The American Heart Association designed their educational program My Life Check® in order to improve health by educating the public on how best to live. The campaign includes Life’s Simple 7™, which are seven factors for a healthy heart:

• Being physically active
• Keeping a healthy weight
• Eating a healthy diet
• Maintaining healthy cholesterol levels
• Keeping blood pressure down
• Regulating blood sugar levels
• Not smoking

Researchers examined whether adherence to the seven steps was associated with reduced cancer risk. The study included 13,253 white and African-American men and women in the ongoing Atherosclerosis Risk in Communities Study, which was launched in 1987 in four U.S. communities. Participants were interviewed and examined at the start of the study to determine which health factors they met or followed.

After 17-19 years of follow-up, the researchers reviewed cancer registries and hospital records and found that 2,880 of the participants were diagnosed with cancer, primarily of the lung, colon or rectum, prostate and breast. They found that participants who adhered to six or seven steps had a 51 percent lower risk of cancer than those who did not adhere to any of them. Those who adhered to four steps had a 33 percent reduced risk and those who adhered to one or two had a 21 percent reduced risk.

When smoking status was not considered, participants who adhered to five or six of the remaining six factors had a 25 percent lower cancer risk than those who adhered to none. The researchers noted that quitting smoking is important, but there are also other factors that are important for living a healthy life.

The researchers concluded that adherence to Life’s Simple 7™ steps is associated with a lower risk of developing cancer. People who follow these steps can protect their health and lower their risk for chronic diseases.

Reference:

Rasmussen-Torvik LJ, Shay CM, Abramson JG, et al. Ideal Cardiovascular Health Is Inversely Associated With Incident Cancer: The Atherosclerosis Risk in Communities Study. Circulation. Published early online March 18, 2013: doi: 10.1161/?CIRCULATIONAHA.112.001183

High dose indium-111 pentetreotide (Octreotide) therapy

In somatostatin receptor expressing neuroendocrine neoplasm

It is with great pleasure to inform you that our Investigational New Drug (IND) Application for “High Dose Indium-111 Pentetreotide (Octreotide) Therapy in Somatostatin Receptor Expressing Neuroendocrine Neoplasms.” has been authorized by FDA. RITA Foundation in collaboration with BioSynthema (St. Louis, MO), Advanced Accelerator Applications (Saint- Genis-Pouilly, France), St. Luke’s Hospital (Houston, TX), and Excel Diagnostics & Nuclear Oncology Center in Houston will provide this therapy to patients with metastatic Carcinoid.

Following is the inclusion and exclusion criteria copied from the protocol for your information:

Criteria for Patient Selection

Inclusion Criteria

1. Patients with biopsy proven malignancies which express the somatostatin receptor as demonstrated by significant uptake of Indium-111 pentetreotide during a diagnostic scan. If possible, tumor tissue should be submitted for somatostatin receptor assay.

2. Patients must have received first line standard chemotherapy and/or radiation therapy for neuroendocrine malignancy in the past and failed the therapy.

Patients must have evidence of residual multifocal active tumor.

3. All patients must sign an informed consent indicating the awareness of the investigational nature of the studies involved.

4. All patients must have a Karnofsky performance status of at least 60%.

5. Patients must be greater than 18 years of age.

6. Patients must have measurable and/or traceable disease based on either clinical or radiologic exam.

7. Sensitivity to Indium-111 pentetreotide or any of its components is an absolute contraindication to participation in this trial.

8. An absolute contraindication is pregnancy as evidenced by the clinical condition, a positive pregnancy test (B-HCG or pelvic ultrasound).

9. If patients have received prior radionuclide therapy of the same product, there must be documented response to that therapy and/or residual active stable disease.

Exclusion Criteria

1. Karnofsky performance status of 50% or less.

2. Patients who are unable to give informed consent.

3. Patients under 18 years of age. There will be no upper age discrimination.

4. Patients who are pregnant or those potentially pregnant subjects not willing to practice effective contraceptive techniques during the study period.

5. Patients with renal insufficiency as defined by a calculated creatinine clearance (based on age, weight and serum creatinine) of 39.9 ml/min or less.

We have been authorized by FDA to administer up to 500 mCi of Indium-111 Octreotide to the eligible patients. This treatment may be administered in an outpatient setting to qualified patients. The above dose can be administered safely to the patients. No significant renal or liver toxicity has been reported in the literature regarding this therapy. Hematological toxicity is typically seen 4 to 6 weeks after therapy and is commonly transient. Multiple dose administration protocol has been approved by FDA. Insurance approval has been accepted by some carriers. Medicare approval is pending.

We are extremely excited for having this therapeutic option available to the patients with Octreotide avid neuroendocrine malignancies in Houston.

Ebrahim S. Delpassand, M.D., F.A.C.N.M.
Principle Investigator
Protocol IND: 72,037
Medical Director
Excel Diagnostics & Nuclear Oncology Center

LU-177 Octreotate is administered along with intravenous amino acids, to protect the kidneys from radiation.  The Octreotate binds to somatostatin receptors on cells, thus providing highly targeted radiation to the tumors.  A patient has 4 sessions of the treatment, spaced six to ten weeks apart. The use of LU-177 Octreotate as a targeted treatment was pioneered by Dr. Eric Krenning and Dr. Dik J. Kwekkeboom at Erasmus Medical Center in Rotterdam, the Netherlands.

This therapy can be used for neuroendocrine tumors including carcinoid, islet cell carcinoma of the pancreas, oat cell carcinoma of the lung, pheochromocytoma, gastro-entero-pancreatic neuroendocrine tumors (GEPNETS), and rare thyroid cancers unresponsive to radioiodine.

The principal investigator for the U.S. program is Dr. Ebrahim S. Delpassand and the project is in collaboration with Baylor College of Medicine, St. Luke’s Episcopal Hospital and Radio-Isotope Therapy of America (RITA) Foundation in Houston.

For further information regarding this treatment, contact Ms. Susan Cork, therapy patient coordinator, at 713-341-3203 or scork@exceldiagnostics.com

Breast cancer is the second leading cause of cancer death in women in the United States. The chance of an individual developing cancer depends on both genetic and non-genetic factors. Non-genetic factors may include diet, exercise, or exposure to other substances, including tobacco. The relationship between smoking and breast cancer has been controversial—and studies have produced conflicting results.

In this study, researchers analyzed data from 73,388 women from the American Cancer Society’s Cancer Prevention Study II (CPS-II) Nutrition Cohort. During a median follow-up of 13.8 years, researchers identified 3,721 cases of invasive breast cancer. They found that the rate of new breast cancer cases was 24 percent higher in smokers than nonsmokers and 13 percent higher in former smokers than nonsmokers.

What’s more—the researchers found that the risk of invasive breast cancer was highest among women who began smoking at an earlier age. Compared to nonsmokers, women who started smoking prior to the beginning of menstruation had a 61 percent higher risk of developing breast cancer. Women who began smoking after the initiation of menstruation, but 11 or more years prior to the birth of their first child, had a 45 percent higher risk of developing breast cancer compared to nonsmokers.

The researchers noted that their findings were supported by numerous other cohort studies. In fact, the combined results of nine studies (including this one), indicated that women who started smoking at a younger age had a 12 percent increased risk of breast cancer and those who started smoking before the birth of their first child had a 21 percent increased risk.

The researchers noted that breast tissue is not fully developed until a woman has her first child, which makes it more sensitive to the harmful effects of tobacco. They concluded that it is important to encourage young women to not start smoking. Smoking has been associated with a number of types of cancer, including lung cancer and cancers of the mouth, lips, nose and sinuses, voice box, throat, esophagus, stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, and ovary, as well as acute myeloid leukemia.

Reference:

Gadet MM, Gapstur SM, Sun J, et al. Active Smoking and Breast Cancer Risk: Original Cohort Data and Meta-Analysis. Journal of the National Cancer Institute. Published early online February 28, 2013. doi: 10.1093/jnci/djt023

We all experience them. From life-changing to momentarily disruptive, crises come in all shapes and sizes and are seen as unwelcome visitors because they generally force us out of our routine as we cope with their impact.

There are many ways to define crisis. For the purpose of this piece, I like this one, from Merriam-Webster’s Dictionary: “an unstable or crucial time or state of affairs in which a decisive change is impending.”
In a crisis there is a lack of stability. Often something ruptures or breaks, forcing us to put our lives back together in a new way. Because we are creatures of habit, our first inclination is to embrace the past and resist the change. We might say things like, “This is not possible,” or we may look back and say, “If only. . . .” The shock of the event can make us feel overwhelmed and powerless.

Although we cannot control what happens in a crisis, we can control how we deal with its aftermath. And looking beyond the immediate discomfort and disruption, it’s clear that working our way through a crisis can help us grow and thrive.

Here are four ideas to help you navigate a crisis and maybe even use the experience to create positive change in your life:

Speak truthfully and from the heart. In a difficult situation, you may find yourself at a loss for words to describe your own feelings or respond to others. At these times your first instinct may be to say things indirectly because you think it will be easier to hear. This leads to confusion and misunderstandings.  Instead of trying to say “the right thing,” say what you feel. Be direct. When you speak from your heart, you feel better, and whatever you have to say will be easily understood and well tolerated.

Develop a support system. When people ask, “What can I do to help?” Tell them! You are not being a burden. It makes people feel good to help. By letting them help you, you are giving them something, too.

Communicate your needs clearly. Be open and clear with friends and family about your needs and expectations during this time. If you want to be alone and have time to yourself to process, make sure people know that. If, on the other hand, you feel the need for close communication and support, be clear about that wish.

Consider this scenario as an example: Maggie does not want to see anyone because she needs time to grieve her mother’s recent death. Instead of directly telling people that she needs time to herself, she does not return calls or e-mails from family and friends. People then call and e-mail more because they are concerned. Maggie becomes even more overwhelmed. Had Maggie asked a friend or family member to get the word out that she needs some downtime, the situation could have been avoided and those close to her would have relaxed and understood what she needed. When you communicate clearly, you are more likely to have your needs met.

Take time for you. Figure out what makes you feel centered and whole and do it—guiltlessly. Just as you fuel your body with food, you must nourish your soul, especially in challenging times. Spiritual food is as essential as the food we eat!

Use the opportunities created by crises to help you improve your life. Sometimes opportunities present themselves in peculiar packages!  _

Denise King Gillingham, MSW, CPCC, is a certified coach and mediator who specializes in helping people achieve enduring life change through accessing their inner wisdom. Her international practice includes clients from all walks of life. Denise received her master’s degree in social work from Columbia University and has been a mental health professional for more than 15 years. She shifted her focus from therapy to coaching in 2006. Her professional experience includes a private supportive psychotherapy practice in Prague, Czech Republic; crisis intervention with New York University; in-patient therapy at Payne Whitney Clinic in New York City; and substance abuse counseling at Bronx VA Medical Center in New York City. She develops and conducts workshops on emotional intelligence for organizations in the United States and Europe. Contact Denise at dkgcoach@gmail.com.

The chance of an individual developing cancer depends on both genetic and non-genetic factors. A genetic factor is an inherited, unchangeable trait, while a non-genetic factor is a variable in a person’s environment, which can often be changed. A genetic predisposition means that a person may be at higher risk for a certain cancer if a family member has that type of cancer. Of course, a family history of cancer is not a modifiable risk factor—however, researchers continue to explore the risks and develop a better understanding of familial risk in order to improve screening and prevention for the disease.

Researchers used the nationwide Swedish Family-Cancer Database in order to examine the familial risk of concordant cancer (meaning parent and offspring have the same type of cancer) for offspring as a function of the age at which a parent was diagnosed. The study population included more than 12.2 million people born after 1931. Since they were examining familial risk in advanced age, researchers limited their results to cancers with at least 50 cases in the offspring of parents whose cancer was diagnosed at age 80 or older.

They found that the highest familial risk occurred in people who were diagnosed at an early age and whose parents were diagnosed with the same type of cancer at an early age; however, an increased risk still exist for several cancers when diagnosed at advanced ages.

In fact, for some types of cancer, the excess risk that results from family history included cancers diagnosed in parents even at ages 90 and older—including skin cancer (90 percent excess risk), colorectal cancer (60 percent), breast cancer (30 percent), and prostate (30 percent).

One example—when a parent’s colorectal cancer was diagnosed before age 40 and the offspring was diagnosed before age 60, the hazard ratio was 9.9. When the parent was diagnosed between ages 80-90, the hazard ratio declined to 1.7, but remained significant.

The researchers concluded that the highest familial risks of cancer are observed in offspring whose parents received a diagnosis of a concordant cancer at an earlier age, but increased risks exist even in several cancers of advanced ages. They suggest that increased clinical surveillance is important even in families where parents are diagnosed at a late age.

Reference:

Kharazmi E, Fallah M, Sundquist K, et al. Familial risk of early and late onset cancer: nationwide prospective cohort study. British Medical Journal. 2012;345:e8076.

Hormone replacement therapy (HRT) is often prescribed for women during menopause, which is a natural phase of the female lifecycle during which the ovaries produce significantly less estrogen, ovulation ceases, and menstruation ends. For many women, menopause has uncomfortable side effects such as hot flashes, sleep disturbances, depression, mood swings, and anxiety. Additionally, menopause may also be accompanied by increased urinary tract infections, incontinence, vaginal discomfort due to a lack of estrogen-based lubrication, and decreased bone density.

Although HRT has been widely prescribed for menopausal women, it has come under scrutiny as a result of the Women’s Health Initiative (WHI) Study, which indicated that it could be linked to increased incidence of certain types of cancer and other health problems.[2] Combined HRT has been linked with an increased risk of breast cancer, lung cancer, heart disease, stroke, and blood clots, but a decreased risk of colorectal cancer and fractures. Researchers continue to evaluate single-agent HRT and combined HRT to determine the risks and benefits of its use.

The Kronos Early Estrogen Prevention Study (KEEPS) trial was a multi-center, randomized study that included 727 healthy women ages 42 to 58, all within three years of onset of menopause at baseline. The study differs from many previous studies on HRT, including the WHI, because the participants were younger—the mean age was 52, compared to 60s for the other trials.

Women in the KEEPS trial were randomly assigned to one of three groups: placebo, progesterone plus oral estrogen, progesterone plus an estrogen patch. Both intervention groups experienced a reduction in menopausal symptoms, including hot flashes and night sweats, as well as improved sexual function and improved bone mineral density compared to the placebo group. What’s more—the results indicated that oral estrogen plus progesterone improved lipid levels and the estrogen patch improved insulin sensitivity. Neither combination raised blood pressure or altered the progression of atherosclerosis (hardening of the arteries).

The data is in sharp contrast with the WHI and other studies that raised the alarm flags regarding the use of HRT. The results of one study cannot provide enough information to make an informed decision regarding HRT use; however, they can add to the existing information so that women can make informed decisions.

The WHI was a large and comprehensive study that included 16,000 women and suggested that HRT was linked with increased blood pressure and higher risks of breast cancer, dementia, and stroke. However, some critics have speculated that the effects were magnified because the study included older women (in their 60s and 70s) who took HRT for long periods of time. In contrast, the KEEPS trial evaluated younger women who took HRT for shorter periods of time.

The jury is still out on HRT and the controversy will likely continue as ongoing research attempts to evaluate the safety of the treatment. In the meantime, the results of this particular study suggest that newly menopausal women may benefit from short-term use of HRT—in fact, it might ease menopausal symptoms and improve cholesterol and metabolic function.

Women considering the use of HRT should discuss the risks and benefits with their physician.

References:

The chance of an individual developing cancer depends on both inherited genetic factors as well as environmental or behavioral factors. Dietary and lifestyle habits may play a role in the development of cancer and researchers continue to evaluate different foods and supplements and their relationship to different types of cancers. Identifying dietary factors related to cancer could lead to potentially preventive lifestyle habits and strategies.

There has been conflicting evidence regarding the relationship between vitamins and cancer risk, with many studies focusing on individual vitamins such as vitamin D, vitamin B, vitamin C, and calcium. Multivitamins are the most common dietary supplement—approximately one-third of all U.S. adults take them—but there has been little evidence for or against them.

Researchers conducted a large-scale, randomized, double-blind, placebo-controlled study called the Physicians’ Health Study II, which included 14,641 male physicians in the U.S. age 50 or older. The study began in 1997, with treatment and follow-up through June 2011. At the beginning of the study, 1,312 men had a history of cancer.

Participants in the study were randomized to receive a monthly package of multivitamins or placebo. The primary endpoint of the study was total cancer (excluding non-melanoma skin cancer) and secondary endpoints included prostate, colorectal, and other site-specific cancers.

After a follow-up of 11 years, there were 2,669 new cancer cases, including 1,373 cases of prostate cancer and 210 cases of colorectal cancer. The researchers found that the men taking multivitamins had about an 8 percent lower risk of developing cancer. Multivitamins, however, had no significant effect on prostate cancer, colorectal cancer, or other site-specific cancers. What’s more—there was no significant difference in the risk of cancer mortality among the multivitamin or placebo groups.

The researchers concluded that daily multivitamin supplementation was associated with a modest, but significant, reduced risk of total cancer. It’s important to note that multivitamins—or any supplements, for that matter—are not a panacea. Individuals may wish to take multivitamins to prevent nutritional deficiency, but should always consult with a physician regarding the best course of action. Some supplements are contraindicated for certain individuals. For example, individuals taking common heart medications should avoid vitamin K. Consult with a physician to choose dietary supplements that can help rather than harm.

Reference:

Gaziano JM, Sesso HD, Christen WG, et al. Multivitamins in the prevention of cancer in men: The Physicians’ Health Study II Randomized Controlled Trial. Journal of the American Medical Association. Published early online October 17, 2012. doi:10.1001/jama.2012.14641

Colorectal cancer is the second leading cause of cancer death in the United States. The disease strikes both men and women, with more than 140,000 cases diagnosed each year. Approximately 50,000 people die from colorectal cancer each year.

The chance of an individual developing cancer depends on both inherited genetic factors as well as environmental or behavioral factors. Dietary and lifestyle habits may play a role in the development of cancer and researchers continue to evaluate different foods and supplements and their relationship to different types of cancers. Identifying dietary factors related to cancer could lead to potentially preventive lifestyle habits and strategies.

The relationship between B vitamins and colorectal cancer remains unclear. Some research has indicated that vitamin B6 deficiency could increase the risk of colorectal cancer.[2] Other studies, however, have failed to establish a relationship between B vitamins and colorectal cancer.

The Women’s Antioxidant and Folic Acid Cardiovascular Study was a randomized, double-blind, placebo-controlled clinical trial that included 5,442 female health professionals at high risk for cardiovascular disease. The study ran from April 1998 through July 2005. Participants were randomly assigned to receive a combination pill of folic acid (2.5mg), vitamin B₆ (50mg), and vitamin B₁₂ (1mg) or placebo. About a quarter of the patients in this study—1,470 women—were followed for as long as 9.2 years and underwent an endoscopy at some point during that follow-up.

Researchers used data from this group of patients to determine the risk of colorectal cancer and found that the risk was almost identical among participants receiving the vitamin supplements (24.3%) compared to those receiving placebo (24%). Even when data was analyzed by subsite, size, stage, and the number of adenomas, supplementation with folic acid, B6 and B12 had no effect on the risk of colorectal cancer.

The researchers concluded that there was no statistically significant effect of combined supplementation with folic acid, vitamin B6 and vitamin B12 on the risk of colorectal cancer among women at high risk for cardiovascular disease.

References:

Neurotensin is an amino acid peptide primarily expressed in the central nervous system and the gastrointestinal tract. It regulates satiety and breast cancer growth. Proneurotensin is a precursor to the hormone and researchers have speculated that it could be a marker of underlying disease.

Researchers from Sweden conducted a study to determine whether fasting levels of proneurotensin were associated with future risk of diabetes, cardiovascular disease, breast cancer, and death. They measured proneurotensin in blood from 4,632 fasting participants of the population-based Malmo Diet and Cancer Study baseline examination 1991-1994 and then used various models to evaluate the relationship between baseline proneurotensin and subsequent events. The study had a long-term follow-up until 2009, with median follow-up ranging from 13.2 to 15.7 years, depending on the disease.

They found that proneurotensin was related to an increased risk of the diseases, especially in women. Women with elevated proneurotensin were at an increased risk of diabetes, cardiovascular disease, breast cancer, death, and death from cardiovascular disease. The researchers speculated that elevated proneurotensin could be a marker of underlying disease susceptibility rather than subclinical disease. In other words, the elevated proneurotensin is not necessarily causative.

The researchers noted that the relationship between proneurotensin and the three diseases was significant in women, but not men. The study marks the first time that a satiation hormone has been linked to diabetes, cardiovascular disease, and breast cancer in women. While obesity is a common risk for for all three conditions, the connection with proneurotensin and neurotensin is not explained by obesity.

Research will be ongoing to study the relationship between neurotensin and these diseases.

Reference:

Melander O, Maisel AS, Almgren P, et al. Plasma proneurotensin and incidence of diabetes, cardiovascular disease, breast cancer, and mortality. Journal of the American Medical Association. 2012; 308(14): 1469-1475.