HEADLINES / TRENDS l STATS l RESEARCH l MEDIA l PEOPLE

May 2012

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The Complexities of Cancer Screening

Cancer screening—testing people who don’t have symptoms to find malignancies at their earliest stages—has been credited with contributing to the downturn in US cancer death rates over the past 20 years. But authorities in the field stress that the benefits have to be weighed against potential drawbacks, including false-positives that result in unnecessary diagnostic testing, and the need for people to make informed decisions based on their own medical and screening histories.

Screening recommendations come from two main sources: the US Preven­tive Services Task Force (USPSTF) and the American Cancer Society (ACS). These groups don’t always agree. For example, the ACS recommends that women start going for mammograms annually at age 40. The USPSTF sets the cutoff age at 50, with an option for earlier screening taking “patient context into account,” and that women go biannually. Both groups recommend lengthening the annual Pap smear interval; the ACS says every two or three years after age 30, the USPSTF says every three years between the ages of 21 and 65. Both recommend colorectal cancer screening to begin at age 50, and neither supports regular PSA screening for prostate cancer.

These recommendations are based on evaluations of large-scale studies. Some of the differences result from timing; new research is always being published. Others result from different interpretations of those studies.

Making these recommendations requires balancing under-screening, not testing people who should be tested, against over-screening, testing people who will not benefit. “More care is not necessarily better,” says USPSTF chair Virginia Moyer, MD, MPH. She cites cervical cancer screening as a “giant success story—it works. But just because having a Pap smear is going to decrease your chances of dying of cervical cancer doesn’t mean you have to have 10 of them.”

However, “people who are older and who would still benefit from screening are not getting it,” says Robert Smith, PhD, the ACS’s director of cancer screening. Many of them have chronic, but not life-threatening, illnesses that tend to monopolize doctor visits. Smith says, “People who might be seeing the doctor often in a year, but are not having checkups, have a lower rate of cancer screening.” On the other hand, screening provides little value—and the potential for needless suffering—in patients with grave health issues. “If the patient is not a candidate for surgery, they are not a candidate for screening,” says Smith.

Making this benefit-versus-risk decision on what to screen for, and how often, requires regular discussions with one’s practitioner, including the willingness to challenge that professional if their approach seems off-handed. Moyers says, “The default position should be that recommendations be evidence-based. If your doctor says something different, you should ask, ‘Why am I different from the general population?’ He or she should have a good reason based on science.”

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Cutting Glucose Intake by Cancer Cells

It’s been a natural health mantra for years: Sugar is bad. Now standard-medicine voices have joined the chorus. Robert Lustig, MD, of the University of California, San Francisco, gave an anti-sugar lecture on YouTube that has been viewed more than 2.2 million times, and his assertion that sugar is toxic is starting to bear research fruit.

Excessive sugar consumption has been linked with insulin resistance, in which this key blood sugar-control hormone becomes less effective. As we saw in our May 2011 story “Doubly Dangerous,” high levels of insulin and related substances have been linked to increased cancer risk. And researchers have found that cells of some common cancers have insulin receptors on their surfaces that tell tumors to start consuming glucose.

Fermented wheat germ extract (FWGE) has been found to inhibit the ability of cancer cells to take in
glucose. In a recent Nutrition Journal article, German researchers wrote that FWGE “has
the potential to improve response to chemotherapy and thereby extend the progression-free survival and overall survival of cancer patients even in advanced stages.” For example, in a study of people with melanoma, those that received FWGE along with standard chemotherapy lived more than 21 months longer on average than patients who received chemo by itself.

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Attacking Cancer from All Sides

For decades, scientists have searched for a single, sure treatment that could destroy cancer. But we’ve learned that cancer is more complicated than we thought—and the magic bullet has proven maddeningly elusive.

Today, doctors often combine standard anti-cancer therapies. But Raymond Chang, MD, author of Beyond the Magic Bullet: The Anti-Cancer Cocktail (Square One), doesn’t think that approach goes far enough. He advocates the use of “cocktails” that mix conventional treatments with off-label use of non-chemo drugs, such as blood thinners, along with supplements and herbs. The idea, Chang says, “is to attack the cancer from multiple angles in order to overwhelm it.”

Chang, trained in both Western and Eastern medicine, makes his case for cocktail therapy in the first part of Beyond the Magic Bullet. The second part provides data on more than four dozen off-label drug classes, herbs and supplements. Case studies show how cocktail treatments work in real life.

Cancer, once thought unstoppable, has been found to have its vulnerable spots. Beyond the Magic Bullet presents an intriguing way to target those weaknesses.

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Numbers

795,000
Number of lung cancer deaths prevented between 1975 and 2000
by tobacco-control campaigns, according to a Fred Hutchinson
Cancer Research Center computer model

3.15 Million
The deaths that did occur during that time period

19.3%
Percentage of US adult population who were current smokers
in 2010; about 52% tried to quit that year

Sources: Journal of the National Cancer Institute, Centers for Disease Control

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Resource

Cook for Your Life

Its Mission:

Helping people with cancer learn to cook for health and enjoyment; the website,
by cancer survivor Ann Ogden, includes recipes and short instructional videos

Contact:
www.CookForYourLife.org

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Vitamin A Shows Melanoma Promise

Sun in the sun comes with a serious downside by raising one’s risk of skin cancer, including
the potentially deadly form called melanoma. But a recent study has found a link between vitamin
A supplements and reduced melanoma risk.

Researchers at Kaiser Permanente Northern California in Oakland obtained lifestyle
information, including vitamin usage, from nearly 70,000 people in Washington state. After five years, 566 of the participants had developed melanoma; those who had taken vitamin A supplements were 40% less likely to develop the disease. Writing in the Journal of Investigative Dermatology, the study team called for clinical trials on vitamin A for melanoma prevention, noting that their work did not prove a cause-and-effect relationship.

As with other forms of skin cancer, health authorities recommend lowering melanoma risk through reduced sun exposure, including the use of sunglasses and sunscreen.

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