Sniffing Out Leukemia?

3 doctorsOK Ladies – here’s a question for you.   If you suffer from seasonal allergic rhinitis who do you go and see?

(a)  An allergist

(b)  An oncologist

(c)  A hematologist

If you answered (a) you’re probably feeling pretty confident right now.  After all the more common term for seasonal allergic rhinitis is hayfever and that’s something best managed by an allergist.  Right?

Not so fast! Maybe (b) or (c) would have been better choices.  You see, a team of scientists looking into the interplay of the immune system and cancer have just found a link between a history of airborne allergies – in particular those to plants, grass and trees – with risk of blood cancers in women.

Notably, the study did not find the same association in men, which suggests a possible gender-specific role in chronic stimulation of the immune system that may lead to the development of hematologic cancers.

The findings were published online last week ahead of the December print issue of the American Journal of Hematology.

allergic rhinitisTo the best of our knowledge, ours is the first study to suggest important gender differences in the association between allergies and hematologic malignancies,” says Mazyar Shadman, MD, from the Fred Hutchinson Cancer Research Center.

According to Shadman, who led the research, the immune system’s potential role in the cause of cancer is a focus of intense scientific interest. “If your immune system is over-reactive, then you have problems; if it’s under-reactive, you’re going to have problems. Increasing evidence indicates that dysregulation of the immune system, such as you find in allergic and autoimmune disorders, can affect survival of cells in developing tumors.”

The study included a large sample of men and women aged 50-76 years old from western Washington from the VITamins And Lifestyle (VITAL) cohort study. Participants answered a 24-page questionnaire that focused on: (i) health history and cancer risk factors, (ii) medication and supplement use, and (iii) diet. Participants provided information on age, race/ethnicity, education, smoking, diet (fruit and vegetable intake), and other lifestyle characteristics, self-rated health, medical history, and family history of leukemia or lymphoma.

History of asthma and allergies was also taken, including allergies to plants, grasses or trees; mold or dust; cats, dogs or other animals; insect bites or stings; foods; and medications.  Of the 79,300 VITAL participants who filled out the questionnaires, more than 66,000 individuals were selected after eliminating those who had a prior history of malignancies other than non-melanoma skin cancers and missing information on baseline cancer history.

Participants were then followed for eight years until they either withdrew from the study, moved away, had a cancer diagnosis other than hematologic malignancy or non-melanoma skin cancer, or died.

seer_logoIncidence of hematologic malignancies and other cancers was identified via the Surveillance, Epidemiology and End Results (SEER) cancer registry of western Washington.

Of the participants, 681 developed a hematologic malignancy during the follow-up period. These participants were more likely to have two or more first-degree relatives with a family history of leukemia or lymphoma, to be less active and rank their health status as low.

A history of allergies to airborne antigens was associated with a higher risk of hematologic malignancies. The most statistically significant association was seen with allergies to plants, grass and trees.

cat allergyThere was also an increased risk of plasma-cell neoplasms for participants who reported a history of allergies to cats, dogs or other animals. Plasma-cell neoplasms are conditions, both cancerous and noncancerous, in which the body makes too many plasma cells.

When stratified by gender, the incidence of blood cancers in response to these allergens was increased in women but not in men. The reason for this is as yet unknown.

However, Shadman and colleagues warn, “Given the limited number of cases within each sub-type of hematologic cancer, the risk estimates need to be interpreted with caution … and the possibility of chance finding due to multiple testing should be recognized.”

Even so, if you’re a women with allergies, you may want to keep a close eye on your blood work.

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Personal Growth Following Breast Cancer Diagnosis

smiles-for-survivors-foundationAs National Breast Cancer Awareness month draws to a close, and the world becomes a little less pink, we share with you some positive news to help sustain the momentum until next October.

Although breast cancer is usually an extremely stressful experience for most of the 300,000 or so women in the US diagnosed each year, a new study by researchers at Wake Forest Baptist Medical Center has found that there also can be unexpected benefits.

Many women who have breast cancer often experience distress but sometimes are surprised that they also may experience a variety of positive outcomes following diagnosis,” said Suzanne Danhauer, Ph.D., lead author of the study.

pink white houseThe study, which is published in the current online edition of the journal Psycho-Oncology, examined change in post-traumatic growth (PTG) over two years in 653 women.

PTG is defined as the positive psychological change experienced as a result of a struggle with highly challenging life circumstances. Commonly reported aspects of PTG include enhanced interpersonal relationships, increased appreciation for life, a sense of increased personal strength, greater spirituality and changes in life priorities or goals.

women-smiling-together2Participants completed surveys within eight months of diagnosis and also six, 12 and 18 months after that. The survey results were assessed using the Post-Traumatic Growth Inventory (PTGI) – an instrument for assessing positive outcomes reported by persons who have experienced highly stressful or traumatic events.

According to the researchers, total PTGI scores increased over time mostly within the first few months following diagnosis. Greater PTGI scores were associated with education level, longer time since diagnosis, greater baseline level of illness intrusiveness and increases in social support, spirituality, use of active-adaptive coping strategies and mental health.

Our findings suggest that there are women who see a variety of positive changes during and after breast cancer treatment,” Danhauer said. “Our study showed just how common it is for women to talk about the good things that have happened in their lives because of this illness, and it doesn’t seem to be related to how optimistic a person is or not.”  The study also showed that an increased amount of social support was associated with more post-traumatic growth in these women.

Way to go ladies.  A great example of when life gives you lemons…make lemonade?!?  Better yet, find somebody else whose life has given them vodka, and throw a lemon drop party.

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Potty Mouth?

potty-mouth-734In need of an extra incentive to brush your teeth this Monday morning?  Well, they don’t come much better than this. According to a new study published in the journal Cell Host & Microbe a common type of mouth bacteria may contribute to colorectal cancer.

Colon cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in both men and women in the US. The American Cancer Society estimates that almost 143,000 people will be diagnosed in 2013 and that more than 50,000 will die of the disease.

fusobacterium_ll_111017_wgThe bacteria  at issue –  Fusobacterium nucleatum is a key component of periodontal plaque and plays a role in periodontal disease.  But, according to the researchers from Case Western Reserve University School of Dental Medicine, it can also attach to colon cells and trigger a sequence of changes that lead to colon cancer.  Although they noted that levels of F. nucleatum are much higher in people with gum disease, than in those without, it was not possible to prove a cause and effect relationship.

Nevertheless, the findings emphasize the importance of good oral hygiene.

colon-cancer-600The research team also found a way to prevent the bacteria from attaching to colon cells. “This discovery creates the potential for new diagnostic tools and therapies to treat and prevent colon cancer,” says lead investigator Yiping Han.

Until such time, SRxA’s Word on Health will be focused on flossing.

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Vegetable Fat Slashes Prostate Cancer Deaths

prostate cancerThe link between cancer and diet has been extensively studied, It is known for example that being overweight is related to as many as one in five cancer-related deaths. Weight is most closely connected with cancers of the breast and uterus in postmenopausal women. Other cancers associated with obesity include:

              • Esophagus
              • Pancreas
              • Colon and rectum
              • Kidney
              • Thyroid
              • Gallbladder

But less is known about the association between diet and prostate cancer.  The three well-established risk factors for prostate cancer: are race (specifically, African American race), family history, and age. Unfortunately, these are three things we cannot change. So given this reality, there is much interest in identifying modifiable risk factors for prostate cancer, not least among the roughly 2.5 million men in the United States currently live with prostate cancer.

Now, a new study might provide some hope. It showed that replacing carbohydrates and animal fat with vegetable fat may be associated with a lower risk of death in men with non-metastatic prostate cancer.

olive-oil-walnuts-healthy-fatsErin Richman, a postdoctoral scholar at the University of California, San Francisco, and colleagues at UCSF examined fat intake after a diagnosis of prostate cancer in relation to lethal prostate cancer and all-cause mortality in 4,577 men diagnosed with non-metastatic prostate cancer. Their findings have just been published in Online First by JAMA Internal Medicine.

Between 1986 and 2010, the researchers noted 315 lethal prostate cancer events and 1,064 deaths during a median follow-up of 8.4 years. They also discovered that replacing 10% of calories from carbohydrates with vegetable fat, such as oil or nuts, was associated with a 29% lower risk of lethal prostate cancer and a 26% lower risk of death from all-cause mortality.

Overall, the findings suggest that men with prostate cancer should be advised to follow a heart-healthy diet in which carbohydrate calories are replaced with unsaturated oils and nuts to reduce the risk of all-cause mortality.

And although the exact reason for the reduction in mortality is unknown, the authors conclude; “the potential benefit of vegetable fat consumption for prostate cancer-specific outcomes merits further research.”

SRxA’s Word on Health agrees.

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Radioactive Bacteria:1 – Pancreatic Cancer:0

pancreatic cancer facesYears ago, when I was just starting my healthcare career, I worked with a team specializing in the management of patients with pancreatic cancer.  Despite the dedication and compassion of our team, revolutionary surgical techniques, and top-notch palliative care, all too often our patients died. Even today, some 30 years later, pancreatic cancer has a poor prognosis. It’s seldom detected in its early stages, and often spreads rapidly. Signs and symptoms frequently don’t appear until the disease is advanced and surgical removal isn’t possible.

Pancreatic cancer touches so many people. It killed my childhood mentor and one of my best friends. It’s taken the lives of many household names, from astronauts to actors, entrepreneurs to opera singers.  For example, Patrick Swayze, Randy Pausch, Luciano Pavarotti, Dizzy Gillespie, Count Basie, Michael Landon, Joan Crawford, Sally Ride and of course, Apple CEO – Steve Jobs.

So, I was excited to hear about new research into a targeted anti-cancer therapy that promised limited side effects. The study, published April 22 in the Proceedings of the National Academy of Sciences found that treating mice with an attenuated, radioactively labeled bacteria –  Listeria monocytogenes – drastically reduced the number of metastases, while leaving normal tissue unscathed.

The notion of using bacteria to attack tumors is not new. Robert Hoffman, a cancer biologist at the University of California, San Diego, who was not involved in the current study, has shown that Salmonella can kill mouse cancer cells, including metastases of pancreatic cancer.

Other research has shown that a Listeria strain known as CRS-207 has the ability to stimulate an immune response in Phase 1 and 2 trials.

listeria.monocytogenesIn the new study, researchers at Albert Einstein College of Medicine have paired this technique with a radioactive isotope to selectively kill tumor cells, focusing on the metastatic cells that so often elude current treatment regimens.

It’s this combination of approaches that synergistically target metastases, that’s new. Claudia Gravekamp, an immunologist at Albert Einstein College of Medicine who led the study with nuclear medicine researcher Ekaterina Dadachova had previously demonstrated that an attenuated strain of Listeria monocytogenes, a type of bacterium that penetrates host cells during infection, selectively killed breast cancer cells without damaging normal tissue. The bacteria’s ability to target only diseased cells raised the possibility that it could be used to treat metastatic cancer by both directly killing cells and by carrying anti-tumor therapies—like radiation—to cancer cells.

pancreatic_cancerGravekamp and Dadachova tested the bacteria against highly metastatic pancreatic cancer in mice. First, they demonstrated that the bacteria proliferated well in the animals’ metastases, but poorly in the primary tumor, and not at all in normal tissues like spleen, suggesting the bacteria would be good candidates for delivering a therapy to far-flung metastases.

Then, the researchers armed the Listeria with the Rhenium-188, a radionuclide that kills cells by releasing DNA-damaging. Sure enough, regular injections of the Rhenium-188 labeled bacteria decreased metastases by 90% versus controls.

While this implies that bacteria have to potential to be used to deliver therapeutic radiation doses to metastases, the bacteria were administered before metastases were established, notes Donald Buchsbaum, a radiation biologist at the University of Alabama at Birmingham who was not involved in the study.  “So to some extent it’s a prevention model.”

Future work will need to focus on targeting established metastases, possibly by exploring other radioisotope options.  Gravekamp and Dadachova are currently refining their protocol and examining alternative radioisotopes to achieve a 100% reduction of metastases, but have high hopes for their bacteria.

Though primary tumors are often removed surgically, even small pieces left behind can produce new metastases. It might be possible that one day radioactive Listeria could be part of an “early second-line treatment after surgery to prevent further metastases,” says Gravekamp.

ListeriaWhich is great news in the war against cancer and not a bad deal for the Listeria bacteria which normally gets a bad rap for causing the infection listeriosis  – the leading cause of death among food-borne bacterial pathogens – responsible for approximately 2,500 illnesses and 500 fatalities annually in the United States.

Exciting stuff!

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The Scoop on Poop

toilet paperWhat are your bowel movements telling you?

Whether you love or hate the Quilted Northern TP ads on TV,now’s the  time to get real about what happens in the bathroom. Before March morphs into April we need to spread the scoop about poop in recognition of colorectal cancer awareness month.

Bottom line, (excuse the pun), we all poop. So now it’s time to stand up, or sit down, and take notice of what our bowel movements are telling us.

Signs of everything from disease to stress may show up in your bathroom bowl. The key is knowing what to look for — and what the signs may mean.

First off, there is no normal. People are different. So are bowel movements. The size, shape and consistency of feces will change greatly from person to person.

So instead of looking for “normal,” look for change. Are you going less, or more often? Has the consistency altered? Have you gone from runny to solid? If you experience a noticeable change that lasts, it’s time to see your doctor.

bowel_movement-360x307Are you seeing red?

If there is blood in your feces on a recurring basis, you need to see a doctor, stat. Blood can be a sign of polyps or colorectal cancer. It also can be caused by benign conditions such as hemorrhoids and anal fissures. In any case, it’s worth getting checked out.

Also, keep an eye out for other symptoms: weight loss, fever, chills. When they come together, those are “high-alert” symptoms of bowel disorders.

Size does matter!

If you used to have sizeable stools but now they are always pencil thin and hard to pass, consult your doctor. In certain types of colorectal cancer, the bowel gets narrow, and so can your bowel movements. And while thin stools do not automatically mean cancer you should still see your doctor and have a  colonoscopy just to be on the safe side.

colonoscopyConsistency, consistency, consistency

We all have bouts of diarrhea from time to time, usually as a result of food poisoning or an infection. But if you have frequent diarrhea it could be a sign of an inflammatory bowel condition such as Crohn’s disease or ulcerative colitis.

The scoop on stress

Your body as well as your brain reacts to things that go on around us. The impact of stress and unresolved issues may show up in your bathroom.

So next time you go to the bathroom instead of simply wiping and flushing take a moment or two to look and learn what your bowel movements are telling you.

No s**t!

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When’s Your Time to Die?

risk of dyingWhat are your chances of dying in the next 10 years?

Obviously there are some activities that may increase your risk  such as driving drunk and active military duty in a war zone, but how about getting winded after walking several blocks or having trouble pushing a chair across the room

Turns out the latter might be just as dangerous as the former.

Researchers at the University of San Francisco VA Medical Center have recently come up with a “mortality index” to predict when a person may die.  Marisa Cruz and her colleagues have developed a list of 12 questions that can help predict chances of dying within 10 years for patients aged 50 and older.  The researchers created the index by analyzing data on almost 20,000 Americans over 50 who took part in a national health survey in 1998. They tracked the participants for 10 years. Nearly 6,000 participants died during that time.

risk of dying 2While the test scores may satisfy people’s morbid curiosity, the researchers say their index wasn’t meant as guidance about how to alter your lifestyle.  Instead, it is mostly for use by doctors, to help them discuss the pros and cons of costly health screenings or medical procedures in patients who are unlikely to live 10 more years.

That said, we know that many of our readers are “simply dying” to take the test themselves – right now.

So without further ado…here’s how it works.

The 12 items on the mortality index are assigned points.  The fewer your total points the better odds of living.

  • Men automatically get 2 points. In addition, men and women ages 60 to 64 get 1 point; ages 70 to 74 get 3 points; and 85 or over get 7 points.
  • Two points each for: a current or previous cancer diagnosis, excluding minor skin cancers; lung disease limiting activity or requiring oxygen; congestive cardiac failure; smoking within the past 2 weeks; difficulty bathing; difficulty managing money because of health or memory problem; difficulty walking several blocks.
  • One point each for: diabetes or high blood sugar; difficulty pushing large objects, such as a heavy chair; being thin or normal weight.


The highest, or worst, score is  26, which equates to  a 95% chance of dying within 10 years. To get that, you’d have to be a man at least 85 years old with all the above conditions.
healthy young womanFor a score of zero, which correlates to a 3% chance of dying within 10 years, you’d have to be a woman of “normal weight” younger than 60 without any of those infirmities.

While it’s hardly surprising that a sick, older person would have a much higher chance of dying than someone younger why would being overweight be less risky than being of normal weight or slim?  One possible reason is that thinness in older age could be a sign of illness.

Dr. Stephan Fihn, a health quality measurement specialist with Veterans Affairs health services in Seattle, said the index seems valid and “methodologically sound.”
However, he adds that it is probably most accurate for the oldest patients, who don’t need a scientific crystal ball to figure out their days are numbered.

For fans of SRxA’s Word on Health, I’m pleased to report that my 10-year mortality index is zero. Let the blogging continue!

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