A new study has found that people who drink 2 or more soft drinks per week had two times the risk of developing pancreatic cancer compared with those who do not drink soda. The researchers, from the School of Public Health at the University of Minnesota, believe that regular consumption of sweetened, carbonated beverages could raise insulin levels, which could promote the growth of pancreatic cancer cells. They found no similar link from fruit juice consumption. 

The study followed over 60,000 men and women in Singapore for over 10 years. Senior author of the study, Dr. Mark Pereira suggested that the results were likely to be applicable to the U.S. and other Western countries because of similarities between the countries such as good health care, wealth of the country, and pastimes.

The study was published in Cancer Epidemiology, biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR).

Today, Feb. 4, is World Cancer Day, brought about by organizations such as International Union Against Cancer, the World Health Organization, and others. The theme of this year's World Cancer Day is "Cancer Can Be Prevented, Too."  The WHO recommends simple steps:
*no tobacco use
*a healthy diet and regular exercise
*limited alcohol use
*protection against cancer-causing infections.

For some World Cancer Day exercise tips, visit my blog, Fitness for Survivors.

A new study, published in the journal Cancer, finds that doctors often delay discussing end-of-life care with their terminally ill patients. The study found that the majority would only discuss prognosis with their patients. Only 44% said they would discuss do-not-resuscitate orders, 26% would talk about hospice care, and just 21% bring up the patients preferred site of death. Doctors usually wait until symptoms are more severe and treatments have failed.

This delay can mean that patients may not be able to make considered, well-informed choices about their end-of life care.

The Los Angeles Times reports that billions of dollars are spent on end-of-life treatment in the United States. According to the Centers for Medicare and Medicaid Services, 5% of the patients who die each year take up 30% of the $446-billion annual Medicare budget. Eighty percent of that money is spent on mechanical ventilators, resuscitation and other aggressive life-sustaining care during the final month.

Patients who plan ahead for their end-of-life care have significantly lower costs as well as a higher quality of life during their final days.

Health risks from obesity, like cardiovascular disease and type 2 diabetes, are well known. But obesity also increases the risk of developing certain cancers, including liver cancer. In the January 22nd issue of the journal Cell, researchers report that they now have good evidence of how obesity increases the risk.

According to Michael Karin, PhD, of the University of California, San Diego, earlier studies show a 1.5% increase in risk of developing any type of cancer for obese people. Obese people have a 4.5% higher risk for developing liver cancer. 

The UC, San Diego team studied liver cancer in mice, and found that it is fostered by a chronic inflammatory state that goes with obesity. Researchers were able to track the increased risk to two inflammatory factors called IL-6 and TNF.

January is National Cervical Health Awareness Month . The month was designated so by Congress to highlight issues related to cervical cancer and HPV (human papilloma virus) disease.

According to the American College of Obstetricians & Gynocologists, 2009 saw an estimated 11,270 new cases of cervical cancer, and over 4,000 deaths from the disease. From their factsheet on women's cancers, "Protect and Detect":

     Your risk for cervical cancer depends on your sexual history, your immune system, your health, and
     your lifestyle. Those at highest risk of developing cancer of the cervix include:
     *Women with certain strains of HPV
     *Women over age 30. While it can occur in younger women, cervical cancer rarely occurs in
       women younger than age 21
     *Women who smoke are about twice as likely as nonsmokers to develop cervical cancer

     *Women who have problems with their immune system
     *Women with the human immunodeficiency virus (HIV) infection
     *Women who were exposed to diethylstilbestrol (DES) before birth
     *Women with a previous precancer of the cervix 

Although cervical cancer often has no symptoms, some warning signs include unusual vaginal bleeding, spotting or discharge, pain or problems urinating. (Click here to download the PDF from ACOG .)

The good news is that the Pap test is a highly effective tool in early detection of cervical cancer. Regular screening can often find precancerous conditions before they become cancer.

Clinicians at M.D. Anderson Cancer Center in Houston have found that women with cervical cancer who receive curative-intent radiotherapy have a higher likelyhood of developing pelvic fractures. From a grouop of 300 women, 9.7% developed pelvic fracture during the followup period. They estimate that an age-matched population of women not receiving radiation therapy would have a fracture rate of less than 5%. The median time from the end of radiation therapy to the fracture diagnosis was 14 months.

Dr. Kathleen Schmeler , of M.D. Anderson suggests that, based on these findings, bone mneral density screenings and drug intervention should be considered for women undergoing radiation therapy for cervical cancer.

A new study published in the Journal of the National Cancer Institute finds that a person who has multiple family members with pancreatic cancer is 6 times as likely to develop that cancer. And if one of those relatives developed their cancer under the age of 50, the risk goes up to 9 times the risk of the general population. Up until now, it was unclear fi family members of young-onset pancreatic cancer were at greater risk.

Alison Klein, PhD, of the Sol Goldman Pancreatic Cancer Research Center at Johns Hopkins School of Medicine, and colleagues looked at over 9,000 individuals from 1,718 families. The authors write, "These data should help to further inform risk assessment and subsequent early detection screening of individuals at hish risk of developing pancreatic cancer."

Postmenopausal women with a hormone receptor-positive breast cancer who develop arthralgia or myalgia (A/M) while taking anastrozole may benefit from switching to letrozole. Dr. Denise Yardley, MD, Director of Breast Cancer Research at the Sarah Cannon Research Institute in Nashville, Tennessee, and colleagues found that women who experienced >= grade 2A/M while on Anastrozole developed significantly less A/M when switched to leterozole. Their findings were announced at the Annual San Antonio Breast Cancer Symposium .

Aromatase inhibitors are the standard of care for postmenopausal women with hormone-receptive breast cancer. However, as many as one third of women experience side effects such as A/M, and as many as 20% of patients may stop their therapy due to those side effects. 

Switching to another aromatase inhibitor therapy may improve symptoms and allow women to remain on aromatase inhibitor therapy.

Previous studies have shown exercise can reduce the risk of developing colorectal cancer, but researchers at the Dana-Farber Cancer Institute have found that men who have been treated for colorectal cancer can reduce their risk of dying from the disease with regular exercise. Their findings were recently published in Archives of Internal Medicine.

The study followed 668 men with colorectal cancer, around 50% of whom exercised the equivalent of walking for one hour six days per week. The patients who engaged in regular, moderate exercise were 53% more likely to be alive and disease free than men who were less active. The benefit was seen regardless of age, disease stage, weigh or previous physical activity.

According to Jeffrey Meyerhardt, MD, MPH, lead author of the study, "Moderate exercise has now been incorporated in some guidelines for colorectal cancer survivors and this new research should further reinforce to oncologists that they should discuss this in their survivorship plan."

The National Cancer Institute released it's annual report to the nation, which finds continued delines in cancer rates. The report also includes a special feature on current and projected trends in colorectal cancer. New diagnoses and rates of death from all cancers combined decreased significantly for both men and women. This drop is largely driven by declines in the three most common cancers for men (lung, prostate, and colorectal), and by two of the three top cancers in women (breast and colorectal). Cancer rates for men continue to be higher than for women, however men experienced greater declines in incidence.

Included in the report is a Special Feature section focused on colorectal cancer. The authors used modeling projections to find that, with higher use of screening and if Americans adopt more healthy behaviors, colorectal cancer deaths could decline by as much as 50% by 2020.

Cancer rates continue to raise for certain cancers, however. For men, kidney/renal, liver, and esophageal cancers increased. And in women, incidence rates increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as non-Hodgkins lymphoma, melanoma and leukemia. 

Racial disparities continue to exist, with cancer death rates highest among black men and women.

The CDC (Centers for Disease Control) has provided information about flu for all people who have or have had cancer. Cancer survivors are at a higher risk for complications from the flu. It is not clear if they are also at higher risk of infection.

Click here to read the CDC's report.

Last week, the U.S. Preventive Services Task Force announced new mammogram recommendations which started an uproar. Their report, published in Annals of Internal Medicine, recommends against regular screenings for women age 40-49, and screenings every other year for women age 50-74. In addition, the panel recommends against doctors teaching their patients to do breast self exams. The report was based on analysis of several large US and international studies.

This examination of the efficacy of mammograms comes out of concern for the number of false positives, unnecessary biopsies, over-treatment of disease that might never become life-threatening, and the understandable stress these things cause. 

Visit www.annals.org to read the new guidelines and report.

While one can debate the conclusions of this panel, it is important to consider the issues raised. I suggest everyone read this report and discuss the issue.  To read my opinion, please visit my blog, FitnessforSurvivors.

In August, researchers from the University of Pennsylvania reported in the New Enland Journal of Medicine that weight lifting was shown to be beneficial to breast cancer survivors who suffered from lymphedema. New results from that study found that there are further benefits from a regular weight lifting program. The study found the breast cancer survivors who lift weights feel better about their bodies and appearances, and are also more satisfied with their intimate relationships compared with survivors who do not lift weights. The new results were published in the journal Breast Cancer Research and Treatment.

The improved self-perception appeared to not be related to the amount of strength gained. According to Kathryn Schmitz, PhD, MPH, assoc. professor of epidemiology and biostatistics at Penn's Abramson Cancer Center , "The results suggest that the act of spending time with your body was the thing that was important - not the physical results of strength."

Reasearchers from the University of Kuopio in Finland studied the health of 2,560 men for about 17 years, and found that exercise reduced their likelihood of developing cancer.  At the start of the study, none of the men had cancer.  At study's end, 181 men had died of some type of cancer.  After controlling for smoking, diet, age, and other variables, the researchers found that the most physically active ment were least likely to develop cancer, especially gastrointestinal or lung cancer. 

Of particular interest, the intensity of exercise was a significant factor.  The more strenuous the exercise, the more protection it afforded the men.  In the study, jogging was the most strenuous activity recorded.  Men who jogged or did activity of equivalent intensity had a 50% reduction in the risk of dying prematurely from cancer.  

The study was carried out by researchers at the School of Public Health and Clinical Nutrition at the University of Kuopio in Finland, and published in July in the British Journal of Sports Medicine .

A slowly progressive weight training program results in significant benefits for women with breast cancer-related lymphedema.  The study was led by Dr. Kathryn H. Schmitz, of the University of Pennsylvania School of Medicine in Philadelphia, and colleagues.  The results were released in the New England Journal of Medicine . 

 For years, women have often been counseled to avoid lifting heavy bags or objects, and even limit overall exercise.  The study found that, counter to that advice, weight lifting did not lead to significant increase in swelling, and was actually associated with fewer lymphedema flare-ups. 

 The study looked at 141 breast cancer survivors with lymphedema.  The women were randomized into a twice-weekly progressive weight lifting group or a non-weight lifting control group.  After one year, the number of women who had experienced a 5% or more increase in limb swelling was similar in both groups.  In addition, the weight lifting group experienced a reduction in the number and severity of arm and hand symptoms, and had fewer flare-ups of lymphedema.  

Moderate to vigorous exercise during early adult years may lower the risk of prostate cancer in black men.  In the study which was carried out by the National Institutes of Health and the AARP, black men age 51-72 were much less likely to develop prostate cancer if they had been physically active in their 20s.  The reduction in risk was similar but not significant for men who had been active in their late 30s. 

These findings suggest that efforts to improve physical fitness in young black men may lower the rate of prostate cancer for black men in the future.  Black men have a 30-50% higher risk of developing prostate cancer than white men.  In addition, the cancer is often more aggressive in black men, with the death rate twice as high as white men.

Dr. Steven C. Moore, PhD, a postdoctoral fellow in the Nutritional Epidemiology Branch of the Nation Cancer Institute's Division of Cancer Epidemiology and Genetics, presented the findings at the annual meeting of the American College of Sports Medicine (ACSM) in Seattle, WA.

A telephone-based, home diet and exercise program could slow functional decline in long-term cancer survivors.  Miriam Morey, Ph.D. of Duke University, Wendy Demark-Wahnefried of MD Anderson, and colleages found that a telephone intervention program significantly slowed decline in cancer patients compared with patients who had no intervention.  Patients in the intervention group experienced meaningful improvements in physical function and other quality of life issues. 

Long-term survival rates for many early-stage cancers are high and increasing, however, many patients suffer a risk for accelerated functional decline.  The researchers wanted to know whether lifestyle programs could benefit long-term, older cancer survivors whose diagnoses were at least five years ago.  The Reach Out to Enhance Wellness (RENEW) intervention consisted of a tailored workbook and quarterly newsletters, plus 15 sessions of telephone counseling.  

Researchers found less decline in the intervention group.  In basic lower body function (stairs, using a step stool, for instance), there was little change in the intervention group, but the control group with no intervention showed decline in abilities during the same time period.  The intervention group also had significantly greater weight loss and sustained higher quality of life scores.

The authors say that these findings suggest that more effort should be made to promote these types of programs among older cancer survivors.  Dr. Morey's study, "Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors", was published in the May 12 issue of the Journal of the American Medical Association.

Speaking at a symposium on cancer survivorship at the 2009 Annual Meeting of the American Association for Cancer Research (AACR ), Melinda Irwin, PhD, MPH, of Yale School of Medicine, said that oncologists should recommend exercise to their patients.  This is based on accumulating evidence that exercise can improve both quality of life and prognosis for cancer patients. 

The strongest evidence comes from breast cancer studies.  Several studies have shown that exercise reduces the risk of recurrence and death from breast cancer.  One study cited by Dr Irwin was the Health, Eating, Activity and Lifestyle (HEAL) study.  The HEAL study showed that in a group of 933 breast cancer patients, moderate-intensity physical activity reduced the risk of death by 67% in the women who were still active two years after diagnosis (that includes death from breast cancer and other causes, mostly heart disease and diabetes).  Other studies show reductions in breast cancer deaths of 40 - 55%, "which is as much as standard treatments," Dr Irwin pointed out.

There is also evidence of a similar benefit from exercise for prostate and colorectal cancer.  Dr. Irwin believes that the benefits from exercise may extend to all cancers, especially for improving quality of life.

Researchers found that oncologist recommendations for exercise were important predictors for whether patients exercise.  However, the study found that only half of the patients said their oncologist had mantioned exercise.

A study published in the journal Breast Cancer Research has found that Black Women are at higher risk of developing a specific type of aggressive breast cancer - a "triple negative" tumor.  Triple negative tumors lack expression of estrogen and progesterone receptors and the HER2 gene.  Researchers, led by Dr. Carol Rosenberg at Boston University School of Medicine, found this to be true even after accounting for differences in lifestyle, age and weight. 

Black women in the US have a lower incidence overall of breast cancer than white women.  However, when they do get it, it tends to be more advanced, has a higher risk of recurrance, and poorer outcomes.  According to Dr. Rosenberg, "The higher prevalence of triple negative breast tumors in black women in all age and weight categories likely contributes to black women's unfavorable breast cancer prognosis."

A large study, published in the New England Journal of Medicine , has found that a class of drugs used to fight bone loss may reduce by as much as a third the chance of some breast cancers' spread.  The study looked at over 1800 premenopausal women whose cancers were estrogen receptive.  All women were given drugs to shut down their ovaries along with drugs to prevent cancer cells from using estrogen to grow.  Half of the women were also given Zometa, a drug used to fight bone loss.  After four years, 54 women who received Zometa and 83 women who did not had a recurrence, a new cancer in the opposite breast, or a metastisis. 

Two other large studies of bone drugs and breast cancer are ongoing.  Other studies are testing the drugs in patients with lung and prostate cancers.

A small molecule found in urine could reveal how advanced a prostate cancer is.  Researchers found the molecule, called sarcosine, after examining all of the metabolites (substances produced by chemical reactions that take place in the body) found in urine samples from prostate cancer patients.  Generally, researchers only screen for certain metabolites; this study used mass spectrometry to look at all metabolites.  

This discovery could lead to simple tests for the disease that could avoid the need for invasive biopsies.  A sarcosine test could be used to predict which prostate cancers are aggressive and spreading.  It could also become a drug target in future therapies.  The research needs to be further validated, however Christopher Beecher at the University of Michigan in Ann Arbor, who led the analysis, hopes that sarcosine will find a place in prostate cancer tests.  

Results were published in the journal Nature.

A new study from the UK, published in the journal International Seminars in Clinical Oncology and reported by Reuters, finds that many women with a family history of breast cancer are obese or sedentary.  Both are factors in an increased risk for that disease.  Researchers found that most of the women surveyed were overweight, with 37% being obese.  Three quarters of the overweight women knew that excess weight is a risk factor for developing breast cancer.

In addition, few of the 92 women were getting adequate exercise.  Only 15% of the postmenopausal women in the study said they exercised at least four hours per week.  

Studies have shown that obese women are at greater risk for breast cancer, and that women who exercise regularly cut their risk.  The study group was already at a higher risk for breast cancer because of their family history, so it is troubling that most of the overweight women knew of the higher risks of being obese and not exercisin.

Research conducted by the American Cancer Society has found that moderate, or even light-intensity exercise reduces the risk of endometrial cancer that is associated with excess weight.  Physically active women in the study engaged primarily in low- to moderate-intensity activities, like walking or riding a bike, for about 2 hours per week.  

“All measures of physical activity and the avoidance of sedentary behavior were associated with lower endometrial cancer risk,” according to Dr. Alpa V. Patel of the American Cancer Society in Atlanta.  

But physical activity was most strongly associated with reduced risk among women who were overweight or obese. "Since physical activity, even in the absence of weight loss, significantly improves insulin sensitivity and has direct effects on bioavailable estrogen," the authors propose that "it is biologically plausible that overweight or obese women engaging in regular physical activity may experience a greater risk reduction compared to active, normal weight women."

Dr. Patel and colleagues report these results in the October 15 issue of the International Journal of Cancer.

2008 Komen New York City
Race for the Cure^®

Sunday, September 14, 2008, Central Park, 9 am

You can help create a world without breast cancer. 

Join more than 20,000 New Yorkers - including over 1,500 breast cancer survivors - at our annual 5K Run/Walk and help run breast cancer out of town!

Komen Greater NYC was founded in 1990 by friends of the late television journalist Benita Feurey — friends committed to keeping her memory alive by providing breast health education, screening, treatment, and other services to individuals in the five boroughs of New York City, on Long Island, and in Westchester and Rockland Counties. Since its inception, Komen Greater NYC has raised over $40 million. Seventy-five percent of money raised supports local programs; twenty-five percent goes to national research to find the cures.

In 2008, Komen Greater NYC awarded over $3.8 million in grants. Nearly $2.3 million will support 38 community-based organizations that provide breast health programs to underserved women. Three area hospitals will receive $225,000 to increase the capacity of local researchers to enroll women in breast cancer trials and Komen Greater NYC will make $45,000 in grants to local breast cancer conferences and education programs. This year, Komen Greater NYC provided close to $1.3 million for national peer-reviewed research.  For more information, visit http://www.komennyc.org

This year, I will be participating in the Race for the Cure as part of the Continuum Team. If you would like to support me  Click here to donate online.   - Julie

Rueters News Agency announced yesterday a first of it's kind study from Japan looking at the relationship between exercise and leisure and the development of cancer.  The research group led by the Japanese health ministry found that physically active people are less likely than sedentary people to develop cancer.  Men in the most active group had a 13 percent lower risk of developing cancer compared with the least active group.  The difference was even greater for active women - 16 percent lower risk. 

Dr. Manami Inoue, section chief of the National Cancer Centre, pointed out that in the West there has been much research into this area.  "However, our research is the first in Japan of its size and scope - we looked at overall exercise and labor. There are a lot of physical differences between Asians and our Western counterparts. Asians are usually leaner, with a lower BMI (Body Mass Index). Many contributing factors for cancer have been suggested ... our research showed that lack of general physical activity is one of such reasons." 

Researchers surveyed nearly 80,000 men and women between ages 45 - 74 in nine different Japanese prefectures.   Researchers found the most notable trend was among Japanese women who were engaging in regular exercise and led an active lifestyle.  The study was published in the American Journal of Epidemiology .

In November, The American College of Sports Medicine (ACSM) and the American Medical Association (AMA) launched Exercise is Medicine TM, a new program designed to encourage America's patients to incorporate physical activity and exercise into their daily routine.  Exercise is Medicine TM calls on doctors to prescribe exercise to their patients.
 
A recent survey conducted of the public by ACSM found that nearly two-thirds of patients (65%)
would be more interested in exercising to stay healthy if advised by their doctor and given
additional resources. Four out of 10 physicians (41%) talk to their patients about the importance
of exercise, but don't always offer suggestions on the best ways to be physically active. Patients
(25%) look to their doctor first for advice on exercise and physical activity. They turn next to
fitness and health Web sites (24%). 
 
The goal of the Exercise is Medicine TM program is to encourage physicians to record physical
activity as a vital sign during patient visits. Able patients will be advised to participate in at least
30 minutes of physical activity and 10 minutes of stretching and light muscle training five days a
week.
 
A new Web site- www.exerciseismedicine.org - contains educational materials and toolkits for
physicians to use in their practices. The site also includes information for patients, the media, and
policymakers, as well as a listing of initial supporting organizations. Educational models will be
developed for use in medical schools so students can learn the importance of prescribing
exercise to patients early in their careers.  
 
Physical inactivity is a fast-growing public health problem in this country and contributes to a
variety of chronic diseases and health complications, including obesity, coronary artery disease,
diabetes, high blood pressure, cancer, depression and anxiety, arthritis and osteoporosis. In
addition to improving a patient's overall health, increasing physical activity has proven effective in
the treatment and prevention of chronic disease. 
 
"We already advise against smoking; recommending exercise should be no different," said Robert
E. Sallis, M.D., ACSM president. "Physicians can support the program by prescribing exercise
and offering patients basic educational materials.  Exercise can have tremendous health benefits
for patients."
 
"More than half of Americans don't get nearly enough exercise and would be astounded to
see how much difference a brisk 30-minute walk a few times a week makes in their overall
health," said Ronald M. Davis, M.D., AMA president. "We encourage physicians to talk to their
patients about the importance of exercise and to work with them to establish programs they can
start today and continue throughout their lives."

A week after launching Exercise is MedicineTM, a new initiative designed to encourage physicians to counsel patients about physical activity and prescribe exercise, the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) are reaching out to leaders at the national and state levels and supporting organizations.

The two organizations have issued a five-point action plan that will help Exercise is MedicineTM, and the idea that exercise is an integral part of healthcare, be further implemented among physicians and the public. Specifically, ACSM and AMA will work with national and state leaders to:

1. Increase the number of physicians who are prescribing exercise and increased physical activity to their patients by expanding medical education about the health benefits of exercise, encouraging physical activity to be considered as a vital sign, and providing additional tools and resources for physicians to incorporate exercise into their everyday practice.

2. Build the science and evidence base connecting physical activity and health, and also the relationship between physical inactivity and chronic disease, and accelerate the transfer of this knowledge into medical practice.

3. Increase collaborations among physicians and exercise professionals to benefit patients for whom exercise and increased physical activity can prevent, treat, or manage chronic diseases.

4. Educate the public on the health benefits of exercise and physical activity, and encourage patients to talk to their physician about their physical activity needs.

5. Encourage even greater leadership and action by organizations and individuals - at both the national level and in each state - to make commonplace and effective the discussion between physician and patient about physical activity and health.

Please visit the initiative website - http://www.exerciseismedicine.org/ - for further information.