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Category: cancer

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 The following article supported what I have been reading over the past few years: that medical tests and treatments also have downsides, that it is possible to "know too much", that more harm than benefits can occur from certain tests, procedures, and medicines, and lifestyle changes (eat a less processed more plant-based diet, move more, and don't smoke) can be better than some medicines or certain procedures. The doctor mentioned in this article (Dr. H. Gilbert Welch) recently published a book aimed at the general public which I just read and highly recommend: Less Medicine, More Health. Dr. Welch is an academic physician, a professor at Dartmouth Medical School, and a nationally recognized expert on the effects of medical testing. In 2012 he published the well regarded and more technical and in-depth book on this issue: Overdiagnosed: Making People Sick in the Pursuit of Health. From The Atlantic:

The Downside of Medical Screening

If you had a disease, and you could find out sooner rather than later, why wouldn’t you?Medicine has long focused on early detection of diseases as part of a move toward preventive care. But imperfect tests, false positives, and overdiagnosis mean that sometimes the tests do more harm than good, and in recent years, there have been more recommendations to reduce some kinds of screening, including pap smears, colonoscopies, mammograms, and even annual pelvic exams.

“This is something we all need to understand, the two sides of early detection. It does help people, but it’s almost guaranteed to harm others,” said H. Gilbert Welch, a professor of medicine, public policy, and business administration at Dartmouth College, and author of the book Should I Be Tested for Cancer? (He reveals his answer in the book’s subtitle: “Maybe not.”)

The more you look for disease, the more you find it. And in the case of cancer, it’s hard for doctors to know if what they find is dangerous and needs to be addressed, or if it’s just a small tumor that won’t grow and poses no threat. “We can’t be sure which is which, so we treat everybody,” Welch explained at the Aspen Ideas Festival’s Spotlight Health session. “That means we’re treating people who will never experience problems from their disease.”

But they may experience problems from the treatment.The panel gave the example of prostate cancer, which is very common in men—one in seven American men will be diagnosed with it in their lifetimes. “But it turns out a lot of these cancers are very indolent,” said Jessica Herzstein, a preventive-medicine consultant and member of the U.S. Preventive Services Task Force. Around 30 to 40 percent of men who’ve been treated for prostate cancer likely had “slow-growing tumors that would never have become a threat to the man’s lifespan or health,” according to the Prostate Cancer Foundation.

In other words, “you’re going to die with them, not of them,” Herzstein said, “and the treatments are very very harmful.” Radiation therapy, for example, can cause incontinence and erectile dysfunction, and hormone therapy can cause osteoporosis and depression.

The possibility of a false positive is another downside. Not only could it lead to more invasive follow-up tests or treatments that aren’t needed, but it can also give patients unnecessary anxiety.“If we resolve the test by saying ‘The test was wrong, you’re fine!’, that’s one thing,” Welch said. “But most false alarms aren’t resolved that way. [It’s more like] ‘You don’t have cancer, but you have some abnormality that possibly puts you at a higher risk for cancer, but we’re not going to do anything about it. I think that’s where there can be [mental] harm.”

Ultimately, it comes down to a weighing of the benefits and the harms, and, in the absence of clear evidence, the preferences of the patient. The U.S. Preventive Services Task Force helps identify which tests are beneficial by evaluating and grading them. It gives tests an A if there’s a high certainty of substantial benefit, a B if there’s moderate certainty of substantial benefit, a C if there’s moderate certainty of a small benefit, a D if there’s moderate or high certainty of no benefit, and an I if the evidence is just too insufficient to say.

The task force gave prostate cancer screening a D. HIV screening got an A. For breast cancer screening, an always-controversial topic, the results vary. Breast self-exams got a D. Mammograms got a B, but only for women between 50 and 74 years old. For women in their 40s, the grade is a C, meaning the task force recommends patients and physicians discuss and decide together.

Before getting a screening test, patients should think about what would happen if they get a positive result, and if they’d be ready for it, Welch advised. “If I were to go through this, and have this diagnosis, would I want to have this surgery?” Herzstein asked, posing a hypothetical. Would you want to undergo the biopsy, the chemo, whatever treatments come next? “Maybe you don’t even want to go there if there is no treatment for the disease,” she added. Welch gives an example. “With Alzheimer’s disease that’s a fundamental question: What are you going to do with a positive result?” he asked. 

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A recent report found that when a person is exposed to a little bit (or low doses) of a lot of different commonly encountered chemicals, than the combinations over time may cause changes that increase the risk of cancer (they may initiate cancer). Think about it - we are not exposed to just one chemical at a time (which is how chemicals are tested), but to mixtures or a "chemical soup". It is almost impossible to avoid them. As one of the researchers said: "We urgently need to focus more resources to research the effect of low dose exposure to mixtures of chemicals in the food we eat, air we breathe and water we drink." Testing mixtures of chemicals is currently not required by law.

The effects may be synergistic  - an enhanced effect that is more than the sum of the individual chemicals. And some chemicals may have bigger effects at smaller doses (typical of endocrine or hormone disruptors), than at larger doses - which is not how chemicals are typically viewed (typical view: the more you are exposed to a chemical, the greater the effect). A global task force of 174 scientists looked at 85 common everyday chemicals (at everyday low doses), and 50 were found to support cancer-related mechanisms (processes essential to cancer development). Examples of problematic chemicals that are common in everyday life: triclosan (in many soaps and personal care products), bisphenol A (in many plastics, including can linings), and atrazine (common herbicide or weedkiller). From the LA Times:

Combinations of 'safe' chemicals may increase cancer risk, study suggests

Lots of chemicals are considered safe in low doses. But what happens when you ingest a little bit of a lot of different chemicals over time? In some cases, these combinations may conspire to increase your risk of cancer, according to a new report. “Many [chemicals] have the possibility, when they are combined, to cause the initiation of cancer,” said Hemad Yasaei, a cancer biologist at Brunel University in England, one of the authors of the report. “They could have a synergistic or enhanced effect.”

This is not the way regulators typically think about cancer risk when they evaluate a compound’s safety.Normally, they test an individual chemical on laboratory animals, exposing them to progressively smaller amounts until it no longer causes malignant tumors to grow. Then they take that dose, determine the equivalent for humans, and apply what is called a “margin of safety” by declaring that some small fraction of that low dose is safe for people.

The big assumption driving the margin of safety is that a smaller amount of a chemical is less dangerous than a larger amount. (Think of the familiar axiom, “The dose makes the poison.”) But that’s not true for all chemicals, experts say. Some chemicals, such as those that mimic hormones, may actually be more dangerous at lower doses because the human body is exquisitely attuned to respond to minute amounts of natural hormones such as estrogen and testosterone.

And regulators haven’t required testing of mixtures of chemicals at all...Leroy Lowe, president of Canadian nonprofit Getting to Know Cancer and leader of the report published this week by the journal Carcinogenesis. The new report raises questions about whether this approach is adequate...Humans are exposed to about 80,000 man-made chemicals over their lifetimes, experts say. These chemicals are in the foods we eat, the water we drink and the air we breathe. "We live in a chemical soup,” said toxicologist Linda Birnbaum, director of the National Institute of Environmental Health Sciences, who was not involved in the new study.

The research team — a coalition of 174 researchers from 28 countries — set out to determine whether mixtures of these chemicals, at the very tiny concentrations found in the environment, could plausibly trigger the formation of cancerous tumors. They focused on 85 particular chemicals that were impossible to avoid in modern life, that were likely to disturb biological function and were not thought to pose cancer risks at the very low doses that people tend to ingest them.

The researchers scoured the scientific literature to understand how each of these chemicals could affect 10 important processes that are essential to cancer development. Among them: tumor-promoting inflammation, resistance to cell death and the formation of new blood vessels to feed malignant cells. In addition, they categorized whether each of the chemicals exerted biological effects at very low doses to which humans are ubiquitously exposed. (These doses are so small that they tend to be measured in parts per million or parts per billion.)
Of the 85 chemicals researchers examined, 50 were found to affect cancer-causing processes in the body, even at very low doses.

These 50 everyday chemicals included bisphenol A (used in manufacturing plastics), triclosan (often found in hand sanitizer and anti-bacterial soap) and atrazine (a commonly used herbicide). Since each of these chemicals affects different processes that could lead to cancer — bisphenol A makes cells less sensitive to signals to stop reproducing, for example, while atrazine encourages inflammation — it’s plausible that consuming mixtures of these chemicals is riskier than consuming any one individually.

More details about this report. From Science Daily: Cocktail of common chemicals may trigger cancer

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Again, more research finding that being overweight or obese is associated with an increased risk of breast cancer - specifically higher risk of invasive breast cancer in postmenopausal women. They found that the heavier the woman, the higher the risk, but the risk did not vary with hormone therapy use or race and ethnicity. From Medical Xpress:

Obesity associated with increased breast cancer risk in postmenopausal women

An analysis of extended follow-up data from the Women's Health Initiative clinical trials suggests that postmenopausal women who were overweight and obese had an increased risk of invasive breast cancer compared to women of normal weight, according to an article published online by JAMA Oncology. Obesity is a major public health problem in the United States and obesity has been associated with breast cancer risk in observational studies, systematic reviews and meta-analyses.

The Women's Health Initiative (WHI) protocol measured height and weight, baseline and annual or biennial mammograms, and breast cancer in 67,142 postmenopausal women enrolled from 1993 to 1998 with a median of 13 years of follow-up. There were 3,388 invasive breast cancers. Analysis by the authors found:

  • Women who were overweight (body mass index [BMI] 25 to < 30); obese, grade 1 (BMI 30 to < 35); and obese, grade 2 plus 3 (BMI > 35) had an increased risk of invasive breast cancer compared to women of normal weight (BMI < 25)
  • The risk was greatest for women with a BMI greater than 35; those women had a 58 percent increased risk of invasive breast cancer compared with women of normal weight (BMI < 25)....
  • Obesity was associated with markers of poor prognosis; women with a BMI greater than 35 were more likely to have large tumors, evidence of lymph node involvement and poorly differentiated tumors
  • Women with a baseline BMI of less than 25 who gained more than 5 percent of body weight during the follow-up period had an increased risk of breast cancer....

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Women: if you sit at work all day, and then you sit 6 or more hours during your leisure time, then you are at significantly greater risk of developing any cancer (compared to women who sit for fewer than 3 hours a day during leisure time). And the odds for certain cancers (multiple myeloma, ovarian cancer, and invasive breast cancer) are greatly increased. That 30 minutes at the gym doesn't cancel out the negative effects of sitting all day. But interestingly, this pattern didn't apply to men. From Medscape:

Leisure Time Sitting Increases Cancer Risk in Women

Women who sit 6 or more hours a day during their leisure time have a 10% greater risk of developing any cancer compared with women who sit for fewer than 3 hours a day. In addition, they are more likely to develop certain site-specific cancers, such as invasive breast cancer, ovarian cancer, and multiple myeloma. However, no similar pattern emerged for men.

"So when we think about independent risk factors for many types of cancer, and definitely for invasive breast cancer, you want to tell women to maintain a physically active lifestyle, to maintain a healthy weight, to limit their alcohol consumption, and now you also want to tell them to reduce their time spent sitting," she said.

The findings come from an analysis of data on some 69,260 men and 77,462 women enrolled in the American Cancer Society Cancer Prevention Study II Nutrition. All participants were cancer-free on enrolment. Between 1992 and 2009, 18,555 men and 12,236 women were diagnosed with cancer. On average, men were followed for 13.2 years, and women were followed for an average of 15.8 years.

"In women, leisure-time spent sitting was associated with a statistically significant higher risk of total cancer incidence...after adjustment for physical activity, [body mass index (BMI)], and other potential confounders," the authors report. Sitting 6 or more hours a day during leisure time was also associated with a 65% greater risk for multiple myeloma, a 43% greater risk for ovarian cancer, and a 10% greater risk for invasive breast cancer compared with women who sat less than 3 hours a day during leisure time. The association between longer sitting times and endometrial cancer was statistically significant before adjusting for BMI, but was attenuated when adjusted for BMI.

The same pattern was not seen in men in this study. Leisure time spent sitting was not associated with cancer risk in men, with the exception of an 11% higher risk associated with sitting time among obese men.

"There are a lot of individuals whom I would describe as 'an active couch potato.' " Dr Patel said. "People are going to the gym and maintaining a healthy weight, but they spend the majority of the rest of their time in sedentary activities — sitting at work, sitting in the car, sitting at home — so you really have to think not just of that 30 minutes a day where you are intentionally engaging in physical activity, but what does the rest of your day look like?"

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Citrus paradisi (Grapefruit, pink) white bg.jpgWill these research results hold up over time? It is known that certain fruits (citrus fruits and juices) and vegetables contain photosensitizing chemicals called psoralens, and the researchers suspected that a high intake of citrus products over time could make individuals more susceptible to melanoma than people who rarely ate citrus fruits. During more than 2 decades of following more than 100,000 persons they found 1840 melanomas , And yes, even though there were relatively few melanomas, they did find a dose-dependent relationship between citrus product consumption and melanoma risk, specifically that ingesting citrus fruit 1.6 or more times per day had a 36% higher risk for melanoma than people who ate it less than twice per week. But this association was only with whole grapefruit and orange juice, and weirdly, not with consumption of grapefruit juice or whole oranges. Before people panic, remember that citrus fruits have all sorts of great health benefits and should be eaten. From Science Daily:

Can orange juice, grapefruit raise your melanoma risk?

People who enjoy a glass of orange juice or some fresh grapefruit in the morning may face a slightly increased risk of melanoma—the least common but most deadly form of skin cancer. That's the finding from a study of more than 100,000 U.S. adults followed for about 25 years. Researchers discovered that those who regularly consumed orange juice or whole grapefruit had a higher risk of developing melanoma, compared to people who avoided those foods.

Experts were quick to stress that the findings, reported online June 29 in the Journal of Clinical Oncology, do not prove that citrus foods help cause skin cancer. It is plausible, however, that certain compounds in citrus explain the association, said senior researcher Dr. Abrar Qureshi, chair of dermatology at Brown University and a dermatologist at Rhode Island Hospital, in Providence.

Citrus foods contain particular "photoactive" chemicals—namely, psoralens and furocoumarins—that are known to make the skin more sensitive to the sun when they're applied topically, Qureshi said."You'll see children get a sunburn in spots where a citrus popsicle dripped down the chin, for example," Qureshi explained.

But even if citrus foods potentially make some people susceptible to sunburn, it's not orange juice that should be avoided, Qureshi said. "The citrus can't hurt you without the excessive sun exposure," he pointed out. So the message remains the same, Qureshi said: Protect your skin from soaking up too many rays by staying in the shade, using sunblock and wearing a hat. "I don't think the general public should make any changes based on this study," said Berwick, a professor of dermatology at the University of New Mexico in Albuquerque. 

For the study, the researchers analyzed data from two long-running studies of U.S. health professionals. Every couple of years, the participants answered detailed surveys on their health and lifestyle. Over about 25 years, more than 1,800 people developed melanoma and the risk was higher among those who regularly drank orange juice or ate whole grapefruit. That was true, the researchers found, even when several other factors were taken into account—including people's reports of their overall sun exposure and history of bad sunburns.

People who had orange juice at least once a day were about 25 percent more likely to develop melanoma than those who drank the juice less than weekly. Similarly, people who ate whole grapefruit at least three times a week had a 41 percent higher melanoma risk, versus those who never ate it. On the other hand, there was no connection between melanoma risk and either whole oranges or grapefruit juice, the researchers found.

Qureshi did offer a potential explanation for why only orange juice and whole grapefruit may be tied to melanoma risk."There are different types of these photoactive compounds in different parts of the fruit," he said. So, it's possible that not all citrus fruits are alike when it comes to melanoma risk. Plus, Qureshi said, heat—like that used in pasteurizing juice—neutralizes the photoactive compounds. That might help explain why grapefruit juice was not connected to melanoma risk.

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The study results of 218 overweight, postmenopausal women who had insufficient levels of vitamin D (like most people) at the beginning of the study found that weight loss (including exercise), in combination with vitamin D supplementation, had a greater effect on reducing chronic inflammation than weight loss alone.

Current thinking is that chronic inflammation is linked to various chronic diseases as well as cancers. So reducing chronic inflammation is good. From Medical Xpress:

Weight loss plus vitamin D reduces inflammation linked to cancer, chronic disease

For the first time, researchers at Fred Hutchinson Cancer Research Center have found that weight loss, in combination with vitamin D supplementation, has a greater effect on reducing chronic inflammation than weight loss alone. Chronic inflammation is known to contribute to the development and progression of several diseases, including some cancers.

"We know from our previous studies that by losing weight, people can reduce their overall levels of inflammation, and there is some evidence suggesting that taking vitamin D supplements can have a similar effect if one has insufficient levels of the nutrient," said lead and corresponding author Catherine Duggan, Ph.D., a principal staff scientist in the Public Health Sciences Division at Fred Hutch. 

To explore this question, Duggan and colleagues recruited 218 healthy, overweight older women who had lower-than-recommended levels of vitamin D (less than 32 ng/mL). The women then took part in a 12-month diet and exercise program (including 45 minutes of moderate-to-vigorous exercise five days a week). Half of the study participants were randomly selected to receive 2,000 IU of vitamin D daily for the duration of the year-long trial, and the other half received an identical-appearing placebo, or dummy vitamin. 

At the end of the study, all of the participants had reduced levels of inflammation, regardless of whether they took vitamin D, "which highlights the importance of weight loss in reducing inflammation," Duggan said. However, those who saw the most significant decline in markers of inflammation were those who took vitamin D and lost 5 to 10 percent of their baseline weight. These study participants had a 37 percent reduction in a pro-inflammatory cytokine called interleukin-6, or IL-6, as compared to those in the placebo group, who saw a 17.2 percent reduction in IL-6. The researchers found similar results among women in the vitamin D group who lost more than 10 percent of their starting weight. While IL-6 has normal functions in the body, elevated levels are associated with an increased risk of developing certain cancers and diabetes and may be implicated as a cause of depression, Duggan said.

Inflammation occurs when the body is exposed to pathogens, such as bacteria or viruses, which puts the immune system in overdrive until the "attack" ceases and the inflammatory response abates. Overweight or obese people, however, exist in a state of chronic inflammation. This sustained upregulation of the inflammatory response occurs because fat tissue continually produces cytokines, molecules that are usually only present for a short time, while the body is fighting infection, for example.

"It is thought that this state of chronic inflammation is pro-tumorigenic, that is, it encourages the growth of cancer cells," she said. There is also some evidence that increased body mass "dilutes" vitamin D, possibly by sequestering it in fat tissue."Weight loss reduces inflammation, and thus represents another mechanism for reducing cancer risk," Duggan said. "If ensuring that vitamin D levels are replete, or at an optimum level, can decrease inflammation over and above that of weight loss alone, that can be an important addition to the tools people can use to reduce their cancer risk."

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New research finding health benefits to humans from a four day low calorie diet - the Fasting Mimic Diet (FMD). Cutting calories to 34 to 54% of normal for a few days is obviously much easier to do than actual fastiing, so these results look very promising. In summary: the researchers found that in a small human trial, three cycles of this diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer (and with no major adverse side effects). Three earlier posts on various types of minifasting health benefits: Minifasting May Benefit Health, Health Benefits of Feast and Famine Diet, Fasting and the Immune System. From Science Daily:

Diet that mimics fasting appears to slow aging

Want to lose abdominal fat, get smarter and live longer? New research led by USC's Valter Longo shows that periodically adopting a diet that mimics the effects of fasting may yield a wide range of health benefits. In a new study, Longo and his colleagues show that cycles of a four-day low-calorie diet that mimics fasting (FMD cut visceral belly fat and elevated the number of progenitor and stem cells in several organs of old mice -- including the brain, where it boosted neural regeneration and improved learning and memory.

The mouse tests were part of a three-tiered study on periodic fasting's effects -- testing yeast, mice and humans...Mice, which have relatively short life spans, provided details about fasting's lifelong effects. Yeast, which are simpler organisms, allowed Longo to uncover the biological mechanisms that fasting triggers at a cellular level. And a pilot study in humans found evidence that the mouse and yeast studies were applicable to humans.

In a pilot human trial, three cycles of a similar diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer with no major adverse side effects, according to Longo.

The diet slashed the individual's caloric intake down to 34 to 54 percent of normal, with a specific composition of proteins, carbohydrates, fats and micronutrients. It decreased amounts of the hormone IGF-I, which is required during development to grow, but it is a promoter of aging and has been linked to cancer susceptibility. It also increased the amount of the hormone IGFBP-, and reduced biomarkers/risk factors linked to diabetes and cardiovascular disease, including glucose, trunk fat and C-reactive protein without negatively affecting muscle and bone mass.

Longo has previously shown how fasting can help starve out cancer cells while protecting immune and other cells from chemotherapy toxicity. 'It's about reprogramming the body so it enters a slower aging mode, but also rejuvenating it through stem cell-based regeneration,' Longo said. 'It's not a typical diet because it isn't something you need to stay on.'

For 25 days a month, study participants went back to their regular eating habits -- good or bad -- once they finished the treatment. They were not asked to change their diet and still saw positive changes. Longo believes that for most normal people, the FMD can be done every three to six months, depending on the abdominal circumference and health status. For obese subjects or those with elevated disease risk factors, the FMD could be recommended by the physician as often as once every two weeks. His group is testing its effect in a randomized clinical trial, which will be completed soon, with more than 70 subjects.

Despite its positive effects, Longo cautioned against water-only fasting and warned even about attempting the fasting mimicking diet without first consulting a doctor and seeking their supervision throughout the process....Longo also cautioned that diabetic subjects should not undergo either fasting or fasting mimicking diets while receiving insulin, metformin or similar drugs. He also said that subjects with body mass index less than 18 should not undergo the FMD diet.

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This latest study finding health benefits of eating nuts was a review of 36 observational studies, involving a total of 30,000 people. Nut consumption was associated with a lower risk of cancer in general, and a decreased risk of some types of cancer (colorectal, endometrial, pancreatic), but not with type 2 diabetes. So go ahead - eat a small handful of nuts for your health at least several times a week.From Medpage Today:

A Nutty Way to Prevent Cancer?

Nut consumption was associated with a decreased risk of some types of cancer but not with type 2 diabetes in a large review.When patients eating the most nuts were compared with those eating the least, those in the first group had a lower risk of colorectal cancer in three studies (RR 0.76, 95% CI 0.61-0.96; I2=51.3%), of endometrial cancer in two studies (RR 0.58, 95% CI 0.43-0.79; I2=0%), and pancreatic cancer in one study (RR 0.68, 95% CI 0.48-0.96; I2 not available). Those results were reported in the meta-analysis of 36 observational studies, with a total population of more than 30,000 patients.

Nut consumption was also associated with a lower risk of cancer in general (RR 0.85, 95% CI 0.76-0.95;I2=66.5%), according to the authors. But it was not associated with other types of cancer or with type 2 diabetes (RR 0.98, 95% CI 0.84-1.14; I2=74.2%), found the researchers, who were led by Lang Wu, a PhD candidate at the Mayo Clinic. They published their results on June 16 in Nutrition Reviews.

"Overall, nut intake was associated with a decreased risk of cancer," wrote Wu and colleagues. "Given the scarcity of currently available data, however, evidence from additional studies is required to more precisely determine the relationship between nut consumption and risk of individual cancer types." Evidence for the association between nuts and cancer has been mixed, according to the authors. Follow-up time in the studies ranged from 4.6 years to 30 years, found the review.

The amount of nuts eaten ranged from none for some of the patients to eating nuts more than seven times a week....No associations were found between nut consumption and acute myeloid leukemia, breast cancer, gastric cancer, glioma, hepatocellular carcinoma, leukemia, lymphoma, ovarian cancer, prostate cancer, or stomach cancer.

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A wonderful commentary by Dr. Mandrola about recent research of almost 500,000 UK citizens. Researchers found that just asking the patient several basic questions was a better predictor of 5 year mortality than all sorts of blood tests, measurements, and analyses. The best basic questions were: Is your health excellent, good, average, or poor? Is your walking pace slow, average, or brisk? Along with smoking, those two basic questions were the best predictors of staying alive in the next 5 years. These excerpts are from Medscape:

Health Is Not Complicated—Just Ask the Patient

It turns out predicting health is not so complicated. Nor is it digital at all. For persons of middle age (40 to 70 years), self-reported overall health and walking speed were the best predictors of death in the next 5 years, according to a study published this week in the Lancet.[1]

In an analysis of nearly 500,000 UK citizens followed for 5 years, these two simple questions outperformed 655 measurements of demographics, health, and lifestyle. Is your health excellent, good, average, or poor? Is your walking pace slow, average, or brisk? Along with smoking, those two basic questions, inquiries that hardly require a digital device, were the best predictors of staying alive in the next 5 years.

Pause for a moment here and ponder the beauty of that top-line result. Half a million people followed for 5 years; 655 measures of health, including heart rate, blood pressure, and lab tests, and the best predictors were that simple.

In the 5 years of follow-up, 8532 (1.7%) subjects died. Overall, cancer was the most common cause of death (53% in men; 69% in women). The most common cancer-related cause of death was lung cancer in men (n=546) and breast cancer in women (n=489). Cardiovascular disease was the second leading cause of death (26% in men; 33% in women).

 

There were gender differences in predictors of death. Self-reported health was the strongest predictor of death in men (C index 0.74). In women, a previous cancer diagnosis was the strongest predictor (C index 0.73).Self-reported walking pace was a strong predictor of death in both men and women (C index 0.72 and 0.69, respectively.) For example, a man aged 40 to 52 years who reported a slow walking pace was 3.7 times more likely to die than a similarly aged man who reported a steady walking pace. In a large subset of subjects with no reported health conditions, smoking was the best predictor of mortality.

 

The final, and perhaps niftiest, aspect of this study was that researchers developed an 11 to 13 question risk prediction score, which they then put on an interactive website. Anyone can answer these simple questions and get their health-related age relative to the UK population. The researchers call this age the UK Longevity Explorer (UbbLE) age.

I am drawn to these findings because they emphasize something that is increasingly lost on both doctors and patients. True health is not complicated. And the big picture is still useful.Any experienced clinician will testify that patients know when they are well and when they are not. The finding that self-reported health predicts death urges clinicians, generalists and specialists alike, to ask our patients how they feel about their health.

Then there is the matter of self-reported walking pace. How easy it is to be distracted by digital data. We walk into the exam room to see our patient. He is still. We look at him. We poke and listen to his body. We assess his ECG and other measures. Soon we will review his smartphone metrics and DNA data. Yet we tend to forget the obvious: to move is to be healthy. Drs Ganna and Ingelsson teach us that to move briskly may be healthier.

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Prostate cancer diagnosis is scary enough, but knowing that dietary changes can increase favorable odds is good. Once again a Mediterranean style diet  or "healthy diet"(whole grains, fruits, vegetables, seeds, nuts, legumes, olive oil, and fish) is beneficial, while a Western diet (highly processed foods, red meat, processed meat, and dairy) is linked to higher rates of death. This study was from the Harvard School of Public Health and followed male physicians for an average of 14 years after prostate cancer diagnosis. From Science Daily:

Western diet may increase risk of death after prostate cancer diagnosis

After a prostate cancer diagnosis, eating a diet higher in red and processed meat, high-fat dairy foods, and refined grains--known as a Western diet--may lead to a significantly higher risk of both prostate cancer-related mortality and overall mortality compared with eating a diet rich in vegetables, fruits, fish, whole grains, legumes, and healthy oils, according to a new study from Harvard T.H. Chan School of Public Health.

The study, which appears online June 1, 2015 in the journal Cancer Prevention Research, offers insight on how diet may help improve survivorship for the nearly three million men living with prostate cancer in the U.S."There is currently very little evidence to counsel men living with prostate cancer on how they can modify their lifestyle to improve survival. Our results suggest that a heart-healthy diet may benefit these men by specifically reducing their chances of dying of prostate cancer," said Jorge Chavarro, assistant professor of nutrition and epidemiology at the Harvard Chan School and senior author of the study.

Researchers examined health and diet data from 926 men participating in the Physicians' Health Study I and II who were diagnosed with prostate cancer. They followed the men for an average of 14 years after their diagnosis, grouping them into quartiles according to whether they followed a Western dietary pattern or a "prudent" (higher consumption of vegetables, fruits, fish, legumes, and whole grains) dietary pattern.

They found that men who ate mostly a Western diet (those in the highest quartile of the Western dietary pattern) had two-and-a-half times higher risk of prostate cancer-related death--and a 67% increased risk of death from any cause--than those in the lowest quartile. Men who ate mostly a "prudent" diet had a 36% lower risk of death from all causes.