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If you only have one testicle remaining does that make you less likely to get testicular cancer than if you had both?

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17, male: I think I have hemorrhoids but am unsure whether or not it is hemorrhoids or anal cancer. How can I tell the difference? I have constipation

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58yo F diagnosed Barrats Mucosa/Oesophagus via gastroscopy in 2010 How often should gastroscopy be repeated? Assuming NHS will just do minimum req'd

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I've had a mole on my back since birth and within two weeks it went from brown to red/scabbing to shrinking and back to brown. Is this normal?

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How to lead cancer free life.

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Can going on your phone whilst topless cause you to become more exposed to radiation!

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In light of the recent article in the ny times on breast cancer would you recommend surgery for a 90 year old woman recently diagnosed with dcis?

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Can vagina infection lead to cervical cancer?

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Had an Mri.. neuro doc checking for Ms but they also found 2 masses on my head but not in the skull..could it be cancer?Go back doc in a week

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My 80 yr husband has multiple myeloma. He won't eat. Can walk, but lies in bed or couch all day. Dr. will not discuss 'stage'. I know he is failin?

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Small lump on testicle after antibiotics immobile hard lump on right side of neck. Shortness of breath and persistent cough. Thoughts?

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Paranoid about colon cancer. great grandmother had it at 70. had runny + pencil stool last night. 24 y.o female. should I get a colonoscopy screening?

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HeLLo i am 34 yrs old i had thyroid cancer 15 years ago n had 1 other child 12 yrs ago i want to have another baby should i try a fertilty clinic?

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Multivitamins & Prevention Part 4 Breast Cancer Mortality

Several studies have pointed out that multivitamins don't reduce your risk for heart disease.  However, at least one did suggest the possibility of lowering your risk for cancer. So is this a true finding or just a fluke?  In a prospective study published in this month's issue of Breast Cancer Research & Treatment, the authors concluded that compared to nonusers, those post-menopausal women who regularly consumed multivitamins & minerals (MVM) prior to their breast cancer diagnosis had lower mortality.

The authors analyzed an average 7 years of data from 7,728 post-menopausal female participants 50-79yo in the Women's Health Initiative study.  Somewhere between 1 out of 3 and 2 out of 5 women regularly took a MVM, which the authors linked to a 30% lower risk of breast cancer mortality.  In other words, if you regularly take your MVM, while you won't lower your risk of developing breast cancer, at least you decrease your risk of dying from this condition.

Now before you go out and buy an MVM, realize that this is but a small short study that must be replicated before entering common daily use.  But if you're interested . . .
Multivitamins & Prevention Part 3 Heart Disease
Multivitamins & Prevention Part 2 Cancer
Multivitamins & Prevention Part 1 Heart Disease

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Breast Cancer Genetics: The Role of Your Family Physician Part 3

Tuesday was another amazing day of learning & renewal.  The Congress of Delegates heard from several passionate candidates for the Board of Directors as well as Directors vying for President-Elect of this amazing group of people.  The energy & enthusiasm was quite palpable and aptly summed up by one speaker thusly: Being a family physician is the best job EVER!  So after a long day, I crawled back to my room to attempt to catch up on my journals (especially after Nevada State Senator Joe Hardy asked me point blank why I hadn't been actively blogging as I had previously).

Earlier this spring, a day after our taxes were due to be filed, the United States Preventive Services Task Force (USPSTF) published a systematic review of breast cancer chemoprophylaxis in the Annals of Internal Medicine.  Not even a month later, actress & mother Angelina Jolie surprised the world with her announcement of having underwent prophylactic double mastectomy due to her increased genetic risk for breast & ovarian cancer.

So what are the women in our lives to do?  Surgery vs pills?  Follow in the footsteps of a famous actress?  Luckily, the USPSTF followed up their systematic review with a Grade B recommendation statement published online yesterday in the same Annals of Internal Medicine which concluded that women at increased risk for breast cancer, as determined by the Gail Model, and who are also at lower risk for side effects, be given the option to consider chemoprophylaxis in the form of tamoxifen or raloxifene.  On the other hand, the USPSTF also gave a Grade D recommendation statement against the routine use of said chemophylaxis in those women who are not at increase risk for breast cancer.

Most importantly, the USPSTF recognized the importance of shared informed decision making in which our patients are given enough information at an appropriate level of understanding to make a decision consistent with their stated goals & desires.  Of note, these recommendation statements apply only to those women >35yo who are w/o diagnosis of either breast cancer or carcinoma in situ.

Aside from propitious timing, why discuss this article?  Because as family physicians, we care for the whole patient, the whole family, the whole community.  Because as family physicians, we prevent disease, rather than just treat it.  Because as family physicians, we help our patients understand all the options available to them.  And we help each one decide what's best for her (or him) at that stage in life.  And finally, because as family physicians, we are not gatekeepers; we practice comprehensive care w/o discrimination, regardless of gender, age, setting (be it rural or urban, outpatient or inpatient) or any other laundry list item.  We are vital to the foundation to a healthy America.  We have the best job EVER!

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Lifestyle Affects Cancer Risk

Did you ever get an itch that you just couldn't scratch?  Well, some how I got it in my head that some study was published recently linking lifestyle to cancer.  Problem was, I couldn't find it!  So I did my best imitation of the proverbial blind squirrel looking for a nut and finally found the prospective multicenter study published earlier this spring in March in Circulation in which the authors concluded that greater adherence to just seven habits of a healthy lifestyle was associated w/lower risk of cancer.  If this sounds familiar, it's because these same Life's Simple 7 habits were linked to a lower risk of stroke barely 2 months ago.

Of note, the 13,253 participants were in the Atherosclerosis Risk In Communities (ARIC) trial rather than June's Reasons for Geographic And Racial Differences in Stroke (REGARDS) trial.  Let's recall that these 7 ideal metrics are part of the American Heart Association's Strategic Impact Goal Through 2020 and Beyond.  Specifically, they were never having smoked (or having quit more than 12mo); having body mass index less than 25kg/m2; daily consumption of 4-5 components of a healthy diet score; engaging in more than 75min/wk of vigorous physical activity or 150min/wk of (at least) moderate physical activity.  They also looked for an untreated total cholesterol less than 200mg/dL, untreated blood pressure less than 120/80mm Hg; and untreated fasting glucose less than 100mg/dL.  

Those who met at least 6 of the 7 lifestyle goals had half the cancer risk of those who had met none of the goals.  After excluding the effect of tobacco use, those who met at least 5 of 6 lifestyle goals still had 25% lower risk of cancer compared to those who had met none of the goals.  Bottom line: what's good for your heart is good for your brain and also lowers your risk for cancer.  You have to admit that's a pretty impressive 3 for the price of 1 deal!

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If genitals warts gets worse pretty quick is that a bad sign of cancer...?

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USPSTF's Draft Recommendations re Lung Cancer Screening

The US Preventive Services Task Force (USPSTF), that most august body, has just put out a draft recommendation for lung cancer, making it available for public comment thru Aug 26th. This Grade B recommendation to annually screen smokers with low dose CT scan was based upon a systematic review of currently available evidence published online yesterday in the Annals of Internal Medicine.

So what's this mean for you & me?  Well, the evidence was given a B grade.  In other words, USPSTF believes that there is high certainty that net benefit is moderate or that there is moderate certainty that net benefit is moderate to substantial.  Did you catch that?  It's not an A grade in which USPSTF would believe that there is high certainty that net benefit is substantial.  

High certainty means that the available evidence is consistent and derived from well-designed & well-conducted studies, and as such are unlikely to be affected by future data.  OK, that's fine but if you read the systematic review itself, the USPSTF could only find 4 trials, of which only one was large & of good quality showing significant benefit in lung cancer & all-cause mortality.  The other 3 were small (underpowered) & did not demonstrate any benefit (insufficient duration to evaluate effectiveness).  So how is the evidence consistent?  And how is it that underpowered studies of insufficient duration were judged well-designed & well-conducted?

Before you jump to conclusions and rush out for your own LDCT scan, read the evidence review yourself.  And ask the USPSTF (by commenting on their website) if the evidence is really that good & strong enough to support these draft recommendations?  

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Fish (Oil) vs Breast Cancer

You are what you eat.  How many times have you heard that phrase?  Chances are you won't turn into a hot dog or potato chip but study after study demonstrates the impact of good nutrition on our health.  Most observational studies demonstrate benefit to making better choices and even a recent randomized controlled trial was able to demonstrate cause & effect benefit from the Mediterranean diet.  In general, the studies looking at fish (oil) have suggested heart disease & memory benefit.  But what about cancer?

Well, in a meta-analysis of 21 prospective cohort studies published less than 2 weeks ago in the British Medical Journal, the authors arrived at a rather interesting conclusion: while fish (and alpha linolenic acid for vegans) consumption was not linked to breast cancer risk, total intake of marine omega-3 poly-unsaturated fatty acids was inversely linked to breast cancer, such that every 0.1g/d of fish oil was linked to 5% risk reduction in breast cancer.

Sure, they looked at 687,770 participants regarding fish intake, 527,392 regarding omega 3 PUFA intake, and 405,592 regarding ALA intake.  So just how does marine-derived omega 3 PUFA get linked to lower breast cancer risk while fish intake doesn't?  Let's remember that the devil is in the details.  Not every fish is chock full of omega 3 PUFA.  Unfortunately, a meal comprised of fish & chips won't help.  And my guess is that farm-raised salmon won't either.  You need the wild-caught salmon that's been feasting naturally in order to get your fill of omega 3 PUFA.  Think about that the next time you look for fish in your grocery store.

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Fluke or Trend: 5ARIs vs Prostate Cancer

It's been a while since I looked closely at 5 alpha reductase inhibitors.  In March 2011, I discussed the potential side effects from taking a 5ARI.  In July 2011, I reviewed two studies aimed at using a 5ARI as chemoprophylaxis against prostate cancer.  Unfortunately, the results didn't turn out as hoped and the Food & Drug Administration refused to give either finasteride or dutasteride approval for marketing as preventing prostate cancer.

Well, in a case-control study published 10 days ago in the British Medical Journal, the authors concluded that use of 5ARIs to treat lower urinary tract symptoms also lowered Gleason score 2-7 prostate cancer.  This was an expected outcome.  What was unexpected was that 5ARI use did not increase risk of Gleason 8-10 prostate cancer in the ensuing 4yrs.  Recall that while both the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial demonstrated that regular use of 5ARIs can lower prostate cancer risk by up to 1 in 4, they also increased high grade prostate cancer risk.  

So how does a guy decide?  Well, for now, use the 5ARI for its intended purpose, assuming you still need it.    That means take it for your receding hair line or because you have symptoms of an enlarged prostate.  But don't take it in an attempt to prevent prostate cancer.  At least not until we have better research to support such an indication.

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