Berries are good for you!

We have already blogged about the benefits of flavonoids for breast cancer prevention in red apples, strawberries, red grapes, walnuts and coffee beans; but now a new benefit has been reported for another flavonoid in berries.


A researcher from Harvard Medical School http://www.nlm.nih.gov/medlineplus/news/fullstory_124533.html has found that women with high intake of berries delayed cognitive aging by 2.5 years.  As part of the ongoing Nurses Health Study, they began measuring cognitive function in 16,000 women over the age of 70.  They found that those women who ate the most blue berries and strawberries appeared to delay cognitive aging by 2.5 years.  The amount was at least 3 servings per week and each serving is about one-half cup.  They report not enough consumption of other berries to make a comment about them.


These berries contain a particular flavonoid, called anthocyanidin, that crosses the blood-brain barrier and tends to locate in the part of the brain involved with memory and learning.


While the study did not absolutely prove a cause-and-effect relationship, the association between eating berries and maintaining mental function was shown.


So, berries for preserving the brain and breast!




Together we can prevent 75,000 breast cancer cases each year!




The content is general medical information and not personal medical advice.


Comments at www.thedoctor@owenwinsettmd.com.

My prescription: GO TO THE BEACH!

We have blogged about how beneficial exercise is for all of us, but now a new study recommends that to "reap the full benefits" we need to be outside and particularly; THE BEACH.


Katherine Ashbullby and Dr Mathew White from the European Centre for Environment and Human Health (ECEHH), Peninsula College of Medicine and Dentistry and the University of Plymouth, concluded that in findings presented at the recent British Psychological Society Annual Conference in London.  See http://www.pcmd.ac.uk/news.php?id=335.


They studied 2750 participants from Natural England's two year study of people's engagement with the natural environment, comparing visits to city parks, the countryside and the coast.


They found that each outside location was associated with the positive feelings of enjoyment, calmness and refreshment.  They apparently controlled for age, others involved, activity and how far travelled.  The coast was ranked highest and the city park lowest!


Did we need a study to learn this?  Is it called a vacation?


I guess I need to write more prescriptions for a trip to he coast; and I think I will start with me!




Together we can prevent 75,000 breast cancer cases each year!




This content is general information and not personal medical advice.  You have to come in to discuss your travel prescription in person.

A possible mechanism for aspirin's cancer prevention.

AMPK (adenosine monophosphate-ativated protein kinase) is an energy sensing enzyme in all cellular organisms.  Activation of AMPK causes a multitude of beneficial processes, such as promoting healthy glucose and lipid levels, to name just two.  AMPK activation has been associated with treatment or prevention of many chronic diseases, such as obesity, Type II diabetes, metabolic syndrome and cancer.  We know that levels of AMPK are regulated by the ADP/ATP balance in the cell.  We also know that EXERCISE increases AMPK.


Now, it seems that another benefit of aspirin is activation of AMPK.  A recent study from McMaster University, the University of Dundee and the University of Melbourne http://the-scientist.com/2012/04/20/new-target-for-aspirin/ helps explain the benefit.  The salicylate in the aspirin directly increases the activity of AMPK.  Could this be the mechanism of cancer prevention in daily aspirin use?


This finding doesn't mean we should "load-up" on more aspirin, but may point to a new avenue of research for finding cancer or diabetes prevention drugs.


Did Hippocrates envision this discovery, when in 400BC he recommended willow bark (the natural source of salicylate) for aches and pains?


For now, I recommend EXERCISE to activate AMPK and all of its benefits.




Together we can prevent 75,000 cancer cases each year!






This content is intended as general information and not personal medical advice.

TrekDesk!

Can't wait to see one of these at the gym http://www.prweb.com/releases/2012/4/prweb9438631.htm.  


Enough said!


If you get one before I do let me know www.thedoctor@owenwinsettmd.com.




Together we can prevent 75,000 breast cancer cases each year!

We still need more prevention!

So says the American Cancer Society in their annual report http://www.cancer.org/Cancer/news/News/annualreport-more-than-a-million-cancer-deaths-avoided-in-2-decades.


It is interesting reading for those who love numbers.  I will summarize a few important points in the call for prevention.


The good news is that in the last two decades (actually 1990-2008) about 1 million deaths from cancer have been avoided in the US.  That is a decrease in death rate of 23% in men and 15% in women, but they note that there is more to do.


The ACS estimates that for 2012, one third of deaths still will be caused by tobacco use and another third caused by obesity, physical inactivity and nutrition.  


That is worth repeating: TWO THIRDS of cancer deaths could be prevented (that would be 380,000 lives saved in 2012) if everyone did these things:

• Don't smoke
• Be lean
• Regular exercise (they say 150 minutes/week)
• Limit or break sedentary activity with movement
• Limit red meat consumption
• Limit alcohol consumption
• Eat 2.5 cups of fruits and veggies per day

Imagine what can be done!

Together we can prevent 75,000 breast cancer cases each year!

Direct comments to me at www.thedoctor@owenwinsettmd.com.

Closing thoughts from ASBD Meeting.

The recent American Society of Breast Disease in Dallas was well attended and was a good source for information and confirmation of screening and prevention practices.  I have blogged about much of the content from the meeting, but would summarize a few points below.


Whole breast ultrasound dose find more cancers when added to routine mammography, particularly in women with dense breast tissue.


MRI is a good adjuvant screen to mammography and ultrasound, particularly in very high risk situations like BRCA 1 or 2 carriers.


Mammograms DO save lives!  (Seems like I don't need to say it but I see the news misreport findings or report on studies too short to show the benefits.)


Many are looking for the way to personalize risk assessment.  The best available today is the BREVAGen Breast Cancer RIsk Assessment Tool.  




Finally, we all need to heed to the call for prevention.






Together we can prevent 75,000 breast cancer cases each year!

Ruminating on recent ASBD meeting sessions

It is a good feeling to find that the experts agree with you!!!(my tongue is in my cheek).  In the prevention sessions of the recent American Society of Breast Disease meeting, I found my self saying, "I tell patients that" or "I recommend that".  What I have been blogging and saying about how to prevent breast cancer was confirmed again at the meeting.


Key general points to prevent breast cancer:

• Be lean
• Be active
• Regularly exercise
• Don't smoke
• Limit alcohol
• Limit red meat
• Eat more fruits and veggies (particularly cruciforms)
• Take Omega3
• Take aspirin

Together we can prevent 75,000 breast cancer cases each year!

Remember all these points are general information and not personal medical advice.  Consult with your physician.

The Most Bang for the Buck!

As a break from the ASBD meeting blogs, I offer this great article about prices of some of these cancer fighting foods.  This is a look at what a cup, or about one serving, of strawberries, pineapple, spinach, mustard greens and broccoli, cost.  The author is from Houston, so prices are probably close to Austin prices.  Read on at http://www.nlm.nih.gov/medlineplus/news/fullstory_124083.html.


One cup of strawberries (with polyphenols that help reduce the risk of breast cancer) contains 46 calories and costs 89 cents, so says the Clare McKindley the author and dietitian at UT MD Anderson, Houston.


Each in servings of one cup:

• Pineapple: 82 calories and 70 cents
• Spinach: (raw or steamed) NO BUTTER 7 calories and 52 cents
• Mustard greens: cooked with out butter 21 calories and 81 cents
• Broccoli: 30 calories and 63 cents

Fresh is always best, so to the Farmer's Market today.

Together we can prevent 75,000 cancer cases each year!

This content is intended as general information and not personal medical advice.  Check with your doctor if you think one of these may not be right for you.

No lump is ever NOTHING!

This is important and none of us should ever forget it!


Henda Salmeron, at the recent American Society of Breast Disease meeting in Dallas, made this statement.  Who knows what would have happened had she listened to the first doctor who told her the lump was "nothing"!  You can see more at her website http://densebreasttissue.net/dense-breast-tissue/.


We had one session on Diagnosis and Evaluation of the Palpable Breast Mass.


In fact, all breast lumps are something and each requires a diagnosis.  8 of 100 self-detected breast lumps are cancer.  The workup required is whatever it takes to make the diagnosis.  Typically, after the patient detects the lump, the physician confirms it and then may order a mammogram.  If the lady has dense breast tissue then 50% of the time the mass may not be "seen" on the mammogram.  The next step often is a targeted ultrasound or sonogram.  Rarely that may not clearly define the mass.  Ultimately, tissue diagnosis my be required, by fine needle aspiration (FNA) or core biopsy.  This is the decision for you and your breast surgeon to make.  Note that MRI, Molecular Breast Imaging, Tomosynthesis and other breast imaging don't have a clearly defined roll in the diagnosis of the palpable breast lump.


The important thing is that "no lump is ever NOTHING" and requires a diagnosis. SO, if anyone tells you that the lump is nothing, you need to persist and pursue the issue to a diagnosis.




Together we can prevent 75,000 breast cancer cases each year!




  

Why listening to the media reports about mammography is detrimental to your health!

We have blogged before about the benefits of mammography, but recent media articles have tried to suggest otherwise.  We will review one expert opinion today and dissect away at other media hype later in the week.


At the American Society of Breast Disease meeting in Dallas last week, Dr. Robert A. Smith was recognized for his research in cancer screening and gave the Pathfinder Lecture about breast cancer screening.  He is a cancer epidemiologist and Director of Cancer Screening at the American Cancer Society.  You may google him to find out some of his many other accomplishments.


The important points of his talk:

• Mammograms do save lives
• Many studies quoted in the media weren't designed to prove efficacy
• Many studies quoted in the media are old (not modern equipment)
• There is at least a 30% reduction in mortality long term
• For every 414 women screened 7 years 1 life is saved
• 42 years of life are saved per 1000 women screened
• Most lives saved are after 10 years of screening
• Cancers found decrease in size over time
• Fewer node positive cancers are found over time
• The best study is the Swedish Two County Trial

You may read more about this Mammographic Screening trial at http://radiology.rsna.org/content/early/2011/06/15/radiol.11110469.full.

So, lives saved, smaller cancers, more node-negative cancers!  Do I need to say more?

Together we can save 75,000 breast cancer cases every year.

Detecting breast cancer in a blood test

Researchers from McGill University's Faculty of Medicine, lead by Dr David Junker, may be onto something: "detecting breast cancer's fingerprint in a droplet of blood" http://www.mcgill.ca/newsroom/news/item/?item_id=215936.  Imagine a routine of analyzing a drop of blood, like a diabetic checking her sugar, to see if you have breast cancer.  


We have known for many years that tumors make proteins.  You may have heard of CEA, CA15-3 or CA27-29, but they have not proven to be reliable indicators because of a wide range of "normal" levels.  There may be person to person "normal" variation and non-cancer lifestyle differences that may influence the levels in one person over time.


Their research has attempted to find reliable biomarkers by testing an array of proteins and they found a way to do so with a droplet of blood in microfluidics.  Essentially, the technique involves very tiny channels and small (nano liters) of serum, reagents and analytes on something like a tiny glass slide, almost like a computer chip.  With this new technology and using a new approach, they can test many protein biomarkers simultaneously and reliably.


They report on blood samples of 32 proteins from healthy controls and women with estrogen receptor-positive breast cancer.  They found that 6 of these proteins could differentiate those with cancer from those without.  They call it "breast cancer's fingerprint".


More testing needs to be done and results confirmed, but imagine a breast cancer "finger stick"!  And then the mammogram and ultrasound would be used to find what is known to be there.  No more screening imaging!


Wow!  What a radical change from what we do now to screen for breast cancer!
Mammograms are still the gold standard today and we will spend all next week discussing how the screening mammogram saves lives and how listening to the news media reports about them may be harmful to your health!




Together we can prevent 75,000 breast cancer cases each year!

More personalized breast cancer prevention with BREVAGen

BREVAGen™ is an exciting new, clinically validated predictive test for breast cancer.  It is a test for the sporadic (not familial like BRCA 1 & 2) breast cancers, the other 80% or more common ones.  Most of these cancers are estrogen-positive cancers (75%).  The test results allow us to develop a personalized screening and prevention plan for each individual.


The test combines genetic markers (7 SNP's) from an inner cheek swab with clinical information about estrogen exposure, family history and breast biopsy history to give a lifetime risk and a five year risk.  It is these two numbers that allow us to make an individualized action plan.  In studies, the combination of clinical features plus the genetic information has proven to be superior than either alone.


Who should ask for one?


BREVAGen currently approved for women:

• 35 years or older
• Caucasian women (other ethnicities are being investigated)
• May have a higher than usual breast cancer risk
• Negative BRCA 1 or 2 test
• Have had a breast biopsy
• Are concerned about breast cancer risk

Call or come by to find out if this is the right test for you....and bring a friend.   www.owenwinsettmd.com. 

Together we can prevent 75,000 breast cancer cases each year!

  

Individualized risk assessment with NAF.

The finding of cellular atypia has been shown to be associated with increased risk for breast cancer.  Obtained by a number of techniques, cells for the breast ducts provide evidence of what may happen in the next few years.  The finding doesn't diagnose cancer, but is an approved screening tool.   Cells may be obtained for examination by several techniques: open surgical biopsy, fine needle aspiration (FNA), ductal lavage or nipple aspirate fluid (NAF).  


The least invasive, most patient-tolerant and comfortable (88% of those who have had the study would recommend it to a friend) is the HALO Breast Pap Test, a fully automated 5 minute office procedure, using a device similar to a breast pump.  The nipple aspirate fluid (NAF) obtained is then sent for pathological analysis.  


Many studies have shown consistently increased numbers of breast cancers in those with abnormal fluid.  Specifically, the finding of hyperplastic cells has a 2.5-fold increased risk for breast cancer in the next few years.  Atypical cells increase the risk to 5-fold and atypical cells plus a family history have demonstrated an 11-fold increase in breast cancers.  You may read more about the simple non-invasive procedure at www.owenwinsettmd.com or   http://www.neomatrix.com/halonaf/NAF-Collection.aspx. 


Finding the women at greatest risk before the cancer ever happens allows earlier intervention and better outcome!  The HALO is part of the puzzle to learn individual risk.


I recommend this test for asymptomatic women ages 21 to 55 years old.






Together we can prevent 75,000 breast cancers each year!

Personalized medicine and the dense breast.

What makes the density of the breast tissue important?  


If you have it, you may be more likely to have breast cancer, because several studies have shown that women with dense breast tissue have more breast cancers.  In addition, the best screening tool we have to detect breast cancers has limited value in dense breast tissue.  The mammogram "sees" only the most dense tissue between the X-ray source and the film, so anything of the same or lesser density is missed.


So, what do you do if you have dense breast tissue?  


For screening, I recommend mammogram plus ultrasound.  Many studies have demonstrated the benefits of whole breast ultrasound in dense breasts.  The ultrasound "sees" through the dense tissue and finds the mass (if there is one) when the mammogram can't.  In the 4 April issue of JAMA, an update of the American College of Radiology Imaging Network (ACRIN) 6666 study was published.  In this study, whole breast sonograms (ultrasounds) were offered to women who were at an increased risk for breast cancer and had heterogeneously dense breast tissue or dense breast tissue.  The ultrasound found 34% more cancers that were not "seen" on mammogram, in line with previous studies.  Other studies have also shown that the addition of ultrasound also detects smaller tumors, either doubling to tripling the number of tumors detected <10mm.  For more on this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2822222/.


  
That is the screening issue.  If you have dense breast tissue you may benefit from whole breast sonography.  What about the prevention issue?  Of course you are already doing all the things mentioned in Monday's blog, but anything more?  You are already active, staying lean, exercising regularly!  Now for the personalization, where the doctor can make the recommendation unique to you.  If you have other risk factors, like a family history or high BREVAGen score, you might benefit from tamoxifen.  If you are postmenopausal and also have low bone density, then you might benefit from Evista.  If you are postmenopausal and on combined hormone replacement, you might benefit from weaning and eventually stopping the hormones.  You get the picture.  This personalization part requires the doctor visit.  That is where we doctors get to help you in your prevention plan.




Remember this is general information and intended to provoke a conversation with your doctor.  I am glad to help.  Feel free to call.  Personal medical information can only come from your doctor.






Together we can prevent 75,000 breast cancer cases each year!

What can all individuals do to prevent cancer?

Before we look at the breast cancer prevention measures that may apply to some but not all, I will review what each individual can do.  I have reviewed many of these measures in the blog.  To find one, for instance, weight, just type "weight" in the search box at the right and click.  I also recently found a good summary in a Scientific American blog http://blogs.scientificamerican.com/observations/2012/03/28/u-s-cancer-rates-could-be-cut-in-half-today-based-on-whats-already-known/.  


For all of us:

• Be active (being sedentary is a killer)
• Regular exercise (many recommend 1 hour per day)
• Be lean
• Don't smoke
• Limit alcohol consumption
• Limit red meat consumption
• More fruits and vegetables in your diet
• Less processed food of any kind
• Limit sugar intake

For personalized breast cancer prevention, more information is needed from the person, like past medical and family history, breast density, results of HALO Breast Pap Test and results of the BREVAGen Breast Cancer Risk Assessment Tool.  Note that these results are unique for each person and, when known, allows us to make a personalized prevention plan.  We will begin to sort these out tomorrow to find out who may benefit from more personalized breast cancer prevention!

I worked out at the gym, then ran and I am sitting on a 65cm exercise ball to write this blog!

Together we can prevent 75,000 breast cancer cases each year!

Why personalized medicine?

Aside from the obvious, "because we are all different" there are other reasons for personalized medicine.  We often rely on the results of population studies to predict outcome.  I have blogged about such: "if this many high risk women take this breast cancer prevention drug, then only this many will get breast cancer".  But do we know which women can expect to benefit?  The answer is, with personalizes medicine,  YES!  


I will review some advantages of the personalized approach to breast cancer prevention.  We know that everyone benefits from being lean, from regular exercise, and from being active.  Personalized breast cancer prevention is more.  


There are several advantages to both the individual and the common good.  As we learn to treat each person as unique, the population as a whole also benefits.


Some of the advantages of personalized medicine include:

• focus on prevention and disease prediction
• earlier intervention in the disease process
• higher likelihood of desired outcome (success)
• more informed decisions 
• decrease in negative effects
• healthier population, one by one
• reduced healthcare costs

Not just treatment for the "sick" person but intervention offered before the disease occurs so that it may never occur.




We will review items in the personal history and tests that may help us in our quest to prevent breast cancer, beginning tomorrow.






Together we can prevent 75,000 breast cancer cases!