Prevention



25 Nov 09

One simple test could end up saving thousands of women’s lives. Yet, for those without health insurance, the test comes too late. According to the American Cancer Society, this year alone an estimated 40,170 women will lose their lives to breast cancer. Meanwhile, it is estimated that 4,000 breast cancer deaths could be prevented just by increasing to 90 percent the percentage of women who receive breast cancer screenings.

Breast cancer often can be treated with early detection. That’s why health insurance that pays for mammograms is especially important. But mammography rates declined between 2003 and 2005, with a notable decrease for Hispanic women (from 65 percent to 59 percent) and African-American women (from 70 percent to 65 percent). Never mind the controversy over mammograms for women under 50; an estimated one in five women over 50 has not received a mammogram in the past two years.

Everyone needs health insurance to keep healthy, yet women are disproportionately underinsured. An estimated 21 million women and girls went without health insurance in 2007, according to the U.S. Census Bureau. And a recent congressional report found that 18 percent of all women not eligible for Medicare are uninsured.

Why are so many women left uncovered? Perhaps it’s because many medical situations faced by women are treated as pre-existing conditions, including breast cancer. The National Cancer Institute estimated that in 2004 approximately 2.4 million women had a history of breast cancer. Without continuing coverage, cancer survivors face steep risks.

Health Insurance Facts: Fighting Cancer With No Insurance

Why are women falling behind in insurance coverage faster than men? According to the Department of Health and Human Services, various factors restrict women’s access to health care, which include a vast array of “pre-existing conditions” such as breast cancer, pregnancy, caesarian section and domestic violence. In addition, women are less likely to be employed full time, which makes them less likely to be eligible for employer-based health benefits. In fact, fewer than half of women have the option of obtaining employer-based coverage.

Any health care reform proposal should take that into consideration and include access to comprehensive care, including preventative care such as mammograms. Americans, men and women alike, understand this need. A recent poll commissioned by Moving Forward, a values-based research initiative developed by the Women Donors Network and the Communications Consortium, found that a strong majority of voters — 87 percent — think insurance companies should be required to cover women’s preventive care and screenings, such as contraception, Pap tests for cervical cancer and breast cancer screenings.

Public health experts recommend health insurance coverage be universal and available to all regardless of work status, place of residence, health status or other factors unrelated to need. Reform should be aimed at achieving quality outcomes and eliminating disparities as well as at being affordable. Coverage also needs to be continuous from birth until end of life without interruptions or delays, as gaps in existing coverage allow women to fall through the cracks.

Reform will bring health care to more American women and their families than ever before in our nation’s history. Women would do well to learn more about their stake in health care reform. One good resource is www.WomenandHealthCareReform.org. The best thing we can do to end breast cancer is to make sure all health insurance coverage is universal — not limited by exclusions due to pre-existing conditions — and includes preventative care and basic services such as breast and cervical cancer screenings. Let’s create a system that provides health care, not just sick care.

Wendy C. Wolf is a board member of Living Beyond Breast Cancer and Women Donors Network and leads WDN’s effort on reproductive and other health issues.







10 Nov 09

Men with low cholesterol levels have a decreased risk of high-grade prostate cancer..

A study, including almost 5,600 men aged 55 years and over randomized to the placebo section of the Prostate Cancer Prevention Trial (PCPT), showed that men whose cholesterol levels were below 200 mg/dL had a 60% decreased risk of Gleason 8 to 10 prostate cancer compared with men who had higher cholesterol levels, researchers reported in Cancer Epidemiology, Biomarkers & Prevention. Clinicians diagnosed prostate cancer in 1,251 men (22%).

The investigators, led by Elizabeth A. Platz, ScD, MPH, of Johns Hopkins Bloomberg School of Public Health in Baltimore, found no association between cholesterol levels and prostate cancer overall.

“Our findings add to the literature supporting a role for cholesterol in the etiology of prostate cancer with a worse prognosis,” the authors wrote.

The PCPT, which started in 1993, investigated whether finasteride could prevent prostate cancer. Researchers randomized subjects to receive 5 mg/day of finasteride or placebo for seven years. The study showed that finasteride treatment was associated with a 25% decreased incidence of prostate cancer.

In contrast to their findings in the placebo arm of the trial, Dr. Platz and her collaborators observed no association between serum cholesterol and high-grade prostate cancer in the finasteride arm. The researchers said the pattern they observed in the placebo arm, in theory, could be explained by a lower sensitivity for detecting high-grade prostate cancer in the men with low rather than high cholesterol, “but this is not the expectation.” Men with low cholesterol, the group explained, on average have a lower prostate volume. Thus a greater proportion of the total prostate could be sampled by needle biopsy, increasing the sensitivity of detecting high-grade tumors. Another explanation, they noted, is that finasteride prevented the same subset of high-grade cancers that low cholesterol would have prevented. It also is possible that the accuracy in detecting high-grade cancers differed in men with low cholesterol in the placebo arm compared with the finasteride arm.

A prostate cancer researcher not involved with the new study, Stephen J. Freedland, MD, of the Duke Prostate Center at Duke University Medical Center in Durham, N.C., said the study by Dr. Platz’s team is consistent with previous research and “provides some of the strongest data to date” linking high cholesterol with an increased risk of high-grade prostate cancer.

Dr. Freedland said he has started to mention this association to men with high cholesterol when counseling them about whether to go for PSA testing. “I say to patients, ‘There are increasing data to suggest that high cholesterol may increase your risk of aggressive prostate cancer.’”

As for whether a man should be placed on a statin to reduce his risk of aggressive prostate cancer, Dr. Freedland observed, “If he has high cholesterol, he should probably be on a statin anyway.” It is unknown whether statin treatment would further reduce the risk in men with low cholesterol, he said.

Previous studies suggest that statin use may protect against advanced prostate cancer. For example, a study published in the Journal of the National Cancer Institute (2006;98:1819-1825) showed that statin use was associated with a 43% decreased risk of advanced prostate cancer and a 65% decreased risk of fatal or metastatic prostate cancer.

Recently, researchers reported on a study involving 1,351 prostate cancer patients who underwent radical prostatectomy (504 who used statins and 847 who did not). Preoperative PSA levels, tumor volume, and percentage of cancer in the surgical specimen were significantly lower in the statin users, who overall had a proportionately lower rate of adverse tumor pathology features, including a significantly reduced risk of positive surgical margins, researchers reported in BJU International (2009; published online ahead of print).

Dr. Freedland—whose research has focused on risk factors for prostate cancer and its recurrence following treatment, as well as on prostate cancer chemoprevention—said it is biologically plausible for cholesterol to be involved in the pathogenesis of high-grade prostate cancer. Cholesterol is the precursor for testosterone, which promotes prostate tumor growth, Dr. Freedland said. Hypothetically, high cholesterol concentrations could mean greater testosterone production, he said. Evidence is mounting that high-grade, castration-resistant tumors can make their own testosterone from cholesterol, he noted.

Cholesterol also may directly stimulate tumor growth, he explained. In addition, all new cells need cholesterol as part of their membranes. “Thus, lower cholesterol means it is harder for the cells to replicate,” he said. “Given that high-grade tumors grow faster, this could explain why low cholesterol only reduced the risk of high-grade disease. All of these mechanisms suggest that it is indeed plausible that high cholesterol could promote more aggressive cancers.”

From the November 2009 Issue of Renal And Urology News

Cholesterol: What Your Doctor Didn’t Tell You







10 Nov 09

A growing body of laboratory and animal evidence as well as epidemiological data shows low levels of vitamin D may contribute to certain types of cancer. Conversely, strong biological and mechanistic bases indicate that vitamin D may play some role in the prevention of colon, prostate, and breast cancers.

Vitamin D is essential for promoting calcium absorption for bone and overall health in people. Low levels of vitamin D can lead to rickets in infants and children and the loss of bone density in adults.

More than 25 million adults in the United States have or are at risk of developing osteoporosis, a disease characterized by the loss of bone density that makes bones fragile and significantly increases the risk of fractures. When it comes to Osteoporosis, it’s a chicken and egg scenario: osteoporosis is most often associated with inadequate calcium intakes (generally less than 1,000-1,200 mg/day), but insufficient vitamin D contributes to osteoporosis by reducing the body’s calcium absorption.

While the evidence is far from conclusive, vitamin D may also prove to be an important protective nutrient in the prevention and treatment of cancer.

Video: Possible 75% cancer mortality reduction with Vitamin D


In a new study, researchers at the Moores Cancer Center and Department of Family and Preventive Medicine, UC San Diego used a complex computer prediction model to determine that intake of vitamin D3 and calcium would prevent 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer annually in the US and Canada. The researchers model also predicted that 75% of deaths from these cancers could be prevented with adequate intake of vitamin D3 and calcium. Dr. Cedric Garland, UCSD School of Medicine, lead researcher on the study discusses the implications of this finding and the proposed actions.