women who consumed
the most cruciferous vegetables were 62 percent less likely to die of breast
cancer and 35 percent less likely to have a recurrence of the disease, compared
with those who consumed the least.
The most common cruciferous
vegetables that the women reported eating were mustard and turnip greens, bok
choy, cauliflower and green cabbage. Kale, collard greens and arugula are other
cruciferous vegetables.
"This study suggests
that cruciferous vegetables and the bioactive compounds in them may be
protective against breast cancer," said Sarah Nechuta, a research fellow
in the Vanderbilt Epidemiology Center in Nashville, Tenn., and lead author of
the study.
However, it is not clear if
this association would be seen for women in the United States, who tend to eat
a different assortment of the vegetables -- more broccoli, cauliflower and
Brussels sprouts than bok choy, Nechuta added.
Previous studies of women
in China, the United States and Sweden hinted that higher cruciferous vegetable
intake could be linked with reduced risk of developing breast cancer, but the
current research is among the first to examine women after a breast cancer
diagnosis.
The findings are slated for
presentation Tuesday at the American Association for Cancer Research meeting in
Chicago.
The study involved almost
5,000 women between 20 and 75 years old who were part of the Shanghai Breast
Cancer Survival Study. Researchers interviewed the women within six months of
their diagnosis to gather information about diet, lifestyle and such clinical
factors as tumor stage. They also asked about their intake of cruciferous
vegetables at 18 and 36 months after their diagnosis.
Women whose consumption of
cruciferous vegetables was in the top 25 percent were 62 percent less likely to
die of breast cancer during the roughly five-year study period than women in
the bottom 25 percent, the study found.
Recurrence was 35 percent
less likely among women in the top bracket of consumption compared to those in
the bottom 25 percent.
The researchers also found
that women in the top quarter for consumption were 62 percent less likely to
die of any cause than those in the bottom 25 percent.
The Vanderbilt group
previously found a link between cruciferous vegetable consumption and fewer deaths
and less heart disease among healthy Chinese adults, suggesting that this food
group might bestow overall survival benefits, Nechuta said.
On average, the women in
the new study ate about 3 1/2 ounces a day of cruciferous vegetables, which
come from plants with four flower petals that form the shape of a crucifer
cross.
The associations with
reduced death and cancer recurrence remained even after adjusting for other
differences, including consumption of soy and meat, vitamin intake, physical
activity, stage of cancer, income and education level.
Even so, Dr. Laura Kruper,
director of the Women's Health Center at City of Hope in Duarte, Calif., said,
"It's so hard to show a link between cause and effect in these types of
studies." She added that, while the study has merits, more studies have to
be done in other populations and for longer periods of time to establish a
cause-and-effect relationship.
Nechuta noted that women in
the United States may not see the same benefits because different cruciferous vegetables,
with different bioactive compounds, are more popular and because American women
eat far less of this type of produce -- about 1 ounce a day on average.
Also, variations in genes
have been found in the Chinese population that could slow the metabolism of
this type of vegetable, keeping the beneficial compounds in the body longer,
Nechuta added.
Nevertheless, there is
probably no harm in advising women in the United States to up their intake of
these vegetables, Kruper said. The American Cancer Society recommends eating at
least 2 1/2 cups of all kinds of fruits and vegetables a day.
"I tell my patients to
limit alcohol to four drinks a week and limit sugar, and also eat more greens
and flaxseed and less red meat," Kruper said. However, alcohol and
physical inactivity are the only two factors that are known "for
sure" to increase breast cancer risk, she added.
"When we think of
vegetables, we think of lettuce or green beans, and there are a lot of benefits
to those, but I would probably also recommend cruciferous vegetables,"
Kruper said.
Data and conclusions
presented at medical meetings should be considered preliminary until published
in a peer-reviewed medical journal.
More information
(SOURCES: Sarah Nechuta,
Ph.D., M.P.H., research fellow, Vanderbilt Epidemiology Center, Vanderbilt
University School of Medicine, Nashville, Tenn.; Laura Kruper, M.D., director,
Cooper Finkel Women's Health Center, and head, Breast Surgery Service, City of
Hope, Duarte, Calif.; April 3, 2012, presentation, American Association for
Cancer Research annual meeting, Chicago)
Ultrasound, MRI Might Spot Cancer in
Dense Breast Tissue
Study suggests screening methods beyond mammograms may be useful
in high-risk patients.
New research suggests that
adding an ultrasound or MRI scan to breast cancer screening if a woman has
dense breasts and at least one other risk factor for breast cancer would
increase the number of cancers found.
Dense breast tissue
increases a woman's risk of developing breast cancer, and it also makes
screening for breast cancer more difficult with standard mammography, previous
research has found.
The addition of ultrasound
to screening resulted in the detection of an additional 4.3 cancers per 1,000
women screened, and MRI resulted in an additional 14.7 cancers detected per
1,000 screened on average, according to the results of the new study. These
cancers were found before they had spread to nearby lymph nodes.
"This is a very
important time in breast cancer screening. Breast cancer is becoming more
treatable, and now we have these extra tools to find cancers," said the
study's lead author, Dr. Wendie Berg, a professor of radiology at the
University of Pittsburgh School of Medicine, Magee-Womens Hospital.
But, she added that women
need to be informed that while MRI and ultrasound are more sensitive tests that
detect more breast cancers, these tests also come with the risk of false
positives. "You have to be willing to accept the risk of extra testing,"
she said.
Results of the study are
published in the April 4 issue of the Journal of the American Medical
Association. Funding for the study was provided by the Avon Foundation and
the U.S. National Cancer Institute.
The study included almost
2,700 women who underwent annual mammography and ultrasound for three years. At
the end of three years, the women were offered the chance to undergo MRI
screening, which requires the use of a special dye (injected through an
intravenous line) and lying still in the enclosed MRI machine, which can be a
problem for people who are uncomfortable in confined spaces. Just 58 percent of
the women decided to undergo MRI.
All of the women included
in the study had dense or extremely dense breast tissue. Berg noted that about
40 percent of women under 50 years old and 30 percent of women over 50 have
dense breast tissue.
The women in the study also
had at least one additional risk factor for breast cancer, according to Berg.
Risk factors that indicate an intermediate risk of breast cancer include a
personal history of breast cancer, a previous unusual breast tissue biopsy or
an intermediate family history of breast cancer (meaning not someone in the
immediate family).
Factors that indicate a
high risk of breast cancer include having a known breast cancer gene, prior
radiation treatment to the chest or an immediate family history of the disease.
In women with a high risk, which is about 1 percent to 2 percent of women
according to Berg, it's already recommended that they undergo MRI in addition
to mammography.
What's been less clear is
how best to screen women with dense breast tissue and an intermediate risk of
cancer.
After three years, a total
of 7,473 mammograms and ultrasounds were completed, and 612 women had completed
MRIs. There were 111 breast cancers detected. Thirty-three were detected by
mammogram alone, while 32 were found by ultrasound alone, and another 26 were
found by both. Nine cancers were detected by MRI after women had already
undergone mammography and ultrasound. Eleven cancers weren't detected by any of
the screening methods -- they were found either by the women or their doctors
discovering a lump.
As for false positive
rates, Berg said that ultrasound resulted in an additional 7 percent recall
rate, and 5 percent of those women had to have a biopsy. Only 7 percent of the
biopsies detected cancer, she said. But for MRI, the recall rate was 20 percent
and 7 percent of those women needed a biopsy. Just 19 percent of these biopsies
found cancer, said Berg.
Berg pointed out that
insurers may or may not pay for ultrasound screenings, and that requests for
MRI screenings are often denied because of the significant cost of the test.
Commenting on the study
findings, Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill
Hospital in New York City, said: "Insurance companies probably won't pay
for an MRI unless a woman is high risk. And, cost isn't always the bottom line.
MRI does generate false positives, which aren't innocuous. They have their
risks and complications."
Bernik recommended that
women ask their doctors whether or not their mammography showed dense breast
tissue. If you have dense breast tissue, she recommended asking your doctor if
you should be getting a screening ultrasound as well. "There are risk
factors other than dense breast tissue that factor into the decision, so ask
your doctor if you need it," said Bernik.
Both Bernik and Berg noted
that ultrasound screening for breast cancer isn't yet available everywhere, and
that the quality of the test depends a lot on who's doing it.
More information
(SOURCES: Wendie Berg,
M.D., Ph.D., professor of radiology, University of Pittsburgh School of
Medicine and Magee-Womens Hospital, Pittsburgh; Stephanie Bernik, M.D., chief,
surgical oncology, Lenox Hill Hospital, New York City; April 4, 2012, Journal
of the American Medical Association)
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