Smoking, Mortality, Reversal

Time to quit cigarettes is now. The craving may last a year or two but the damages sustained from smoking may take 20 years to reverse completely. According to a study from Harvard and Washington University School of Medicine, the excess risk of death in female smokers who have quit cigarettes decreases rapidly for vascular causes and in 20 years for lung disease.

This study assessed the relationship between cigarette smoking and smoking cessation on total and cause-specific mortality in women. More than 100,000 women were evaluated from 1980 to 2004. In this cohort, there were 12 483 deaths, of which 4485 (36%) were among never smokers, 3602 (29%) were among current smokers, and 4396 (35%) were among past smokers. Causes of mortality were categorized into vascular and respiratory diseases, lung cancer, other cancers, and other causes.

Compared with never smokers, current smokers had an increased risk of total mortality and all major cause-specific mortality. Approximately 64% of deaths among current smokers and 28% of deaths among former smokers were attributable to cigarette smoking. In addition there was a significant association between an earlier age of initiating smoking and all smoking-related cancer deaths. A trend was seen between smoking and colorectal cancer but not with ovarian cancer mortality.

A similar study is being done in a population of men. However, chances are that the results will not be very different from the findings in this study. If you are smoking now, stop. The body will start reversing the damages rapidly but it may take 20 years to reach the level of a person who has never smoked.

Resources to stop smoking.

References: JAMA. 2008;299(17):2037-2047.

Do Antioxidants Prevent Cancer?

It's easy to recommend fruits and vegetables as a source of antioxidants. Observational studies have consistently shown an association between diets high in fruits and vegetables and a lower risk of cancer and heart disease. However, I'm often asked about taking antioxidants as supplements. Pills are easier to take in our time-starved society.

Several studies have been done to determine the role of supplements in reducing the risk of cancer and cardiovascular disease, but the results have been mixed. In a recent paper in the Mayo Clinic Proceedings a systematic review of 12 randomized clinical trials was done to evaluate the effect of antioxidants on cancer incidence and cancer deaths. These trials studied Vitamins C and E, betacarotene, selenium, zinc and lycopene. The majority of the trials included a population of at least 10,000 subjects.

The review concluded that overall there was no reduction in the total number of cancers or in the number of deaths due to cancer. However, in breaking down the data by antioxidants, there were a few antioxidant specific findings. Beta carotene was associated with a slightly higher risk of cancer in smokers. Vitmain E had no effect on cancer incidence or mortality. Selenium was associated with a borderline reduction in cancer incidence and mortality, but this effect was mainly seen in men.

Bottom line is that it may be best to get your antioxidants from food and not from pills.

Photo: courtesy of balanced living.

Genetic Screening For Breast and Ovarian Cancer

Mutations in BRCA1 and BRCA2 genes are the most common causes of genetic predisposition to breast and ovarian cancer. A screening test is available , but who should be tested and what can be done if you test positive?

The US Preventive Services Task Force recommends BRCA testing for women in the following groups.

For Ashkenazis, a woman who has:

• Any first degree relative (siblings, parents, daughters/sons) with breast or ovarian cancer
• Two second degree relatives (grandparents, grandchildren, aunts/uncles, nieces/nephews, half-siblings) with breast or ovarian cancer

For Non-Ashkenazi, a woman who has:

• Two first degree relatives with breast cancer
• Three or more first- or second- degree relatives with breast cancer
• Both breast cancer and ovarian cancer among first- and second- degree relatives
• A first degree relative with bilateral breast cancer
• Two or more first- or second- degree relatives with ovarian cancer
• A male relative with breast cancer

Women with no family history of either breast or ovarian cancer are not recommended to be tested.

If BRCA1 mutation is detected, there is a 57% chance of developing breast cancer and a 40% chance of developing ovarian cancer before the age of 70. If BRCA2 mutation is detected, then there is a 49% and 18% chance of developing the respective malignancies.

According to the American Cancer Society guidelines, women who test positive for BRCA mutation should consider breast and gynecological exams every 6 months. Annual MRI of breasts which have a sensitivity of 75% for detection of breast cancer are recommended starting at age 30. A mammogram is not recommended before age 35 due to concern that ionizing radiation may induce malignant changes in BRCA carriers. The combination of MRI, mammogram, and breast ultrasound increases the sensitivity of detection to 95%.

Although it may be a difficult decision, surgical options should be considered for more definitive cancer risk reduction. A bilateral mastectomy (breast removal) reduces the risk of breast cancer by 90%. A bilateral salpingo-oopherectomy (ovary and tube removal ) reduces the risk of ovarian cancer by 80% and breast cancer is reduced by 50%.

References: The Medical Letter, Vol 49, Issue 1274, November 19, 2007. Also see above links.

Website for Cancer Information

If you're looking for information on cancer treatment and prevention, here's a site that may be helpful. People Living With Cancer is a doctor-reviewed website provided by the American Society of Clinical Oncology . The website was launched about five years ago to provide accurate data on the treatment and care of several types of cancer, but more recently, it has added a prevention section which the general public as well as cancer survivors may find useful.

Top Ten Recommendations for Reducing Cancer Risk

The World Cancer Research Fund (WRFC) recently published their recommendations for reducing cancer risk. The report is based on a comprehensive review of 7000 studies which were conducted worldwide since the 1960's. It is an update from the 1997 report initially published by WFRC and the American Institute for Cancer Research.

The report links weight, exercise, diet, and cancer risk. It concludes that body fat level is closely associated with the risk of developing cancer. Apparently putting on weight can increase cancer risk even if you are still within the healthy range. The closer you are to the lower end of your ideal weight range the lower is your risk of developing cancer. There are no magic elixirs, not even supplements that were proven to be useful for preventing cancer. The good news, however, is that you do have control over many of the factors that contribute to the risk of cancer.

The panel's recommendations based on the extensive review of the literature are the following:
1. Be as lean as possible without becoming underweight. (Ideal weight calculator).
2. Be physically active for at least 30 minutes every day.
3. Avoid sugary drinks. Limit consumption of energy-dense foods (particularly processed foods high in added sugar, or low in fibre, or high in fat).
4. Eat more of a variety of vegetables, fruits, whole grains and pulses such as beans.
5. Limit consumption of red meats (such as beef, pork and lamb) to 750 grams a week, and avoid processed meats.
6. If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
7. Limit consumption of salty foods and food processed with salt (sodium).
8. Don’t use supplements to protect against cancer.
9. It's best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods.
10. After treatment, cancer survivors should follow the recommendations for cancer prevention. 10. Don't smoke or chew tobacco.

Here's an interview with one of the authors of the report.

Evista Approved to Reduce the Risk of Breast Cancer In Postmenopausal Women

The U.S. Food and Drug Administration has recently approved Evista (raloxifene hydrochloride) for reducing the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for breast cancer. Evista is only the second drug approved to reduce the risk of breast cancer. Tamoxifen was the first.

Evista has been on the market since 1997. It has been used for the prevention and treatment of osteoporosis.


The decision to approve Evista for this new indication was based on several large clinical trials. In one trial involving about 15,000 postmenopausal women, Evista was shown to reduce the risk of invasive breast cancer by 44 to 71 percent when compared to placebo. In another study of almost 20,000 women with high risk for breast cancer, Evista was compared to Tamoxifen. Evista was equal to Tamoxifen in preventing breast cancer.


A recent trial found that Evista does not raise the incidence of stroke, but does the incidence of death due to stroke. A boxed warning now says "women with an active or past history of venous thromboembolism should not take EVISTA.. Women at risk for stroke should receive EVISTA only after evaluating the risk-benefit balance with their healthcare providers."



References: U.S. Food and Drug Administration.

Good News on Fight Against Cancer

Cancer death rates in the United States have fallen for the second year in a row as noted in headline news today. The decrease in death rates has occurred in colon, breast and prostate cancer despite the fact that our population is growing in number and living longer. It's good to know that we are making progress in the prevention, detection, and treatment of cancer.

These are some of the recent American Cancer Society's recommendations for screening of common cancers in adults who are at average risk and who do not have any symptoms. Please review to make sure that you are up to date on these recommendations and that you help this winning trend.

Breast Cancer Screening:
Clinical breast exam - at least every 3 years in women in their 20s and 30s and every year in women who are 40 years and older.
Mammography - every year starting at age 40 and with breast exam prior to mammogram.

Colo-rectal Cancer Screening:
Colonoscopy - every 10 years starting at age 50.
Fecal occult blood test and flexible sigmoidoscopy - every 5 years starting at 50.

Prostate Cancer Screening:
PSA and rectal exam - every year starting at age 50 for men who have a life expectancy of 10 years or more.