Digestion, health and nutrition: Dr. Anil Minocha, a gastroenterologist and nutritionist

When is colon cancer screening not worth it?

Colorectal cancer is preventable and screening saves lives. How long should this periodic screening or surveillance continue during a person's life is controversial and raises health, economic and societal issues and concerns.

Dr. Cary Gross and colleagues from the Robert Wood Johnson Clinical Scholars Program at the Yale University School of Medicine tackled this controversial and emotional issue and recently published their findings in the journal Annals of Internal Medicine (November 2006).

They conducted a retrospective cohort study in patients with prior colorectal cancer using population-based cancer registry with linked administrative claims data. They assessed each patient's chronic illnesses based on Medicare claims. Chronic conditions included myocardial infarction, congestive heart failure, peripheral vascular disease, stroke, COPD, dementia, diabetes, renal or liver failure, AIDS etc.

The overall study sample consisted of 35,755 patients. Not surprisingly, they documented that the life expectancy depended on patient's age and the number of chronic illnesses.

They found that among men diagnosed with stage I cancer (curable form of cancer) at the age of 67 years, the life expectancy was 19 years for those without significant illnesses; it was 12 years for those with 1 or 2 chronic conditions as compared to 7.6 years among those with 3 or more illnesses. The numbers for females were 2, 16 and 7 years respectively.

At the other extreme,, these investigators found that if same cancer was diagnosed at the age of 81 years with no concurrent medical illness, the life expectancy was 10 and 14 years among men and women respectively.

They concluded that coexisting chronic illness results in significant reduction in life expectancy after diagnosis of early-stage colorectal cancer. Further screening among such patients should depend upon the overall health of the patient.

These recommendations are controversial since these are based on a retrospective examination of data. Each patient is different and statistical averages may not apply to each and everyone. In addition, we should also partner with the patient and take into account his/her expectations and desired quality of life.

Lets us not forget that healthy diet such as fruits, vegetables, curry and calcium contribute to lower risk for colon cancer.

Are you above the age of 50 years? Have you had your colorectal cancer screening?

Plant diet for prostate cancer?

Cancer of prostate is extremely common as men grow older. Controversy surrounds various treatment modalities. If the patient receives treatment, a rising PSA level after treatment for cancer prostate is a marker for disease recurrence.

Dr. Saxe and colleagues from University of California, San Diego sought to examine if a plant-based diet plus stress management training could be beneficial to the patients. A rise of PSA was used a marker for disease progression. Fourteen patients with recurrent prostate cancer were recruited for this 6-month trial. The authors published their findings in Sept 2006.

These investigators found that the rate of PSA rise decreased significantly as a result of the intervention suggesting less progression or worsening of disease. In fact, median PSA doubling time increased from 11.9 months before the study to 112 months during the intervention period.

This pilot study confirms the negative impact of western diet on the prostate cancer and further reinforces the importance of plant food as a natural antineoplastic intervention.

What are your thoughts on predominantly plant food diet versus western diet? Do you know of anyone who may have benefited from diet intervention?

Green tea heals breast cancer

Numerous studies have documented the beneficial effects of green tea on health including prevention of breast cancer. You might ask, what about the patients who already have breast cancer?

Here is a recent study that shows that the combination of green tea and tamoxifen (a common chemotherapeutic agent used for certain breast cancers) is better than either agent alone.

Dr. Sartippour and colleagues from the from the University of California Los Angeles Medical Center in Los Angeles published in the journal Carcinogenesis (June 2006).

These investigators found green tea potentiated the inhibitory effects of tamoxifen on human breast cells in vitro. In addition, the mice treated with both green tea and tamoxifen had the smallest tumor size as compared to use of either agent.

This study gives us one more reason to sing praises of green tea. Do you drink green tea? I do.

Helicobacter pylori as a lifesaver in cancer: Yes, it is true!

Helicobacter pylori infection of the stomach has been having its ups and downs. We all know that it is implicated in pathogenesis of peptic ulcers (gastric and duodenal ulcer), gastritis and certain forms of cancers. On the other hand, some data has also suggested that the presence of infection is protective against gastroesophageal reflux disease (GERD) or chronic heartburn.

Now comes a study by Dr Meimarakis and colleagues from University Hospitals in Munich, Germany showing the beneficial effect of H. pylori infection in patients who have had curative surgery for stomach gastric cancer (gastric adenocarcinoma).

These investigators studied 166 patients who had surgery for gastric adenocarcinoma between 1992 and 2002. They published their results in the journal Lancet Oncol (2006)

They found that there was 3-fold advantage for H. pylori infected patients with respect to relapse-free and overall survival. For example, the overall survival was 61.9 months in patients positive for H pylori, compared to 19.2 months in patients who did not have H pylori infection.

Considering the problems this infection causes and the advantages it bestows, this celebrity bacteria continues to be a baffling friend and a foe!

Have you been tested or treated for H. pylori infection for any reason? Do any philosophical thoughts come to your mind about this organism, which can be a good, or bad depending upon the situation? At the very least, we should not be killing this poor bug indiscriminately.