Author: noorali

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Good News About Cancer in Canada

Almost every household has had a brush with cancer. That means nobody is immune to it. Diagnosis of cancer brings with it tremendous psychological and physical burden to the patient and patient’s loved ones. Therefore, it is important for each one of us to learn something about the common cancers and how to prevent them.

Good news about cancer is that half of all new cancer cases and cancer deaths worldwide are preventable. The second good news is the 5-year relative survival ratio was 62 per cent for all cancers combined from 2001 to 2003. Some years ago it used to be around 50 per cent.

Each year, Canadian Cancer Statistics review the changing size and nature of the cancer burden in Canada. An article in the Canadian Medical Association Journal (CMAJ • November 18, 2008) reviews the major findings from the 2008 edition of Canadian Cancer Statistics.

The article says, “In Canada, cancer will develop in 45 per cent of men and 39 per cent of women during their lifetime, and about one in four Canadians will die of the disease.” There is a higher incidence of cancer among women aged 20-59 years. The mortality rates among women in their 30s and 40s are higher than among men of a comparable age.

Breast cancer is the most prevalent cancer among Canadian women, about one per cent of women. Among men, prostate cancer is the most prevalent cancer, about 0.8 per cent of men.

Thyroid cancer had the highest estimated 5-year relative survival ratio, and pancreatic cancer had the lowest. In general, the incidence rate has been stable for all cancers combined since 1979. In contrast, the mortality rate is decreasing for all cancers combined and for most specific types of cancer. That means we are making slow progress. But we can do more to decrease the incidence of cancer and increase survival if we take more care of our health, take preventative measures and participate in screening protocols.

Breast cancer

The incidence of breast cancer has fluctuated in the last 20 to 30 years due to screening mammography picking up cancer not previously detected. Now the incidence is stabilized to pre-screening years. Good news for women is that in the last 23 years the mortality rate for breast cancer has fallen by more than 25 per cent. Thanks to screening mammography and use of chemotherapy after surgery. Isn’t that wonderful?

Prostate cancer

The incidence rate of prostate cancer continues to increase moderately. Since the mid-1990s, mortality rates have declined by 2.9 per cent per year, likely because of a combination of earlier detection and improved treatment.

Colorectal cancer

The incidence rate of colorectal cancer, particularly among women, has recently begun to decline. The mortality rate has been falling among both men and women over the past two decades, likely as a result of improvements in chemotherapy.

The article says that screening for colorectal cancer can reduce both the incidence and mortality. Limited screening activity has already been occurring in some provinces, which may account for some of the decline in mortality.

Lung cancer

Among men, the incidence and mortality rates began to decline in the mid-1980s. Among women, incidence and mortality rates have been increasing since at least 1979, and continue to do so (each by 1.2 per cent per year). Overall, the incidence continues to be higher among men than among women. The mortality is also higher among men than among women.

The review shows the 5-year relative survival for cancer has been improving over time. Two of the most common types of cancer, lung and colorectal cancer, the survival rates are poor to fair. Most lung cancers are preventable if you do not smoke. For colorectal cancer, implementation of screening programs in many provinces is expected to improve survival.

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What Is New In Preventing Heart Disease?

So, here we are, into February. An important month after you have recovered from Christmas and New Year celebrations. Valentine’s Day, Family Day and heart month fall into February. And as a bonus, this year the Valentine’s Day falls on the same long weekend as the Family Day. It should be a good weekend for the whole family to bond and have fun and have lots of chocolates……yum!

Ok, let us get back to our heart. If you do not have a good heart or a strong heart then you cannot have much fun. That is why for me each month is a heart month. The reason for that is quite simple – heart disease and stroke is the number one killer.

So, today I will devote this space to see if there is anything new to report about preventing heart disease. I will summarize the American Heart Association’s Scientific Sessions Report (November 8-12, 2008, New Orleans, Louisiana) published by the Canadian Medical Association.

How do you assess cardiac risk factors in individuals whose risk is not readily apparent? Do we have a scoring system, biomarkers of cardiovascular risk or genetic testing which would determine their life-time risk of cardiac disease?

No, we don’t. Lot of research is going on but clinically useful data is yet to come. But management is clear in patients who are obviously at high or low risk. These patients are identified by their age, body mass index, cholesterol levels, smoking and family history.

Is there any justification for the use of Statins to prevent heart disease in people with average or low levels of cholesterol to prevent heart disease?

In a study called JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), patients with normal cholesterol levels were tested for high-density C-reactive protein (hsCRP). They found the rates for a first major cardiovascular event and death from any cause were significantly reduced among those who received rosuvastatin compared with those who received placebo. The clinical implications and cost effectiveness needs further investigations before this can be recommended to the general public.

Other important presentations at the conference were:

-After a heart attack, early intervention within 24-hours (angiography, angioplasty, coronary artery bypass) is just as safe and effective as delaying treatment more than 36-hours for low-risk unstable angina patients and those without ST-elevation heart attack. They also found there was a trend toward better outcomes among those receiving early treatment. So, if possible, it would be nice to get on the table for an angiogram within 24-hours of a heart attack.
-Regular intake of vitamin C and E failed to protect against major cardiovascular events. These vitamins are among the most widely used by the general population. So spend your money carefully.
-A large trial involving heart attack survivors has confirmed the safety of folic acid and vitamin B12, but failed to show that they have a protective effect against heart disease or stroke.

Well, February is a good month to get back into regular exercise, laughter, meditation, organic/healthy food, stress relief and to stop smoking. That sounds like my favourite pet ELMOSS. And February is a good month to consume my favourite dark chocolates….yum.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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No Science Behind Colon Cleansing and Detox Diets

Colonoscopy cartoon. (Hemera/Thinkstock)
Colonoscopy cartoon. (Hemera/Thinkstock)

Much has been written about colon cleansing and detox diets as a way of “detoxifying” your body. On Friday, January 30, Medicine Hat News published a letter to the editor (Take ‘proactive/preventive’ wellness approach) which says the following:

“Articles in American Medicine and others state colonic irrigation is the most effective measure to relieve chronic constipation, nervous diseases, especially neurasthenia, chronic bone diseases of joints, diseased blood and forms of chronic nephritis. Systematic colon treatments and dietary changes are definitely effective in the control of high blood pressure as well. Other journals including the Ohio State Medical Journal, New England Journal of Medicine also corroborate cures of many other diseases with the use of colonic irrigation.”

Now, that is a very strong statement. But the letter writers do not provide any specific references so people like me can look them up and learn something new. I would certainly like to prescribe these treatments to my patients if somebody can show me scientific evidence that colon irrigation and detox diets do help and cause no harm.

I googled American Medicine and was unable to find a journal of that name. I was unable to find any scientific articles on the therapeutic effects of colon irrigation and detox diets in two other journals mentioned in the letter.

In my desire to find something positive about colon cleansing and detox diets, I went to three reliable sources on the Internet: the Mayo Clinic website (www.mayoclinic.com), the Harvard Medical School website (www.health.harvard.edu), and WebMD (www.webmd.com).

The Mayo Clinic gastroenterologist, Michael Picco, M.D., says, “Although doctors may recommend colon cleansing in preparation for a medical examination of the colon, most don’t recommend colon cleansing for better health or to prevent disease.”

He says it is unnecessary and it may be harmful because your colon absorbs water and sodium to maintain your body’s fluid and electrolyte balance. Some colon-cleansing programs disrupt this balance, causing dehydration and salt depletion. Long-term or excessive cleansing programs can lead to problems such as anemia, malnutrition and heart failure.

He further says that if constipation is your concern, you can help prevent constipation without colon cleansing. Drink plenty of water and eat a diet rich in fiber.

On detox diets, Dr. Picco says, “There is no evidence, however, that detox diets actually remove toxins from the body. Most ingested toxins are efficiently and effectively removed by the kidneys and liver and excreted in urine and stool.”

The doctor on the Harvard University website says, “The human body can defend itself very well against most environmental insults and the effects of occasional indulgence. If you’re generally healthy, concentrate on giving your body what it needs to maintain its robust self-cleaning system – a healthful diet, adequate fluid intake, regular exercise, sufficient sleep, and all recommended medical check-ups. If you experience fatigue, pallor, unexplained weight gain or loss, changes in bowel function, or breathing difficulties that persist for days or weeks, visit your doctor instead of a detox spa.”

WebMD website reflects what has been already said. I need to see something very scientific about the benefits of colon cleansing and detox diets before I will tell my patients that these “treatments” are safe.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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New Guidelines for Hormone Replacement Therapy

In 2002, we learnt that in post-menopausal women, hormone replacement therapy (HRT) with estrogen was doing more harm than good. The study, Women’s Health Initiative trial, involved 16,608 post-menopausal women, aged 50 to 79. Because of these findings, the study was discontinued early.

The harmful effects of estrogen therapy were: 41 percent increase in stroke, 29 percent increase in heart attacks, doubling of rates of blood clots in the legs and lungs, 26 percent increase in breast cancer and 22 percent increase in total cardiovascular disease.

But the report also said HRT has benefits: 37 percent reduction in cases of colorectal cancer, 33 percent reduction in hip fractures, no difference in total death rate from all causes and controls hot flashes.

Women have been taking estrogen to relieve post-menopausal symptoms for many years. In 1940s, pharmaceutical companies started producing estrogen from pregnant mare’s urine called Premarin. Twenty years later, the drug was being recommended for women who showed evidence of estrogen lack. Practically, all women over the age of 50. But things changed after 2002. According media reports, the highly publicized research led to a sharp drop in HRT prescriptions, to about five million prescriptions last year from 12 million in 2002.

The new guidelines from the Society of Obstetricians and Gynaecologists of Canada say hormone replacement therapy is safe and effective when used immediately at the onset of menopause and for a relatively short time. That means it would be safe to use HRT in women in their 50s to relieve their hot flashes, night sweats and vaginal dryness. And they should discontinue using HRT within five years.

The new guidelines were announced after a committee of experts re-examined the data from the previous study and came to the conclusion that the age at which women begin taking HRT, the dose and the duration all have an influence on risk. The guidelines do not endorse the use of complementary therapies as there is little or no evidence that herbal products sold for the treatment of menopausal symptoms have any benefit.

Women are advised to take control of their lives. Many problems (mood swings, insomnia, osteoporosis and difficulty concentrating) can be alleviated with lifestyle changes – weight control, healthy eating, exercise, no smoking, stress relief and meditation.

So, what should women do now? Why do experts change their minds about such things? First they create a panic then it takes them seven years to come back and say you are ok to take it within certain limitations.

I guess that is the nature of medical science. There is so much we know and again there is so much we do not know. Physicians find this as frustrating as the general public. Some women are going to be quite upset, may be even angry and frustrated, that they were deprived of HRT when they needed it. But it is never too late to sit down with your doctor and discuss your symptoms and indication for HRT.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!