Breast Cancer Deaths Reduced By Multiple Vitamin Supplements?

Another study shows a powerful association between taking multiple vitamin supplements (MVM) and better health. The largest study ever conducted of multiple vitamin use in postmenopausal women with breast cancer found a strong linkage between MVM use and better prognosis. The Women’s Health Initiative is a massive study (over 161,000 American women) providing us insight into a broad range of lifestyle factors, health and diseases. Whenever you learn of some major discovery on women’s health, the odds are high that WHI data are the source of the groundbreaking research. Investigators studied the 7728 women in the WHI who were diagnosed with invasive breast cancer and followed them for over seven years. About 38% of the women diagnosed with invasive breast cancer were taking an MVM. Those women were 30% less likely to die of their invasive breast cancer than the women who were not taking an MVM. Studies like this are always open to question because association does not prove causation. What are the uncertainties in this study? Women who take an MVM often have other good health habits. Could those other habits explain their improved chances against their cancers? Investigators worked diligently to exclude these sources of confusion. They analyzed the data, digging out the protective effects of age at time of diagnosis, alcohol use, depression, diabetes, education level, hormone characteristics of the tumor, physical activity, race/ethnicity, self report of health status, smoking status and weight. Even after carving out all of these confounders, nearly every known risk factor for breast cancer, the beneficial association with MVM use held up. Women in this study had started taking MVM supplements before they developed breast cancer. Only postmenopausal women were studied. MVM supplements might not help women who start taking MVMs after they are diagnosed or premenopausal women. Of course, MVMs might help those women even more. We do not know yet. Even IF there is some unidentified protective factor more common among women using MVMs, the impact is so big (30% reduction in deaths), that it appears very unlikely to disappear. This is another excellent reason to take an MVM, especially a good...

Breast Cancer and Medication

Many years ago a study came out linking increased use of antibiotics to an increased rate of breast cancer. That study considered cumulative use of all antibiotics, not one specific antibiotic, thus suggesting a range of possible causes. There was insufficient evidence to prove that the antibiotics caused the breast cancers or even certainly made women more vulnerable. Maybe so, but not proven. Maybe changing the bacteria inhabiting women’s bodies influenced risk or impaired the normal cancer eliminating activities of the immune system. Maybe women who took more antibiotics were simply more likely to have mammograms, which we know tend to discover many breast cancers that do not need to be found. There were just too many questions to know what it all meant. Other studies, scattered over the years and appearing in minor medical journals, have found links between a diverse variety of cancers and medication use. Again, definitive proof is lacking. Cancers develop over years or even decades. From our habits and environment, each of us has innumerable exposures to many, many potentially cancer causing factors. Combining these exposures with medication use, including a certain medication or combinations of certain medications, assuredly leads to a massive range of effects. Nailing down the truth is extremely difficult. Such uncertainty allows for nearly any interpretation you want to make. Just ask the tobacco industry about that. A new study does a pretty reasonable job of linking one class of blood pressure medications to invasive breast cancer. Investigators considered the impact of calcium channel blocking medications (NORVASC, PROCARDIA, CARDENE, CALAN). Women with breast cancer were 2.5 times more likely to have taken calcium channel blockers (usually for high blood pressure) for 10 or more years than women without cancer. Again this link does not prove causation. However, combined with other studies linking calcium channel blockers to breast and other cancers, suspicions are rising. Nearly 100 million Americans are prescribed calcium channel blockers each year. If they do raise the risk of cancer, the consequences are pretty big. Although calcium channel blockers were found connected to breast cancer, unlike other blood pressure medications in this study, that finding should not make you complacent about other drugs. As we all know, breast cancer is not the only health problem to which people are subject. Much more can go wrong. Just as they can help manage symptoms, medications can harm us. The bottom line message to me is pretty much the same song I always sing - Be very careful about what you...

Concerning News About Advanced Breast Cancer in Young Women

I am disturbed by a recent study of advanced breast cancer among young women. Published in the Journal of the American Medical Association February 27, the study tracked breast cancer rates from 1976 to 2009. Over those 34 years, the incidence of metastatic breast cancer increased by 1.37 cases in 100,000 women. That is a very small number. Because breast cancer, especially metastatic breast cancer, is so rare among young women, this could be a statistical quirk. However in 1976 the incidence of advanced breast cancer was only 2.9. That means that the rate went up nearly 50%. When you look at it that way, these are pretty distressing numbers. There was no similar increase among older women. The increase in young women was in estrogen dependent cancers, cancers whose growth is driven by estrogen. That catches my attention because our bodies have been facing an onslaught of estrogen mimicking chemicals in the environment. Those chemicals have been linked to a very, very wide range of health problems (obesity, miscarriage) and diseases (cancer, diabetes, allergies, etc). We know that environmental chemicals cause breast cancer. It is not far-fetched to wonder if there could be a connection between these widespread estrogen-dependent cancers in young women and increasing levels of man-made estrogen-like chemicals in our environment. Hopefully not....

Mammography and Breast Cancer

If you have been reading my thoughts for some time, you know that I am not a big advocate of mammograms. I really wish they would do the job they are supposed to do, but they just don’t. Another study appeared recently, documenting the unpleasant consequences of well-intentioned mammographic screening. It is not the first study highlighting a dilemma that would be much more comfortable to deny. Years ago two large studies, including nearly one half million women, found that mammograms often found breast cancers that spontaneously disappeared, and that breast self exam did not reduce deaths from breast cancer. Much of the medical community and society at large have tried, pretty successfully, to ignore those powerful findings. The principle author (H. Gilbert Welch) is someone I respect highly, partly because he thinks so clearly and critically about the application of research in clinical practice. Like me, he is trained in Family Medicine in addition to his research bona fides, so he always considers the “bottom line” outcomes. In the past I have recommend one or another of his books because they contain such clear discussions of the vitally important but infinitely confusing matter of using research to make health care decisions. The concepts he explains so well confused just about every medical student, resident and practicing physician I have worked with through my career. It is no surprise then, that his review of mammography data created a white-hot firestorm of controversy. You can read a simple discussion of the study and its implications in an editorial he wrote- http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or-victim-of-overdiagnosis.html The essential findings of the study, reviewing the impact of three decades of mammographic screening in America, were: Mammograms did not lower the rate of widespread, life-threatening breast cancer Improved breast cancer survivor rates are the result of more effective treatment, not screening 1/3 of the diagnoses of cancer by mammogram were needless, consequently - 1.3 million women have undergone treatment for breast cancers that would never have caused harm Unneeded treatment causes significant harm. The Hippocratic Oath begins with the admonition, “First, do no harm”. The obvious conclusion is that we need to find better ways to determine which cancers need to be treated and which do not. The reaction of much of the medical community has been highly emotional. It has not been reasoned and scientific, like we pretend to be. I admit that I have enjoyed the controversy for a few reasons. Welch’s points are valid, but carry frightening implications about our ignorance. Maybe it...