Finally A Screening Recommendation For Ovarian Cancer

Lancet reports yearly screening for ovarian cancer, using a pelvic ultrasound and checking a blood marker CA125, might reduce deaths from ovarian cancers. The study was done in UK in over 200,000 post menopausal women with no family or personal history of ovarian cancer and they were followed for a period of 11 years.

During the follow-up, the incidence of ovarian cancer mortality was not significantly lower in the screening group  than in the no-screening group. However, the effect of screening became significant after 7 years. In addition, in a prespecified secondary analysis that excluded women with CA125 levels suggesting cancer at baseline, screening was associated with a 20% reduction in ovarian cancer mortality relative to no screening.

 

Apples Beware!

Annals of Internal Medicine reports that people who have a normal body mass index (weight to height ratio) but abdominal fat are at high risk for heart related deaths.

Using National Health and Nutrition Examination Survey data, researchers studied more than 15,000 adults with BMIs greater than 18.5. Normal being 18-24.

After a mean follow-up of 14 years, waist-to-hip ratio (WHR), but not BMI, was associated with higher overall mortality risk. Among men with normal BMI, those with central obesity had an 87% higher total mortality risk than men without central obesity. Similarly, women with normal-weight central obesity had a 48% higher mortality risk than women with similar BMI but no central obesity.

The recommended waist circumference for men is less than 102 cm, and for women is less than 88 cm.

 

Vitamin B3 To The Rescue

Nicotinamide (a form of vitamin B3, Niacin) reduces the incidence of nonmelanoma skin cancers in high-risk adults. High risk was defined as having had 2 cases of skin cancer- either squamous cell or basal cell, in the past 5 years.

This study was done on over 400 adults in Australia, who were randomized to receive oral niacin (500 mg) or placebo twice daily for a year. During the study, the average number of new skin cancers was significantly lower with vitamin B3. Significant reductions were observed for both squamous cell and basal cell cancers. In addition, the number of actinic keratoses, which can turn cancerous, was significantly lower among niacin recipients as early as 3 months after supplementation began. Adverse events did not differ between the groups.

The authors conclude that “nicotinamide is widely accessible as an inexpensive over-the-counter vitamin supplement and presents a new chemopreventive opportunity against non-melanoma skin cancers.”

 

Which Cancers Should We Screen For?

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?

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

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 

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.”