Testosterone Prevents Breast Cancer

A large study published in 2013 reveals a markedly reduced incidence of breast cancer in women treated with testosterone compared to women who received no hormone replacement therapy. (Glaser et al, Maturitas 2013)

Woman in Park1268 women were enrolled in the study, with average follow-up of five years. Treatment was provided with testosterone pellets implanted under the skin of the buttock or abdomen under local anesthesia, repeated every 3-4 months. About half of the implants contained testosterone alone, while the rest included anastrozole as well. Anastrozole blocks the conversion of testosterone into estrogen, offering added safety.

The incidence of breast cancer in the testosterone-treated group was only half that of women who did not receive hormones.

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Niacinamide Reduces Skin Cancer

NiacinamideBasal cell and squamous cell skin cancers are by far the most common type of cancer. They are rarely lethal, but the surgery or radiation required to treat them can be deforming, painful, and expensive. More than 2 million Americans are diagnosed with skin cancer yearly. Sun exposure is a primary risk factor, so people living in California are especially susceptible.

A recent Australian study, presented at a meeting of the American Society of Clinical Oncology, revealed a 25% reduction in the incidence of basal and squamous cell cancers in patients taking niacinamide, 500 mg twice a day.

Niacinamide is a form of niacin, or vitamin B3, that does not cause itching or flushing of the skin. Benefits in skin cancer reduction were seen within the first 3 months of treatment. The benefit was lost when niacinamide was discontinued. In addition, niacinamide reduced the incidence of actinic keratosis, a precancerous lesion, by 15%.

If you have had skin cancer or actinic keratosis, are fair-skinned or spend a lot of time in the sun, consider taking niacinamide 500 mg twice a day, indefinitely. There are no side effects.

Allan Sosin, MD

Prostate Cancer – You Can Live With It

Cancer is the uncontrolled growth of cells that impair normal body functions, leading to disability or death. Most people, including doctors, believe that cancers should be cut out if possible. Some surgeries, such as removal of the breasts or ovaries, are performed even prior to a cancer diagnosis, with the assumption that cancer will otherwise occur.

Certain cancers, however, may linger in the body for years, never causing disability or death. Prostate cancer is one of these.

The chance of having cancer cells in the prostate increases with age. Put a percentage sign next to your age and you know the chance of having cancer within your prostate. So, a 70 year-old man has a 70% chance of cancer residing within his prostate. Most of these cancers are going nowhere. Prostate cancer is diagnosed in 200,000 men every year. Twenty-seven thousand men die yearly from prostate cancer, usually after at least 10 years of involvement. Thus, 90% of men with prostate cancer do not die from it.

PSA (prostate specific antigen) is a good screening blood test for prostate cancer. A level over 4 is abnormal, but does not mean cancer is present. PSA is also related to the size of the prostate, so a prostate gland that is twice normal in size, or more, will often cause the PSA to rise above normal. Inflammation of the prostate, usually from infection, may also raise the PSA. I have seen the PSA rise to 100 from infection alone, then fall to normal when the infection was treated.

Physical exam of the prostate via rectal exam is also informative. Prostate cancer may be felt as a nodule in the gland, or as hardening of the gland in one area.

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Mammography: Perhaps Not a Lifesaving Procedure

MammogramA New England Journal of Medicine article casts doubt on the value of screening mammography in preventing death from breast cancer. (Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence, November 22, 2012, pp 1998-2005).

Screening mammography, or mammography performed in the absence of symptoms, has doubled the frequency of detection of early-stage breast cancer, from 112 to 234 cases per 100,000 women each year. However, the rate at which women have presented with advanced breast cancer has only slightly declined, by 8 cases per 100,000 women. This suggests that many of the cancers detected by mammography are not aggressive, and would never lead to symptomatic disease. Detection of these inactive cancers represent overdiagnosis, the discovery of cancers that would not cause illness. The authors estimate that in 2008, breast cancer was overdiagnosed in over 70,000 women, representing 31% of all diagnosed breast cancers. In the last three decades, breast cancer overdiagnosis has affected over one million women.

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PSA Screening for Prostate Cancer: Going the Way of the Passenger Pigeon?

The US Preventive Services Task Force has recommended against routine PSA screening in men for prostate cancer. The recommendation was based on the conclusion that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” Large studies had revealed either no or very small increases in survival from screening in patients followed for over ten years. In a European study, results showed that in men aged 55-69, screening prevented only 7 deaths per 10,000 men followed over 9 years. In older men, screening is even less useful. Moreover, screening often leads to prostate biopsy with negative results, with complications of pain, infection and bleeding. Subsequent elevated PSA readings lead to additional biopsies with further complications. I have seen patients who had three prostate biopsies performed, all negative for cancer.

The incidence of cancer within the prostate is high, and increases with age. A 50 year-old man has about a 50% chance of having cancer in the prostate, while an 80 year-old man has an 80% chance. Many of these cancers, however, are indolent, do not metastasize, and will not cause death if untreated. Unfortunately, we have no easy way of determining early which individuals have aggressive cancer.

How will this recommendation translate into action in the real world? Will patients not want to have a PSA test? Will doctors recommend against it? Will insurance companies refuse to pay for it? Will lawsuits occur when patients who were not screened develop invasive cancer and die? I think it is unlikely that PSA screening will drop into obscurity, especially when it is compared to the ritualistic frequency of mammography screening, which the Task Force has recommended not be initiated until the age of 50, then performed every two years until the age of 75, and discontinued.

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Intravenous Vitamin C

Vitamin C DripIntravenous vitamin C has a storied past. Not at the time identified as the active therapeutic component, vitamin C in citrus fruits was demonstrated by James Lind in 1747 to prevent scurvy in sailors. Citrus fruit therapy had been inconsistently utilized for 500 years for the same purpose, but was not officially acknowledged and promoted by the British admiralty until 1785, 50 years after Lind’s great experiment. During that interval multitudes of nutritionally deprived seamen suffered and died from a preventable disease Scurvy caused gastrointestinal, skin and mucous membrane bleeding, skin rashes, loss of teeth, fatigue, depression, and poor wound healing. Oranges and limes, high in vitamin C, were the answer.

Linus Pauling, a world famous chemist and beneficiary of two Nobel prizes, began studying vitamin C in 1966, after discussions with Irwin Stone, another researcher. From his work came the recommendation of vitamin C for the common cold, an idea repudiated out of hand by the medical community. He later studied intravenous vitamin C as a treatment for lung cancer, with survival rates months longer than for patients who did not receive vitamin C.Continue Reading

Estrogen May Protect Against Breast Cancer!

After years of upset, hormone cancellations and denials, now comes more evidence that estrogen replacement therapy does NOT cause breast cancer. Estrogen may even protect against breast cancer. If you find this surprising, read on.

Published in Lancet Oncology, March 7, 2012, the study was an extended, 12-year follow-up of 7,645 women, half of whom had been treated with estrogen for an average of 6 years, the other half with placebo. All of the women had received hysterectomy. Follow-up continued for 6 years after the termination of therapy.

The risk of invasive breast cancer was LOWER (0.27% per year) in women taking estrogen than in women taking placebo, meaning no hormone (0.35% per year). In women who did develop breast cancer, those taking estrogen were less likely to die from it (6 deaths, or 0.009% per year) than women who took placebo (16 deaths, or 0.024% per year). Death from any cause was also lower in the hormone-treated group.

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Vitamin D and Breast Cancer

It was found previously that low vitamin D levels increase the risk of developing breast cancer. Recently it has also been found that low vitamin D levels are associated with markers of more aggressive disease and of metastases. (Aggressive Breast Tumors Linked to Vitamin D Deficiency: April 29, 2011, at http://www.urmc.rochester.edu)

Women with vitamin D levels below 32 ng/ml had a higher percentage of hormone negative cancers, known to be more aggressive. They also had a higher Onco Dx score, a genetic test of cancer cells that predicts the likelihood of metastasis.

In other words, higher vitamin D levels not only lessen the chance of getting breast cancer, but will likely also improve survival in those who have breast cancer.Continue Reading

Cancer Prevention Guidelines

The American Cancer Society has published extensive lifestyle guidelines for cancer prevention. (CA Cancer J Clin 2012;62:30-67)

There are 572,000 cancer deaths in the United States each year, one third of which are attributable to diet and physical activity habits, mainly overweight and obesity.  Fully another third is a result of exposure to tobacco products.

Overweight and obesity are estimated to cause 14% to 20% of cancer-related deaths.  The major cancers related to overweight are breast cancer in post-menopausal women, colon and rectal cancer, endometrial, kidney, esophageal and pancreatic cancer.  Several other cancers are likely related to overweight, including liver cancer, non-Hodgkins lymphoma, multiple myeloma, cervical, ovarian and prostate cancer.

A minor reduction in caloric intake, only 50-100 calories a day, may be enough to prevent weight gain, and successful weight loss may occur with caloric reduction of 500 calories a day.  Foods that aggravate the problem include fried foods, cookies, cakes, candies, and sugar-sweetened beverages.  These foods should be replaced with vegetables, fruits, beans and whole grains.  Most restaurants offer meals that exceed recommended serving sizes, are high in hidden fats and sugars, and low in vegetables, fruits, beans and whole grains.

The health of children, and of the teenagers and adults they will become, is closely tied to the establishment of healthy behaviors in childhood.  Weight gain, poor diets, and physical inactivity during childhood and adolescence increase the later risk of cancer, cardiovascular disease, stroke, diabetes, hypertension and osteoporosis later in life. Overweight young people tend to remain overweight when they become adults.

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Research and Cigarette Smoking

CigaretteThe first major quantitative study linking cigarette smoking to lung cancer was published in 1928.  Forty years later, 50% of adults in the United States were still smoking cigarettes.  Today the prevalence is 20% of adults.

How long does it take for important health findings to translate into practice?  How long will it take for the known connection between obesity and cancer, obesity and heart disease, obesity and diabetes, obesity and premature death, to have a societal effect?

Much of the reduction in tobacco use results from legal prohibitions, the increasing cost of cigarettes, and the public unacceptability of smoking.  However, as once occurred with cigarettes, there are strong forces promoting an obesity-enhancing lifestyle: cheap, tasty and easily available fast food and soft drinks, reduction of physical education in our schools, and ever-present advertising.

We have a long way to go in creating health.  So does the rest of the world.  There are at the current time 1 billion cigarette smokers.  It is estimated that by 2050, if nothing changes, 450 million of them will die as a consequence of smoking cigarettes.

Allan Sosin MD