Which Cancers Should We Screen For?

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The American College of Physicians has made the following recommendations on screening for five common cancers.

  • Breast: For women aged 40-49 years, mammography screening every 2 years should be offered if a woman requests it after a discussion of the potential benefits and harms. For women aged 50-74 years who are in good health, mammography should be encouraged every 2 years.
  • Cervical: For women aged 21-29 years, Pap smears are recommended every 3 years. For those aged 30-65, Pap smears with HPV testing can be done every 5 years (instead of Pap smears alone).
  • Colorectal: For patients aged 50-75 years, one of the following strategies should be encouraged: high-sensitivity stool blood testing (FOBT) or stool immunofluorescence testing (FIT) annually; sigmoidoscopy every 5 years; combined high-sensitivity FOBT or FIT every 3 years plus sigmoidoscopy every 5 years; or optical colonoscopy every 10 years.
  • Ovarian: Screening isn’t recommended.
  • Prostate: For men aged 50-69 with a life expectancy of at least a decade, discuss screening’s benefits and risks. If patients prefer screening, order prostate-specific antigen testing no more than once every 2-4 years.

 

Does Orange Juice Increase Your Risk Of Melanoma?

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Consumption of orange juice and grapefruit are associated with an increased melanoma risk, says a study in the Journal of Clinical Oncology.

Nearly 100,000 white participants completed questionnaires about their consumption of citrus fruits and juices and were followed for roughly 25 years. Participants who reported consuming at least 1.6 servings of citrus daily had a 36% increased risk for melanoma, compared with those who ate less than two servings a week. In analyses by citrus type, the findings were significant only for orange juice (increased risk seen with 5-6 servings/week vs. <1/week) and grapefruit (increased risk with <1/week vs. never).

The authors speculate that the association could be due to the psoralen found in citrus fruits. Animal studies have found that psoralen has photocarcinogenic properties.

 

Avoid Ibuprofen, Naproxen If You Are On Any Antidepressants

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Combining antidepressants especially SSRI’s (Lexapro, Zoloft, etc.) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Naprosen might increase the risk for strokes from bleeding in the brain, in patients according to a study published in the BMJ.

Building on the established knowledge that NSAIDs and antidepressants independently increase the risk for abnormal bleeding, researchers examined data on hospital admissions and prescriptions from more than 4 million Korean patients who were prescribed antidepressants for the first time between 2010 and 2013.

Individuals who took both antidepressants and NSAIDs at the same time were at a heightened risk for experiencing bleeding in the brain within 30 days of beginning the drugs, compared with those who used antidepressants alone.

 

Surgery no better than placebo in knee pain 

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A meta- analysis in the BMJ, shows arthroscopic surgery (partial meniscectomy, debridement, or both) for knee pain in middle-aged and older patients is not any better than placebo (exercise or sham surgery), but can actually cause harm in this population. Adverse effects included clots in the legs, clots in the lungs and death from surgical complications like infection.

The authors conclude, “Available evidence supports the reversal of a common medical practice.”

Timing of blood pressure medications and development of diabetes

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According to two Spanish studies in Diabetologia, elevated nighttime blood pressure may promote development of adult onset diabetes, and taking medication to control blood pressure at bedtime, might actually help reduce that risk.

In the first study, 2700 adults who were not diagnosed with diabetes, periodically underwent 48-hour ambulatory BP monitoring. Over 6 years’ median follow-up, 7% developed diabetes. Risk for diabetes was greater with higher levels of sleep-time systolic BP and with smaller BP declines during sleep. Systolic BP during sleep was the second most significant predictor of diabetes, behind fasting glucose.

In the same study group, patients with high BP, were randomized to take at least one of their BP medications before bed or to take all of their BP medications in the morning. Compared with the morning group, the nighttime group had better ambulatory BP control (particularly during night sleep) and was at significantly reduced risk for developing diabetes (12% vs. 5%). When taken at bedtime, angiotensin-receptor blockers, angiotensin-converting-enzyme inhibitors, and beta-blockers showed greater benefit.

 

Double Whammy — Does smoking increase your risk for diabetes?

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Yes, according to an article published in the Lancet Diabetes & Endocrinology. In this meta- analysis, researchers examined data from nearly 90 studies reporting on smoking behaviors and type 2 diabetes; almost 6 million participants and 300,000 diabetes cases were included. The findings were as follows-

Compared to non smokers-

  • Current smokers had a 37% increased risk for diabetes.
  • Former smokers had a 14% increased risk.
  • Those exposed to secondhand smoke had a 22% increased diabetes risk
  • People who quit smoking had a 54% increased diabetes risk in the first 5 years after quitting, this risk increase declined to 11% by 10 years.

 

June 18, 2018- will signal the end of Trans Fats in our diets 

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As most of you have probably read, the FDA has announced that food manufacturers must remove partially hydrogenated oils — the major source of artificial trans fats in processed foods in three years.

After June 18, 2018, companies must petition the agency for approval to add partially hydrogenated oils to their products. This we hope will reduce heart disease and prevent thousands of heart attacks per year.

A New Tool to Find a Surgeon

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ProPublica has published a searchable scorecard to help patients choose a surgeon. It includes the complication rates of roughly 17,000 surgeons at 3600 hospitals across the country.

Using Medicare data for inpatient stays from 2009 to 2013, they focused on eight common elective surgeries (e.g., knee or hip replacement, angioplasty, gall bladder removal, prostate removal). They calculated the 30-day readmission rate for surgery-related complications, such as infections, blood clots, uncontrolled bleeding, and misaligned orthopedic devices and adjusted for factors including patient health and age, among other things.

Overall complication rates were 2% to 4%. Roughly 11% of surgeons were responsible for about a quarter of the complications.

The scorecard is searchable by surgeon, hospital, city, and state.

Surgeon Scorecard 

 

The MIND DIET

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This new diet called the MIND diet, “Mediterranean-DASH Intervention for Neurodegenerative Delay” has received much publicity recently, as the diet to ward off Alzheimer’s Dementia. Published in the journal Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, this study shows that the MIND diet lowered the risk of Alzheimer’s Dementia by as much as 53 percent in participants who adhered to the diet rigorously, and by about 35 percent in those who followed it moderately well.

Developed by the Rush nutritional epidemiologist Martha Clare Morris, PhD, and colleagues, the MIND diet is a combination of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, both of which have been found to reduce the risk of cardiovascular conditions, like hypertension, heart attack and stroke.

The MIND diet has 15 dietary components, including 10 “brain-healthy food groups” — green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine — and five unhealthy groups that comprise red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

The MIND diet includes at least three servings of whole grains, a salad and one other vegetable every day — along with a glass of wine. It also involves snacking most days on nuts and eating beans every other day or so, poultry and berries at least twice a week and fish at least once a week. Dieters must limit eating the designated unhealthy foods, especially butter (less than 1 tablespoon a day), cheese, and fried or fast food (less than a serving a week for any of the three), to have a real shot at avoiding the devastating effects of Alzheimer’s, according to the study.

Berries are the only fruit specifically to make the MIND diet. “Blueberries are one of the more potent foods in terms of protecting the brain,” Morris said, and strawberries have also performed well in past studies of the effect of food on cognitive function.

 

Hormone Replacement Therapy Tied to Ovarian Cancers

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A meta-analysis of 17 prospective studies, published in the Lancet looking at over 12,000 women diagnosed with ovarian cancer, about half of the women with ovarian cancer had received hormone therapy, and the median duration of use was 6 years. Women with current hormone therapy use had roughly a 40% increased risk for developing ovarian cancer, even among those who used hormone therapy for less than 5 years. The risk decreased with time, but 10 years after stopping, there was still an increased risk for certain type of tumors.