Study: Even Light Alcohol Consumption Linked to Higher Cancer Risk

In a study conducted in Japan, even light to moderate alcohol consumption was associated with elevated cancer risks. In the study published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the overall cancer risk appeared to be the lowest at zero alcohol consumption.

Although some studies have linked limited alcohol consumption to lower risks of certain types of cancer, even light to moderate consumption has been associated with a higher risk of cancer overall. To study the issue in Japan, Masayoshi Zaitsu, MD, PhD, of The University of Tokyo and the Harvard T.H. Chan School of Public Health, and his colleagues examined 2005–2016 information from 33 general hospitals throughout Japan. The team examined clinical data on 63,232 patients with cancer and 63,232 controls matched for sex, age, hospital admission date, and admitting hospital. All participants reported their average daily amount of standardized alcohol units and the duration of drinking. (One standardized drink containing 23 grams of ethanol was equivalent to one 180-milliliter cup (6 ounces) of Japanese sake, one 500-milliliter bottle (17 ounces) of beer, one 180-milliliter glass (6 ounces) of wine, or one 60-milliliter cup (2 ounces) of whiskey.

Overall cancer risk appeared to be the lowest at zero alcohol consumption, and there was an almost linear association between cancer risk and alcohol consumption. The association suggested that a light level of drinking at a 10-drink-year point (for example, one drink per day for 10 years or two drinks per day for five years) would increase overall cancer risk by five percent. Those who drank two or fewer drinks per day had an elevated cancer risk regardless of how long they had consumed alcohol. Also, analyses classified by sex, drinking/smoking behaviors, and occupational class mostly showed the same patterns.

The elevated risk appeared to be explained by alcohol-related cancer risk across relatively common sites, including the colorectum, stomach, breast, prostate, and esophagus.

“In Japan, the primary cause of death is cancer,” said Dr. Zaitsu. “Given the current burden of overall cancer incidence, we should further encourage promoting public education about alcohol-related cancer risk.”

Source: Wiley


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Low-Dose Aspirin Might Cut Cancer Risk, Especially for Overweight People

Dennis Thompson wrote . . . . . . . . .

Daily low-dose aspirin might reduce your risk of dying from cancer, particularly if you’ve packed on a few extra pounds, researchers say.

Taking aspirin three or more times a week is associated with a lower risk of cancer death as well as death for any reason, a new study reports.

Aspirin’s protective effect appears particularly pronounced among people who are overweight — those with a body mass index of 25 to 29.9, the results show.

Low-dose aspirin reduced overall cancer death risk by 15% and all-cause death by 19% among more than 146,000 people who participated in a cancer screening trial conducted between 1993 and 2008, the study authors said.

Overweight folks also experienced a marked decline in their risk of death from gastrointestinal cancer (28%) and colon cancer (34%).

“Our primary focus was really on colorectal cancer deaths, since there’s a lot of evidence to suggest that aspirin use may lower risk of gastrointestinal deaths,” said lead researcher Holli Loomans-Kropp, a cancer prevention fellow with the U.S. National Cancer Institute.

The study results support the standing recommendation of the U.S. Preventive Services Task Force (USPSTF), which says people 50 to 59 should take low-dose aspirin to prevent colon cancer if they’re not at increased risk for bleeding.

Daily aspirin use as a preventive health measure has become controversial over the past few years, however.

In March, the American College of Cardiology and the American Heart Association changed their guidelines to restrict low-dose aspirin use to people at high risk for heart disease or stroke. The two groups argued that the bleeding risk from aspirin outweighed the heart benefits for healthy people.

The USPSTF continues to recommend low-dose aspirin for middle-aged people for heart health, if they have a 10% or greater chance of developing heart disease within the next decade.

The new study involved a re-analysis of data gathered during the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, which was sponsored by the National Cancer Institute.

No one knows why aspirin might have this protective effect, but Loomans-Kropp said evidence points toward its anti-inflammatory action.

“Gastrointestinal cancers are highly inflammation-associated cancers, and where the strongest effect has been is with the gastrointestinal cancers,” Loomans-Kropp said.

It’s also possible that aspirin’s blood-thinning effect might play a role, said Eric Jacobs, senior scientific director of epidemiology research at the American Cancer Society.

“Aspirin may help prevent cancer the same way that it helps prevent heart attacks, which is by blocking the activation of blood platelet cells,” Jacobs said. “We know that activated platelets can release factors that help tumors grow, and activated platelets may also help cancers spread throughout the body.”

People worried about colon cancer should talk with their doctor about getting screened for the disease, since a colonoscopy can remove polyps before they can develop into cancer, Jacobs said.

“Aspirin use is not the only way or the best way to lower risk of colorectal cancer,” Jacobs said, adding that maintaining a healthy weight, being physically active, quitting smoking and eating less red meat also can help reduce your risk.

Anyone thinking about taking daily aspirin should discuss it with their doctor first, said Dr. Merry Jennifer Markham, a spokesperson for the American Society of Clinical Oncology and a cancer doctor with the University of Florida.

“It’s important to have a discussion with the physician about whether the benefits of regular aspirin use outweigh the harms,” Markham said. “I don’t believe this is a one-size-fits-all approach, and must be individualized based on the individual person’s other health issues and bleeding risks.”

The new study was published online in JAMA Network Open.

Source: HealthDay

Cancer Patients Are at Higher Risk of Dying from Heart Disease and Stroke

More than one in ten cancer patients do not die from their cancer but from heart and blood vessel problems instead, according to new research published in the European Heart Journal [1] today (Monday). For some cancers, like breast, prostate, endometrial, and thyroid cancer, around half will die from cardiovascular disease (CVD).

Dr Nicholas Zaorsky, a radiation oncologist, and Dr Kathleen Sturgeon, an assistant professor in public health sciences, both at Penn State College of Medicine and Penn State Cancer Institute, Hershey, Pennsylvania, USA, and colleagues compared the US general population with over 3.2 million US patients who had been diagnosed with cancer between 1973 and 2012.

They used information contained in the Surveillance, Epidemiology and End Results (SEER) database to look at deaths from CVD, which included heart disease, high blood pressure, cerebrovascular disease, blocked arteries and damage to the aorta – the main artery carrying blood from the heart to the rest of the body. They adjusted their analyses to take account of factors that could affect the results, such as age, race and sex, and they looked specifically at 28 different types of cancer.

Among the 3,234,256 cancer patients, 38% (1,228,328) died from cancer and 11% (365,689) died from CVDs. Among the deaths from CVD, 76% were due to heart disease, and the risk of dying from CVD was highest in the first year after a cancer diagnosis and among patients younger than 35 years.

The majority of CVD deaths occurred in patients with cancers of the breast (a total of 60,409 patients) and prostate (84,534 patients), as these are among the most common cancers to be diagnosed. In 2012, 61% of all cancer patients who died from CVD were diagnosed with breast, prostate, or bladder cancer.

The proportion of cancer survivors dying from CVD was highest in bladder (19% of patients), larynx (17%), prostate (17%), womb (16%), bowel (14%) and breast (12%).

Patients who were more likely to die from cancer than from CVD were those with the most aggressive and hard-to-treat cancers, such as cancer of the lung, liver, brain, stomach, gallbladder, pancreas, oesophagus, ovary and multiple myeloma.

This is the largest and most comprehensive study looking at deaths from cardiovascular disease among patients with 28 types of cancer with over 40 years of data. Other, smaller studies have looked at the risk of death from CVD in some specific cancers, but none have looked at so many cancers with such a long follow-up.

Dr Sturgeon said: “These findings show that a large proportion of certain cancer patients will die of cardiovascular disease, including heart disease, stroke, aneurysm, high blood pressure and damage to blood vessels. We also found that among survivors with any type of cancer diagnosed before the age of 55 years, the risk of cardiovascular death was more than ten-fold greater than in the general population.

“Cancer survivors with cancer of the breast, larynx, skin, Hodgkin lymphoma, thyroid, testis, prostate, endometrium, bladder, vulva, and penis, are about as likely to die of cardiovascular diseases as they are to die of their initial cancer. The risk of death from cardiovascular diseases is several times that of the general population in the first year of diagnosis; sometimes, this risk decreases, but for most, this risk increases as survivors are followed for ten years or more. Increasing awareness of this risk may spur cancer survivors to implement healthy lifestyle behaviours that not only decrease their risk of cardiovascular disease, but also the risk of cancer recurrence.”

Dr Zaorsky said: “Clinicians need to be aware that the majority of cardiovascular disease deaths occur in patients diagnosed with breast, prostate or bladder cancer. Thus, clinics that aim to open “cardio-oncology” centres should likely focus on the inclusion of these sites, followed by the other sites listed above. Additionally, primary care physicians and cardiologists may seek to control cardiovascular diseases more aggressively in cancer survivors.

“As the number of cancer survivors increase, the rate of cardiovascular deaths will continue to rise.”

He said the reason why cancer patients were more at risk of dying from cardiovascular disease within the first year of diagnosis might be because when they entered the hospital system, other illnesses and problems, such as heart disease, lung dysfunction and kidney failure were also detected. It could also be explained by the aggressive treatment that follows a cancer diagnosis.

Dr Sturgeon concluded: “We hope these findings will increase awareness in patients, primary care physicians, oncologists and cardiologists as to the risk of cardiovascular disease among cancer patients and the need for earlier, more aggressive and better coordinated cardiovascular care.”

Limitations of the study include the fact that the type of treatments the patients received was not known, including whether or not they had therapies that can be more toxic to the heart; the SEER database does not provide information on other illnesses and risk factors (such as smoking, alcohol consumption, obesity); the role played by socioeconomic status on the risk of cardiovascular death after a cancer diagnosis was not investigated. The study was carried out in the US population, so the risks may vary in different populations; the authors believe their findings are most applicable to Canada, Europe and Australia because the cancers and causes of death among cancer patients are similar.

In an accompanying editorial, Dr Jörg Herrmann, a cardiologist at the Mayo Clinic, Rochester, Minnesota, USA, writes: “The important work by Sturgeon et al. confirms that cancer patients have an on average 2–6 times higher CVD mortality risk than the general population. This is a key message that every cardiologist needs to hear. Secondly, the CVD mortality risk is evident throughout the continuum of cancer care, and entails an acute phase (early risk) and a chronic phase (late risk). In view of such grave and persistent consequences, a reactive management approach that comes into play solely when clinical presentations and complications arise is no longer in order. Rather, one would advocate for a proactive approach that starts before any cancer therapy is given and continues for a lifetime thereafter. Thirdly, even with the best possible cardio-oncology care, no difference in population-based outcomes may be achieved in patients with relentless malignancies, while for others it is of increasing significance.”

Source: European Society of Cardiology


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Heart Disease and Cancer Risk May be Linked

Heart attack survivors may have an increased risk of developing cancer compared to people without cardiovascular disease, according to research to be presented at the American Heart Association’s Scientific Sessions 2019 — November 16-18 in Philadelphia. The Association’s Scientific Sessions is an annual, premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

People with more risk factors for cardiovascular diseases were also at higher risk for developing cancer compared to people with lower cardiovascular disease risk.

“It’s a double whammy. Heart disease and cancer are the two leading causes of death in the United States. We now recognize that they are intimately linked. This tells us that we, as physicians, should be aggressive in trying to reduce cardiovascular risk factors not only to prevent heart disease, but also to consider cancer risk at the same time,” said study lead author Emily Lau, M.D., a cardiology fellow at Massachusetts General Hospital in Boston.

Using data from the Framingham Heart Study, researchers evaluated data from 12,712 participants (average age 51) without cardiovascular disease or cancer at the start of the study. The American Heart Association/American College of Cardiology’s Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator and biomarkers (substances released into the bloodstream when the heart is damaged) were used to measure cardiovascular risk. The ASCVD risk estimator is a tool to help predict a person’s risk of developing heart disease within ten years.

During the study period of nearly 15 years, 1,670 cancer cases occurred (19% gastrointestinal; 18% breast; 16% prostate; 11% lung). The researchers found:

Cardiovascular risk factors, including age, sex, high blood pressure and smoking status, were independently associated with cancer.

Those with a 10-year ASCVD risk of 20% or higher were more than three times as likely as those with 10-year ASCVD risk of 5% or lower to develop any type of cancer.

People who developed cardiovascular disease (a heart attack, heart failure or atrial fibrillation) during the study period had more than a sevenfold increased risk for subsequent cancer compared to those who did not experience any cardiac event.

Similarly, those with high levels of BNP, a biomarker frequently elevated in heart failure, were more likely to get cancer during the 15-year follow-up period than participants with low levels of BNP.

“I think it’s interesting that BNP, a cardiac marker linked to heart failure risk, was associated with the risk of cancer in the future. Currently we use BNP to determine if a person has developed heart failure from chemotherapy drugs used to treat cancer,” said Tochi M. Okwuosa, D.O., Vice Chair, American Heart Association Council on Clinical Cardiology and Genomics and Precision Medicine Cardio-Oncology Subcommittee and associate professor at Rush University, Chicago. “This is the first study that has shown that BNP that’s elevated at baseline is associated with the future risk of cancer.”

“Cancer and cardiovascular disease share many of the same risk factors, such as tobacco use, poor nutrition and lack of physical activity. The next step is to identify the biological mechanisms driving the link between cardiovascular disease and cancer,” said Lau.

Many of the same lifestyle habits that reduce the risk of heart disease also reduce the risk of some kinds of cancer; so following the American Heart Association Life’s Simple 7 may help prevent both diseases. Life’s Simple Seven includes recommendations to eat a healthy diet (more fruits and vegetables, whole grains and lean protein), be physically active; avoid all tobacco/nicotine products and attain and maintain a healthy body weight, cholesterol, glucose and blood pressure,” said Eduardo Sanchez, M.D., M.P.H., chief medical officer for prevention for the American Heart Association.

Lau said this was an observational study, so it doesn’t prove cause and effect, but it does shed light on the connection between heart disease and cancer.

Source: American Heart Association


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Study: Common Early Sign of Cardiovascular Disease Also May Indicate Cancer Risk

Jay Furst wrote . . . . . . . . .

A Mayo Clinic-led study involving 488 cardiac patients whose cases were followed for up to 12 years finds that microvascular endothelial dysfunction, a common early sign of cardiovascular disease, is associated with a greater than twofold risk of cancer.

The study, published in the European Journal of Preventive Cardiology, finds that microvascular endothelial dysfunction may be a useful marker for predicting risk of solid-tumor cancer, in addition to its known ability to predict more advanced cardiovascular disease, says Amir Lerman, M.D., a Mayo Clinic cardiologist and the study’s senior author.

“The study demonstrated that noninvasive vascular function assessment may predict the future development of cancer,” says Dr. Lerman, who is director of cardiovascular research at Mayo Clinic. “More studies are needed, but assessment of vascular function potentially may predict individuals at risk.”

Microvascular endothelial dysfunction involves damage to the walls of small arteries in the heart, which affects their ability to expand and limits the flow of oxygen-rich blood. Hypertension, high cholesterol, obesity and diabetes are among the causes, and symptoms of dysfunction include chest pain. The condition is treatable but difficult to detect.

The study reviewed the cases of 488 patients who underwent microvascular endothelial function assessment at Mayo Clinic between 2006 and 2014. The noninvasive procedure, called reactive hyperemia peripheral arterial tonometry, measures blood flow to the fingers during blood pressure inflation and release.

Dysfunction was defined as a tonometry index at or below 2, and the median follow-up period was six years. Of 221 patients identified as having dysfunction, 9.5% were diagnosed with solid-tumor cancer during the follow-up period. This compared with 3.7% of patients who had a tonometry index above 2. The findings were consistent after adjusting for age, gender, coronary artery disease and other factors.

The association between microvascular endothelial dysfunction and cancer was independent but more prominent among men and in patients with factors such as hypertension, significant coronary artery disease, smoking and obesity.

“This abnormal vasoreactivity should alert clinicians not only to the risk of cardiovascular disease but to malignancy, as well,” Dr. Lerman says. “This risk prediction appears to precede the development of disease by more than five years.”

Patients with microvascular endothelial dysfunction tend to have other health issues, as well, and that may have drawn more medical attention to these patients, resulting in higher levels of incidental detection of cancer, according to the study. Whether improvement in dysfunction translates into a reduced risk of cardiovascular disease and cancer remains to be determined.

“Similarly, the mechanism underlying the association between microvascular endothelial dysfunction and cancer needs to be defined in future studies,” Dr. Lerman says.

Source: Mayo Clinic


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