American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline


The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.

This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.

Why Are Black People Less Likely to Get Melanoma But More Likely to Die From It?


Having melanin doesn’t mean that you can’t get melanoma.
Jacqueline Smith after she was declared N.E.D.

Jacqueline Smith, a melanoma survivor, after doctors declared her status N.E.D., or “no evidence of disease.”

Jacqueline Smith was shocked when she received a stage III melanoma diagnosis at the young age of 21. As a black woman, she didn’t think it could happen to her. “Growing up, I learned that middle-aged, fair-skinned Caucasian women were at high risk for skin cancer,” Smith tells SELF. Smith, now 39, is a melanoma awareness advocate and public speaker who devotes much of her time to spreading knowledge of skin cancer risks, especially to other black women who may underestimate their chances of developing this potentially deadly disease.

Yes, black people can get skin cancer. What’s more, when they do, they’re much more likely to die from it.

“Skin cancer in [people] of color absolutely happens. It tends to be a perfect storm, which is why people who have darker skin and who develop skin cancer tend to have a much poorer prognosis,” dermatologist Brooke Jackson, M.D., who specializes in skin of color and owns a private practice in Durham, North Carolina, tells SELF.

A July 2016 study in the Journal of the American Academy of Dermatology found that of all racial groups, non-Hispanic black people had the lowest rates of melanoma diagnoses, but they were also the most likely to be diagnosed at a later stage.

The research pulled data from 96,953 patients given a melanoma diagnosis between 1992 and 2009. White people had the highest rate of skin cancer, with 45.8 diagnoses per 100,000 people, while black people had the lowest, with 1.35 diagnoses per 100,000 people. But despite the low incidence of melanoma in minority groups, these patients had significantly shorter survival rates than white patients.

According to the most recent data available from the American Cancer Society, the five-year melanoma survival rate is 93 percent for white people, but only 69 percent for their black counterparts.

There’s a whole host of complex reasons why black Americans are more likely to die from skin cancer than white Americans. To fully explore them, you first have to know a bit about what skin cancer really is.

Skin cancer happens when your skin cells grow abnormally and out of control. It’s the most common form of cancer in the United States.

Over 5 million people in the United States are diagnosed with skin cancer each year, according to the American Cancer Society’s 2017 report. The most common forms of this disease are basal cell carcinoma, squamous cell carcinoma, and melanoma.

Your skin’s outermost layer is called your epidermis, and it has three main types of cells, according to the American Cancer Society. The squamous cells in the outer part of your epidermis are flat and constantly slough off so new ones can take their place. Basal cells, which are deeper in the epidermis, divide to make new cells to replace the old squamous ones. Then there are melanocytes, which create melanin. It’s the brown pigment that, by making some people’s skin darker than others, allows for the human race to have such a beautifully diverse range in skin tones.

While everyone has a similar number of melanocytes, genetics determine how much of this pigment those cells actually make, according to the American Academy of Dermatology (AAD). The more melanin you have, the darker your skin.

The most prevalent types of skin cancer correspond with these different cells. Around 8 in 10 skin cancers in the United States are basal cell carcinomas, making this the most common form of this disease, according to the American Cancer Society. Basal cell carcinoma typically develops on areas most often exposed to the sun, like the head and neck, and grow slowly. They can present in a multitude of different ways, including as flat, firm, pale, or yellow areas, raised reddish patches, strange bumps, growths with raised edges, and open sores.

Squamous cell carcinoma, which makes up around 2 in 10 skin cancers, normally crops up on sun-exposed areas like the face, ears, neck, lips, and back of the hands, though it also sometimes shows up in the genital area. It often looks like a rough or scaly red patch, raised lump, open sore, or growth similar to a wart. Like basal cell carcinoma, it also grows slowly. The American Cancer Society estimates that these cancers kill around 2,000 people each year in the United States, although it’s hard to pinpoint the exact number of people who die from basal and squamous cell skin cancers annually because cancer registries don’t track them.

Melanoma, which starts in those pigment-providing melanocytes, can be much more lethal. “Melanoma isn’t the most common cancer, but we hear about it so often because it is the most deadly [skin cancer],” oncologist Michael K. Wong, M.D., Ph.D, a professor in the department of melanoma medical oncology at The University of Texas MD Anderson Cancer Center, tells SELF. Melanoma only makes up around 1 percent of skin cancers, but it’s expected to kill around 9,320 people in the United States in 2018. Melanoma is more likely to be fatal because it’s aggressive and typically quicker to spread when left untreated than basal and squamous cell skin cancers.

Melanoma usually shows up as a new mole on your skin that may change in size, shape, or color. Experts use what’s known the ABCDE rule to summarize melanoma warning signs: Asymmetry that means the mole doesn’t look uniform all over, a strange border around the mole’s edge, uneven color, a diameter larger than around ¼ inch, and a mole that is evolving in shape, size, or color.

Melanoma most often appears on the chest and back in men and the legs in women, though it can really occur almost anywhere on your body, according to the American Cancer Society. The most common form is superficial spreading melanoma, according to the U.S. National Library of Medicine. (This is what Smith had.)

Black people are actually more susceptible to the least common subtype of the disease, known as acral lentiginous melanoma. This kind of melanoma shows up in unexpected places, like the palms of the hands, soles of the feet, and under the nails. This unexpected presentation causes it to fly under the radar, which is one reason why black people are more likely to be diagnosed with skin cancer at a later stage. Another reason: the damaging myths about black people being exempt from skin cancer.

There’s a dangerous, pervasive, and categorically inaccurate idea that melanin offers sufficient protection from the sun’s harmful UV rays.

Until she received her diagnosis, Smith says she believed that since she had dark skin, she didn’t need to protect herself from the sun. “I hear all too often that melanin is our natural sunscreen,” she says. She’s far from alone; a 2015 study in the Journal of the American Academy of Dermatology found that non-Hispanic black women were significantly less likely to regularly protect their face or other exposed areas with sunscreen than non-Hispanic white women. Overall, sunscreen use was lowest in people whose skin didn’t tend to burn. But your skin doesn’t need to actually burn in order for you to have skin damage—even a slight tan after sun exposure is a sign your skin has been injured, according to the Centers for Disease Control and Prevention (CDC).

The authors of the study, which was a nationally representative survey of 4,033 people, posited that people whose skin isn’t as sensitive to the sun may think they don’t need sun protection. While the study had its limitations, like relying on people’s self-reported sunscreen use, it points to what experts say is a commonly held belief. “The misperception is that melanin is universally protective and [dark-skinned people] do not need to wear sunscreen,” Dr. Jackson says.

It’s true that melanin does offer some protection from the sun by absorbing or deflecting harmful ultraviolet rays (invisible radiation from the sun that can damage the DNA of genes that control skin cell growth)—but it’s not enough to completely ward off the threat of skin cancer, no matter how dark your skin may be.

That’s why sunscreen—and people knowing they need it—is essential; it absorbs, reflects, or scatters sunlight to protect against UV rays, according to the CDC. The American Cancer Society suggests wearing a broad spectrum sunscreen (meaning it protects against both UVA and UVB rays) with SPF 30 or higher. Experts also recommend wearing accessories like hats and sunglasses, long-sleeved clothing in dark colors (or even with SPF), and trying to stay in the shade between 10:00 A.M. and 4:00 P.M. when UV rays are most intense.

But dutifully slathering on sunscreen and taking other protective measures isn’t enough to completely ward off skin cancer. In fact, the acral lentiginous melanoma that is more likely to affect black people can show up in areas that are rarely exposed to the sun, like the bottoms of the feet. No one knows precisely what causes non-UV related skin cancer to develop, Dr. Jackson explains, but potential factors include gene mutations, a family history of cancer or skin cancer, and various inherited syndromes that raise skin cancer risk, according to the American Cancer Society.

But make no mistake—the racial disparities in skin cancer survival rates are not solely based on insufficient information and sunscreen. There are many more factors at play.

Factors tied to lower socioeconomic status, like a lack of access to preventive screenings, absent or low-quality health insurance, and poor medical care can translate into worse health outcomes for people of color, according to the American Cancer Society’s 2016-2018 report on cancer in African Americans. And without insurance, skin cancer screenings are likely to be an afterthought. According to the United States Census Bureau’s 2016 report, all non-white populations had higher uninsurance rates than white people: 16 percent of Hispanic-origin people were uninsured, compared with 10.5 percent of black people, 7.6 percent of Asian people, and 6.3 percent of white people.

Even the toll of combatting discrimination and racism can affect health disparities, as chronic socioeconomic and race-related stress may contribute to poorer health outcomes, according to the American Psychological Association.

Even when someone is able to access medical treatment, health professionals aren’t immune from the misperception that black people don’t need to worry as much about skin cancer. “Sometimes people who evaluate you are of the belief, ‘Oh, you’ve got dark skin—we don’t have to worry about you,’” Dr. Jackson says. And unfortunately, this can lead to delayed diagnosis and treatment. “There’s definitely a correlation between delayed diagnosis and poor prognosis,” Dr. Jackson says.

This is a lot of heavy, disheartening information. But that doesn’t mean all hope is lost: Prevention and detection make it possible to survive skin cancer.

Melanoma, as deadly as it can be, is most survivable when it’s found and treated as soon as possible.

To catch any strange spots as soon as they pop up, Dr. Wong emphasizes the importance of checking your skin regularly for any new marks. Anything that gives you pause is worth flagging for your doctor, but that’s especially true if you’re a black woman and find spots in areas where acral lentiginous melanoma is most likely to develop. If you see an unexplained, persistent mark on the soles of your feet, under your nails, or on the palms of your hands, make an appointment with your dermatologist, Dr. Wong says, and get a second opinion if you don’t feel they’re taking you seriously. The right doctor will fully evaluate both your mark and medical history, then potentially decide to remove the spot for a biopsy, according to the Mayo Clinic.

If you do in fact have skin cancer, your treatment will depend on the type and stage of your disease. In the early stages, your doctor may be able to surgically remove the cancerous skin without any additional treatment, according to the Mayo Clinic. If your cancer has spread, though, it may also require radiation or chemotherapy.

Thanks to her diagnosis and treatment, Smith is alive, well, and determined to help others avoid the same fate.

After surgery, a clinical drug trial, and radiation, Smith’s cancer status is N.E.D., or “no evidence of disease.” She now works with the Melanoma Research Foundation, is a commissioner on Maryland’s Montgomery County Commission on Health, and has served on the District of Columbia Cancer Action Partnership. She plans to make her life’s work helping other cancer patients through research and advocacy.

“I would like people to realize melanoma is largely preventable,” Smith says. “Had I known I would develop melanoma, I would have diligently used sunscreen and made a better effort to shield myself from sun exposure. However, I am thankful for my life and health, the people I’ve met along the way, and my overall journey.”

Who’s Still Smoking? ACS Report Highlights Most Vulnerable Adults


Reaching these smokers is ‘most pressing challenge’

Cigarette smoking among adults has declined to record low levels in the United States, but some of the most vulnerable in society continue to smoke at far higher rates compared with the population at large.

In a newly released report, the American Cancer Society (ACS) called the continued high prevalence of cigarette smoking among these groups “one of the most pressing challenges facing the tobacco control community.”

 “These populations included individuals in lower education and/or socioeconomic groups; from certain racial/ethnic groups; in the lesbian, gay/bisexual, and transgender (LGBT) community; with mental illness; and in the military, particularly among those in the lowest pay grades,” the report noted.

In 2015, a total of 15% of adults in the United States were cigarette smokers, compared with 42.4% in 1965, the data showed.

While cigarette smoking rates have declined among the vulnerable populations identified in the report, the declines have not kept pace with the adult population as a whole and disparities have widened, said the lead author, Jeffrey Drope, PhD, the ACS’s vice president for economic and health policy research.

Specifically, the results showed the following:

  • Fifty years ago, smoking prevalence was 40%-45% among all educational-attainment groups, but now, just 6.5% of college-educated adults identified as cigarette smokers, compared with 23% of adults with a high school education or less
  • In 2015 and 2016, about one in 10 adults living in high-income households used tobacco, compared with one in four adults living below the poverty line
  • American Indians and Alaskan Natives continued to have the highest smoking prevalence (24.3% among men and 23.4% among women); women in this group have had a recent upward trend in smoking following a nearly 20-year downward trend
  • Among people with mental illness, 27.9% of those reporting a past-year psychiatric episode reported current smoking, as did nearly 60% of people diagnosed with schizophrenia
  • Smoking prevalence among LGBT men and women in the United States remains much higher than among heterosexuals; rates were highest in one survey among people identifying as bisexual (around 33%)

Smoking rates among military personnel have mirrored downward trends in the general population in recent decades, but remain significantly higher (24% in 2011), the researchers found. Roughly 30% of service members in the lowest pay grades (E1-E4) continued to smoke, compared with less than 5% of service members in the highest six pay grades of commissioned officers (O4-O10).

 And smoking prevalence continues to vary considerably across states, from a low of 8.7% in Utah to 26.2% in Kentucky in 2016.

Smoking rates in the area of the country dubbed ‘Tobacco Nation” by the advocacy group Truth Initiative remain higher than in the nation at large (22% versus 15%).

Stretching from the upper Midwest through much of the South, the 12 states — Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia — have smoking rates that exceed “many of the most smoking-dependent countries in the world,” the reported noted.

Drope told MedPage Today that identifying innovative ways to reach these subpopulations that continue to smoke cigarettes at high rates should be a top priority of smoking prevention and cessation outreach.

“We need to think outside the box,” he said. “The tobacco industry has undoubtedly been more effective at using social media and other new tools to reach these populations. We are starting to use them, but we aren’t where we need to be yet.”

Drope said the anti-smoking community’s focus on the safety of new tobacco products, such as electronic cigarettes and heat-not-burn products, while important, is a potential distraction.

“There are still 40 million cigarette smokers in this country, and they are concentrated in these groups highlighted in this report. These are people who are addicted to a deadly product, and roughly two-thirds of them can be expected to die as a result if they continue to smoke.”

Cancer.com Site Sat Dormant for 10 Years. Now It’s Live Again.


After lying moribund for the past 10 years, the website cancer.com is now online and full of content.

Now the question is, with Janssen Biotech finally filling out the site, will it genuinely help patients navigate through their respective cancer journeys or steer them to the company’s products? And will its similarity to cancer.org, the American Cancer Society’s (ACS) flagship site, cause confusion?

The look-alike sites are reminiscent of another situation almost a decade ago, when the for-profit Livestrong.com was created in cooperation with the former Lance Armstrong Foundation’s (now Livestrong Foundation) not-for-profit Livestrong.org site. In the case of cancer.com, the ACS is a partner (albeit one of many) in providing content for the site.

ACS officials familiar with the matter told MedPage Today that they were personally surprised that the society didn’t already own the cancer.com domain, as ACS had made a point of acquiring many cancer-related website names to protect its brand.

That confusion may be mitigated, however, since ACS agreed to sign on with CancerCare (CC) and the Cancer Support Community (CSC) as the primary not-for-profit content providers for the site that Janssen hopes will provide tailored information and resources “to educate, motivate, and empower cancer patients.”

The virtual cancer information website was soft launched at an invitation-only advocacy event by Janssen, a Johnson & Johnson company, at last month’s American Society for Hematology annual meeting in Atlanta. It went public a few days later, according to Janssen officials contacted by MedPage Today.

Planning for the current site has been in the works since the summer of 2015, but the Johnson & Johnson family had originally acquired rights to the cancer.com domain in 1995, Janssen officials told MedPage Today.

 After that, however, the site ran in fits and starts, a review of web.archive.org records suggests. Initially J&J did little with it. By 1999, it was apparently forwarding users to a cancer information page hosted by the now-defunct PlanetRx online pharmacy. It was then disabled altogether for a few years, then revived by Janssen in 2004, which kept it full of content through 2006. The following year, though, it went into hibernation again until the relaunch last month.

To the question of whether the site’s new content will be influenced by Janssen’s commercial interests, the company swears it won’t.

Leslie Amendola, who was recently promoted from senior director of oncology franchise strategy at Janssen to its marketing director, told MedPage Today in a telephone interview (monitored by a media relations representative) that cancer.com is a completely unbranded site.

“We don’t link back to individual products. It’s really important at Janssen Oncology to follow our mission to have a world where cancer is preventable, chronic, and curable,” she said, adding that in addition to developing science the company also wants to bring forth cancer resources and solutions such as cancer.com in a vehicle that is not overwhelming to patients.

She said that the initial phase of the project is a “learn and adapt” approach, with resources that included cancers with high prevalence or in areas where Janssen had expertise and products, such as in multiple myeloma, non-Hodgkin’s lymphoma, and prostate cancer.

 Breast and lung cancer constituted the initial high prevalence areas, with the goal of adding many more tumor types in the future.

The site also currently offers resources such as an Advocacy Connector that can be used by any cancer patient without providing the in-depth registration information required by another other part of the site, My Care Activator, which Amendola described as a digital health coaching tool developed by J&J behavioral scientists to help patients customize their unique challenges and improve better health outcomes.

She said that using the cancer.com URL required great responsibility and the company wanted to “get it right,” adding that Janssen has had considerable growth in oncology during the past 5 years, and had finally found the right not-for-profit partners.

The initial criterion for advocacy partnerships was a pan-cancer orientation rather than focusing on a single cancer site. Other factors included the quality of content, the organization’s reputation, and the availability of support services and programs.

Janssen said that ACS, CC, and CSC had all been approached within a time frame of about a month in 2015, and confirmed a longtime commitment to the partnerships, which involve renewable 6 to 18 month contracts with licensing fees paid for use of web content.

Other advocacy partners will be added over time, and the site also has other Janssen-approved licensed third-party sources including:

  • 2 Minute Medicine
  • BusinessInsider
  • Cleveland Clinic
  • CNN
  • Environmental Nutrition
  • Greatist
  • Harvard Health Letter
  • HealthDay
  • Healthline
  • Inside Health
  • Mayo Clinic Health Information Library
  • Men’s Health
  • National Cancer Institute
  • Patient Resource Publishing
  • Prevention
  • Psychology Today
  • Reuters
  • Science of Us
  • The Associated Press
  • The New York Times
  • Tribute Content Premium Health Columns
  • Women’s Health

Janssen has an agreement with the Community Oncology Alliance to sponsor its in-practice TV network by running a brief informational video on cancer.com to increase patient awareness, and plans a publicity push on World Cancer Day, February 4th.

Amendola said that Janssen would only collect patient information at an aggregate level or “in ways to help patients improve their experience on the site.”

MedPage Today originally asked to speak with ACS CEO Gary Reedy to comment on the deal, but instead interviewed ACS chief cancer control officer Richard C. Wender, MD.

Wender explained that ACS’s board had decided that Reedy should not be directly involved in the project to avoid a potential conflict of interest since the ACS head had worked for Johnson & Johnson in several senior management positions for many years, including as president of Ortho Biotech, which became Janssen Biotech.

He said that Janssen had initially contacted ACS’s Cancer Action Network , the society’s lobbying arm, and that ACS determined that he would manage the Janssen relationship.

ACS has a full-time team dedicated to gathering cancer information amounting to about 20,000 pages for its own site, and Wender said that he felt that the more places where people can get cancer information, the better.

He said that there are so many cancer organizations today that the public is often confused about which is which, adding that the similarity between ACS and Janssen’s websites makes the potential for confusion pretty great and increased the reasons for ACS’s participation.

“In this case we would have been willing to share our information [with cancer.com] anyway, but the added motivation was that if people thought that they were getting to the American Cancer Society [site by mistake], we would want to make sure that they would see our information and could link back to our site.”

Wender said that he was surprised Janssen did not have a more developed idea when discussions began with ACS, although that allowed the participating partners to have more initial input into the final design. He added that cancer.com was upfront about collecting information and that visitors could clearly see where information was from and could link back to the original sources.

“This doesn’t alter Google hits, meaning that hits are attributed back to the original sites, not the site offering the shared information,” Wender said.

Wender noted that although he wasn’t certain whether the original three not-for-profit partners had veto power over the addition of certain new partners in the future, he said that Janssen would consult with them.

CancerCare CEO Patricia J. Goldsmith told MedPage Today that she thought that “third time was the charm” concerning the cancer.com site.

She had a professionally long history with the URL, she explained, going back to when she was a senior administrator at the Moffitt Cancer Center in Tampa, Florida, in the 1990s, and learned that Ortho Biotech owned cancer.com.

“I was told that J&J had a vision for the URL as a destination site for cancer patients focusing on helping and supporting patients, and from a Moffit and a psychosocial point of view I was very interested in working with them.”

Goldsmith said that a few years later, after she was named EVP and COO of the National Comprehensive Cancer Network (NCCN), she learned that cancer.com was still languishing and spoke with NCCN Foundation Board member William N. Hait, MD, PhD, who was to eventually become Global Head of Janssen Research and Development.

“Bill said that Janssen and J&J were interested in making something out of the site in terms of a cancer destination that was as influential as the URL itself. Believe me, I often wished that somewhere in my career we had the opportunity to acquire that URL,” she said, adding that NCCN was unsuccessful in getting Janssen to turn over the site to the network after the company decided not to pursue the project at the time.

She then fast-forwarded to when she joined CancerCare and still maintained strong relationships with Janssen, which asked if she would be interested in partnering with cancer.com.

It was a no-brainer and Goldsmith noted again that she hoped the third time would be the charm.

“It made no sense to reinvent the wheel, and working together with partners that were complementary, and Janssen, finally brought this project to fruition.”

The Cancer Support Community welcomed inclusion into the current project because it leveraged the collective strengths of all three partners rather than duplicating efforts.

“Janssen was going to leverage good content already established by the partners,” said the group’s president, Linda House, “so instead of creating its own site and having us endorse it, we were invited to help create a site with quality content from trusted partners.”

House said that it was in the best interests of all the organizations to get the best information into the hands of patients and caregivers at the point when it was needed, there’s a lot of cross-linking on the site, and the partners meet with Janssen quarterly.

“Putting it all together was a collaborative effort like I’ve never seen before,” she said.

Men Who Have this Popular PSA Prostate Cancer Screening Have a Staggering 4-Fold Increase in Serious Blood Infections


Men Who Have this Popular PSA Prostate Cancer Screening Have a Staggering 4-Fold Increase in Serious Blood Infections

Story at-a-glance

  • The benefits of PSA prostate cancer screening has been repeatedly shown to be minimal at best and detrimental at worst. Overall, PSA screening barely has any impact on mortality rates from prostate cancer. As a result, the U.S. Preventive Services Task Force will soon recommend that men not get screened for prostate cancer.
  • According to Stanford University researchers, the PSA test indicates nothing more than the size of your prostate gland. . The false positive rate is high, and the bulk of the harm is a result of subsequent unnecessary treatments.
  • Canadian researchers have raised the alarm over prostate biopsies, citing a four-fold increase in serious blood infections over the past decade from the procedure. Researchers are also questioning the conventional treatments of prostate cancer, which include surgical removal of the prostate gland and radiotherapy, as they may not be necessary for most men.
  • Your diet can greatly impact your prostate health and help prevent enlarged prostate and prostate cancer. Ideally, you’ll want to eat as much organic (preferably raw) food as possible, and limit sugar/fructose and grains from your diet. Highly processed or charcoaled meats, pasteurized dairy products, and trans fats correlate with an increased risk for prostate cancer and should also be avoided. Other specific nutritional therapies are discussed.

Prostate cancer is one of the most common cancers in men, but it is not  as deadly as breast cancer.

According to the latest statistics from the American Cancer Society, an estimated 240,890 men will be diagnosed with prostate cancer this year, and just over 33,700 men may die from it, so only one in seven diagnosed with it will die from it.

Overall, American men have a one in six chance of being diagnosed with prostate cancer at some point in their lives, or one in 42 chance of dying from it..

Most cases of prostate cancer do not occur until after men turn 50, but in recent years there has been a steady rise in the percentage of men in their 30s and 40s with both prostate problems and prostate cancer, primarily as a result of poor diet and increasing environmental pollution.

Unfortunately, investigations over the years have discovered serious flaws with the PSA test used to diagnose prostate cancer.

And the U.S. Preventive Services Task Force—which has also declared women in their 40s don’t need mammograms—may soon recommend that men not get screened for prostate cancer using the PSA test.

Researchers are also questioning the conventional treatments of prostate cancer, which include surgical removal of the prostate gland and radiotherapy, as they may not be necessary for most men.

All in all, I think this really highlights the necessity to employ preventive strategies, which I will discuss at the end of this article.

Moderate to High Certainty PSA Test Does More Harm than Good, Task Force Says

The prostate-specific antigen test (PSA test), analyzes your blood for prostate-specific antigen (PSA), a substance produced by your prostate gland.  When higher-than-normal levels of PSA are detected, it is believed that cancer is present.

However, the PSA test has been criticized as useless for a number of years now. For example, back in 2004, Stanford University News reported:

“The most commonly used screening tool for detecting prostate cancer – the PSA test – is virtually worthless for predicting men’s risk of contracting the disease, medical school researchers have determined. Stanford scientists studied prostate tissues collected in the 20 years since a high PSA test result became the standard for prostate removal. They concluded that as a screen, the test indicates nothing more than the size of the prostate gland.”

The U.S. Preventive Services Task Force is now planning on recommending a “D” rating for PSA testing, meaning that “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”  A review of studies has shown that the PSA blood test yields “small or no reduction” in prostate cancer deaths.

As reported by CNN:

“The report adds that PSA testing is ‘associated with harms related to subsequent evaluation and treatments.’ … The problem is that many of the cancers that get detected are so small and slow-growing, they’ll never be harmful, and doctors have a difficult time discerning the quick, harmful cancers from the slow, harmless ones.”

The PSA Test for Prostate Cancer is Deceptive

Today, many experts agree that PSA testing is unreliable at best and useless at worst for accurately diagnosing prostate cancer. Many also agree that routine PSA blood tests often lead to over-diagnosis of prostate cancer, resulting in unnecessary treatments. Similar to mammograms, the PSA screen has become little more than an up-sell technique. The false positive rate is high, and the bulk of the harm is a result of subsequent unnecessary treatments.

According to the American Cancer Society: “There can be different reasons for an elevated PSA level, including prostate cancer, benign prostate enlargement, inflammation, infection, age, and race,” all factors that make PSA test results confusing, leading to potential for unnecessary treatment and suffering when tests are elevated.  Getting a PSA test reduces your lifetime risk of dying from prostate cancer from three percent to just 2.4 percent, so the difference is negligible.

Drs. Boyle and Brawley of the International Prevention Research Institute, Lyon, France have said,

“The real impact and tragedy of prostate cancer screening is the doubling of the lifetime risk of a diagnosis of prostate cancer with little if any decrease in the risk of dying from this disease.”

Complications of ill advised prostate cancer treatments include urinary incontinence and erectile dysfunction. Both of these conditions are difficult to reverse and can significantly decrease your quality of life.

Prostate Biopsies Can Result in Dangerous Infections

A positive PSA test will typically lead to a biopsy—which has also come under increasing scrutiny and criticism in recent years. On the one hand, the procedure itself may cause acute or long-term harm, and on the other, the rate of false negatives is high.

There are over one million prostate cancer tissue biopsy procedures performed annually in the U.S. Approximately 25 percent of these tissue biopsies are reported “positive,” indicating the presence of prostate cancer. The remaining 75 percent are reported “negative.” One-third of the men with initial “negative” results for prostate cancer actually do have prostate cancer that was missed by the biopsy.

A prostate biopsy involves inserting fine needles into the prostate gland. But specialists have begun to worry about a recent, significant increase in the risk of complications from the procedure. In particular, they are concerned about hard-to-treat bloodstream infections that can require weeks of treatment. Over the past decade, the rate of hospital admissions in Ontario, Canada, for serious infections caused by prostate biopsy increased four-fold.

Earlier this summer, the NPR reported:

“Doctors all over the world are increasingly concerned about post-biopsy infections. At last week’s annual meeting of the American Urological Association, there were 10 reports on the phenomenon … The underlying problem, many say, is the spread of antibiotic-resistant microbes.”

Prostate biopsies inherently pose a risk for infection because:

  • The needles that collect a tiny piece of prostate tissue can transport bacteria through your rectal wall into the prostate and bloodstream, and/or
  • The needles can spread harmful bacteria present in your gut into your bloodstream

Many Cancer Screenings Don’t Save Lives and May Cause Cancer

A recent article featured on PreventDisease.com brings up yet another problem with the PSA test:

“Perhaps most concerning, the PSA test frequently identifies something that qualifies as cancer under a microscope but acts nothing like cancer in real life. That is to say, the large majority of PSA-discovered “cancers” would never cause any problem whatsoever if they went undetected. Finding something through screening invariably leads to treating it through conventional means which cause cancer themselves.”

An underlying issue that needs to be addressed is that both breast- and prostate cancer screenings (mammography and PSA testing respectively) fail to address prevention. Although they are commonly viewed as “preventive” measures, they’re nothing of the sort.  Furthermore, they both appear to result in increased risk of mortality.

The article on PreventDisease.com also includes the following shocking statistics about breast- and prostate cancer screening:

“In a Swedish study of 60,000 women, 70 percent of the mammographically detected tumors weren’t tumors at all. These “false positives” aren’t just financial and emotional strains, they may also lead to many unnecessary and invasive biopsies. In fact, 70 to 80 percent of all positive mammograms do not, upon biopsy, show any presence of cancer.

When it comes to prostate cancer, a 20-year study from Sweden suggests that screening for prostate cancer does not reduce the risk of death from the disease. In fact, many men receive false-positive results and overtreatment, adding an element of risk to widescale screening, researchers report in the March 31 online issue of the BMJ.

“In the light of our findings, I would say that the benefit from screening is not sufficient to support mass screening,” said study author Dr. Gabriel Sandblom, an associate professor at the Karolinska Institute in Stockholm.”

http://www.afcomponents.com/flv/swf/flv_demo.swf

Screens and Treatments Involving Radiation Promote Cancer

Cancer screens like mammography and radiation treatment of either breast- or prostate cancer are not benign tests and treatments. It’s important to understand that radiation exposure causes genetic mutations in cells, and is also known to switch off a tumor suppressing gene. According to PreventDisease.com:

“[N]ew research from the Lawrence Berkeley National Laboratory in America (a US Government facility) has shown that radiation both changes the environment around breast cells, and increases the risks of mutation within them; a mutation that can be passed on in cell division. Four to six weeks after exposure to radiation at a level below that of a screening mammogram, breast cells started to prematurely age.

This results in their inability to send certain chemical messages into their immediate environment, which then filled with pre-cancerous mutated cells also from the radiation.

Paul Yaswen, a cell biologist and breast cancer research specialist with Berkeley Lab’s Life Sciences Division says “our work shows that radiation can change the microenvironment of breast cells, and this in turn can allow the growth of abnormal cells with a long-lived phenotype that have a much greater potential to be cancerous.”

Yawsen stated that radiation specialists have been slow in understanding these concepts. “Many in the cancer research community, especially radiobiologists, have been slow to acknowledge and incorporate in their work the idea that cells in human tissues are not independent entities, but are highly communicative with each other and with their microenvironment.”

Despite the Evidence, Many Cling to the PSA Test

Shannon Brownlee, author of Overtreated, recently wrote an insightful article for Time Magazine on this topic as well.  Many men are responding with outrage at the news that the PSA test will no longer be recommended. Many prostate cancer survivors credit the PSA test with saving their lives.

“The trouble is most men who get treated didn’t have a cancer that needed treating,” Brownlee writes. “So while a given man may believe fervently that early treatment saved his life, there’s a better than even chance that he would have been fine even if his cancer had been left well enough alone.

We never hear from the men who died from their prostate cancer treatment or biopsy. And there have been plenty of them. The mortality rate during or shortly after prostate surgery is estimated to be 1 in 200, according to a study published in the Journal of the National Cancer Institute. We also don’t hear much from the men who are suffering from incontinence, impotence, or both, the devastatingly common side effects of treatment.”

This is probably to be expected. If it was you, how willing would you be to tell the world that you’re now incontinent and impotent as a result of opting to get tested for prostate cancer? These are personal details that few men are willing to share.

How to Maintain Optimal Prostate Function and Help Prevent Prostate Cancer

Men over 70 have a 50/50 chance of developing an enlarged prostate, known as benign prostate hyperplasia (BPH). This is not the equivalent of prostate cancer. However, you do need to address this issue, and unfortunately, the conventional route includes drugs. It’s important to know that some of these drugs actually carry a warning label that if you have benign prostate hyperplasia, the drug may increase your cancer risk, and/or may promote a much more aggressive form of cancer.

For more information about this, please review this previous article on prostate health, which includes an informative interview with Dr. Rudi Moerck. Diet is a factor that can greatly impact your prostate health and help prevent enlarged prostate and prostate cancer.

You’ll want to eat as much organic (preferably raw) food as possible, and liberally include fresh herbs and spices, such as ginger. Make sure to limit carbohydrates like sugar/fructose and grains as much as possible to maintain optimal insulin levels, which will help reduce your cancer risk in general. Highly processed or charcoaled meats, pasteurized dairy products, and trans fats correlate with an increased risk for prostate cancer and should also be avoided.

There are also a number of more specific nutritional therapies that are particularly beneficial for avoiding and/or treating prostate cancer.

  • Include prostate-healthy foods in your daily diet: Foods that support prostate health include vegetables and fruits rich in antioxidants, vitamins, cartenoids like astaxanthin, and lycopene. One 2009 study identified tomatoes, cauliflower, broccoli and green tea as being particularly beneficial against prostate cancer
  • Try saw palmetto: The medical literature contains about 100 clinical studies on saw palmetto for prostate health and reduced incidence of prostate cancer. Trying saw palmetto before you resort to a drug is well worth it, considering the stern warnings that accompany some of these drugs. According to Dr. Moerck, saw palmetto in combination with pumpkin seed or lycopene may be an even more potent combination.

    Beware that quality is very important when selecting a saw palmetto supplement. Most brands on the market are ineffectual because they use the inactive form of the plant.

    The highest quality products are the organic supercritical-extracted saw palmetto oils, which are very dark green in color. Only one or two out of every 20 brands will be of this high quality. Dr. Moerck recommends a daily dose of 320 mg of saw palmetto oil (supercritical CO2 extract). Keep in mind that saw palmetto is a fat soluble supplement, so it will not absorb well unless you take it in conjunction with a little bit of fat. I recommend taking it with eggs, which contain phospholipids that enhance absorption of fat soluble nutrients.

  • Optimize your vitamin D levels, ideally by exposing your bare skin to natural sun light on a regular basis. (Your skin also synthesizes vitamin D sulfate, which may account for many of vitamin D’s potent health benefits, so sun exposure is really the ideal way to optimize your levels and get the greatest overall health benefits.) Evidence suggests that vitamin D may be one of the most potent variables associated with a lower risk of prostate cancer.

    There are well over 800 scientific studies confirming the link between vitamin D deficiency and multiple types of cancers, including prostate cancer. For example, according to a 2005 study, men with higher levels of vitamin D in their blood were half as likely to develop aggressive forms of prostate cancer as those with lower amounts. Another study published two years ago found that men with higher levels of vitamin D in their blood were seven times less likely to die from prostate cancer than those with lower amounts.

    Testing your vitamin D levels is done by a simple blood test. Anything below 20 ng/ml is considered a serious deficiency state, which will increase your risk of breast- and prostate cancers.

    The optimal value that you’re looking for is between 50-70 ng/ml. However, research has suggested that maintaining a slightly higher level of 70-100 ng/ml may be optimal for cancer prevention. If you can’t get regular sun exposure, you may want to consider using a safe tanning bed (one that uses electronic rather than magnetic ballasts and has less, not more, UVA than the sun produces). If these are unavaialble you can opt for an oral vitamin D3 supplement. Keep in mind that when using a supplement, regular testing becomes even more important to make sure you’re staying within therapeutic range.

  • Consider a vitamin K2 supplement: Another nutrient that has been found to offer significant protection against prostate cancer is vitamin K2. For more information about that, please refer to this previous article. Although I don’t typically recommend taking a lot of supplements, vitamin K is one you may want to seriously consider because many people don’t get nearly enough of it on a daily basis through the foods they eat.
  • Exercise your body, and your prostate: Having a well-rounded exercise regimen is essential for overall health, and is now becoming more widely accepted as a critical piece of cancer prevention and treatment. Having sex on a regular basis, which exercises your prostate specifically, is also important.
  • Check your testosterone levels: Contrary to popular belief, restoring testosterone levels in aging men does not appear to promote prostate cancer—on the contrary! According to meticulous research by Dr. Abraham Morgentaler, MD, author of Testosterone for Life, men with low testosterone are the ones at greater risk. For an interesting article that contains a lot more information about this, read Dr. Morgentaler’s report Destroying the Myth About Testosterone Replacement and Prostate Cancer.

    It explains how unfortunate assumptions have led to a dogmatic belief that testosterone replacement increases your risk of prostate cancer—a belief that might now be preventing many men from being optimally healthy. If you are low you can consider trans rectal DHEA cream. I personally use about 50 mg twice a day, and it has done wonders to optimize my testosterone levels as DHEA is converted to testosterone in your body.

Ideally, you’ll want to pay close attention to your prostate health early on—avoid waiting until you’re in your 60’s. Incorporating the lifestyle recommendations discussed above can help you prevent prostate problems from developing in the first place.

Source:mercola.com

Gardasil for Boys? The American Cancer Society Doubles Down, for No good reason.


the ACS Board of Directors recently voted to make prevention of HPV-associated cancers through increased vaccination a nationwide priority for the organization. The ACS convened and leads the National HPV Vaccination Roundtable, a national coalition of over 70 organizations working together to prevent HPV-associated cancers and precancers by increasing and sustaining US HPV vaccination.”

shamrock

Human Papillomavirus Vaccination Guideline Update: American Cancer Society Guideline Endorsement 

The American Cancer Society (ACS) has recently doubled down on its endorsement of the HPV vaccine (Gardasil 9) for boys and girls aged 9 through 26, according to a recent press release. This amendment to their policy is in response to the December 2015  Advisory Committee on Immunization Practices’ (ACIP) recommendation for Gardasil 9. The ACS press release appears to promote the vaccine without stating the risks, the side effects, the contraindications, or the risk that getting the vaccine can potentially progress an existing HPV infection and and cause cancer if left untreated.

CDC poster boys

I contacted the ACS for comment, and I was directed to a footnote citation aimed at clinicians which details the reasons behind their policy update. However, contraindications were not discussed anywhere in this document, and they punted safety issues to the ACIP and CDC (page 6). Also, nowhere does the press release state that pap tests, the only measure proven thus far to reduce the incidence of cervical cancer, will continue to be necessary. When I asked why that was, I was told that that information is contained elsewhere on their website. When I asked why Gardasil 9 was being recommended for boys when no new data was available, I was referred to the above-mentioned clinicians’ report, which incredibly concludes (page 21) that “At this time, there is a lack of direct evidence of efficacy for cancer or pre-cancer prevention in average-risk men . . . .” Confused? More on that later on.

Ultimately, the ACS recommendation fails to advise the public adequately with the unbiased, independent information on cervical, throat, penile, and anal cancers contained on its own website. I’m not saying there is a conflict of interest when a nonprofit supposedly dedicated to health endorses a product made by their very generous corporate donor (Merck), but I might be implying it.

One could be forgiven for not knowing which way to turn when it comes to advice on whether or not to vaccinate your 11-year-old boys and girls with Gardasil. Previously, the vaccine had been heavily marketed to girls for prevention of cervical cancer. However, the narrative has been changing over the years, with a seeming exponential explosion in the number of cancers that HPV is associated with — cancers of the vagina, vulva, penis, anus, rectum, and throat, and now the more general “head and neck” cancers, which doesn’t have the obvious connection with the sexually transmitted nature of HPV infection. As in the ACS press release, we are now hearing the vaccine referred to simply as the “HPV vaccine.” It seems to have been completely rebranded, topped off with the most offensive, egregious TV ad I have ever seen, to ensure that the kids get the message. The fear mongering is at an all-time high for a condition which clears spontaneously, without symptoms, in most people. It’s as if we have all forgotten that HPV is a sexually transmitted infection with no symptoms in over 90% of cases and rarely leads to cancer.

CDC poster boys

CDC poster boys

So why vaccinate the boys? The reasons given for vaccinating boys vary depending on the source and the marketing tactics used. To ease us into it in 2010 — because, remember, boys don’t have a cervix — we were told it was because of the risk of genital warts (apparently there is a new case every minute!). During the Gardasil trials, the vaccine was never shown to prevent genital warts in men or boys; it was an endpoint in an uncontrolled clinical trial in women aged 27-45 (page 14). Based on this, an assumption was made about efficacy in boys, which I guess could be valid, but it is an assumption.

Merck then sponsored a study, Protocol 020, which was presented to the FDA in 2011 to argue that the vaccine be licensed for men who have sex with men, where genital wartswas an endpoint. Merck planned a “long-term extension study” to follow the men for 10 years, but it was without a placebo control, which experts deemed was necessary to conclude effectiveness, safety, and immunogenicity of the vaccine. What is interesting about this study is, it also attempted (but failed) to show efficacy against pre-cancerous anal lesions. More on that in a moment.

We were then told that Gardasil could be used to prevent many penile, anal, and throat cancers. I think Merck’s marketing people were getting brave and decided we could handle casually mentioning “penile” and “anal” cancer as if we’ve always been worried about them — just so long as no one mentions the uncomfortable fact that the most at-risk population for these cancers is the gay and bisexual population. However, just like genital warts, Gardasil has not been demonstrated to prevent penile, anal, or throat cancer. In fact, a quick control-F on Gardasil 9’s package insert does not even come up with the word “throat.” I’m not sure why ENT doctors all over the country are collectively losing their minds over this vaccine and pushing to mandate it, hoping it will reduce incidence of throat cancer. Is smoking all of a sudden off the hook? There are many recent studies citing HPV 16 as a possible suspect in throat cancer, but it’s not the overriding culprit in 80% of cases per this large international study. However, in this study, conducted by a Sanofi-Pasteur MSD (European distributor of Gardasil) consultant, the results were quite different and showed a large number of head and neck cancers relating to HPV. It should be noted that neither study has said that a vaccine can prevent throat cancer, and only the latter mentioned that it was theoretically possible.

Next we see that any claim about prevention of penile cancer was eliminated following the original trials for Gardasil when Merck admitted in the original package insert (Page 16) that the results were statistically insignificant:

Efficacy against penile/perineal/perianal intraepithelial neoplasia (PIN) grades 1/2/3 or penile/perineal/perianal cancer was not demonstrated as the number of cases was too limited to reach statistical significance.

Just like “throat,” the word “penile” is not even mentioned in Gardasil 9’s package insert. Why is penile cancer even mentioned by doctors with regard to this vaccine, especially given the average age of penile cancer diagnosis is 65? There are only 2,000 cases a year in the U.S., only about half of which are associated with HPV infection, with an 85% survival rate. This is hardly something 11-year-old boys and their parents should be worried about.

Finally, let’s look at anal cancer, for which the average age of diagnosis is mid-60s. The (composite) endpoint used in the trials for anal cancer was stage 1, 2, or 3 of Anal Intraepithelial Neoplasia in a cohort of 200 16-26 year old boys and men in an uncontrolled clinical trial (Protocol 020), i.e. the placebo was not saline or an inert substance, it was the adjuvant and vaccine excipients (page 13). The efficacy came out at around 75% for the quadrivalent vaccine. According to Medscape, Dr. Diane Harper noted that of the five cases of AIN lesions reported in Protocol 020, only two were possibly carcinogenic and three were not. However, combining the results is how investigators arrived at statistical significance and were able to report a positive finding.

Furthermore, buried in the Gardasil 9 package insert, we see that Merck could find no association with incidence in the other five HPV types in the vaccine, rendering the “upgrade” to Gardasil 9 unnecessary: “Efficacy of GARDASIL 9 against anal lesions caused by HPV Types 31, 33, 45, 52, and 58 was not assessed due to low incidence.”

American Cancer Society Logo (PRNewsFoto/Live Nation Entertainment)

In this press-release-disguised-Gardasil-commercial, the ACS also claims that “Studies now show that vaccination in males is effective in preventing HPV infection. New evidence has also allowed the ACS to make recommendations for vaccination through age 26.” There are two problems with this statement, for which there was no footnote citation:

One, I know of no such “new evidence” of safety or efficacy for males beyond the paltry uncontrolled clinical trials I have described above, none of which focused on safety beyond the 14-day follow-up period. The ACS did cite 10 studies in its addendum for clinicians at the bottom of the press release but it’s a few clicks in and you really need to know what you’re looking for. The studies they rely on to base their recommendations can be found on page 13 here, which are all Merck-funded and show no new data.

Second, if the ACS is now recommending that the vaccine be given to an age group which is sexually active, then people in that age group should know that Gardasil vaccination might increase their risk of developing cancer should they already have an HPV infection of the type they were vaccinated for. Merck showed this “negative efficacy” (a 44.6% increase in pre-canercous lesions in women who received the vaccine; men were not studied, but if we can assume prevention of genital warts based on the women’s result then why not assume increase in cancer risk based on the women’s result?), in Protocol 013 in the original trials (table 17, page 13).

When I asked the ACS why they did not raise the alarm on the outcome of study Protocol 013 when universally recommending the vaccine for everyone up to the age of 26, they merely quoted the Center for Biologics Evaluation and Research’s (CBER) assessment (which I provided to them) on page 14 that stated

This demonstrated a limitation of the evaluation of small subgroups, where subgroups might have imbalances in baseline demographic characteristics. In this case it appeared that subjects in this subgroup of study 013 who received GardasilTM might have had enhanced risk factors for development of CIN 2/3 or worse compared to placebo recipients. (emphases mine)

The key word here is “might.” What does that mean? It “might” mean that they are presuming that some risk factors present contributed to the progression of the infection. And what exactly are those risk factors? Arguably, the very ones that exist in the real world: smoking, a history of STDs, and an irregular pap smear test, which makes complete sense and should not be disregarded! When a package insert lists ingredients as “approximate” and words like “might” are used to explain away a highly significant safety signal, I have a hard time believing that the proper testing and controls that should be in place for such a complex medical product as this one, actually are.

The ACS should also be asking, since Gardasil only has four HPV types, how is Merck allowed to say that Gardasil 9 can protect against the additional five strains they claim lead to more cancer in males? In fact, they can’t say this at all. In the package insert, buried on page 14, Merck admits that during the uncontrolled studies they conducted

The effectiveness of GARDASIL 9 in girls and boys 9 through 15 years old and in boys and men 16 through 26 years old was inferred based on a comparison of type-specific antibody GMTs to those of 16 through 26-year-old girls and women following vaccination with GARDASIL 9.

For all endpoints, the efficacy against the HPV Types 31, 33, 45, 52 and 58 in GARDASIL 9 was evaluated compared with GARDASIL. Efficacy of GARDASIL 9 against anal lesions caused by HPV Types 31, 33, 45, 52, and 58 was not assessed due to low incidence. Effectiveness of GARDASIL 9 against anal lesions was inferred from the efficacy of GARDASIL against anal lesions caused by HPV types 6, 11, 16 and 18 in men and antibody responses elicited by GARDASIL 9 against the HPV types covered by the vaccine. (emphases mine)

However, the ACS did provide some additional information based on a review of Pubmed research they performed to find support for endorsing this vaccine for boys. Incredibly they admit that they found no evidence it would be effective in preventing cancer in boys at all, which leaves us scratching our heads. In the supporting citation, under “Discussion,”paragraph 9, linked (buried) in its press release it states:

For average-risk men (excluding men who have sex with men and immunocompromised/HIV-positive men), there is no direct evidence of efficacy for cancer or precancer prevention because of the small number of disease outcomes. There is also no evidence for prevention of oropharyngeal cancers in males or females; however, there is limited evidence of prevention of oral HPV infection. (emphases mine)

In fact, in addition to the assumed but not demonstrated prevention of rare cancers in males, the only reason the ACS can come up with to vaccinate the boys is to support “herd immunity” which “may” provide protection for girls:

Modeling results suggest that vaccination of males, through herd immunity, may provide additional protection to females in addition to providing protection against HPV-associated cancers in males.” (emphases mine)

And is vaccinating their boys to possibly protect girls the reason why parents are agreeing to give this vaccine to their children? Shouldn’t the ACS and doctors be telling parents that they are putting their 11-year-old boys at risk of vaccine injury in order to protect a girl they have not yet met or had sex with at some point possibly in the future? But given the tone of the new TV ad, that’s not what they’re saying, is it?

“Did you know, Mom? Dad?”

“Did you know, Mom? Dad?”

If “herd immunity” existed in the female population then there would be no need to vaccinate heterosexual boys to protect them. The problem arises when there is only 30% uptake in girls and 18% in boys, as we currently have in the US. However, this type of narrative provides a dangerous argument for mandating this vaccine for 11 and 12-year-olds, something that will be a disaster for every state that implements such a law. It would put thousands of children in harm’s way for a perceived, unproven benefit, decades into the future, based on incomplete studies which are without proper inert placebo controls.

Incredibly, the American Cancer Society has chosen to promote a vaccine for boys, without demonstrating a benefit for any but a very small minority of the population. It’s hard to imagine why universal vaccination is the preferred path over pap tests (for women) and better sexual health education (for all), considering the magnitude of the possible risks and the groundswell of resistance that exists in the public mindset as regards this vaccine. And we haven’t even discussed the cost. Why are doctors not listening? Well, to answer that I would have to go all conspiracy-nut on you, so I won’t.

Welcome to a world where parents are losing their right to make these important medical decisions for their children. Welcome to the era of vaccine mandates and pharmaceutical dominance over our government, where conflicts of interest are now the norm. Welcome to an incredible new vaccine paradigm where doctors and the trusted American Cancer Society will tell you a vaccine prevents cancer, even when the manufacturer has never shown that it does.

Is Toxoplasma Gondii Deadly? Parasite Found In Cat Poop May Actually Help Treat Ovarian Cancer


You may know that Toxoplasma gondii, the parasite commonly found in cat feces, is linked to a number of adverse health consequences, such as rage disorder and even schizophrenia. However, new research suggests that the parasite may actually have a use in the medical world, and could play a role in research to find the elusive cure for cancer.

Scientists from Dartmouth’s Geisel School of Medicine found that a specific protein secreted by T. gondii causes the immune system in mice to attack ovarian tumors, ultimately increasing their chances of survival. The scientists hope they can replicate these results and eventually use the protein in the immunotherapy treatments currently administered to human ovarian cancer patients.

Past research has shown that a safe vaccine strain of T. gondii could cure several types of tumors in mice; however, in this recent study, the Dartmouth team wanted to understand why. To do this, the teamsystematically deleted genes in the parasite and then injected these altered parasites into mice with aggressive ovarian cancer to see what would happen. Eventually, through this trial and error process, they were able to identify the specific protein excreted by the parasite that was responsible for the cancer-fighting effect.

Although the research is still in its infancy, the study shows promise in treating ovarian cancer, a serious condition that accounts for about three percent of all cancers among women. According to the American Cancer Society, about 22,280 women will receive a new diagnosis of ovarian cancer in 2016, and about 14,240 women will die from ovarian cancer — the fifth in cancer deaths among women.

CatCatCat

Could our favorite four-legged friends lend a paw in the fight against cancer?

Immunotherapy itself relies on utilizing the patient’s own immune system to combat cancer. Part of what makes cancer so deadly is its ability to evade the body’s immune system. This ability to hide, also called immune tolerance, makes it difficult for the immune system cells to know which cells to attack. As a result, cancer is allowed to grow and spread.

However, in mice, T. gondii helps to break the ovarian cancer cell’s immune tolerance, making it easier for the mice’s immune system to effectively detect and destroy aggressive ovarian cancer cells. There are already clinical trials underway to explore the usefulness of bacterium Listeria monocytogenes in breaking the immune tolerance of pancreatic tumors.

Early Specialty Palliative Care — Translating Data in Oncology into Practice.


Palliative care suffers from an identity problem. Seventy percent of Americans describe themselves as “not at all knowledgeable” about palliative care, and most health care professionals believe it is synonymous with end-of-life care.1 This perception is not far from current medical practice, because specialty palliative care — administered by clinicians with expertise in palliative medicine — is predominantly offered through hospice care or inpatient consultation only after life-prolonging treatment has failed. Limiting specialty palliative care to those enrolled in hospice or admitted to the hospital ignores the majority of patients facing a serious illness, such as advanced cancer, who have physical and psychological symptoms throughout their disease. To ensure that patients receive the best care throughout their disease trajectory, we believe that palliative care should be initiated alongside standard medical care for patients with serious illnesses.

For palliative care to be used appropriately, clinicians, patients, and the general public must understand the fundamental differences between palliative care and hospice care. The Medicare hospice benefit provides hospice care exclusively to patients who are willing to forgo curative treatments and who have a physician-estimated life expectancy of 6 months or less.2 In contrast, palliative care is not limited by a physician’s estimate of life expectancy or a patient’s preference for curative medication or procedures. According to a field-tested definition developed by the Center to Advance Palliative Care and the American Cancer Society, “Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.”1 Several clinical trials have shown benefits of early specialty palliative care in patients with advanced cancer.3 The effect of early specialty palliative care in other patient populations is less well studied, but there are data suggesting a beneficial role in patients with multiple sclerosis4 and congestive heart failure.5,6

Although there are salient differences between hospice care and palliative care, notably the limitations on prognosis and use of curative therapies with hospice care, most palliative care is currently provided at the end of life. This perceived association between palliative care and end-of-life care has led to a marginalization of palliative care.1 Debates over “death panels,” physician-assisted suicide, and reimbursement for advance care planning have made policymakers reluctant to devote resources to initiatives perceived to be associated with “death and dying.” For example, National Institutes of Health allocations for research focused on palliative care remain far behind funding for procedure-oriented specialties.7 The practice and policy behind palliative care must be considered independently from end-of-life care. Palliative care should no longer be reserved exclusively for those who have exhausted options for life-prolonging therapies .Traditional versus Early Palliative Care.).

We present three separate cases — clinical, economic, and political — focused predominantly on data in patients with advanced cancer to show the value of earlier specialty palliative care. We then use these data to propose initial priorities for clinicians and policymakers to achieve early integration of palliative care across all populations with serious illness.

THE CLINICAL CASE

Several randomized studies involving patients with advanced cancer show that integrating specialty palliative care with standard oncology care leads to significant improvements in quality of life and care and possibly survival .Randomized Trials of Early Specialty Palliative Care Interventions in Patients with Cancer.).6,9-12 Patients with advanced cancer who receive palliative care consultations early in the course of their disease report better symptom control than those not receiving consultations.11,12 Several prospective trials have also shown that early palliative care improves patients’ quality of life.10-12 For example, patients with metastatic lung cancer who receive outpatient palliative care from the time of diagnosis and throughout the course of their illness report better quality of life and lower rates of depression than do controls.11,13

Initiating palliative care upon diagnosis of advanced cancer also improves patients’ understanding of their prognosis.14 Patients with serious illness often feel that their doctors do not provide all available information about their illness and treatment options.1 These information gaps can lead patients to misunderstand their treatment goals. For example, recent studies show that the majority of patients with metastatic cancer incorrectly report that their cancer can be cured with chemotherapy or radiation.15,16 Palliative care clinicians can remedy this situation by helping patients develop a more accurate assessment of their prognosis.14Improved prognostic understanding may explain why patients with advanced cancer who receive early palliative care consultations are less likely to receive chemotherapy near the end of life than are controls.14,17

THE ECONOMIC CASE

Cost savings are never the primary intent of providing palliative care to patients with serious illnesses, for whom ensuring the best quality of life and care is paramount. Nevertheless, it is necessary to consider the financial consequences of serious illness, because 10% of the sickest Medicare beneficiaries account for nearly 60% of total program spending.18 The growing cost of hospital care is the main driver of the spending growth observed for seriously ill patients.19 Fortunately, the quality improvements offered by early specialty palliative care may also lead to lower total spending on inpatient health care.20Hospitals with specialty palliative care services have decreased lengths of stay, admissions to the intensive care unit, and pharmacy and laboratory expenses.9,21-23 One study estimated that inpatient palliative care consultations are associated with more than $2,500 in net cost savings per patient admission.23

Similarly, outpatient palliative care services have been estimated to reduce overall treatment costs for seriously ill patients by up to 33% per patient.6 Early outpatient palliative care achieves these savings by decreasing the need for acute care services, leading to fewer hospital admissions and emergency department visits.11,24 The site of death may be another mediator of savings, because patients receiving early specialized palliative care are more likely to forgo costly inpatient care at the end of life than are other patients.6 Outpatient palliative care may thus lower health care spending by reducing patients’ need for hospital and acute care. The goal of early palliative care, both in and out of the hospital, is to provide a better quality of life; cost savings through reduced resource use are an epiphenomenon of this better care.

THE POLITICAL CASE

These data show that earlier specialized palliative care services meet the “triple aim” of better health, improved care, and lower cost.25 Despite such positive outcomes, legislative efforts to support the delivery of palliative care have lagged behind clinical interest. High-profile and controversial legal cases, such as those of Terry Schiavo and Dr. Jack Kevorkian, have heightened public sensitivity about medical care perceived to hasten death. Similarly, the inflammatory language surrounding “death panels” that surfaced during the Affordable Care Act debate left legislators wary of addressing policies perceived as promoting end-of-life care.

However, policy momentum is now building, bolstered by evidence establishing the quality-of-life benefit of palliative care for patients with advanced cancer. Federal legislative proposals, including the Patient Centered Quality Care for Life Act and the Palliative Care and Hospice Education and Training Act, have built bipartisan support for federal and state legislation that addresses palliative care research, the palliative care workforce, and barriers to accessing care. These efforts foreshadow more legislative initiatives that prioritize quality of life and survivorship.

Although legislation is a key step toward changing policy regarding palliative care, the main impediment remains a matter of messaging. Reframing the policy and professional discussion around palliative care as a means to improve quality of life without decreasing survival is essential to make this advocacy agenda more politically tenable. More than 90% of Americans react favorably to a definition of palliative care that emphasizes it as “an extra layer of support” that is appropriate at “any stage in a serious illness.”1 Advocacy groups, practitioners, and researchers should use this language consistently to advance this effort to integrate palliative care earlier in illness.

SOLUTIONS TO MAKE THE TRANSITION

Although data to date support the use of early specialty palliative care for patients with advanced cancer, the clinical and economic benefits are likely to apply to other patient populations. Randomized trials of early palliative care have shown benefit for patients with chronic obstructive pulmonary disease, congestive heart failure, and multiple sclerosis.4,6,9 Further investigation of the role of early specialty palliative care in patients with other serious illnesses is clearly warranted. In addition, all clinicians caring for patients with serious illness, not just palliative care specialists, must be capable of practicing “primary palliative care,” which includes managing illness- and treatment-related symptoms to improve quality of life and assessing treatment preferences and prognostic understanding.26

Incentive Changes

To reinforce the practice of early palliative care for all serious illnesses, hospitals, insurance providers, and the government would need to provide practice and payment incentives for clinicians. Medicare reimbursement for clinicians to counsel patients about their goals and options for care throughout their illness is necessary to encourage and reinforce early palliative care. Unfortunately, congressional efforts to reimburse for this service have been unsuccessful. Hospital administrators have also identified several barriers to implementing consultative specialty palliative care teams, including limited institutional budgets, poor reimbursement, and few trained staff.27 Although public awareness of the clinical benefits of palliative care may itself drive hospital-level integration, increased reimbursement would most strongly convince hospitals and physicians to integrate primary and specialty palliative care into routine practice.

More broadly, reimbursement structures should encourage coordinated medical care that aligns treatments with patients’ goals. Health care systems that provide structured palliative care services in coordination with disease-centered treatment have enjoyed tremendous success. The Aetna Compassionate Care Program of early nurse-managed palliative care and advanced care planning alongside usual care has decreased hospital lengths of stay and admissions while decreasing costs at the end of life by 22%.28,29 The success of such initiatives should convince Medicare and commercial insurers to reimburse for palliative care services regardless of prognosis and treatment goals.

Educational Reform

Dedicated clinical exposure to seriously ill patients, in combination with structured didactic teaching, improves medical students’ attitudes toward palliative care.30 A study based on survey data from 1998 through 2006 from the Association of American Medical Colleges showed greater student exposure to palliative care training over the past decade.31 However, current curricula generally focus exclusively on care at the end of life. Instead, we believe that health professional schools should establish content areas in palliative care during the preclinical and clinical years and train students in managing symptoms, providing psychosocial support, and discussing prognosis and treatment preferences for all seriously ill patients. Furthermore, lawmakers should adjust the current cap on training positions in graduate medical education and increase funding for fellowship programs in palliative care to expand the palliative care workforce.

Expanding Hospital-Based Palliative Care Teams

Integrated palliative care requires patients to have access to palliative care services in the inpatient and outpatient settings, across both the acute and chronic phases of disease. Although hospital-based palliative care teams improve quality of care while reducing inpatient costs, their prevalence varies considerably according to geographic region and is quite low in some locations. Among adult-care hospitals with 50 or more beds, the statewide prevalence of inpatient palliative care teams ranges from 20 to 100% across the United States.32 Small, for-profit, and public hospitals are far less likely to have palliative care teams than large and nonprofit institutions.22 Hospital leaders should ensure that all hospitals have access to integrated palliative care services within the next decade. Data suggest that this trend has already begun: more than half of administrators at major cancer centers plan to increase palliative care professional recruitment in the short term.27 The American Hospital Association and Center to Advance Palliative Care have released guidelines advocating the use of specialist palliative care services for the management of complex conditions in inpatient settings.33 These efforts, coupled with strong external incentives such as Medicare Conditions of Participation and Joint Commission accreditation requirements, will reinforce hospital penetration of palliative care.

CONCLUSIONS

Early provision of specialty palliative care improves quality of life, lowers spending, and helps clarify treatment preferences and goals of care for patients with advanced cancer. However, widespread integration of palliative care with standard medical treatment remains unrealized, and more evidence is needed to show the potential gains of early palliative care in other populations. This will require improved public and professional awareness of the benefits of palliative care and coordinated action from advocacy groups, health professionals, educators, and policymakers. Patients who access earlier specialty palliative care have better clinical outcomes at potentially lower costs — a compelling message for providers, policymakers, and the general public.

Source: NEJM

 

 

China: Pollution Blamed for 8-Year-Old’s Lung Cancer.


To the list of China’s environmental horrors, add one: an 8-year-old with lung cancer. Doctors at a hospital in coastal Jiangsu province blamed the girl’s condition on pollution, according to a state media. The child, who has not been identified, reportedly lived near a busy road and was exposed to harmful particles and dust. She is being called China’s youngest-ever lung-cancer patient.

The news comes amid growing concern about the health effects of air pollution. Last month the World Health Organization for the first time classified air pollution as a cause of cancer. The agency said air pollution caused 220,000 cancer deaths in 2010 and that more than half of lung-cancer deaths from particulate matter were in East Asia. Lung-cancer deaths in China have multiplied more than four times in the past three decades, according to government statistics.

The problem is particularly bad in northern China, where coal-powered heating systems add extra filth to the mix. These emissions have shortened the lifespans of Chinese people living north of the Huai River by an average of five years, according to a study published this year by the Proceedings of the National Academy of Sciences, an American journal. In Beijing, the smog-addled capital, cancer is now the leading cause of death, with lung-cancer rates jumping 60% in a period of 10 years.

Chinese urbanites are all too familiar with chest-rattling smog. In the northern Chinese city of Harbin last month, the pollution was so thick that kids were granted a “smog day” off school, roads were closed and planes grounded. State media said the PM 2.5 reading (which measures the level of dangerous particulate matter in the air) “exceeded” 500. A Reuters report put the figure at 1,000, or 40 times higher than what the World Health Organization deems safe. Last year, Beijing endured weeks of off-the-chart pollution that English speakers now refer to as the “airpocalypse.”

Perhaps the only upside of the city-shuttering smog is that it has forced the Chinese government to own up to the problem. This fall, the government announced a new blueprint for cleaning up the air by 2017. The plan calls for 5 billion yuan, or $817 million, to fight pollution. There will also be color-coded emergency measures for bad pollution days in Beijing. On red days, for instance, half the city’s cars will be idled and schools closed. Under a code orange, factories will slow and activities like fireworks and outdoor barbecues will be restricted.

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These plans are better than nothing, but many wonder why the government hasn’t done more to keep people safe. After news of the 8-year-old’s diagnosis broke, hundreds of people commented on the story, wishing the child luck and expressing their own fears about living in a region where the air quite literally kills.

Channeling the sentiment of many here, one reader invoked a Chinese idiom: “Hao hao xuexi, tian tian xiang shang,” or, roughly, “Study hard and make progress every day.” Parents and teachers have been saying it for years, urging children to work harder, do better. But to this old phrase, they added a second bit of advice that reflects the dark mood as the country heads into another toxic winter: “Study hard and make progress every day,” they wrote. “And then leave China.”

Ketones, Cancer, and Eating Right.


The ketogenic diet goes against conventional wisdom asserting that we should consume a diet that is high in carbohydrates, and instead recommends a system based on the idea of putting the body in a state of “ketosis”. Ketosis is defined as a state of elevated ketone bodies in the human body. Ketone bodies are defined as three different water-soluble, biochemicals that are produced as by products when fatty acids are broken down in the liver for energy. Ketosis is achieved by reducing the daily amount of carbs in one’s diet, to 50 grams or less of carbohydrates. The premise being that your body will use fat and ketone bodies for energy, rather than glucose. Glucose is one of the main forms of energy that the body uses, and when carbohydrates enter the body, they are converted into glucose. So with the ketogenic diet, the goal is to essentially switch the body from a carb burning machine to a fat burning machine.

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Controversy 

The controversy has been around since physician and cardiologist Dr. Robert Atkins(1930-2003) has been preaching a low carb diet. This kind of diet flies in the face of conventional wisdom, which says that carbs are needed for energy, eating fat makes you fat, and weight loss is simply a calories in, calories out equation. As far back as 1973, the chair of Harvard’s nutritional department, went on record before a US Senate committee and denounced the Atkins diet. In 2003 the Physicians Committee for Responsible Medicinecame out against the Atkins diet, claiming that high fat, carbohydrate-restricted diets lead to increased risk of chronic health diseases and health problems. These same claims have been made for decades, and numerous medical associates and groups have spoken out against the Atkins diet, including the American Medical Association, American Dietetics Association, American Cancer Society, American Heart Association, The Cleveland Clinic, Johns Hopkins, The American Kidney Fund, American College of Sports Medicine, and the National Institute of health. Of course, there also exists plenty of evidence showing that a high carb diet can itself be harmful.

While the arguments for and against the low-carb, ketogenic diet are many, possibly the most common argument(and misconception) is in regards to what is referred to as ketoacidosis. Ketoacidosis is a condition in which abnormal quantities of ketones are produced in an unregulated biochemical situation. The amount of ketones produced during a ketogenic diet are far lower than in ketoacidosis, which is something that mainly affects patients with type 1 diabetes. This simple similarity in terms has led to a confusion regarding a low carb diet being dangerous.

Health Benefits of The Ketogenic Diet

There has been research done in the topic of using a ketogenic diet to treat cancer. Dr. Thomas Seyfried has published a book called, “Cancer as a Metabolic Disease: On the Origin, Management, and Prevention of Cancer”, and in it he brings together methods and findings regarding the sources and prevention of cancer that he spent many years working on at Boston College and Yale University. In the book, he writes “Emerging evidence indicates that impaired cellular energy metabolism is the defining characteristic of nearly all cancers regardless of cellular or tissue origin.” The main idea behind using a ketogenic diet as a cancer treatment, is to deprive the cancer cells of the glucose and other fuels they need to survive, and to provide support for the mitochondrial respiration process in healthy tissues. The obvious advantage to using the diet as a treatment, is that there are no harmful side effects that are so commonplace in conventional cancer treatments such as chemotherapy and radiation. The treatments have not always been successful, but newer research is showing that ketosis can be beneficial for many cancer cases.

Take the case of Dr. Fred Hatfield, a former power lifting champion, author of over a dozen books, and millionaire businessman. After being diagnosed with metastatic cancer in his skeletal system, he was given only three months to live by his doctors. He was preparing himself to die when he heard about an anti-cancer diet, so with nothing to lose he gave it a try. To his amazement, the diet worked, and his cancer is gone. “The cancer was gone! Completely. To this day there’s no trace of it, and it’s been over a year.” Important to note when undertaking this diet is that your body will need supplemental salt (NaCl) to offset the water retention lost during the change from a high carb to a low carb diet.

Another exciting development in the ketogenic diet it’s success at treating seizures of individuals with epilepsy. Several studies have shown the effects of the ketogenic diet with epileptic patients, and each study showed and massive improvement in most of the patients and even complete elimination of all seizures from some of them. Whether the ketone diet is always applicable or useful is a different question, but it seems clear that we can be healed or harmed through our nutrition.

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