4 Research-Backed Supplements to Boost Your Hair, Skin, and Nails


fish oilCollagen. Biotin. Shark cartilage. Frankincense. Even… placenta? Every day, patients in my dermatology practice ask about supplements claiming to restore or improve the skin, hair, or nails. But do they, really?

Unlike medicines, which are regulated by the Food & Drug Administration, over-the-counter supplements are subject to little oversight. There is no guarantee that their claims or ingredients are backed by science (or that the ingredients on the label are actually even in the tablet) – making the supplement aisle the wild west of every pharmacy. While no vitamin or supplement should ever be taken without consulting a physician first, there are a few that are backed by scientific research showing that they may have a positive effect on our strands, skin, or nails. Here are some of them.

For skin cancer prevention: Vitamin B3, also called nicotinamide, has been shown to lower the risk of nonmelanoma skin cancers (such as basal cell carcinoma or squamous cell carcinoma) and precancerous growths (called actinic keratoses). In a 2015 New England Journal of Medicine study of more than 600 patients with a history of skin cancer, 500mg of B3 taken twice daily led to a 23% drop in new cancerous growths over 1 year. Sun protection remains the most important way to lower skin cancer risk – but those stats aren’t too shabby, for a vitamin.

For brittle nails: Biotin (also called vitamin H or B7) was shown to increase nail plate thickness by 25% in patients with brittle nails, while reducing splitting and improving nail smoothness, according to studies from the Journal of the American Academy of Dermatology (JAAD) and Cutis. The optimal dose isn’t known, but dermatologists have suggested 2.5mg daily for those with delicate nails. Just be sure to let your doctor know if you take biotin, and consider holding off on the vitamin prior to any bloodwork: In 2017, the FDA issued a warning that it can interfere with certain lab tests, including some measuring cardiovascular and thyroid levels.

For thinning hair: As a dermatologist, I never used to recommend dietary supplements for patients with sparse or shedding hair, unless there was a specific nutritional or medical issue to correct. Now I sometimes do for patients with male or female pattern hair loss – the gradual thinning many of us are prone to later in life. Small, randomized, double-blind, placebo-controlled studies of men and women with thinning hair, published in the Journal of Cosmetic Dermatology and Dermatology Research and Practice, showed a significant increase in hair density with reduced shedding over 3 to 6 months on a marine supplement called Viviscal. And the plant-based Nutrafol led to an increased number of hairs, with increased thickness, volume and growth rate in women over 3 to 6 months, according to a May 2018 study from the Journal of Drugs in Dermatology. This supplement contains ingredients said to reduce inflammation, antioxidants to help guard against cell-damage, and saw palmetto, which may inhibit hormonal factors that can contribute to hair thinning.

For psoriasis: Fish oil supplements may help to alleviate rashes in those suffering from psoriasis – a chronic condition of scaly, pink skin that often affects the elbows, knees, scalp, and other areas. A 2014 meta-analysis published in JAAD showed a moderate benefit in psoriasis – reduced area of rash, and improved thickness and redness of psoriasis – after supplementing with omega-3 polyunsaturated fatty acids from fish oils (eicosapentanoic acid, EPA, and docosahexanoic acid, DHA). The study authors suggested doses of 0.45 to 13.5 grams of EPA and up to 9 grams of DHA daily – and explained that the supplements are expected to be most helpful when used along with established psoriasis medications.

For whatever ails you: If there’s a supplement you believe in, it might just work – due to the powerful placebo effect. Decades of research have shown that the expectation of results is sometimes enough to actually see results. That’s one reason I don’t discourage vitamins that have a decent safety profile, if a patient truly believes in them.

But before starting any supplement, be sure to talk to your doctor to find out if it’s right for you and whether it’s safe to take with other medicines.

The Truth About Melanoma and Skin Cancer: Facts and Common Myths


Often caused by excessive exposure to ultraviolet (UV) rays in sunlight, melanoma accounts for only 4 to 5 percent of skin cancer cases, but is responsible for most skin cancer-related deaths. As with many forms of cancer, melanoma is often misunderstood, and myths persist.

When detected and treated in its earliest stages, however, melanoma is often curable. The key is to avoid overexposure to UV rays – by limiting time outdoors during the peak hours of sunlight and wearing sun-protective clothing and sunscreen – and to be on the lookout for changes in moles and other blemishes that can be an early sign of the disease.

Jennifer Y. Lin, MD, of Dana-Farber Cancer Institute’s Melanoma Treatment Program, sets the record straight on five of the most common myths about melanoma.

Myth 1: A diagnosis of melanoma means that I have months to live.

There are four stages of melanoma — five if you include a form known as melanoma in situ, an early form of the disease that affects only the top layer of skin. Stage 1 melanomas, which are less than one millimeter thick and almost always have not spread beyond their original site, have an excellent prognosis and are generally cured by surgery. The depth of the original melanoma is critical to determining how it will be treated and how people with it are likely to fare. Although more melanomas are being diagnosed, the largest portion are made up of Stage 1 melanomas. Before worrying about the worst outcomes, speak with your doctor about what stage melanoma you have.

Myth 2: There is no difference between SPF 30 and SPF 100 sunscreen.

Although the baseline protection from SPF 30 and SPF 100 is not vastly different, the higher number provides longer coverage. (SPF stands for sun protection factor, or the amount of ultraviolet radiation the skin can absorb without burning while the sunscreen is on.)

If it normally takes you 10 minutes in the sun to burn, an SPF 30 sunscreen protects you for 300 minutes. An SPF 100 should, in theory, provide 1,000 minutes of coverage. If you are sweating and active, the sunscreen can rub off and should therefore be reapplied every two hours. When you are using a high SPF, there is a smaller likelihood of having a “missed spot.” A good way to know that you are applying enough sunscreen is to use the measurement of a shot glass of sunscreen for exposed sites.

Myth 3: If it is a cloudy day, I do not need to wear sunscreen.

About 80 percent of ultraviolet radiation reaches the earth even through clouds. Use a moisturizer with sunscreen daily, especially for areas that have high exposure, such as your face.

Myth 4: If I am low in vitamin D levels, I must get some sun exposure.

Although the skin is the most efficient site of vitamin D production, adequate amounts can be obtained from your diet and from supplements. Vitamin D helps you absorb calcium and build strong bones, so we frequently recommend supplements that include vitamin D and calcium.

Myth 5: If I have dark skin, I can’t burn and won’t get melanoma.

Even people with dark skin can burn if they’re exposed to the sun long enough. Although melanoma is much more rare in individuals of darker skin, it can occur. We recommend that darker-skinned individuals inspect their hands and feet once a month.

Source: Dana-Farber Cancer Institute.

For all book lovers please visit my friend’s website.
URL: http://www.romancewithbooks.com

Age may be a factor in facial skin cancer treatment


https://speciality.medicaldialogues.in/age-may-be-a-factor-in-facial-skin-cancer-treatment/

Common Blood Pressure Drug Tied to Increased Risk of Skin Cancer


People who take a certain diuretic prescribed to control fluid retention and treat high blood pressure may be more likely to get skin cancer than other individuals, a Danish study suggests.

While the drug, hydrochlorothiazide, has long been linked to an increased risk of sunburns, the current study offers fresh evidence that this commonly prescribed medication may also make people more likely to develop basal cell carcinoma and squamous cell carcinoma.

For the study, researchers examined national prescription registry data on hydrochlorothiazide use from 1995 to 2012 as well as cancer registry records on skin malignancies diagnosed from 2004 to 2012.

Overall, people who took hydrochlorothiazide daily for at least six years were 29% more likely to develop basal cell carcinoma and almost four times more likely to get squamous cell carcinoma than individuals who didn’t take this medication, the study found.

“We already knew that hydrochlorothiazide makes the skin more vulnerable to damage from UV light of sun or sunbeds,” said senior study author Anton Pottegard of the University of Southern Denmark.

“However, we did not know that hydrochlorothiazide use also appears to translate into an increased risk of non-melanoma skin cancer,” Pottegard said by email.

The study included more than 71,000 people with basal cell carcinoma, 8,600 patients with squamous cell carcinoma, and a control group of more than 313,000 people in the Danish population who didn’t have these malignancies but were otherwise similar to the cancer patients.

About 2.7% of patients with basal cell carcinoma and 2.1% of the control group were high users of hydrochlorothiazide, with a lifetime cumulative dose of at least 50,000 mg, or roughly six years of daily use.

Ten percent of squamous cell carcinoma cases were high users, as were 2.8% of people in the control group.

With the highest cumulative hydrochlorothiazide exposure – approximately 24 years of daily use – patients were 54% more likely to develop basal cell carcinoma and more than seven times more likely to get squamous cell carcinoma.

The study wasn’t a controlled experiment designed to prove whether or how hydrochlorothiazide might cause skin cancer.

Another limitation is that researchers lacked data on two main factors that influence the risk of skin cancer: ultraviolet light exposure and skin type, the study authors note online December 3 in the Journal of the American Academy of Dermatology.

“There may be a relationship between taking hydrochlorothiazide and risk for skin cancer,” said Dr. Aaron Farberg of the Icahn School of Medicine at Mount Sinai in New York City.

“However, the relationship may not be directly causative,” Farberg, who wasn’t involved in the study, said by email.

Even so, the findings add to the evidence suggesting that patients taking hydrochlorothiazide should take extra precautions to protect their skin from damage caused by the sun, said Dr. Elizabeth Martin, president of Pure Dermatology & Aesthetics in Hoover, Alabama.

“Everyone can reduce their skin cancer risk by avoiding unprotected exposure to UV light,” Martin, who wasn’t involved in the study, said by email. “Don’t use indoor tanning devices, and protect yourself from the sun by seeking sunscreen with an SPF of 30 or higher.”

Patients taking hydrochlorothiazide shouldn’t stop without first seeing a doctor, Pottegard cautioned. While there are other safe, affordable options to manage high blood pressure, patients already taking hydrochlorothiazide won’t meaningfully alter their skin cancer risk by staying on the drug for a few months until a physician can advise them, he said.

“If you are at an increased risk of skin cancer, due to high exposure to sunlight, have already experienced skin cancer, or are otherwise predisposed to skin cancer, you should consider consulting your physician regarding a potential therapy shift,” Pottegard said.

Artificial intelligence can now identify skin cancer as accurately as experts


And it could be coming to your phone.

 

A new artificial intelligence system can spot the tell-tale signs of skin cancer just as accurately as human doctors, say researchers, and the next step is to get the tech on a smartphone, so anyone can run a self-diagnosis.

Once the system is refined further and becomes portable, it could give many more people the chance to get screened with minimal cost, and without having to wait for an appointment with a doctor to confirm the symptoms.

 The Stanford University researchers behind the deep learning system say the key to its success is an algorithm that enables it to apply what it knows from its existing database of skin cancer samples to pictures it hasn’t seen before.

“We made a very powerful machine learning algorithm that learns from data,” says one of the team, Andre Esteva. “Instead of writing into computer code exactly what to look for, you let the algorithm figure it out.”

To give the system its smarts, the researchers trained it using 129,450 close-up images of skin lesions covering more than 2,000 different diseases, providing a vast database of examples to learn from.

Next, the team borrowed an algorithm developed by Google to spot the difference between cats and dogs in images, and adapted it to tell the difference between skin marks.

They put their new device up against 21 qualified dermatologists, who were shown 376 images of skin lesions and asked to judge if they would refer the patient for further analysis, or give them the all-clear.

Across the board, the AI was able to match the success rate of the professionals.

 But the technology isn’t designed to replace doctors – the researchers stress that it’s designed to give people easier access to the first two screening stages before getting expert help.

Spotting the difference between a deadly lesion and a benign one is no easy task, which makes the efforts of the AI system even more impressive.

But the researchers are cautious about releasing the tool to the public before they know it won’t make any false assessments, and real-world clinical testing should help improve it further.

Eventually, the team wants to make their device available through a phone app, so anyone can use it.

“My main eureka moment was when I realised just how ubiquitous smartphones will be,” says Esteva.

“Everyone will have a supercomputer in their pockets with a number of sensors in it, including a camera. What if we could use it to visually screen for skin cancer? Or other ailments?”

We’re now seeing numerous programs and apps, powered by the intuitive reasoning of artificial intelligence showing up on phones, and giving us cheap and easy ways of assessing our health at home – and that has to be better than just typing a few symptoms into Google.

And like many other diseases, early diagnosis of skin cancer crucial: if spotted early, 10-year survival rates are around 95 percent, but that drops to 10-15 percent if the cancer has reached its later stages before being treated.

Consultant dermatologist Anjali Mahto, spokesperson for the British Skin Foundation, told Nicola Davis at The Guardian that the findings were encouraging.

“This is an exciting new technology that has the potential to increase access to dermatology at a time where there is a national shortage in this speciality and the rates of skin cancer continue to rise,” she said.

Sunscreen is killing the coral, sea life & is causing skin cancer, NOT the Sun! (Video)


Image: Sunscreen is killing the coral, sea life & is causing skin cancer, NOT the Sun! (Video)

Elizabeth Plourde is talking about sunscreen that is killing the coral, sea life & is causing skin cancer.

Sunscreen Won’t Prevent Skin Cancer but Some Could Actually Cause It


Does wearing sunscreen prevent skin cancer? If you listen to public health officials that urge every man, woman and child to slather on sunscreen every day, you would think the answer is an unequivocal yes.

Aside from those who use sunscreen for the purpose of preventing wrinkles, it’s a safe assumption that many people use it with the intent of preventing skin cancer. But here’s the rub: wearing sunscreen may not actually protect you from cancer and, in some cases, may actually increase your risk.

Applying Sunscreen

Story at-a-glance

  • A study compared the daily application of sunscreen with the occasional use of sunscreen over a period of 4.5 years
  • There was no difference between the numbers of people who developed skin cancer in the daily or occasional sunscreen groups
  • Vitamin D levels above 40 ng/mL are associated with a more than 65 percent lower risk of cancer

Daily Sunscreen Use Versus Occasional Use: No Difference in Skin Cancer Rates

A Cochrane Review attempted to determine whether the use of topical sunscreen and physical sun-protective methods (such as wearing protective clothing, hats, and seeking shade) prevented the development of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) compared to taking no precautionary measures.1

There wasn’t much data on the topic to be found, so the review includes the results of just one study, which compared the daily application of sunscreen with the occasional use of sunscreen over a period of 4.5 years.

Among the more than 1,600 Australian participants, there was no difference between the numbers of people who developed BCC or cSCC (the most common types of skin cancer) in the two groups during the trial period.

As noted in the Cochrane Review, “So, there did not seem to be a difference in applying sunscreen daily compared with using it occasionally.”2

While I certainly don’t recommend spending so much time in the sun that your skin gets burned, the one-size-fits-all recommendation from public health officials to apply sunscreen daily may be causing more harm than good.

The fact is, sunlight offers many benefits to your health, the majority of which are only beginning to be understood. Meanwhile, most sunscreens contain harmful chemicals and may not protect your skin from overexposure the way you think they do. Some may even increase your risk of cancer.

Certain Sunscreens May Speed the Development of Skin Cancer

Close to 16 percent of U.S. sunscreens contain vitamin A, which sounds like a natural addition that might be beneficial for your skin, acting as an antioxidant.

However, retinyl palmitate, a form of vitamin A, has been found to promote the development of skin tumors and lesions when applied topically and exposed to sunlight.3

The U.S. Food and Drug Administration’s (FDA) National Center for Toxicological Research (NTP) has been studying the ability of vitamin A ingredients to trigger skin cancer when exposed to the sun for more than a decade.

One study on hairless mice revealed that the development of skin tumors was accelerated when a vitamin-A-laced cream was applied to the mice and then exposed to ultraviolet light daily for one year.4

Despite the known risks, these ingredients are still found in sunscreens with no warnings to consumers. The Environmental Working Group (EWG) reported:5

“Six years after EWG sounded the alarm about retinyl palmitate, the FDA still hasn’t completed follow-up studies that will allow the agency to take a position on the safety of vitamin A and related chemicals in cosmetics and sunscreens.

Most cosmetics companies have not removed these ingredients from sunscreens and other skin and lip products … EWG calls for sunscreen makers to voluntarily stop adding this ingredient to sunscreens until there is proof that it can be safely used on sun-exposed skin. …

EWG recommends that consumers avoid sunscreens and other skin and lip products containing vitamin A, retinyl palmitate, retinol, retinyl acetate, retinyl linoleate, and retinoic acid.”

The SPF Myth: Is Higher SPF Really Better?

Dermatologists at Northwestern University in Chicago conducted a survey to assess people’s understanding of sunscreen labels.6 Many people consider SPF (sun protection factor) as a leading factor in their decision of which sunscreen to buy, despite the fact that, in the study, fewer than half knew what SPF meant.

Meanwhile, most of the people surveyed believed that SPF 30 offered double the sun protection of SPF 15. It’s an understandable assumption, but one that’s blatantly false. In fact, the difference between the two is much smaller — about 4 percent.

While an SPF 15 sunscreen should filter out about 93 percent of UVB (ultraviolet B) rays, SPF 30 filters out about 97 percent. Higher SPFs offer only minute benefits beyond this, with SPF 50 blocking 98 percent, and SPF 100 blocking 99 percent, of UVB rays.7

While SPF works by absorbing, reflecting or scattering the sun’s rays on your skin, its protective ability is not linear and does not offer a great deal more protection at higher levels.

SPF Refers Only to Protection Against UVB Rays, Not UVA

In regard to SPF, another important factor to remember is that an SPF rating refers only to protection against UVB rays, which are the rays within the ultraviolet spectrum that allows your body to produce vitamin D in your skin.

But the most dangerous rays, in terms of causing skin damage and cancer are UVA rays. According to EWG:8

“A sunscreen lotion’s SPF rating has little to do with the product’s ability to shield the skin from UVA rays. As a result of the FDA’s restrictions on ingredients and concentrations, U.S. sunscreens offer far less protection against UVA than UVB, particularly those products with the highest SPF.

Because UVA and UVB protection do not harmonize, high-SPF products suppress sunburn much more effectively than other types of sun damage.”

Not to mention, studies show that high-SPF products may not offer the SPF they claim. One study found that even small differences in testing conditions of an SPF 100 sunscreen yielded results between SPF 37 and 75.9

The amount of sunscreen applied, sunlight intensity, sweat, swimming and more can all affect how much sun protection you actually receive. There’s also evidence that people tend to stay in the sun longer when wearing high-SPF sunscreens, putting them at risk of overexposure.10

No Evidence in Support of Full-Body Screening for Skin Cancer?

The nervousness people experience over threats of skin cancer such as melanoma is augmented by U.S. government intervention that equates sun exposure with skin cancer.11

Yet, at the same time, the U.S. Preventive Services Task Force (USPSTF) says there’s not enough evidence that screening for skin cancer can lower skin cancer cases or deaths.

Still, European studies suggest that after public awareness campaigns to inform people about whole body visual screening for skin cancer, the rates of melanoma, the most deadly type of skin cancer, and non-melanoma skin cancers went down, Time reported.12 According to The Washington Post:13

An editorial accompanying the task force’s statement said the ‘I’ rating [insufficient evidence] does not mean there is not a benefit from screening but that more research is needed to determine if it should be recommended — and, if so, for whom.

… the statement doesn’t apply to people who have skin lesions or any other kind of suspicious growths or to those with an increased risk of cancer or a family history of the disease.”

Optimal Vitamin D Levels Linked to 65 Percent Lower Risk of Cancer

Another way that wearing sunscreen daily has the potential to increase your cancer risk rather than decrease it is by blocking your body’s ability to produce vitamin D.

If you do not get regular sun exposure on your bare skin (or consume a vitamin D3 supplement), there’s a good chance you may be vitamin D deficient, which is a risk factor for cancer. One recent study published in PLOS One found vitamin D levels above 40 ng/mL are associated with a more than 65 percent lower risk of cancer. According to the researchers:14

We found a clear association between 25(OH)D [vitamin D] serum concentration and cancer risk, according to multiple types of analyses. These results suggest the importance of vitamin D for the prevention of cancer. Women with 25(OH)D concentrations ≥40 ng/ml had a significantly lower risk of cancer (~70 [percent]) compared to women with concentrations <20 ng/ml.”

Optimizing your vitamin D levels may reduce your risk of as many as 16 different types of cancer, including pancreatic, lung, ovarian, breast, prostate and skin cancers.

Higher Vitamin D Levels at Melanoma Diagnosis May Improve Prognosis

Studies show melanoma mortality actually decreases after UV exposure. Additionally, melanoma lesions do not tend to appear primarily on sun-exposed skin, which is why sunscreens have proven ineffective in preventing it. Exposure to sunlight, particularly UVB, is protective against melanoma (the deadliest form of skin cancer) — or rather, the vitamin D your body produces in response to UVB radiation is protective. The following passage comes from The Lancet:15

“Paradoxically, outdoor workers have a decreased risk of melanoma compared with indoor workers, suggesting that chronic sunlight exposure can have a protective effect.”

In another recent study, it was found that vitamin D deficiency at the time of melanoma diagnosis is associated with thicker tumors that likely have a poorer prognosis.16

The researchers believe increasing vitamin D levels to 20 ng/ml or higher (which is actually still a deficiency state) could result in 18 percent of melanoma patients having thinner tumors and therefore improved prognosis. If their levels were increased to optimal levels (50-70 ng/ml), it’s likely this rate would improve even more.

Oxybenzone: Another Reason Why Many Sunscreens Are Dangerous

Oxybenzone, a popular sunscreen ingredient that has been detected in nearly every American, is believed to cause hormone disruptions and cell damage that may provoke cancer.

This endocrine-disrupting chemical acts like estrogen in your body, alters sperm production in animals and is also associated with endometriosis in women. It has relatively high rates of skin allergy and is a highly skin-penetrating chemical.17 According to the Environmental Working Group (EWG):18

“…the chemical oxybenzone penetrates the skin, gets into the bloodstream and acts like estrogen in the body. It can trigger allergic reactions. Data are preliminary, but studies have found a link between higher concentrations of oxybenzone and health harms.

One study has linked oxybenzone to endometriosis in older women; another found that women with higher levels of oxybenzone during pregnancy had lower birth weight daughters.”

There’s really no reason to risk exposure to this chemical, as safer alternatives exist. In lieu of the skin-penetrating hormone-disrupting chemicals like oxybenzone, safer sunscreens tend to use non-nanoparticle sized zinc- and titanium-based mineral ingredients, which block the sun’s rays without penetrating your skin.

Four Steps to Safely Enjoying the Sun

Applying chemical sunscreens every time you step outdoors may do little to prevent your risk of skin cancer while raising other risks. In addition, you’re blocking your body’s production of vitamin D and possibly some of sunlight’s other health benefits, like its pain-relieving properties. That being said, you don’t want to overexpose your skin to the sun and end up with a sunburn, either. To continuously enjoy the positive effects of sun exposure without getting burned, I recommend following these simple safety tips:

1.Protect your face and eyes by wearing a wide-brimmed hat or a cap. The skin around these areas is much thinner than other areas of your body and is more at risk for cosmetic photo damage and premature wrinkling. If it’s too hot to protect your skin by covering with light clothing, and you’ll be outside for extended periods, be sure to use a natural mineral-based broad-spectrum sunscreen on your skin — these products often contain zinc.

2.Limit your initial sun exposure and slowly work your way up. If you are a fairly light-skinned individual who tends to burn easily, limit your initial exposure to just a few minutes, especially if it is in the middle of summer. The more tanned your skin gets, the longer you can stay in the sun without burning. If it is early or late in the season and/or you are a dark-skinned individual, you could likely safely have 30 minutes on your initial exposure.

3.Build an internal sunscreen with beneficial antioxidants. Astaxanthin, a potent antioxidant, can be used both internally and topically to protect your skin from the sun. You can make your own lotion by adding astaxanthin to organic coconut oil, but be careful of staining your clothing, as astaxanthin is dark red.

Other helpful antioxidants include proanthocyanidins, resveratrol and lycopene. Eating healthy is also important. Fresh, raw, unprocessed foods deliver the nutrients your body needs to maintain a healthy balance of omega-6 and omega-3 oils in your skin, which is your first line of defense against sunburn.

Fresh, raw vegetables also provide your body with an abundance of powerful antioxidants that will help you fight the free radicals caused by sun damage that can lead to burns and cancer.

4.Moisturize your skin naturally. Before sunbathing, apply organic coconut oil on the exposed areas of your skin (as noted above, you could add some astaxanthin to the oil for an added measure of protection). This will not only moisturize your skin to prevent dryness but will also give you additional metabolic benefits.

Coping with Active Surveillance


Has your doctor said that active surveillance,also known as watchful waiting, is a treatment option for you? Many people with early forms of prostate cancer, breast cancer, thyroid cancer, lymphoma, and skin cancer are told they should consider this option. But even if you’ve made the choice to go that route, you may still worry about what’s happening in your body. MSK psychiatrist Andrew Roth offers strategies to help you cope.

Highlights
  • Active surveillance can be a welcome alternative to surgery, chemotherapy, and other more aggressive forms of treatment.
  • Some people struggle with the uncertainties and lack of closure with this option, however.
  • Our experts offer advice and support to help you cope.

It’s the dreaded diagnosis: cancer. But instead of surgery, radiation, or another invasive treatment, your doctor recommends that you enroll in a program of active surveillance, also known as watchful waiting.

This can be positive news in many ways. With active surveillance, you have the benefit of not having to go through surgery or experience uncomfortable side effects from medicines or radiation therapy. Instead, you agree to a regular schedule of check-ins, scans, or other tests to make sure your cancer isn’t growing or changing over time.

Cancer sometimes grows very slowly or not at all. As doctors learn to better predict whose tumors will get bigger or spread, they’re increasingly recommending active surveillance for patients with certain early forms of prostate cancer, breast cancer, thyroid cancer, lymphoma, and skin cancer.

“Active surveillance is a great choice for a lot of people,” says Memorial Sloan Kettering psychiatrist Andrew Roth. “But it’s not for everyone.” For some people, just knowing there’s something abnormal going on in their body makes them very anxious. “With active surveillance, there’s a burden in knowing that things aren’t neatly tied up and behind you,” he explains. Even if it’s not likely, “you have to face the possibility of needing more invasive treatment down the road.”

He offers these ways to cope:

Leave the Worry to Your Doctor

We live in an information-saturated world, and it’s easy to question and second-guess a doctor’s advice. Some people travel to different doctors for testing and second opinions, for example. Or they spend hours on the internet reexamining their options.

Dr. Roth recommends that once you find a doctor you trust, try to accept his or her conclusion that active surveillance is the best choice for you. “It’s hard,” he explains, “but if you can, let the doctor worry for you.”

Then, he says, focus on what you can control. For example, ask the doctor to explain how your age, general health, and family background contribute to active surveillance being right for you. He or she can also put into perspective any confusing statistics about treatment choices and outcomes.

“The more the doctor can help you understand why active surveillance is a good choice for you as opposed to other treatment options, the more confident you’ll likely feel,” says Dr. Roth.

Don’t Go It Alone

When dealing with cancer, emotional support is crucial. So when it’s time for your regular surveillance checkup, Dr. Roth recommends asking a friend or family member to come along for companionship and comfort.

This person can also take notes — by keeping track of what the doctor says, you’re less likely to get confused or distort the facts later on. Dr. Roth suggests repeating back what you’ve heard before the appointment ends. “Try saying, ‘So what I hear you telling me is….’” This can help with a reality check later on, if you start to question what the doctor actually said.

Reaching out to other people in active surveillance is also a good idea, he adds. Join a support group. Professional counseling can also help, as can meditation, relaxation, yoga, and other activities, all of which are offered through MSK’s Integrative Medicine Service.

MSK internist Debra Mangino

Consider Lifestyle Changes

“Being in active surveillance is a great opportunity to start taking better care of yourself,” adds Dr. Roth. Make sure you’re eating well and exercising, “without going bananas.” The feel-good endorphins will help you handle stress better. “And while you’re exercising, you’re at least not focusing on cancer or being in active surveillance,” he adds.

Find Distractions

It’s normal to worry a bit, notes Dr. Roth. You may occasionally feel buyer’s remorse. When this happens, he suggests reminding yourself that if there were a more “right” decision, your doctor would have said so at the start. “Don’t miss enjoying life because you’re worried about what might happen down the road!” he adds.

Discover the power in keeping busy. Distract yourself with whatever works for you — crossword puzzles, cooking, listening to music, anything that keeps your mind occupied.

“And then think about what you’ve gained,” he suggests, like freedom from the side effects and other difficulties that can happen with surgery and other more invasive treatments.

Screening Tips for Finding Skin Cancer Early


As we peel off winter clothing and head for the beach, it’s a perfect time to learn about the benefits of screening exams for melanoma and other skin cancers. Preventing these cancers withsun safety awareness is important – but so is detecting skin lesions in their earliest, most treatable stage.

Skin cancer screeningsMelanoma, the deadliest form of skin cancer, is now the fifth most common cancer in men and the seventh most common in women in the United States. About 42,670 melanoma cases in men and 31,200 in women are projected for 2015, with 9,940 deaths. It’s also the only preventable cancer with a rising incidence rate in this country.

Most people who have thin, early melanoma tumors can be cured or have long survival, but after the cancer has spread inside the body, survival drops drastically.  Melanoma most commonly arises in the skin and with awareness and examination can be directly spotted in its very early stages – a huge advantage over most other cancers.

No nationwide policy on melanoma screening exists at present, but the evidence for its effectiveness is growing. A 2012 study reported that population-wide screening over 10 years in a region of Germany reduced melanoma deaths by 40 percent.

The American Academy of Dermatology (AAD) encourages individuals to have skin exams at intervals recommended by a dermatologist. The frequency of screenings should be based on risk factors. Risk factors include having fair skin, a family history of skin cancer, a personal history of excessive sun exposure, or tanning bed usage. Other risk factors are a tendency to freckle or having many moles that are atypical. Another high-risk group is Caucasian men over the age of 65, who frequently have advanced melanomas at the time of diagnosis.

“The main message is, the more awareness the better,” says Jennifer Lin, MD, dermatology director  in the Dana-Farber/Brigham and Women’s Cancer Center’s (DF/BWCC) Melanoma Treatment Center. “This includes yourself or anyone who sees your skin; there is a movement to train hair dressers and masseurs to check the skin.”

Primary care physicians don’t necessarily do skin exams as part of a routine physical, so Lin suggests that individuals who are concerned about melanoma or other skin cancers ask their primary care physicians to perform an examination, or be referred to a dermatologist.

Experts recommend monthly self-exams starting at age 18.

“Routine self-exams, especially while referring to a  photo of what melanoma should look like, lead to thinner tumors and better prognosis,” says Lin. The acronym ABCDE is a reference for the warning signs of melanoma:  A is for Asymmetry; B is for Border irregularity; C is for varying Color, D is for Diameter, typically greater than the size of a pencil eraser; E is for Evolving or changing in size, shape or color over time.

“Change is one of the most important things we want to hear about,” emphasizes Lin. “Get to know your skin. Check your skin routinely on a monthly basis – it is a cheap and effective safety measure you can do for yourself and your family.”

Learn more from this guide to self-screening from the Melanoma Research Foundation.

Throughout the summer, the Dana-Farber Blum Family Resource Center Van will bring its traveling Sun Safety Education and Skin Cancer Screening Program to various locations throughout Massachusetts. For more information about these screenings, email Sabrina_Gonzalez@dfci.harvard.edu.

In addition, the American Academy of Dermatology sponsors a nationwide skin cancer screening program, SPOTme(TM) that offers free screening at community events in collaboration with the National Football League and other organizations. In May, which is Melanoma Skin Cancer Awareness Month, AAD dermatologists are offering free screenings at locations in Massachusetts and other states listed on this page.

Scientists are using herpes to treat skin cancer .


In a few months time, those suffering from skin cancer may find an unlikely hero in their treatment regimen: herpes. A modified version of the Herpes Simplex 1 virus (known for causing cold sores and some cases of genital herpes) called T-Vec has successfully been used to treat melanoma in a phase III clinical trial. That means it’s just waiting for a final okay from the FDA before the Amgen product can hit the market. The results of the trial were published Tuesday in Journal of Clinical Oncology.

In a study of 436 patients with inoperable melanoma, Talimogene Laherparepvec had 16.3 percent of patients showing results at the six-month mark, compared to 2.1 percent taking the control therapy. Some patients were continuing to respond to T-VEC three years later.

Patients with stage III and early stage IV melanoma treated with T-VEC (163 people in all) lived an average of 41 months. This compared with an average survival of 21.5 months in the 66 earlier-stage patients who received the control immunotherapy. Immunotherapy, where agents are used to boost a body’s natural defense against a tumor, are already the best treatments against melanoma. But this is the first time a modified virus has been successful in carrying out that treatment.

Using a virus as a drug isn’t a new idea. Phage therapy, where viruses that attack certain bacteria are used in place of antibiotics, is commonly used in Europe and on the rise in the United States. But cancer therapies like the one described in the new paper take things a step further, manipulating existing viruses to turn them into cancer-fighting tools.

Kevin Harrington, Professor of Biological Cancer Therapies at The Institute of Cancer Research and head of the trial, has been working on this particular virus for about a decade. Before he signed onto the project, it was primarily being investigated as a breast cancer treatment. But Harrington brought head, neck, and skin cancer patients into the mix, and melanoma seemed to have the best responses of all.

Here’s how T-VEC works: It starts with the herpes virus, which is magnificent at proliferating itself within cells and then causing them to burst (that’s where the cold sores come from). But T-VEC has had two key genes removed. These keep it from replicating within healthy cells, which can quickly spot it because of the missing genes.

 

But cancer cells aren’t as savvy, and T-VEC has its run of them. Meanwhile, T-VEC has also been modified to produce a molecule called GM-CSF, which serves as a red flag waved at the immune system.

So in addition to the destructive power of the T-VEC cells themselves, the therapy summons the immune system right to where it’s needed — the tumor.

“This is a first in class agent, a brand new therapy,” Harrington said. “But it’s just the farthest along of what we hope will be many more.”

Harrington expects the FDA to clear T-VEC within the year, and it could potentially be available to patients right away.

But there’s more work to be done to determine just how T-VEC can fit into the cancer-treatment landscape. When the latest trial was started, Harrington explained, there was no standard of treatment for melanoma — so it’s compared to a treatment that no one expected to outpace T-VEC. Now that other therapies  — ones that target specific mutations in patients’ cancer cells — are showing more success than what was available when the trial was formed, researchers will have to see how T-VEC compares.

“The next steps are exciting, and already underway,” he said. “The next big frontier will be to combine this with existing immunotherapies. There’s a strong rationale that other drugs on the market could act synogistically with ours.”

Trials are also underway to determine how T-VEC might do with other cancers. In the meantime, other researchers will continue to crack the codes of other viruses to make them do our bidding.