Breast cancer patients who receive treatment in the prone, or face-down, position may lower their risk of long-term radiation-related damage compared to patients treated in the more traditional face-up position, two cancer treatment experts explained during a recent forum on breast cancer treatment.
Not every breast cancer patient is a candidate for prone positioning. However, those that are may benefit from it in several ways, including reducing the risks of secondary cancers and heart damage.
“Seventeen percent of all newly diagnosed cancers per year are second cancers,” explained second cancer expert John D. Boice, Jr., Sc.D., president of the National Council on Radiation Protection and Measurements and professor of medicine at Vanderbilt University School of Medicine. By minimizing the body’s exposure to radiation, prone breast treatments help reduce this second cancer risk.
Heart damage risk reduced
Research also shows that prone positioning reduces the risk of heart damage by limiting the heart’s exposure to radiation. A recent New England Journal of Medicine study — Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer — found a significant increase in the risk of developing ischemic heart disease in women previously irradiated for breast cancer treatment, Boice noted.
Dr. Moira Sutton, radiation oncologist and breast cancer specialist with The Cancer Center at Lake Manassas, explained that such risks are not short-term issues.
“Radiation toxicity can be seen decades after a treatment,” Sutton told attendees at the event. “As radiation oncologists, I think it’s important for us to always select the safest, most appropriate treatment for each patient.”
Supine positioning — the most common position for radiation treatments — requires the patient to lay flat on her back, with one arm behind her head. With prone positioning, the patient lies on her stomach, allowing the breast receiving radiation to fall through an opening in the treatment table.
“With prone positioning, we treat just the breast we want to irradiate,” explained Sutton. “The breast falls away from the chest wall, and this decreases the radiation dose to the lung, heart, ribs and other breast.
“By putting patients in the prone position, there may be a greater than two-fold decrease in the risk of them developing a secondary lung cancer,” Sutton added.
The Cancer Center at Lake Manassas was the first facility in Northern Virginia to offer prone treatment to breast cancer patients. The center began its prone treatments in 2010.
Local cancer physicians and specialists attended the forum, held at 2941 Restaurant in Falls Church in late April. The event, organized by The Cancer Center at Lake Manassas, is part of the center’s ongoing effort to improve long-term outcomes for cancer patients by offering professional education and collaboration opportunities for regional cancer specialists and physicians.
“Knowledge is important,” said Dr. Sanjeev Aggarwal, medical director at The Cancer Center at Lake Manassas, who facilitated the forum. “More knowledge and conversation among practitioners will lead to better treatment and outcomes for patients.”
Hearing “You have cancer" for the first time is a life-changing moment. A cancer diagnosis often occurs without any warning, unsettling even the calmest of individuals. We all experience cancer differently, but it’s generally safe to experience a roller coaster of emotions--not to mention lots of questions--in the coming weeks. By knowing what to expect, you can be an active participant in your cancer treatment journey.
A cancer diagnosis is just the beginning. More tests may be needed to determine the stage and complexity of each type of cancer. From blood work to PET/CT scans, the list of possible tests varies from cancer to cancer and patient to patient.
Your doctors, nurses, therapists and support staff will have lists of questions for you. More important, though, are the questions you — out patients and caregivers — will have for us. Big or small, it is important to ask your questions. Because we are all unique, it’s always best to get your answers from doctors who know you, rather than through a late-night Internet search.
Write your questions in a notebook as you think of them. This will help you remember what you wanted to ask at your next appointment. Take the time to learn about the ins and outs of your type of cancer, including the stage, treatment options and potential side effects. Never be afraid to ask us any of your questions.
Here at the Cancer Center at Lake Manassas, we are eager to help you understand the process of your treatment, and we'll be with you through every step of your journey. We are committed to listening to each and every patient, and we strive every day to provide as much information as possible. We want you to be able to make informed decisions about your care and be as knowledgeable as possible with your treatment process.
Every patient responds in his or her own way to a cancer diagnosis. A key part of your treatment plan is to surround yourself with positive and optimistic energy. Some patients may find friendship and community through one of our support groups, where they meet and get to know others who are facing similar challenges. For others, having a strong support system of family and friends will be more than enough emotional support.
In addition to your own response to your diagnosis, your family, friends, co-workers and caregivers will have their own reactions. Many may not know what to say at first. Here at the Cancer Center at Lake Manassas, we do also offer support groups for caregivers, friends and family members. If someone close to you is struggling, this may offer him or her some help.
As you ask questions, doctors and nurses will provide answers, and it can be easy to forget some of what you hear. Consider bringing a notebook to your appointments, so that you can write down key points. Or, perhaps you’d rather bring a friend or family member who can help you remember the details of your appointment and will also be able to offer support if desired.
Every cancer diagnosis, patient and treatment process is different. By knowing what to expect and asking many questions, you can begin to prepare yourself for the journey that lies ahead.
The Cancer Center at Lake Manassas Care Team is always available to help our patients, with questions big or small. Contact us anytime with your questions.
WEDNESDAY, Feb. 15 (HealthDay News) -- A new blood-thinning medication called semuloparin reduces the risk of blood clots in people undergoing certain cancer treatments, new research shows.
When people with cancer are treated with chemotherapy, they have an increased risk of developing blood clots (venous thromboembolism). These clots can be dangerous, and have the potential to cause heart attacks or strokes.
This new drug reduced the risk of blood clots by 64 percent, according to the study, which was funded by Sanofi, the drug's manufacturer. Sanofi was also responsible for the analysis of the study's results.
Semuloparin, which is not currently approved by the U.S. Food and Drug Administration, didn't appear to increase the risk of excessive bleeding, which can be a side effect of blood thinners.
"Thromboembolism and the effects are very significant," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City. Even if blood clots don't cause life-threatening complications, they can cause lifelong problems, such as pain and a decreased ability to exercise, she explained.
"What's interesting about this paper is that they're decreasing the rate of thromboembolism without increasing bleeding. This needs to be confirmed in other studies, but this drug may play an important role for cancer patients in the future," said Bernik, who was not involved with the research.
The current study included more than 3,000 people from 47 countries. All had been diagnosed with cancer, including cancers of the lung, pancreas, stomach, colon, rectum, bladder or ovary.
The study volunteers were randomly assigned to one of two groups. One group received treatment with semuloparin, which is a type of heparin, while they were undergoing chemotherapy. The other group received a placebo.
The medication or the placebos were given as an injection once a day. Treatment lasted an average of 3.5 months.
Blood clots occurred in just 1.2 percent of those taking semuloparin compared to 3.4 percent of those on the placebo, according to the study.
The incidence of any type of excessive bleeding was 2.8 percent for the semuloparin group and 2.0 percent in those on placebo. Major bleeding occurred in 1.2 percent of those on semuloparin and 1.1 percent of those on placebo.
Results of the study are published in the Feb. 16 issue of the New England Journal of Medicine.
In addition to preventing clots, heparin medications may also help fight cancer tumors, according to the authors of an accompanying editorial in the same issue of the journal.
"This study by itself did not show any effect on mortality, but when we included it in a meta-analysis, we found that there is a likely survival benefit," said one of the editorial's authors, Dr. Elie Akl, an associate professor of medicine at the State University of New York at Buffalo.
The meta-analysis done by Akl and his co-author reviewed 11 studies including more than 6,000 people taking heparin medications during chemotherapy. They concluded that for every 1,000 people being treated with chemotherapy for cancer, there would be 30 fewer deaths if people were also treated with heparin during their chemotherapy. They also estimated that there would be 20 fewer blood clots. And, they estimated that there would be one more major bleeding episode and five more minor bleeding episodes if everyone on chemotherapy were to receive heparin treatment.
"Patients with cancer, who have a low risk of bleeding and who have no problem with injecting themselves with heparin, are likely to benefit in terms of survival from heparin treatment," he said.
What isn't yet clear, Akl said, is if heparin would provide more or less benefit depending on the type of cancer someone has, and how far advanced the cancer is. He said that there are currently six different studies under way to help answer those questions. The cost of the medication is also unclear, since it has not been approved for use in the United States yet.
To learn more about blood clots and cancer, read this information from the American Society of Clinical Oncology.
SOURCES: Elie Akl, M.D., M.P.H., Ph.D., associate professor, medicine, State University of New York at Buffalo; Stephanie Bernik, chief, surgical oncology, Lenox Hill Hospital, New York City; Feb. 16, 2012, New England Journal of Medicine
WEDNESDAY, Feb. 15 (HealthDay News) -- Good dietary advice and supplements can boost nutrition while improving quality of life in malnourished cancer patients, a new study finds.
However, the interventions do not appear to affect survival for these patients, according to the findings published in the Feb. 15 issue of the Journal of the National Cancer Institute.
For the study, Christine Baldwin, a lecturer in the nutritional sciences division at King's College London, and colleagues analyzed data from 13 clinical trials that included a total of more than 1,400 cancer patients who were malnourished or at risk of malnutrition. Some of the patients received oral nutritional support (dietary advice and/or supplements) while others received routine care.
Oral nutritional support had a wide range of effects on both weight and energy intake, and led to improvements in aspects of quality of life, such as emotional functioning, shortness of breath and loss of appetite. However, this type of intervention had no effect on patient death rates, the study authors noted in a journal news release.
The level of benefit varied between patients, and the authors concluded that "it is likely that the factors such as site and stage of disease and, indeed, variations in the duration, nature and intensity of the nutritional intervention will account for difference in effects in patients."
International guidelines have suggested oral nutritional intervention for malnourished cancer patients or those who are at nutritional risk, but these suggestions are based largely on expert opinion as opposed to clinical trials, according to background information in the study.
Commenting in an editorial accompanying the study, Ann O'Mara and Diane St. Germain of the U.S. National Cancer Institute wrote that "until future research provides clearer answers regarding who will benefit from nutritional interventions, the use of a comprehensive assessment, published nutritional guidelines and early interventions are essential."
The American Cancer Society has more about cancer patients and nutrition.
SOURCE: Journal of the National Cancer Institute, news release, Feb. 15, 2012
TUESDAY, Feb. 14 (HealthDay News) -- The U.S. Food and Drug Administration said Tuesday that it was cautiously optimistic that a feared shortage of a life-saving drug used to treat a form of childhood leukemia will be averted.
The drug, methotrexate, is used in combination with other drugs to combat acute lymphoblastic leukemia (ALL), which typically strikes children ages 2 to 5 and is the most common type of cancer in children.
Methotrexate is a linchpin in the treatment of children battling acute lymphoblastic leukemia. In high doses, the generic drug has been successful in curing patients and beneficial in preventing recurrence. Without the drug, a patient's chance for a cure is reduced while the risk of recurrence rises, oncologists report.
"We are seeing the [three] companies [that make methotrexate] respond to this shortage and they are planning on some very large releases, and we are planning on having the situation resolved," said Valerie Jensen, associate director of the FDA's drug shortage program.
"Right now, from what we are understanding from the companies, the releases will resolve these shortages. So we are watching this very closely," Jensen added. "We are expecting some good releases at the end of this month and continuing into March and beyond."
Oncologists are worried that supplies of methotrexate could be gone in as little as two weeks.
One of the three makers of methotrexate, Hospira Inc., based in Lake Forest, Ill., said Tuesday that it had increased production to "make up for the supply gap."
Thomas Moore, president of U.S. Hospira, said in a news release: "Hospira is doing everything it can to help bring more product to market. This includes working with the U.S. Food and Drug Administration to qualify a second supplier of the drug's active ingredient to enable increased production. Hospira believes that it can increase its supply to the market if it can secure additional methotrexate active ingredient supply."
The other two manufacturers are Mylan Inc., of Canonsburg, Penn., and Sandoz US Inc., of Princeton, N.J. Both said they are working to head off a shortage of the drug.
Mylan, in a Tuesday news release, said it has "ramped up its production in order to try to meet the resulting increased demand. We are working both on the manufacturing and regulatory fronts to expedite the FDA regulatory approvals necessary to further increase capacity to the extent possible to support the additional demand."
Dr. Elizabeth Raetz, an associate professor of pediatric hematology/oncology at NYU Langone Medical Center in New York City, said methotrexate is a "critical component of ALL therapy."
The concern is that there is a 90 percent chance for cure of acute lymphoblastic leukemia, but that's based on the total drug regimen including methotrexate, Raetz said. "There is a deep concern that if that key component is eliminated there would be a reduced chance for cure," she said.
There hasn't been a shortage of the drug at her hospital, Raetz noted, but many other hospitals across the country have reached a critical point, and some centers don't have any at all, she said.
Acute lymphoblastic leukemia is the most common type of cancer in children. It's a disease that affects white blood cells, which help to fight infections in the body. Blood cells are produced in bone marrow. But in leukemia patients, the bone marrow produces abnormal white blood cells, which crowd out healthy blood cells. In acute lymphoblastic leukemia, the excess white blood cells are called lymphocytes or lymphoblasts, according to the U.S. National Library of Medicine.
The potential shortage of methotrexate is just the latest in a series of drug shortages that have existed for several years.
In 2011, prescription drug shortages in the United States hit an all-time high. Last fall, some 200 drug shortages had been reported, compared to 178 in all of 2010, the FDA reported.
Many of the scarce drugs are injectables, such as cytarabine and cisplatin, used to treat serious conditions such as cancer. Some are only given in hospitals and are "absolutely critical," Jensen said during a news conference in late September.
More than half (54 percent) of shortages in 2010 were due to quality issues, such as sterility or drug impurities. Some were caused by delays or manufacturing capacity problems, while 11 percent were caused by discontinuation of a drug and 5 percent resulted from raw material shortages, Jensen said.
Jensen also said the shortages tend to occur in drugs that aren't "economically attractive." This could mean that only one company produces the drug, making it harder to find alternatives if the supply dries up.
A lot of the problems are tied to generic drugs, health experts explained, because few manufacturers make them and profit margins aren't as high as for drugs still under patent protection.
On Oct. 31, 2011, President Barack Obama signed an executive order designed to help ease the drug shortages. The order directed the FDA to "take action" to prevent and reduce the worsening prescription drug shortages.
Specifically, the order directed the FDA to take steps to require drug manufacturers to report any impending shortages or discontinuances six months ahead of the shortage. The agency should also speed up its review of new manufacturing sites, new suppliers and new manufacturing protocols, and also add more staff to its drug-shortage office, the order stated.
For more on drug shortages, visit the U.S. Food and Drug Administration.
SOURCES: Valerie Jensen, R.Ph., associate director, Drug Shortage Program, Center for Drug Evaluation and Research, U.S. Food and Drug Administration; Elizabeth Raetz, M.D., associate professor of pediatric oncology, NYU Langone Medical Center, New York City; Feb. 14, 2012, news release, Hospira Inc., Lake Forest, Ill.; Feb. 14, 2012, news release, Mylan Inc., Canonsburg, Penn.
TUESDAY, Feb. 14 (HealthDay News) -- After breast cancer treatment, many women suffer from hot flashes and night sweats, but a type of "talk therapy" might relieve these symptoms for some women, British researchers suggest.
In a new study, women who received this form of psychotherapy, known as cognitive behavioral therapy, had reduced their symptoms by half within six months.
"Hot flashes and night sweats are distressing symptoms, which cause social embarrassment and sleep problems, and they are challenging to treat, especially for women who have had breast cancer" because hormone replacement therapy is generally not recommended for these women, explained lead researcher Myra Hunter.
According to background information in the study, which is published in the Feb. 15 online edition of The Lancet Oncology, 65 percent to 85 percent of women have hot flashes after breast cancer treatment.
Group cognitive behavioral therapy is a safe and effective treatment for women who have hot flashes and night sweats following breast cancer treatment, Hunter said, with additional benefits to mood, sleep and quality of life.
"The women in this trial reported frequent and problematic symptoms and relatively low quality of life," said Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry.
Hunter's team randomly assigned 96 women who had been treated for breast cancer and suffered from night sweats and hot flashes to either "talk therapy" or usual care.
The 47 women who received the therapy attended weekly 90-minute sessions for six weeks. For the others, usual care consisted of access to nurses and oncologists, telephone support and cancer support services, the researchers noted.
The therapy sessions included psycho-education, paced breathing, and behavioral strategies to manage hot flashes and night sweats, as well as interactive PowerPoint presentations, group discussion, handouts and weekly homework, Hunter said.
In addition, participants learned how to handle the stress associated with hot flashes and night sweats, and found new ways to decrease anxiety, she explained.
The women were also taught to manage hot flashes in social situations and to understand night sweats and improve sleep habits using mental and behavioral strategies.
The investigators found that the women who had received the cognitive behavioral therapy significantly reduced the number of hot flashes and night sweats they experienced in the nine weeks after the start of the study.
This reduction in symptoms lasted for 26 weeks. At nine weeks there was a 46 percent reduction in symptoms and a 52 percent reduction at 26 weeks, Hunter's team found.
However, among women receiving usual care, hot flashes and night sweats decreased by 19 percent after nine weeks and 25 percent after 26 weeks.
"These reductions were sustained and associated with significant improvements in mood, sleep and quality of life," Hunter said. "This is a safe, acceptable and effective treatment option, which can be incorporated into breast cancer survivorship programs and delivered by trained breast cancer nurses."
Holly Prigerson, director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, wrote an accompanying journal editorial.
"Hot flashes and night sweats are very common, distressing and persistent -- women reported being troubled by them for an average of two years after breast cancer treatment," Prigerson said.
She noted that the new study provides sound evidence upon which to recommend cognitive behavioral therapy for breast cancer patients suffering from these symptoms.
"Adaptations to an online, self-management version of the intervention would allow for more flexible scheduling and greater access at potentially lower cost of delivery," Prigerson said. "Combining the intervention with medications that effectively treat hot flashes and night sweats might produce the most dramatic effects with reductions in symptoms as well as the distress caused by them."
Prigerson said this type of therapy might also be used to treat postmenopausal women suffering from these symptoms.
"Of course, scientifically, we can't generalize beyond the sample of women who experience menopausal symptoms as a result of treatment for breast cancer," she said. "But given that they found that [this type of therapy] worked on the distress associated with hot flashes and night sweats, then it would seem likely to generalize to menopausal symptoms experienced outside of this context."
For more about psychotherapy, visit the U.S. National Institute of Mental Health.
SOURCES: Myra Hunter, Ph.D., professor, clinical health psychology, King's College London, Institute of Psychiatry, London; Holly G. Prigerson, Ph.D., director, Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute, Boston; Feb. 15, 2012, The Lancet Oncology, online
MONDAY, Feb. 13 (HealthDay News) -- For older people with a certain type and stage of lung cancer, administering radiation treatment after surgery may not extend survival, according to a new study.
Radiation is not without risks, and the new study "questions the benefit of this treatment," said study leader Dr. Juan Wisnivesky, an associate professor of medicine at Mount Sinai School of Medicine in New York City.
He and his team looked at survival outcomes in more than 1,300 lung cancer patients with locally advanced disease, 710 of whom got the postoperative radiation therapy. It is routinely given in an attempt to prevent recurrence.
No substantial survival benefits were found at one year or three years.
"We found in this group of elderly patients, many of whom received the treatment, the use of the treatment did not appear to help them live longer," he said.
Patients in the study, all 65 or older, had stage 3 non-small cell lung cancer and involvement of N2 lymph nodes. Their cancer had spread but not widely. All had been diagnosed from 1992 through 2005 and were included in the U.S. Surveillance, Epidemiology, and End Results database, which is linked to Medicare.
The study, published online Feb. 13 in the journal Cancer, was funded by the U.S. National Cancer Institute.
About 226,000 new cases of lung cancer will be diagnosed in the United States this year, 90 percent of which will be non-small cell, according to the American Cancer Society. Within non-small cell cancers, there are three main subtypes.
Previous studies looking into the survival benefits of post-op radiation for this group of patients have produced mixed results, Wisnivesky said.
However, in his study, he found no substantial differences between those who had the treatment and those who didn't. And, radiation therapy carries risks. Besides the inconvenience of the additional treatments, the therapy can cause irritation of the lungs and inflammation of the esophagus, he said.
"Patients need to be well informed," he said. "They have to have a good discussion with their doctor about what are the potential benefits," he said. They also need to discuss possible side effects.
Another expert, Dr. Dan Raz, an assistant professor of surgery at City of Hope Comprehensive Cancer Center in Duarte, Calif., emphasized that the study is not talking about all stage 3 lung cancer patients, but only a specific group, those with stage 3 non-small cell and involvement of the N2 lymph nodes.
"It's a small subset of patients" of all lung cancer patients, he said, adding that it's a challenging group.
Some previous small studies have also suggested that post-op radiation may be unnecessary in these patients, and the new findings add to that argument, he said.
"In the end, survival and quality of life are the most important things for patients," Raz said. But recurrence, a key factor, was not addressed in the study, he said.
The new finding "wouldn't change the way I treat patients, but I think it raises a very important point."
What's needed is a trial comparing use of post-operative radiation and its non-use in this group of patients, Raz said. According to Wisnivesky, such a study is under way in France, but will take several years to finish.
For more on radiation therapy, go to the American Cancer Society.
SOURCES: Juan Wisnivesky, M.D., Dr.Ph., vice-chair for research, Department of Medicine, Mount Sinai School of Medicine, New York City; Dan Raz, M.D., assistant professor, surgery, City of Hope Comprehensive Cancer Center, Duarte, Calif.; Feb. 13, 2012, online, Cancer
MONDAY, Feb. 13 (HealthDay News) -- The cancer rate in children with juvenile arthritis is four times higher than in other children, a new study says.
This increased risk of cancer isn't necessarily linked to arthritis treatments, such as tumor necrosis factor (TNF) inhibitors, according to the study published online Feb. 13 in the journal Arthritis & Rheumatism.
In the United States, TNF inhibitors carry a "black box" warning about the potential cancer risk associated with the drugs.
In this study, the researchers analyzed 2000-2005 Medicaid data from more than 7,800 children with juvenile arthritis and comparison groups of about 650,000 children with asthma and nearly 322,000 children with attention-deficit hyperactivity disorder (ADHD).
The incidence rate of probable and highly probable cancers in children with juvenile arthritis was 4.4 times higher than in the other groups of children.
Juvenile idiopathic arthritis (JIA) in children is a general term covering different types of chronic arthritis. Symptoms, similar to adult arthritis, include joint pain, swelling, tenderness and stiffness.
"While our findings show children with [juvenile idiopathic arthritis] have a higher incidence of cancer compared to peers without JIA, the greater frequency of malignancy does not appear to be necessarily associated with treatment, including use of TNF inhibitors," concluded Dr. Timothy Beukelman, of the University of Alabama at Birmingham, in a journal news release.
"This highlights the critical importance of appropriate comparator groups when evaluating the safety of new medications. Further confirmation of our findings with large-scale and long-term investigation of the association between cancer and [juvenile arthritis] and its treatment is needed," he added.
Most of the children with juvenile arthritis in the study were treated with injections of etanercept, a soluable TNF-receptor blocker. Other anti-TNF drugs that work by different mechanisms may yield different results, Dr. Karen Onel and Dr. Kenan Onel from the University of Chicago noted in an accompanying journal editorial.
But, "By focusing on the possible cancer risk associated with the use of TNF inhibitors, the underlying cancer risk associated with [juvenile arthritis] may have been understated, and it is important to make patients, families and physicians aware of the possible late consequences of this disease," they added in the news release.
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more about juvenile arthritis.
SOURCE: Arthritis & Rheumatism, news release, Feb. 13, 2012
MONDAY, Feb. 13 (HealthDay News) -- Patients with a history of heart disease will most likely not reduce their risk for developing cancer by taking vitamin B and/or omega-3 fatty acid supplements, a new French analysis suggests.
"In the population we studied, we found no beneficial effects of either B vitamins or omega-3 fatty acids taken over five years on cancer occurrence or cancer-related death," noted study author Valentina Andreeva, who is with the nutritional epidemiology research unit at the University of Paris XIII in Bobigny, France.
Andreeva and her colleagues report their findings in the Feb. 13 online edition of the Archives of Internal Medicine.
To explore the protective potential of B vitamins and fatty acid supplements, the authors did a secondary analysis of data that had been collected in a previous study involving almost 2,000 French men and 500 women.
All were between 45 and 80 years of age, and all had experienced cardiac trouble (heart attack, unstable angina or ischemic stroke) in the year leading up to the start of the study.
In turn, the participants were divided into one of four different groups that consumed a daily supplement regimen involving various types of vitamin B and omega-3 fatty acids at "relatively low supplementation doses."
By the end of the original five-year study, 7 percent of the participants had gone on to develop some form of cancer, and just over 2 percent ultimately died of cancer. The vast majority of cancer cases (including prostate, lung, bladder and colorectal cancer) and deaths occurred among men (81 percent and 83 percent, respectively).
The team unearthed no evidence that any form of vitamin B or omega-3 fatty acid supplement improved cancer outcomes in any way.
The investigators noted that there were some indications that cancer risk might have actually gone up, specifically among women taking vitamin B and/or omega-3 fatty acid supplementation. However, the authors stressed that this observation was based on too few cases to substantiate a firm conclusion, and called for further research involving a larger pool of participants.
"The results of our study suggest that individuals should exercise caution when deciding to take dietary supplements, especially over a long period of time and without a physician's advice," advised Andreeva. "Such supplements constitute active substances and might have adverse effects in some populations. To be on the safe side, individuals should strive to achieve dietary recommendations via healthy, balanced diets."
Joseph Su, the Washington, D.C.-based program director of the division of cancer control and population science within the U.S. National Cancer Institute's epidemiology and genomics research program, said that nothing about the findings struck him as surprising.
"So far, study findings have been very inconsistent," he noted. "But most supplement studies, if anything, have shown no beneficial effect whatsoever. Just like this one. So, I don't think there's anything that can really back up the idea that these supplements can prevent cancer."
However, Vicky Stevens, strategic director of laboratory services at the American Cancer Society in Atlanta, expressed some reservations about the French analysis.
"Compared with other trials, they used much lower levels of supplements," she noted. "From the B-vitamin point of view, dramatically lower. So, it could be argued that they just weren't using high enough levels of supplements to see any effects," Stevens suggested.
"And they used a natural form of folate [vitamin B supplement], whereas other trials use a synthetic form," Stevens added. "But the real problem in being able to evaluate the effects they do see is that they don't have enough people. And it's not really a long enough follow-up period to really see an effect of these supplements on cancer onset. Five years isn't really enough. It can take 10 or 20 years in most cases. So, what they may be seeing is an effect on preexisting abnormalities, but not the impact on cancer onset itself."
Duffy MacKay, a naturopathic doctor and vice president of scientific and regulatory affairs for the Council for Responsible Nutrition in Washington, D.C., agreed.
"When you look at an intervention like this, you're definitely not looking at the role of the supplements at preventing tumors, because the tumors likely started well before the trial," he noted. "So really what the trial is about is giving vitamin B and omega 3 and seeing if they altered the outcome, the progression, of these cancers," MacKay explained.
"And with that you have to realize that cancer is a very complex multi-factorial disease," MacKay stressed. "And two supplements would never be expected to be a successful treatment on their own. I would say, however, that proper nutrition is one of your best allies in terms of wellness, period. And while no one ever claimed these were cancer drugs, if you will, supplements make sense, cancer or no cancer."
For more on vitamins and cancer, visit the American Cancer Society.
SOURCES: Valentina Andreeva, Ph.D., nutritional epidemiology research unit, University of Paris XIII, Bobigny, France; Vicky Stevens, Ph.D., strategic director, laboratory services, American Cancer Society, Atlanta; Duffy MacKay, naturopathic doctor and vice president, scientific and regulatory affairs, Council for Responsible Nutrition, Washington, D.C.; L. Joseph Su, Ph.D., program director, division of cancer control and population sciences, epidemiology and genomics research program, U.S. National Cancer Institute; Feb. 13, 2012, Archives of Internal Medicine, online
FRIDAY, Feb. 10 (HealthDay News) -- People with the condition called Barrett's esophagus who are smokers may have double the risk of developing esophageal cancer, a new study warns.
These people also have twice the risk of developing advanced precancerous cells, according to the study in the February issue of Gastroenterology.
"We found that tobacco smoking emerged as the strongest lifestyle risk factor for cancer progression. Contrary to popular belief, alcohol consumption didn't increase cancer risk in this group of patients with Barrett's esophagus," lead author Helen Coleman, of Queen's University Belfast in Northern Ireland, said in a news release from the American Gastroenterological Association.
In people with Barrett's esophagus, damage caused by stomach acid causes the lining of the esophagus to become similar to the lining of the stomach, according to the U.S. MedlinePlus Medical Encyclopedia. Most people with Barrett's esophagus do not develop esophageal cancer.
For the study, researchers looked at more than 3,000 Barrett's esophagus patients worldwide and identified 117 cases of dysplasia or cancers of the esophagus or stomach.
Current smoking, regardless of the number of cigarettes smoked per day, was significantly associated with an increased risk of esophageal cancer. Therefore, cutting down on cigarette consumption may not be enough to reduce the risk of esophageal cancer in people with Barrett's esophagus, the researchers suggested.
"Tobacco smoking has been long established as highly carcinogenic," Coleman said. "Barrett's esophagus patients who smoke should start a cessation program immediately."
Although the study authors pointed out that more research is needed to confirm the findings, and the association noted in the study did not prove a cause-and-effect relationship between smoking and esophageal cancer in these patients, Coleman's team suggested that smoking should be discouraged.
The investigators also noted that developed countries have seen a rise in the incidence of esophageal cancer.
The U.S. National Cancer Institute has more about esophageal cancer prevention.
SOURCE: American Gastroenterological Association, news release, Jan. 30, 2012