I read two interesting studies lately about acetaminophen (tylenol) and NSAIDs of the cox-2 variety ( rofecoxib, celecoxib, etc).
We were told previously that cox-2 non-steroidal anti-inflammatory drugs can have adverse effects on the heart. The latest study in the journal Circulation arrives at the same conclusion. To sum up the study, the authors show that patients with prior heart attacks, NSAIDs use increased the risk of death and recurrent heart attacks in as little as one week of use. There was a 45% increased risk of death or recurrent heart attack in the first seven days of treatment and a 55% increased risk of treatment continued for three months. So the conclusion for those of you who have had prior myocardial infarctions, stay off the cox-2 inhibitor NSAIDs. Cox-1 inhibitors such as aspirin and tylenol are better for short term use.
Having said that, the newest research on acetaminophen in the Journal of Clinical Oncology shows that chronic users of acetaminophen nearly doubled their risk of developing blood type cancers like lymphoma and myeloma.
To quote the author:
"A person who is age 50 or older has about a one-percent risk in ten years of getting one of these cancers," White said. "Our study suggests that if you use acetaminophen at least four times a week for at least four years, that would increase the risk to about two percent."
Some of you might be thinking, who uses tylenol four times per week? I can tell you that there are a lot of people out there who use pain killers daily. No one wants to live in pain. Sometimes there are other options like acupuncture, cupping or the use of some herbs to help. At other times, medication is needed. But just as with all things in life, there are trade-offs and one needs to know the risks. I hope this information helps you to make an informed decision.
Yours in Health,
Ian Koo, ND
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"The care you want, the health you need."
Showing posts with label Breast Cancer. Show all posts
Showing posts with label Breast Cancer. Show all posts
Acupuncture for Drug-Induced Joint Pain - Aromatase Inhibitors & Breast Cancer
Acupuncture may help treat some of the common side effects of hormonal drugs called aromatase inhibitors.
Aromatase inhibitors, such as anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara), are used to treat hormone-receptor-positive breast cancer in postmenopausal women. The drugs lower blood levels of estrogen, a hormone that stimulates the growth of these cancer cells. Although aromatase inhibitors are considered effective for early-stage cancer, nearly half of people taking them experience pain and stiffness in the joints and muscles.
The researchers studied 43 women with breast cancer who reported joint pain associated with aromatase inhibitors. The participants were randomly assigned to either true acupuncture or sham acupuncture twice a week for six weeks. During the sham acupuncture, a superficial needle was inserted into non-acupoints. All of the participants continued taking aromatase inhibitors.
At the beginning of the study and three and six weeks after treatment, pain was assessed using the Brief Pain Inventory-Short Form (BPI-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Modified Score for the Assessment of Chronic Rheumatoid Affections of the Hands (M-SACRAH).
According to the results, published in theJournal of Clinical Oncology, true acupuncture significantly improved joint pain and stiffness after six weeks. In addition, 20 percent of the patients who reported taking pain-relieving medications no longer needed them after acupuncture treatment. No significant improvements were reported in the sham group.
The authors concluded that "acupuncture is an effective and well-tolerated strategy for managing this common treatment-related side effect."
Scientific evidence supports the use of acupuncture for several other indications, including osteoarthritis, chronic pain, post-operative pain, dental procedures, endoscopy-related pain, fibromyalgia and several types of nausea and vomiting.
References:
- Crew KD, Capodice JL, Greenlee H, et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol. 2010 Mar 1;28(7):1154-60.
Yours in health,
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
Acupuncture vs. Drug Therapy (Hot Flashes & Sex Drive)
In a study published in the Dec. 2009 Journal of Oncology comparing the benefits of acupuncture vs. Effexor, the number one choice for the treatment of hot flashes - something that affects the majority of breast cancer survivors - the randomized control trial showed that acupuncture had a longer-lasting effect on the reduction of hot flashes and night sweats for women receiving hormone therapy for breast cancer. The women also reported additional energy, improved sex drive and clarity of thought with the acupuncture treatments.
A good article summarizing the findings can be found here.
Journal Reference:
Yours in health,
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
A good article summarizing the findings can be found here.
Journal Reference:
- Walker et al. Acupuncture Versus Venlafaxine for the Management of Vasomotor Symptoms in Patients With Hormone Receptor-Positive Breast Cancer: A Randomized Controlled Trial. Journal of Clinical Oncology, 2009; DOI: 10.1200/JCO.2009.23.5150
Yours in health,
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
Mammograms & Breast Cancer Screening - New guidelines debated
As some of you may be aware, there's been a lot of brouhaha about the new breast cancer screening recommendations by the US Preventive Services Task Force (USPSTF). The new recommendations were published in the November 17 issue of the Annals of Internal Medicine and now recommends against routine screening mammograms for women under 50 years and suggests that screening end at 74 years. They also recommend against teaching breast self-examinations.
This advice is in contradiction to the guidelines of the American Cancer Society and the American College of Radiology which recommend yearly mammograms from 40 years old. However, many advocacy groups like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network are in favour of the new guidelines.
So again, like I always say, things are not so clear cut in medicine. There will always be experts with piles of research on both sides of the issue and my job as a health care practitioner is to help you figure out what's best for each person. Individualized medicine, right?
Here's my stab at tackling this complex issue.
Should I continue to do Breast-Self Examinations?
My answer is a resounding yes!
The USPSTF states that current evidence is insufficient to determine the additional benefits and harms of breast exams by clinicians beyond screening mammography for women 40+ years of age. Essentially, they're saying there's no proof that it benefits or harms you. However, if breast exams are done consistently & properly, women can detect hard masses and abnormalities in which case, they definitely need to go in for further testing.
Yearly mammograms starting at 40 years? or Bi-yearly mammograms starting at 50?
The reason for the USPSTF's new guidelines is that they believe that the stress & anxiety that women are put through to do these procedures outweighs the benefits. Many false positives are detected and women can undergo unnecessary biopsies and follow-up testing. One scientist noted that women in their 40s have about a 10 percent chance of a false positive and a 1 percent chance of having a biopsy each time they have a mammogram. That compares against the relatively small risk of cancer for women in their 40s of 1.5 per of 1,000 women.
A greater harm is overdiagnosing by finding cancers that are better off not being found. Dr. Barnett Kramer of the National Institutes of Health describes overdiagnosis as "pure harm" because it means that women are treated with measures like chemotherapy, radiation and surgery for tumors that do not need treating. One scientist says that you can view cancer as three different types. One type grows so fast that early diagnosis is futile. Another grows so slowly it does not need to be found early to be cured. And as many as a quarter of those slow-growing cancers would never be noticed in a woman's lifetime. Cancers in the third group can be cured if they are caught early. But with breast cancers, that third group makes up only 15 percent of the deadly cancers.
This breast cancer screening question has also been posed for prostate cancers as well. There are a number of experts who believe that screening for prostate cancers is unnecessary later in life as many people die of other causes rather than the cancer.
These are all legitimate concerns so it makes this question of to mammogram or not to mammogram more complex.
What risk factors do you have? How worried are you? Would you rather have peace of mind and get the yearly mammograms even if it means getting a false positive? Are you someone who believes that they must take all preventative measures available? There are different levels of prevention. Some women with the BRCA1 & BRCA2 genes decide that the risk of breast cancer is too high and choose to have mastectomies, whereas others choose to live as healthy a life as possible to prevent these cancer genes from turning on. We know that genetics only accounts for a fraction of your health because what you put in your body and your lifestyle can determine which genes get activated or turned off.
Each person needs to weigh the risk factors and figure out what kind of personality they have. After doing all this, you will probably be able to come to a satisfactory conclusion and you can definitely discuss your thought process with your doctor.
Risk Factors
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
This advice is in contradiction to the guidelines of the American Cancer Society and the American College of Radiology which recommend yearly mammograms from 40 years old. However, many advocacy groups like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network are in favour of the new guidelines.
So again, like I always say, things are not so clear cut in medicine. There will always be experts with piles of research on both sides of the issue and my job as a health care practitioner is to help you figure out what's best for each person. Individualized medicine, right?
Here's my stab at tackling this complex issue.
Should I continue to do Breast-Self Examinations?
My answer is a resounding yes!
The USPSTF states that current evidence is insufficient to determine the additional benefits and harms of breast exams by clinicians beyond screening mammography for women 40+ years of age. Essentially, they're saying there's no proof that it benefits or harms you. However, if breast exams are done consistently & properly, women can detect hard masses and abnormalities in which case, they definitely need to go in for further testing.
Yearly mammograms starting at 40 years? or Bi-yearly mammograms starting at 50?
The reason for the USPSTF's new guidelines is that they believe that the stress & anxiety that women are put through to do these procedures outweighs the benefits. Many false positives are detected and women can undergo unnecessary biopsies and follow-up testing. One scientist noted that women in their 40s have about a 10 percent chance of a false positive and a 1 percent chance of having a biopsy each time they have a mammogram. That compares against the relatively small risk of cancer for women in their 40s of 1.5 per of 1,000 women.
A greater harm is overdiagnosing by finding cancers that are better off not being found. Dr. Barnett Kramer of the National Institutes of Health describes overdiagnosis as "pure harm" because it means that women are treated with measures like chemotherapy, radiation and surgery for tumors that do not need treating. One scientist says that you can view cancer as three different types. One type grows so fast that early diagnosis is futile. Another grows so slowly it does not need to be found early to be cured. And as many as a quarter of those slow-growing cancers would never be noticed in a woman's lifetime. Cancers in the third group can be cured if they are caught early. But with breast cancers, that third group makes up only 15 percent of the deadly cancers.
This breast cancer screening question has also been posed for prostate cancers as well. There are a number of experts who believe that screening for prostate cancers is unnecessary later in life as many people die of other causes rather than the cancer.
These are all legitimate concerns so it makes this question of to mammogram or not to mammogram more complex.
What risk factors do you have? How worried are you? Would you rather have peace of mind and get the yearly mammograms even if it means getting a false positive? Are you someone who believes that they must take all preventative measures available? There are different levels of prevention. Some women with the BRCA1 & BRCA2 genes decide that the risk of breast cancer is too high and choose to have mastectomies, whereas others choose to live as healthy a life as possible to prevent these cancer genes from turning on. We know that genetics only accounts for a fraction of your health because what you put in your body and your lifestyle can determine which genes get activated or turned off.
Each person needs to weigh the risk factors and figure out what kind of personality they have. After doing all this, you will probably be able to come to a satisfactory conclusion and you can definitely discuss your thought process with your doctor.
Risk Factors
- Personal & family history of breast cancer
- Ethnicity - White women are at a slightly greater risk of getting breast cancer than African-American women, but African-American women are more likely to die of this cancer. Asians, Hispanics & Native-American women have lower risks of developing and dying of breast cancer. The BRCA genes are found more in women of Jewish Eastern European background.
- Drink 2 or more cups of alcohol per day. Technically even 1 cup/day increases your risk!
- Dense breast tissue
- Women who started menstruating early (before 12 years old) &/or had late menopause (after 55 yrs old). Scientists postulate it's due to total lifetime exposure to the hormones estrogen and progesterone.
- Current oral contraceptive use appears to elevate risks slightly, but women who have stopped for 10 yrs do not appear to have any increased risks.
- Not having children or having children later in life seems to increase the risk slightly, though frankly, I do not recommend having kids just to reduce your risk.
- Not breast-feeding may increase the risk. However, studies suggest that you may need to breastfeed for 1.5 - 2 yrs to get the protective effects. That's tough to do, but I have met patients who have done this.
- Some forms of hormone replacement therapy (HRT) increase risks
- Being overweight
- Lack of physical activity
- Smoking
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
Breast Cancer & Hormone Replacement Therapy: What we know now - The good news
By now, a lot of people know about the increased risks of getting breast cancer when a woman goes on hormone replacement therapy (HRT). The Women's Health Initiative - a large scale study - was stopped in 2002 when it was noticed that estrogen and progestin users had a noticeably greater risk of developing heart problems and breast cancer. Statistical analysis shows that at the peak, the breast cancer risks for women on HRT were twice that of women on a placebo pill.
Fortunately, retrospective analysis shows that these risks dropped quickly once the HRT group stopped using the pills. In fact, this group's risk levels returned to normal in about two years. Very good news indeed considering it takes about 10-15 years for a smoker's risk profile to go back to normal levels.
Yours in health,
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
Fortunately, retrospective analysis shows that these risks dropped quickly once the HRT group stopped using the pills. In fact, this group's risk levels returned to normal in about two years. Very good news indeed considering it takes about 10-15 years for a smoker's risk profile to go back to normal levels.
Yours in health,
Ian Koo, ND
Doctor of Naturopathic Medicine
Naturopathic Essentials Health Centre
"The care you want, the health you need"
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