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Cancer Project: The News You Need

Taxol Improves Survival in Advanced Breast Cancer

Women with metastatic breast cancer have better survival rates and fewer side effects when treated with Taxol (paclitaxel), instead of a standard chemotherapy combination of cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP), according to a study conducted at the Sydney Cancer Center in Sydney, Australia. In women receiving each regimen as first-line treatment for advanced cancer, two-year survival was 20 percent in the CMFP group versus 39 percent in the Taxol group. The Taxol group also had fewer side effects, primarily hair loss, nerve symptoms, and joint and muscle pains. The CMFP group suffered nausea and vomiting, loss of white blood cells and platelets, and other symptoms.

Bishop JF, Dewar J, Toner GC, et al. Initial paclitaxel improves outcome compared with CMFP combination chemotherapy as front-line therapy in untreated metastatic breast cancer. J Clin Oncol. 1999;17:2355.

Folic Acid Cuts Alcohol-Related Breast Cancer Risk

Alcohol is known to increase risk of breast and colon cancer, presumably by blocking the DNA repair actions of the B-vitamin folic acid. New data suggest that women who drink alcohol can counteract some of this increased risk by getting more folic acid through diet or supplements. The Harvard Nurses' Health Study, following 88,818 women from 1980 to 1996, found that breast cancer risk was 24 percent higher for those consuming 15 grams of alcohol or more per day, compared to nondrinkers. However, daily consumption of 600 milligrams of folic acid returned the risk to the level of nondrinkers.

A 12-ounce beer contains 12.8 grams of ethanol. A 4-ounce glass of wine contains 11.0 grams of ethanol. A 1.5-ounce shot of 80-proof liquor contains 14.0 grams of ethanol.

Here are some great folic acid sources (micrograms per 1-cup cooked serving): asparagus–176, black beans–256, broccoli–108, chick peas–282, blackeyed peas–356, lentils–358, navy beans–255, pinto beans–294, and spinach–262.

Zhang S, Hunter DJ, Hankinson SE, et al. A prospective study of folate intake and the risk of breast cancer. JAMA. 1999;281:1632-1637.

Low-Potency Estrogen Pills Linked to Cancer

Low-potency estrogens, such as estriol used orally or in vaginal creams, have been prescribed to many women to relieve symptoms of vaginal atrophy and dryness, particularly in Europe. It has never been clear whether these estrogens are safer than the higher-potency formulations, such as estradiol and conjugated estrogens (Premarin) that are often used to treat hot flashes and night sweats. High-potency estrogens are known to increase risk of uterine cancer unless accompanied by a progestin. They also increase breast cancer risk regardless of whether progestins are added.

In a case-control study at Stockholm's Karolinska Institute including 789 women with uterine (endometrial) cancer and 3,368 controls, oral low-potency estrogens were linked to cancer risk, just as stronger estrogens are. Women using low-potency estrogen pills had double the cancer risk of women who had never used them, and triple the risk if they used them for five years or longer. Risk quickly dropped with discontinuation of use. Vaginal application was not associated with cancer risk. However, this result does not apply to vaginal use of more potent estrogens.

Weiderpass E, Baron JA, Adami HO, et al. Low-potency oestrogen and risk of endometrial cancer: a case-control study. Lancet. 1999;353:1824-1828.

Screening Helps Younger Women

Many studies have shown benefits of mammography only for women over 50. Two new British studies, however, indicate there may be a benefit for younger women as well. The U.K. Trial of Early Detection of Breast Cancer found a 27 percent reduction in breast-cancer mortality among those attending screening centers, with similar benefits for women aged 45 to 49 compared to older women. A University of Edinburgh study arrived at a similar conclusion, finding a 21 percent reduction in breast-cancer mortality. The bad news is that approximately three-quarters of breast cancer mortality risk remained despite screening, highlighting the need for prevention measures rather than relying solely on cancer detection.

UK Trial of Early Detection of Breast Cancer group. 16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet. 1999;353:1909-1914.
Alexander FE, Anderson TJ, Brown HK, et al. 14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening. Lancet. 1999;353:1903-1908.


DES Dangers May Extend to Grandchildren

Diethylstilbestrol (DES), a drug for preventing miscarriages, was prescribed to an estimated 4.8 million pregnant women from the mid-1940s to 1971 before being linked to vaginal and cervical cancer in their exposed children. At a recent conference on DES sponsored by the U.S. Department of Health and Human Services, researchers reported two new concerns. First, cancers may not appear until women reach their 40s, 50s, and 60s. In addition, because DES given during pregnancy affects not only the fetus but also the tiny eggs developing within the fetus' ovaries, risk may extend to the treated women's grandchildren.


What Is It about Those Vegetarians?

It's the fiber! It's the beta-carotene! No, it's the phytoestrogens! Scientists have been trying to figure out why vegetarians have only about half the cancer risk of meat-eaters. The latest plant supernutrient, beta-sitosterol, was lauded at the Federation of American Societies of Experimental Biology by University of Buffalo nutrition researcher Atif Awad, Ph.D. Beta-sitosterol was shown to inhibit the growth of breast cancer cells in the test tube, cutting the number of cancer cells by 66 percent compared to control cell cultures. Dr. Awad had previously found that beta-sitosterol inhibited prostate cancer cell growth but did so by a different mechanism, inhibiting an enzyme called PP2A, which is involved in cell growth.

Don't Thank Fiber; Blame Meat and Milk

The very low rate of colon cancer among blacks in South Africa compared to whites is probably not due to a high fiber intake but rather to a very low intake of animal products, according to a recent study in the American Journal of Gastroenterology. Colon cancer affects only 1 in 100,000 South African blacks and is 17 times more common among whites. The cornmeal-based diet common among South African blacks is not particularly high in fiber and is low in calcium. According to Stephen J.D. O'Keefe and colleagues at the University of Capetown, the healthfulness of the diet comes from the absence of "aggressive" factors such as animal protein and fat. Osteoporosis, which is also linked to diets rich in animal protein, is also extremely rare among South African blacks.

O'Keefe SJ, Kidd M, Espitalier-Noel G, Owira P. Rarity of colon cancer in Africans is associated with low animal product consumption, not fiber. Am J Gastroenterol. 1999;94:1373-1380.

Herbal Prostate Cancer Treatment Proves Its Worth

A mixture of Chinese herbs called PC-SPES has emerged from clinical testing to show benefit against prostate cancer. The mixture includes saw palmetto, which is commonly used to shrink an enlarged prostate, along with seven other herbs prepared by a southern California company. Its name comes from the words "prostate cancer" and the Latin word for "hope."

The treatment reduced the prostate-specific antigen (PSA) level, a blood marker commonly used as an index of cancer activity, in all 27 men whose cancer had never been treated by hormones and in 19 of 34 men whose cancers had grown resistant to ongoing hormone treatments. The study was conducted by Eric Small and colleagues at the University of California at San Francisco.

Meanwhile, high-fat diets were again linked to increased risk of benign prostate enlargement, according to a new study conducted in Athens, Greece. Higher intakes of butter and margarine increased risk, while fruit decreased risk.

Lagiou P, Wuu J, Trichopoulou A, Hsieh CC, Adami HO, Trichopoulos D. Diet and benign prostatic hyperplasia: a study in Greece. Urology. 1999;54:284-290.


Autumn 1999 (Volume VIII, Number 4)

Autumn 1999
Volume VIII
Number 4

Good Medicine

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