Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

The American Cancer Society

Success In The Past And Hope For The Future

by Dr. Len November 25, 2008

Since 1998, the American Cancer Society along with the National Cancer Institute, the Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries have provided an “Annual Report to the Nation on the Status of Cancer.”  This year’s report has just been released in the current issue of the Journal of the National Cancer Institute.


For the first time in the history of these reports, the researchers have found that both the incidence rates and deaths from cancer in both men and women are declining.


But before you become too excited, you need to remember that we still have a long way to go in our efforts to reduce the burden and suffering from the diseases we commonly call “cancer.”


First, some good news:


From 1999 through 2005, the rate of cancers diagnosed in the United States has declined 0.8% each year for men and women combined.  From 2002 to 2005, the rate of death from cancer has also declined 1.8% a year.  In 2005, 106,000 deaths from cancer were averted as a result of our progress.


For men, lung cancer incidence and deaths have been declining since the early 1990’s at a rate of 1.8% per year for incidence and 1.9% each year for deaths.  That’s because men decreased their cigarette consumption years ago.  Over that time, hundreds of thousands of lives have been saved.


Now, some not so good news:


For women, the incidence rates for lung cancer have been increasing year over year since 1975 and they continue to grow even now.  And, although death rates from lung cancer in women may not be climbing any longer, they aren’t declining either.  This is a direct result of the “You’ve come a long way, baby” advertising theme that was prominent in the 1970’s and hooked women born between 1950 and 1960 on cigarettes.


Much of the improvement in incidence and deaths in men is due—as noted—to the decline in cigarette consumption, as well as a decline in colorectal cancer and prostate cancer incidence and deaths.


For women, the decrease in incidence and deaths is due primarily to the changes in rates for breast cancer and colorectal cancer, in part because of a decrease in the use of hormonal replacement therapy and more women being screened for colorectal cancer.


When you look at the trends for individual cancers, you find some interesting information.


For example, among men, the incidence rate for prostate cancer is dropping 4.4% per year from 2001 to 2005. This may be due to a “leveling off” for PSA testing, meaning that fewer prostate cancers are being diagnosed in the first place.   Incidence rates for some other cancers in men have been increasing, including a 7.7% increase year-over-year for melanoma and 2.4% per year increase for liver cancer in men.  


For women, incidence rates for breast cancer are going down 2.4% a year from 1999-2005, and colorectal cancer is declining 2.2% per year.  Melanoma is rising 2.3% per year, and thyroid cancer continues its rapid increase at 6.9% per year from 1997-2005.


When examining death rates in men for common cancers, we find that colorectal cancer is decreasing 4.3% per year from 2002-2005 and stomach cancer deaths are falling 3.7% per year.


For women, colorectal cancer deaths declined by an annual rate of 4.3% per year from 2002-2005, and cervical cancer continues to fall at a rate of 3.4% per year from 1995-2005.


We hope that the decline in cancer incidence is due to better health and nutrition, higher rates of screening, and better treatment among other factors.  But, when you consider that this reflects the numbers of cancers that are actually diagnosed, it may be problematic since it is possible that fewer cancers are being diagnosed because people aren’t getting screened or can’t afford to go to the doctor.


Deaths from cancer, on the other hand, tend to a more reliable measure of the impact of our efforts.  In a sense, they represent the sum of our efforts when it comes to lifestyle, prevention and early detection and appropriate treatment.  There is no question that the rate of death from cancer has been declining for many years, which means we are clearly doing something right.


The report also provides considerable detail on our efforts to curb cigarette smoking and its inevitable impact on cancer deaths.


In those states where they take the prevention of deaths from lung cancer seriously, there are fewer smokers and fewer lung cancer deaths.  And, in those states where they snub their noses at the issue, there are more smokers and more deaths.


Consider Utah, Kentucky and California.


Lung cancer incidence for men in Utah is 39.6 newly-diagnosed lung cancers per 100,000 men per year.  In Kentucky, the number is 136.2, or more than 3 times greater.  For women, the incidence numbers are 22.4 in Utah and 76.2 in Kentucky, respectively.   Lung cancer death rates for men are 33.7 lung cancer deaths per 100,000 men per year in Utah and 111.5 in Kentucky.  For women, the corresponding numbers are 16.9 in Utah and 111.5 in Kentucky.


California is cited in the report for having the greatest changes in lung cancer death rates over time.  In California, the death rates for lung cancer in men are now approaching the death rate in Utah.


Utah has a culture that does not encourage smoking.  But how did California accomplish its remarkable results?  From 1996 through 2005, the decline in lung cancer deaths in men was 2.8% each year.  This was more than twice the decline seen in many states in the Midwest and South, according to the report.


California accomplished this goal by being the first state in the United States to implement a comprehensive state-wide tobacco control program, as noted by the report’s authors.  As a result, they have made the greatest progress in reducing tobacco use.  Clean indoor air laws, high tobacco taxes, and advertising and education worked to get the job done.  The citizens of California are being rewarded with better health and fewer lung cancer and tobacco-related deaths because California cared enough to do something bold.


States that don’t embrace these proposals see their citizens needlessly die prematurely every day.  That--to me and many others--is simply not acceptable.


What does the future hold?


We have the power within ourselves to reduce the burden and suffering from cancer right now.  We can pay more attention to what we can do to keep ourselves healthy.  It isn’t a guarantee, but it does improve the odds.  Exercising, eating a healthy diet, maintaining a healthy body weight, not smoking and getting screened for breast, cervical and colorectal cancers among others are all part of a healthy lifestyle.


Access to affordable, quality health care is another necessary step forward in moving us to our goal of reducing the risk and burden of cancer.  Too many people in this country don’t have that access, and the American Cancer Society recognizes that we need to make access to health care a nationwide priority if we are going to be successful in our journey.


We need to continue and expand our investment in cancer research, to continue our efforts to understand how cancer cells work and what we can do to exploit their weaknesses and improve our treatments. 


And, lest we forget, we have a lot to do to improve the support we provide our patients throughout the cancer experience, especially for those who need comfort and care as they approach the end of their personal journeys. 


At this time of the year, as we celebrate Thanksgiving, there is one overarching thought that I believe summarizes the successes reflected in this report and the successes we hope to achieve in the future:


This Thursday, hundreds of thousands of people will be sitting down with their families and friends to enjoy a wonderful Thanksgiving dinner.  They are fathers, mothers, brothers, sisters, sons, daughters, friends and colleagues who would not have been with us for the celebration were it not for the progress we have made in the fight against cancer.  Some of them may not even be aware how special they are, and that is the greatest blessing of all.


It doesn’t get much better than that.


Happy Thanksgiving to all!!!



Filed Under:

Cancer Care | Prevention | Treatment

The Numbers Tell The Sad Tale Of Tobacco Tragedies

by Dr. Len November 13, 2008

No sooner had I completed posting my blog this morning about the Great American Smokeout than two new tobacco-related reports appeared in my email from the Centers for Disease Control and Prevention.  The articles detailed the latest information from the CDC on cigarette smoking in the United States, including the economic impact as well as years-of-life-lost in this country due to tobacco use and exposure to second-hand smoke.


Some success, to be certain,  but also sad and substantial failures.  The price that tobacco makes us pay--both in lives and money--defies our ability to comprehend much less accept.


The information describing the number of current smokers was interesting.  For several years, the percentage of adult smokers who fit the definition of “current smokers” in the United States has remained fairly steady at around 21%. In 2007, fortunately, the most recent survey data from CDC show that number has declined about 1% to 19.8%.  That is a significant year-over-year improvement.


As one might expect, more adult men (22.3%) than women (17.4%) are current smokers.  Somewhat surprisingly—given the past high rates of smoking in the African American community and as discussed in a recent blog—more whites (21.4%) than blacks (19.8%) are current smokers.  Blacks also had a large decline in smoking prevalence from 2006 to 2007, going from 23% of adults to 19.8%.  That’s an absolute reduction of over 3% and a relative decline of over 14%.  This considerable decrease sustained over time explains why the rates of smoking related cancers have fallen so much in the African American community. 


The report also notes that 13.3% of Hispanic adults are current smokers, which is far less than most other ethnic groups.  Higher education and socioeconomic status were also associated with much lower smoking rates.


Unfortunately, the report confirms once again that most smokers who try to quit simply don’t use recommended methods or avail themselves of counseling services such as the American Cancer Society’s Quitline discussed in my blog earlier today.  The net result is that only 10-20% of smokers who try to quit are able to stay cigarette-free at 3 months.


The somewhat good news, according to the CDC report, is that young adults were more likely to quit smoking during the survey year.  Stopping smoking earlier is associated with a lower rate of premature death later in life.  Young adults have better success at quitting since they haven’t had as long a time to be addicted or develop the ingrained social and behavioral habits associated with smoking. And, they are more likely to live in environments which support their desire to quit according to the CDC.


When it comes to the human and financial side of the equation, the numbers are staggering according to the second CDC report. 


The latest data from 2000-2004 shows that cigarette smoking and exposure to tobacco smoke (second-hand smoke) leads to at least 443,000 premature deaths each year.


That is a horrendous number.  But think about this one: each year, smoking and exposure to second-hand smoke results in 5.1 million years of productive life lost.  5.1 MILLION YEARS!!!!  That is an astounding number of years that mothers, fathers, sons, daughters, family members, friends, co-workers and others are lost to each of us.


The new analysis also shows that 49,400 lung cancer and heart disease deaths are related to second-hand smoke every year.


In terms of financial impact of productivity losses related to tobacco use each year—which to me is important but pales in comparison to people dying needlessly and prematurely— amounted to $96.8 billion.  Health care costs attributable to smoking amounted to another $96 billion.  The total cost per year? About $193 billion.


And what do we do as a country to combat these losses?  How many billions do we spend to reduce tobacco dependence?  The answer: about $595 million on comprehensive statewide tobacco prevention and control programs.  That is 325 times less than the amount of money we spend on tobacco related health costs and productivity losses every year. 


Does anyone care about this carnage?  Does it make a difference to our legislators?  Are we that inured to these numbers that no one understands the harm that tobacco brings to our country and our children?  Doesn’t this make you mad as heck and want to demand that something be done?


My friends, this is personal to every one of us.  Every one of us knows someone who has been impacted by the end result of using tobacco as intended, which is sickness and death.  Every one of us knows someone who is ill or has died prematurely because they smoked.  Every one of us has seen first hand the impact of the tragedy that we call tobacco.


Yet we still have to plead our case to enact and enforce clean-indoor air laws.  We still have to plead our case—especially in the southeastern United States and in Washington—that tobacco taxes must be raised to effectively stem this epidemic.  And we still have to plead our case that the United States sign on to the international treaty that will help control our exporting the tobacco scourge to developing countries around the world.


When, I ask, are we going to wake up and demand more?  Aren’t these numbers enough to get some action where it is needed most?


That action is too late for the thousands who have died already this year.  That action can’t come too soon for those who may be the next years’ and the next generations’ victims.


The slaughter is beyond our ability to imagine and comprehend, and these numbers prove it.  Millions of lives here in the United States and throughout the world depend on our commitment and our success to make this death-dealing product go away.



Filed Under:

Lung Cancer | Prevention | Tobacco

Great American Smokeout: A Time To Quit

by Dr. Len November 13, 2008

It’s never too late to stop smoking.  And it isn’t too early—if you or a loved one or good friend is a smoker—to start thinking about next week’s Great American Smokeout.


The Great American Smokeout—or GASO, for short—is a signature American Cancer Society event that occurs every year on the Thursday before Thanksgiving.  This year’s GASO celebrates the 32nd anniversary of this successful program which began in 1976. 


Since GASO started, millions of men and women in this country have stopped smoking, and millions more haven’t started.  In fact, today there are more former smokers in the United States than current smokers.  But we still have about 20% of adults in this country still smoking cigarettes.  Unfortunately, that number is not falling as much as it did when GASO was first introduced over 30 years ago.


Did you know that the American Cancer Society estimates that since the early 1990’s hundreds of thousands of lives—especially among men--have been saved as a result of tobacco cessation and decreased uptake of the smoking habit?  But we still lose over 435,000 people every year because of tobacco, which is the leading preventable cause of cancer deaths. If you smoke, the odds are 50% that it will lead to your death, frequently prematurely.


Tobacco increases cancer deaths from 15 different cancers, including many forms of head and neck cancer, esophageal cancer, stomach cancer, kidney cancer and cervical cancer among others.


And it’s not only the people who smoke who die prematurely from tobacco.  The American Cancer Society estimates that there are 38,000 deaths in this country every year from the effects of second-hand smoke.  The impact of smoking on children and their respiratory health is also well documented.


Tobacco is one of the most powerful addicting substances we know of.  Despite that power, almost half of the nation’s 45.3 million smokers tried to quit sometime during the past year.  Unfortunately, many of them weren’t successful.  But that shouldn’t take away from the message that many desperately want to do something for their health.  


The power of addiction is strong, but there has never been a better time to quit smoking than right now.  We know so much more now about how to help people quit.  We know that it is tough to do.  We know that it can take many—yes, many—attempts at quitting before you are successful.  We know that the best way to quit is to take the first step to put a plan in place that will help you focus on what you have to do to quit smoking.


There are lots of ways to help you quit.  There are patches, lozenges, gums, sprays, and now effective medicines that can help you achieve your goal.  We have telephone counseling services that are there to counsel you during your journey, and can double your chances of success.


In fact, the American Cancer Society’s Quitline has provided support to over 380,000 smokers since its inception in 2000.  And it’s only a phone call away at 800-227-2345 (800-ACS-2345).


We have internet-based tools at www.cancer.org/GreatAmericans  that can explain the best ways to quit, and provide you with information regarding the resources available to move you to success.


We have made remarkable progress in this country in reducing the burden of tobacco-related disease, but we have a long way to go. 


Over half the communities in this country now have smoke-free laws.  43 states have raised tobacco taxes since 2000.  The average tax nationwide on a pack of cigarettes is now $4.32.


One of my favorite examples of what can be accomplished is New York City, where the number of adult and teen smokers has dropped dramatically since the mayor, health commissioner and city council committed their authority and their resources to reducing cigarette consumption.  The results (as previously reported in this blog) are nothing short of stunning.  And if they can do it in New York, as the song goes, they can do it anywhere.


A journey begins with but one step.  Start thinking today about taking that step next Thursday or any day of your choosing. Gather your friends and family around you and have them help you to begin your journey to become your own smoke-free zone. 


Go to the web at www.cancer.org/GreatAmericans and check out the information on how to get started.  Or call us at anytime—24 hours a day, 7 days a week—at 800-227-2345 and learn about how you can stop smoking and where you can get counseling and other help to get you to your goal.


We hope and pray that next year at this time, in Frank Sinatra’s words, you will find yourself “A number one, top of the list, king of the hill.”


Don’t forget: If they can do it there, you can do it anywhere!!!







Filed Under:

Lung Cancer | Prevention | Tobacco

Vitamin D Fails To Decrease Breast Cancer Risk

by Dr. Len November 11, 2008

Finally, we have the results of a large scale randomized, placebo-controlled clinical trial to tell us whether or not vitamin D can reduce the risk of breast cancer.


The study, reported in today’s issue of the Journal of the National Cancer Institute, concludes that there is no evidence that vitamin D decreases breast cancer incidence in post-menopausal women.


But I will bet you dollars-to-doughnuts (well, maybe not doughnuts—they are fattening) that this study isn’t going to provide closure to the hotly-debated question of whether or not vitamin D reduces breast cancer risk.


The study was part of the larger Women’s Health Initiative which was designed to look at the impact of hormone therapy on the health of post-menopausal women.  As part of that study, close to 18000 post-menopausal women were randomly assigned to take 1000 mg of calcium and 400 IU (international units—the recommended daily allowance for vitamin D) daily.  The other 18,000 women took placebos.


The problem is that both groups of women were allowed to take extra vitamin D and calcium, and a good number of them did just that—although the number of women who did so was basically the same in both groups. By year 6 of the trial, about half of the women in both groups were taking extra vitamin D.


The end result was that over the seven years of this study, there was no difference in the frequency of breast cancer between the two groups.  The vitamin D did not make a difference in how often women developed breast cancer.


An editorial that accompanied the report pointed out some of the problems with the study, and which I would also consider important:


  • There were large number of women took vitamin D and calcium on their own, even if they were selected as part of the vitamin D treatment group or as part of the placebo group.  


  • Breast cancer takes a long time to develop in most women.  Seven years may simply not be enough time to detect a benefit that may have been seen if the study was longer. 


  • It is possible based on the results of other studies that vitamin D would be more effective if given to pre-menopausal women as opposed to post-menopausal women as was the case in this study. 


  • Some experts recommend a fairly high dose of vitamin D to prevent cancer which is much greater than that studied here (however, if women were taking vitamin D on their own, it is quite possible that they were taking doses greater than 1000 units a day).


In the same editorial, the authors wrote:


“Because preclinical, epidemiological, and clinical trial results of vitamin D supplementation are conflicting, additional studies will be needed to determine whether vitamin D plus calcium will prevent breast cancer…Future clinical trials should address the above questions to help determine whether higher does of vitamin D supplements will be cancer preventive.  The potential health benefits of vitamin D and calcium may yet have a bright future.”


Another interesting finding pointed out by the authors of the research report was that vitamin D blood levels measured at the beginning of the study didn’t necessarily relate that closely to the amount of vitamin D that the women had been taking in the past.  High vitamin D intake did not necessarily mean high vitamin D levels in the blood.  That raises the question of how much vitamin D our bodies absorb when we take supplements.  Those amounts may be different in different people, and may be controlled by other factors such as our genetic makeup.


The authors concluded:


“Such results suggest that factors other than dietary and supplement intake of vitamin D likely influence (blood levels of vitamin D)…Before future clinical trials of high-dose vitamin D regimens to reduce breast cancer risk are implemented, it will be important to demonstrate that the selected vitamin D dose can definitively increase (blood vitamin D) levels to the projected target level.  Definitive assessment of factors that influence the relationship between vitamin D supplement use and subsequent changes in circulating (vitamin) D levels are therefore a research priority.”


The bottom line?


When it comes to vitamin D there are a lot of questions and not many answers.


For now, we would be hard-pressed to conclude that vitamin D reduces the risk of breast cancer in post-menopausal women.


There is still a lot we don't know:  we don't know how much vitamin D is healthy in our bodies, and if in fact there are risks associated with too much vitamin D (see prior blog).  We don't know whether or not we should be routinely measuring vitamin D in our bodies with blood tests.  We don't know how much vitamin D we should be taking every day, and whether each person responds the same way to the same dose of vitamin D.  We don't know whether vitamin D reduces cancer risk or influences outcome after cancer is diagnosed and for which cancers, if any.


Unfortunately, when it comes to vitamin D, confusion reigns supreme.  We deserve better.

Filed Under:

Breast Cancer | Prevention | Vitamins

Finally, Some Good News On Disparities And Cancer

by Dr. Len November 08, 2008

Sometimes I don’t think we acknowledge and celebrate our successes.  An example would be the decrease in the number of smokers in New York City, especially among young people.  Too few of us are aware of this remarkable success.


Another example would be something that I have noted previously: there has been a significant decline in smoking related cancer deaths among African American men in the United States.


A paper in the current issue of Cancer, Epidemiology and Biomarkers now sets the record straight with respect to that second observation.


Unfortunately, the news is not all good.  In cancers where screening for early detection is available, the impact of disparate care has led to an increase in the mortality gap between whites and blacks in this country for these cancers.


The researchers—who are from the epidemiology department at the American Cancer Society--examined the trends in cancer deaths in the United States from 1975 through 2004.  They looked at cancer death rates and the differences between white American men and women, and African American men and women.  They further divided the analysis into the rates for all cancers combined, for smoking related cancers and cancers where screening is available including prostate, colon and breast cancers.  (Cervical cancers were excluded since there are few deaths in this country from cervical cancer.)


The findings were reasonably straight forward: death rates for all cancers in all groups declined over that time period, except for lung cancer in women.  The declines were greater in men than women.


Since 1993, the gap in death rates between African American and white men has been closing for men and since 1997 for women.  The real news was that there was a more rapid decrease in death rates from lung cancer and other tobacco related cancers in African American men than white men.


The bad news is that when it came to looking at death rates in screened cancers, the disparities have increased over the 30 year period for those cancers (breast, prostate and colon).


When the researchers delved further into the data, they found that a substantial decline in deaths from esophageal cancer—which is known to be related to cigarette smoking—accounted for 45% of the overall decline in the cancer death rates in African American men. 


This news actually wasn’t news to me.  I had previously written about this over a year ago in my blog, when I discussed the results of the 2007 “Report To The Nation” which is published every year by the American Cancer Society along with other organizations committed to reducing the burden and suffering from cancer:


“One of the items noted in the report—but that does not get a lot of press attention—is the significant decline from 1995-2004 in incidence rates of cancers in black men that are related to cigarette consumption.


“The examples that I would cite include: lung cancer, down 2.9% per year; oral cavity and pharynx, down 3.1% per year; esophagus, down 5.5% per year; larynx, down 2.8% per year.


“Those declines—which are modest from year to year, but substantial over a decade—will help reduce the especially high burden of cancer in this community.”


As the current research report points out, there has been a stunning decline in the number of black men who smoke.  In 1974, 53% of African American smoked.  In 1995, it was 32%, and in 2004 24%.  For white men, the comparable numbers are 42%, 26%, and 22%.  The message here is that a large number of black men listened to the message about the dangers of smoking, and quit.  The results are what we now see: a significant decline in the rates of death from tobacco related cancers.


But the news on the screening side isn’t as good.  Blacks are less likely than whites to get screened, and that disparity shows up in the widening gap in death rates.  They are also less likely to receive appropriate treatment in a timely manner. (I should point out that the authors state that mammography rates in white and African American women are essentially the same.  For reasons that I won’t go into here, I don’t agree that the survey results that serve as the source for those numbers reflect the real situation “on the ground”.  See my recent blog on that topic.)


So let’s take note of our successes, but also be aware of our shortcomings.


A community has heeded the message and taken control where they could take control.  Black men have substantially decreased their smoking rates, and the benefit is that many fewer are dying of tobacco-related cancers.  Just think of what that means in a group that has for so long been victimized by an unacceptably high rate of death from cancer.  Think of the lives saved and the impact of those lives on families, friends and the community.


Unfortunately, when it comes to cancers we can prevent and/or detect early, the news is not as good.


It’s obvious we have a long way to go, but I am heartened by the observation that when we make an impact on behaviors, we make an impact on life.  We have demonstrated success. People have listened to the message about smoking. 


Now let’s meet the challenge and take the next step.  Let’s address and further reduce the disparities for cancers where we know that screening can save even more lives.


As I have written before, we should accept nothing less. 

Filed Under:

Lung Cancer | Screening | Tobacco

Ronald Davis, MD

by Dr. Len November 07, 2008

Ronald Davis, MD, a friend and trusted colleague, passed away yesterday from pancreatic cancer.  Ron was 52 years old.


The House of Medicine, the tobacco control community, his family and his many friends have lost someone who was not only committed to his profession but also served as an exemplar of what it meant to be a physician, a husband, a father, and a friend.


This past June, I shared my thoughts about Ron and his battle with cancer on this blog.  Being part of the audience the day he gave his speech as the outgoing president of the American Medical Association was very special. I know that his words, his optimism, his faith and his reality impacted many of you as well.


As I write this, I am on my way to Orlando to participate in another meeting of the AMA’s House of Delegates.  Ron’s passing is certain to hang heavy over our gathering, but his spirit and his soul will never be far from our thoughts.


To his wife, his sons, and his family, our sympathy, thoughts and prayers are with you.


To those who knew Ron and worked closely with him these many years, his loss is shared by many.


His memory will give strength to all who knew him, and renew our faith to carry his commitment forward.  We will never forget him.

Filed Under:

Other cancers

Migraines Reduce Breast Cancer Risk

by Dr. Len November 06, 2008

Have you ever wondered what gives a researcher the idea for a particular project? 


If so, then try this one on for size:  Is breast cancer less frequent in women who have migraine headaches?


At first glance, that seems to me to be an odd question.  But someone did ask the question, and the answer was a bit surprising: Yes, migraines are associated with a lower risk of breast cancer. And, yes, there actually is a scientific rationale for having asked the question in the first place.


Women with migraines are probably very aware that there is a relationship between when they get their migraines and their menstrual cycles.  Women on birth control pills who have a history of migraines have an increase in their migraines if they take one of the pills where they take a week off their medicine.  And, women who are pregnant have fewer migraines.


So what is the clue in all of this that would lead to asking the migraine/breast cancer question?


All of the above are associated with a significant change in circulating estrogen levels. High estrogen, fewer migraines.  In the circumstances noted when estrogen levels go up (pregnancy), migraines go down.  When estrogen levels fall, migraines increase (during the menstrual cycle and off the birth control pills).


The next step in the theory is that if a woman has migraines, then she may have a lower life-long exposure to estrogen in her body.  More migraines, less estrogen.  More migraines, less breast cancer.


And that is what the researchers found in their study, published in the current issue of Cancer Epidemiology, Biomarkers and Prevention.  Women with a history of migraines had about a 1/3 less chance of developing two forms of invasive breast cancer compared to women who did not have a history of migraine headaches.  Most of the reduction occurred in the type of breast cancer that was hormone sensitive.


There is a word of caution however, as noted by the researchers.


Women who have migraines also use large amounts of pain killers, in particular drugs that are called “NSAIDs” like ibuprofen.  These drugs may have a role in reducing cancer risk.  If migraine sufferers take these drugs, it is possible that could explain the decrease in breast cancer observed in this study.


But I would also add that there may be another as yet unknown association which could explain the findings.  Yes, women with migraines have a lower incidence of breast cancer.  But lower estrogen may not be the cause. Think of it as the old “true-true-unrelated” answer on the logic tests we used to take.


There are other studies done in the past which have shown similar relationships between what I would call “surrogate health markers” and breast cancer risk. 


For example, women with osteoporosis have a lower incidence of breast cancer.  That may be explained in part by the theory that osteoporosis is a surrogate marker for lower lifetime estrogen levels.  Also, post-menopausal women who are overweight and obese have a higher risk of breast cancer, possibly due to estrogen that is produced in body fat cells, raising the already low estrogen levels associated with menopause.


At the end of the day, it is legitimate to ask the question what difference does this make in practical terms?


To be honest, I don’t know and I suspect not much. When it comes to practical advice to women who have migraines and their clinicians, the reality is there isn’t anything different that I would do based on the results of this research.


Before we knew much about tuberculosis, it was a feared and often fatal disease (unfortunately, it can still be very serious).  Once we understood the disease and developed effective treatments, we were less fearful of its consequences.  Before we had that understanding, we had all sorts of surrogate theories that would make us comfortable that we had some understanding of the disease.  It helped us feel better about our ignorance and lack of therapeutic control.


Ditto pneumonia before penicillin.  Ditto diabetes before insulin.  Ditto high blood pressure before water pills.  These were all killers of many people.  They are still killers, but we aren’t quite as afraid of them now as we were decades ago.


One day we will have a detailed and in-depth understanding of cancer and how it works.  That will lead us to even more effective treatments and prevention strategies.


Until then, we will continue to ponder the ponderable and measure the measureable.  We will ask the question whether migraines and osteoporosis are associated with lower breast cancer risk.


Interesting, intriguing, but not actionable. 


I’ve been surprised in the past when I read this type of research and dismissed the implications only to later admit the error of my ways years later when those reports turned out to be the foundation of very important discoveries (for example, helicobacter bacteria as a cause of stomach ulcers and stomach cancer). 


So, one should never be unwilling to listen, learn, and be ready to reevaluate.


In the meantime, for female migraine sufferers, I doubt that this information will provide much comfort or lead them to a new or different path for their health.


Vitamins And Cancer: Looking In The Wrong Places

by Dr. Len November 05, 2008

Are we looking for cancer prevention clues in all the wrong places?  That is the question I am asking myself as another vitamin theory bites the dust.


A report in this week’s Journal of the American Medical Association (and supported in part by research funding from the American Cancer Society) examined the relationship between folic acid, vitamin B6 and vitamin B12 and breast cancer.


The bad news? A combination vitamin pill did not reduce the risk of breast cancer. 


The good news? A combination vitamin pill did not increase the risk of breast cancer, or any other cancer.


In the study, the researchers examined the effect of giving a daily dose of the three vitamins in a single pill to a group of women who were at high risk of heart disease.  Half the participants received the vitamins, and the other half took a placebo (or dummy pill) that did not contain the vitamins.


After a little over 7 years of treatment, there was no difference between the two groups of women with respect to the incidence of breast cancer or any other cancer.  There was also no difference in the frequency of cancer deaths between the two groups


The theory behind this research was that these particular vitamins play an important role in orderly cell growth, and therefore may prevent cancer. 


The reason the theory is so attractive is the same as it is for every vitamin claim: vitamins are easy to take, inexpensive, and thought to be harmless.  For many of us, they are a part of our daily routine.  What could be easier than popping a vitamin pill in the morning to prevent cancer and a host of other diseases?


The problem is—as it has been for many years—that when the vitamin claims are subjected to the magnifying glass of a well-done clinical trial, the claims simply don’t hold up.


Trust me, I know.  Years ago, vitamin C and vitamin E were the rage.  I took them until the research didn’t support the claims that they reduced the risk of cancer and heart disease, respectively. 


Then there was folate, which many of us take that as part of our daily multivitamin tablets.


First folate was reported to reduce the risk of colorectal cancer.  More recently, some research suggests that folate may promote polyp growth for people who already have colon polyps possibly resulting in an increased risk of colon cancer.


To be honest, the research on the risks and benefits of folate in colorectal cancer is conflicting and confusing to medical experts, let alone people who are trying to make the right decisions about their health.


This is important, since beginning in 1998 folate was added to our food in an effort to reduce the incidence of a certain birth defect in the spinal cord.  The food fortification program has been successful, and blood levels of folate in our bodies have increased over the past decade.


But now there is concern—in part because of the research results noted above—that too much folate may actually cause harm, and increase the risk of some cancers.


That’s why this study’s negative outcome is so important: folate did not increase the incidence of colorectal cancer or any other cancer.


Do you find yourself asking the question how something so simple—and so “natural”--as a vitamin can hurt people? 


If we hadn’t done the research, we would all be taking large doses of vitamin C to prevent cancer (it doesn’t).  We would never have found out that beta carotene leads to an increased risk of lung cancer in heavy smokers.  We wouldn’t know that vitamin E and selenium—alone or in combination—did nothing to reduce prostate cancer in men.


Next on my list is vitamin D.  But we won’t have definitive answers to questions about the cancer-related benefits and risks of the “sunshine vitamin” for years.


Maybe we are looking for cancer prevention in all the wrong places, and maybe not. 


It would be great if something as simple as a vitamin pill would ward off the risk of cancer.  Right now, however, the vitamins aren’t scoring any home runs in the cancer prevention arena.    


For now, we are just going to have to do things the old fashioned way: eat your five fruits and vegetables a day, maintain a healthy weight, eat a balanced diet, and exercise, exercise, exercise.


I know.  That’s much more complicated than taking a vitamin pill once a day.  But at least we know those are strategies that work for reducing your risk of cancer.


Broccoli, anyone?







Filed Under:

Breast Cancer | Prevention | Vitamins

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.