The idea of the 'Polypill' was first mooted in 2003 by Professors Nick Wald and Malcolm Law of London’s Wolfson Institute of Preventive Medicine (1), suggesting that if everyone over age 55 and anyone with existing cardiovascular disease took a single pill per day without screening, ischaemic heart disease events would be reduced by 88% and stroke by 80%. Side effects would be “minimal” (only 15% of those taking the pill).
The polypill proposed by Wald and Law would have six ingredients: a statin, aspirin, folic acid, and three antihypertensives (a thiazide, a ß blocker, and an angiotensin converting enzyme inhibitor), all at half dose. The combination, the authors said, would prevent heart disease and stroke by reducing four different risk factors—blood pressure, lipid concentration, homocysteine concentration, and platelet function. Financial considerations reduce the cost-benefit ratio: if the Polypill included the three classes of blood pressure lowering drugs with the lowest prevalence of adverse effects (thiazide, angiotensin II receptor antagonist, and calcium channel blocker) instead of the three with the cheapest ingredients (thiazide, ß blocker and ACE inhibitor) only 8% of those taking the pill would suffer adverse symptoms.
At a recent meeting of experts organised by the US Centers for Disease Control in Atlanta it was suggested that three powerful groups are threatened by the Polypill idea: the drug industry, doctors, and the public health lobby, which “generally favours lifestyle change over mass drug treatment”. The drug industry and doctors obviously stand to lose income and clientele from removing individualised diagnosis, treatment and prescription, as the Polypill will no longer need consultations and can use generic components that are not subject to patent protection. The public health lobby however could lose the option of personalised healthcare, and the right to take control of their own health and prevent disease through the natural self-healing ability of the body when using appropriate diet and natural medicine according to individual need without any side effects.
The fact that while statins can perform the dubious task of lowering cholesterol levels in healthy individuals, it can also cause cardiomyopathy by depletion of coenzyme Q-10, is one of the ironies of both statins and the Polypill concept, apart from the rarer side-effects of rhabdomolysis, memory loss and hepatitis, however statins are now available over the counter in the UK without prescription, with no inclusion of or recommendation to take co Q-10. Beta-blockers are well known for their mind-numbing effects as well as their unsuitability for those with asthma. Hypokalaemia (potassium deficiency) may occur with thiazide diuretics. ACE inhibitors can cause acute renal failure, more common in the older population. Aspirin is unsuitable for those with salicylate intolerance, and causes internal bleeding, particularly in individuals of blood group O, however the authors say that the risk of increase in haemorrhagic stroke (from bleeding) would be exceeded by the reduction in thrombotic strokes (from a blood clot), giving the all-important cost-benefit ratio. The authors failed to mention natural medicines that prevent strokes from bleeding without any side-effects. The authors say about a third of people taking the Polypill would ‘benefit’ overall (at the expense of half of this number of people having side-effects).
The only useful thing about this concept is that it raises the profile of the significance of homocysteinaemia in cardiovascular disease. [The role of folic acid for reduction of homocysteine is well documented, however research suggests that synthetic folate supplementation (pteroyl-L-monoglutamic acid, a product of the pharmaceutical industry which rarely occurs in nature) could cause an increase in the incidence of breast cancer (2). The authors of this paper would wish that it be considered as nothing more than a 'research pointer', as the number of deaths in the study was small (31 actual deaths), and the findings were balanced with commentary and several notes of caution, although the article has already caused front page headline reactions in the tabloid press. Although we are told in the research that the "tablets were supplied in six colours, two of which contained folate in 0.2 mg and 5 mg daily doses”, what is not reported is which colouring agents were used, and whether carcinogenic azo dyes had an influence on the results].
Interestingly a version of the polypill is likely to appear on the market in India by the end of 2005, as the authors stated “widespread use would have a greater impact on the prevention of disease in the Western world than any other single intervention”. Is it that resistance would be less from the three major groups who could influence the acceptability of the Polypill idea would have less influence in India? The recipients of the pill are unlikely to be monitored for side-effects due to the fact that “the tests lack specificity, so the increased risk of cardiovascular disease after stopping the drug in people positive on monitoring may outweigh any benefit” – the cost-benefit ratio again.
Based on the potential costs and adverse effects of the Polypill, the concept of the Polymeal was raised in 2004 (3) with the objective of identifying “an effective, non-pharmacological, safe, cheap, and tasty alternative to reduce cardiovascular morbidity and increase life expectancy in the general population”. The ironic tone of this article suggests that an “evidence based recipe” includes wine, fish, dark chocolate, fruits, vegetables, garlic, and almonds. Using similar analysis to that of the Polypill study, the authors state that “combining all the ingredients of the Polymeal resulted in cardiovascular disease being reduced by 76%. Whether increasing the amount of each ingredient would increase the effect of the Polymeal is uncertain”.
The article was published just before Christmas and makes amusing reading: if the Polypill ingredients were used to fortify flour used in Polymeals, “redundant cardiologists could be retrained as Polymeal chefs and wine advisers”. There are however some serious conclusions: “Pharmacological interventions are not the only option for preventing heart disease; a healthy diet and an active lifestyle reduce cardiovascular disease as well”. It is unfortunate that the idea of a healthy diet is not taken seriously by the medical community at large, and the article had to be presented as a joke.
The concept behind the Polymeal article could also be applied to the idea of the Polypill: “The preventive strategy outlined here is radical. But the ‘healthy person’ is an outdated concept from the era before scientific prevention. We should recognise that in Western society we all have cardiovascular risk factors, so everyone is at risk, and the diseases they cause are common and often fatal.”
What the authors of both Poly- studies fail to appreciate (or admit) is that some individuals are at greater risk of heart disease than others, and the cost-benefit ratio of many foods are different according to some easily-measured factors, not least ABO blood group and salivary secretor status. If individuals were given access to the information about simple food choices on a large scale they could take control of their own health.
1. A strategy to reduce cardiovascular disease by more than 80%.
Wald N J and Law M R, BMJ 2003 326: 1419.
2. Taking folate in pregnancy and risk of maternal breast cancer.
Charles D, Ness AR, Campbell D et. al., BMJ 2004;329:1375-1376.
3. The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%.
Franco OH, Bonneux L, de Laet C et. al., BMJ 2004;329:1447-1450
Researchers writing in the journal Lancet (1) report that drinking is unlikely to be good for you. The popular notion that one or two units of alcohol a day can be protective from heart disease had been well supported by observational data, although there had been no clinical trials to confirm the theory [but then, so was the equally popular notion that hormone replacement therapy protected women from heart disease—until proper clinical trials showed that observational data cannot always be trusted]. It now seems likely that complete tee-totallers are simply too different from people who drink in moderation to be able to quantify the impact of alcohol on heart disease.
In a study in the American Journal of Preventive Medicine (2) 27 out of 30 cardiovascular risk factors were more common among abstainers than moderate drinkers. The study was carried out in the U.S. by telephone survey, and found that non-drinkers were more likely to have characteristics associated with increased cardiovascular disease mortality in terms of demographic factors, social factors, behavioural factors, access to health care, and health-related conditions. This makes moderate drinkers look good, even though their lower cardiovascular risk is nothing to do with the occasional glass of wine.
The study concludes: "Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States." If anything, heavy drinking is more likely to be protective of heart disease than light drinking, say the researchers. Unfortunately, there's little point in cleaning out your coronary arteries with a cellular poison that will simply kill you in some other way.
It would appear that moderate drinkers live longer in spite of their occasional glass of wine, not because of it. Season's Greetings.
1) Lancet 2005;366: 1911-2
Alcohol and ischaemic heart disease: probably no free lunch.
Jackson R, Broad J, Connor J, Wells S
2) Am J Prev Med. 2005 May;28(4):369-73.
Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults.
Naimi TS, Brown DW, Brewer RD, et. al.
Big Babies Become Obese Adults
Starting off as a big baby may not be so good for you when you grow up: a new study (1) has found that the largest babies, or those who grow fastest are more likely to become overweight adults. The British Medical Journal carried out a review of the association between infant growth during the first two years of life and obesity in adulthood, and all studies were found to be consistent. Prevention of obesity may therefore need to start very early.
Diet and Alzheimer's Disease
Another recent dietary study (2) links a 'high fat' diet with the amyloid-beta (Abeta) deposits that cause Alzheimer's disease (AD) in the brains of mice. Previous studies have linked the consumption of cholesterol and saturated fats with Abeta deposition. The difference with this new study is the low carbohydrate content of the diet that the mice were given.
The principle that dietary fat might play a relatively passive role in metabolism and that the distribution of fat is regulated by the hormonal state stimulated by carbohydrate is standard basic biochemistry knowledge, but remains an under-appreciated factor in many studies, possibly due to the emphasis on low-fat recommendations of nutritional agencies. Because of the requirement of brain cells for glucose (or ketones) for energy metabolism and, in particular, because of the involvement of insulin in regulating a proteolytic enzyme in Abeta production, it is relevant to inquire about the role of macronutrient composition in the diet in AD. In doing so, the medical research world seems to be gradually getting closer to the fact that many people eating according to their blood group have known for a long time: sometimes dietary carbohydrate restriction can be part of a collection of factors that reduce inflammation. What doesn't seem to be appreciated in most diet studies is how other research shows that individuals of blood groups A and B are more prone to Alzheimer's disease than O and AB due to a different reason: a higher stress response to cortisol (3).
The authors of the study conclude: "a diet rich in saturated fats and low in carbohydrates can actually reduce levels of Abeta. Therefore, dietary strategies aimed at reducing Abeta levels should take into account interactions of dietary components and the metabolic outcomes, in particular, levels of carbohydrates, total calories, and presence of ketone bodies should be considered." The description 'high fat diet' is thus an inadequate way to characterize a diet: one must also specify the level of carbohydrate.
Looking for a reason for this, the article postulates: "evidence suggests that the primary genetic risk factor for late onset AD, the epsilon4 allele of apolipoprotein E, may have been selected against in populations with long historical exposure to agriculture." Individuals with this genotype are more prone to AD. The gene that did better with exposure to agriculture was the blood group A gene, which expressed in people who survived on a lower fat diet. Reduced levels of intestinal alkaline phosphatase in individuals of blood group A and AB means that they cannot digest fat well in their diet, but they may be able to better tolerate complex carbohydrate. Conversely individuals of blood group O and B may be able to tolerate more dietary fat, and less carbohydrate - the diet which gave less Abeta deposition in the study (on mice).
The study also says: "foods rich in carbohydrates are relatively recent additions to the human diet and are likely to be more evolutionarily discordant than high fat diets. Therefore, the recent evolutionary switch to high carbohydrate diets may play an important role in development of AD". In terms of blood groups, this is more likely to be true with individuals of blood groups O and B, but those with blood groups A and AB may not benefit from the high fat levels seen in this study.
Perhaps we should get away from the principle that “you are what you eat,” and replace it with the idea that “you are what you do with what you eat.”
Reduce That Sweet Tooth With Weight Loss
Losing weight sensibly can reduce sugar cravings: In a recently published study (4) ten women were tested to see how quickly they found repeated eating or drinking of a sweet substance to be unpalatable after fasting overnight. They were then put on a weight loss diet (composed of 50% carbohydrate, 25% protein and 25% fat). After 3 months they had all lost weight, most had reduced their BMI by over 5%, but also all felt satiated earlier and withdrew from ingesting the sweet substance more quickly than before they started dieting.
The authors conclude: "Maintaining a lowered set-point, by consuming a sensible diet that promotes satiety and gradual weight loss, may be the key for long-term success, as the body strives to maintain a body weight close to that set-point by reducing food intake and enhancing energy expenditure."
This study shows that a standard calorie-controlled weight loss programme will eventually reduce the amount of sweets that the dieter craves before feeling satiated.
(1) Baird J, Fisher D, Lucas P, et. al:
Being big or growing fast: systematic review of size and growth in infancy and later obesity
BMJ 2005 331: 929
(2) Van der Auwera I, Wera S, Van Leuven F, Henderson ST:
A ketogenic diet reduces amyloid beta 40 and 42 in a mouse model of Alzheimer's disease
2005 Nutr Metab (Lond) 2005. 2:28
(3) Complete Blood Type Encyclopedia
(4) Frankham P, Gosselin C, Cabanac M:
Diet induced weight loss accelerates onset of negative alliesthesia in obese women
BMC Public Health 2005, 5:112
The second conference of the Institute for Human Individuality The Four Masters: Nutrigenomics in Practice heralded the start of a new era in medicine. It took place in Tempe, Arizona, between April 15-17, and this year the event lasted two and a half days, packed with new information for clinicians and the public alike.
On arrival delegates were fingerprinted, and asked to put two pieces of paper in their mouth to assess a bitter taste, but were not told why. The reason for this became apparent later.
Dr. Bland - FUNCTIONAL MEDICINE/NUTRIGENOMICS
The first master to speak after the opening ceremonies on Friday Morning was the widely venerated Dr. Jeffrey Bland PhD. Dr. Bland is author of the book Genetic Nutritioneering, - a Functional Approach (which contains a chapter on blood groups), and also wrote the preface for 'Live Right for Your Type'. He set a lively pace to the start of the conference, introducing the connection between genetics and inflammatory conditions, pharmacogenomics and the "trilogy of omics": functional genomics, proteomics and metabolomics.
The latest definition of nutrigenomics includes: "The study of how different foods may interact with specific genes to modify the risk of common chronic diseases... seeks to identify the bioactive molecules in the diet that affect health by altering the expression of genes... the influence of diet on health is related to an individual's genetic makeup."
Genetics is closely linked with evolution, and Dr. Bland expounded the two different theories relating to evolution: natural selection and adaptation. He said that if human evolution happened by natural selection, it took hundreds of millions of years. The subsequent transition from the 'average' human less than a hundred years ago to the typically unwell obese junk-food eating subfertile American could not have happened by the same method, but by the modulation of gene and protein expression and function that controls our phenotype (how we look and feel) by food and the presence of absence of nutrients. This situation is unsustainable, and according to Dr. Bland it is based on a false set of assumptions which are eventually guaranteed to bankrupt the medical healthcare system while opening the door for the development of 'personalised medicine' through the diet/chronic disease connection. Numerous scientific references demonstrated how the revolution in nutrigenomics is taking medicine away from "Taylorism", or standardisation of the client, towards an age of investigation and respect for individuality. The implication throughout was that nutrigenomics is not a fad, but is here to stay. Dr Bland’s message is to encourage people to "exercise their central nervous systems" to find out what is behind the media manipulation, and ''get on the bus or be left behind at the bus stop".
The ability of folate to modify gene expression was discussed extensively during the lecture. Using folate in preconceptual care can be extended beyond the traditional role in prevention of neural tube defects according to recent research: maternal folate supplementation decreases incidence of childhood acute lymphoblastic leukaemia in offspring; coronary heart disease may be considered a long latency disease, beginning in utero; nutritional reduction of breast cancer risk may be folate-dependent; the effects of lowering homocysteine relies on folate; a specific post-methotrexate folate rescue protocol helps counteract the side-effects of methotrexate; epilepsy is sometimes related to folate.
The aetiology of Parkinson's disease, including genetic factors, environmental factors, and the interaction between them is modifiable at many levels: oxidative stress; mitochondrial dysfunction; excitotoxicity; inflammation; Dr. Bland explained how all these may respond to appropriate specific nutritional intervention.
Nutrigenomic intervention to balance immunity may be targeted at either division of the immune system, TH1, the innate (primitive, or cellular), or TH2, the acquired (adaptive, or humoral) division. Individual differences in secretory IgA and glycosylated polypeptides (ABO blood group) influence the genetic uniqueness of the GALT system (Gut-Associated Lymphatic Tissue) and enteric colon bacteria. ABO secretor status is significant in childhood asthma, allergy and atopy (TH2-dominant disorders), susceptibility to systemic inflammation (TH1-dominant). Conditions such as COPD (chronic obstructive pulmonary disease) and arterial disease depend on the the neuroendocrine immune system functioning as a whole, which is tightly controlled by genetic uniqueness (as in a polymorphism of the COX-2 gene, for example). There was much more information that Dr. Bland did not have time to present...
Dr. D'Adamo - POLYMORPHISMS
In his first lecture Dr. D'Adamo encouraged people to move away from the idea that blood type medicine is a perfect unchangeable monolithic structure. Rather it is a working system; the innovations in nutrigenomics presented at this conference along with further discoveries relating to ABO blood group and other polymorphisms can all be incorporated into the concept of treating patients as individuals.
The lecture gave an overview of the ABO blood group system and the influence of salivary secretor status: Dr. D'Adamo reviewed how gene linkage with an individual's blood group decides activity of both dopamine beta-hydroxylase (an enzyme affecting monoamine oxidase activity, which governs metabolism of noradrenaline and serotonin) and arginine succinate synthase (affecting nitric oxide synthesis, having many effects throughout the body), as they all overlap on the same gene location (at 9q34). Clinical tools such as the connection with blood group B and BUN (urea) blood values, and the haemaglutinin titer were introduced.
On Friday evening North American Pharmacal hosted a poolside reception with a blood group compatible buffet, live music suitable for all blood groups, and a chance for conference attendees to mingle.
Martha D'Adamo - MOO PAL DAN KHUM
Saturday and Sunday mornings started at 7am with meditation and breathing. Martha D'Adamo, a black belt in karate, took early risers through the Moo Pal Dan Khum exercise sequence. This is a qi gong-style series of ancient breathing exercises designed to help tone and move energy through the body.
Dr. Pizzorno - THE SALUGENETICIST
Dr. Joseph Pizzorno, originally a student of Dr. Bland, and subsequently a tutor of Drs. D'Adamo and Crinnion, presented a more detailed analysis of the crisis in healthcare. The US system has spiraling costs, and yet ranked 72nd in health of the population in a survey of 191 countries in 2002. Like Dr. Bland, Dr. Pizzorno also suggested that the solution is to move away from symptomatic treatment, whether conventional of using 'green drugs', to a new personalised curative medicine promoting health, disease resistance and reversal. An example was given of a post-menopausal woman with progressive bone loss and low sunlight exposure due to family history of skin cancers, who was unresponsive to standard natural interventions. She was found to have a polymorphic deficit in vitamin D receptors, and increasing her dosage of calcium and vitamin D to above the normal range stabilised her bone density.
Evaluation of all variables in a situation such as migraine needs assessment of 27 possible physiological dysfunctions, 25 possible environmental/drug toxins, 40 possible natural medicine therapies and evaluation of 900 research citations. This is too much for any physician to keep in their head. The increasing amount of possible causes and interventions for any given situation lead Dr. Pizzorno to investigate the use of artificial intelligence (AI) tools in natural medicine. The result is a tool using a Bayesian inference system called the Salugenicist (meaning health promotion, as opposed to pathogenesis). As one would expect from the author of so many naturopathic textbooks, the report generated by his software contains recommendations for dietary, nutritional, lifestyle and exercise, herbal adjustments and even healthy recipes based on the patient's individualised analysis.
Although fully functioning and demonstrated live at the conference, the program was estimated to be about a quarter of what will be in the final version. Impressive drill down options allowed exploration of every answer, including abstracts of referenced articles. The system is rapidly expanding, but does not yet contain blood type specific information or secretor status (one of the first questions asked by the audience). The program is designed to reduce the time spent by the doctor looking into his computer screen and give more quality time with the patient, with fewer adverse reactions of interactions and improved efficacy of intervention. With the advent of AI, natural medicine is truly coming of age. Further details can be seen at www.salugenecist.com<br />
Dr. D'Adamo - DERMATOGLYPHICS, BIOMETRICS AND SYMMETRIES
Dr. D'Adamo's second lecture introduced this surprise topic. The scientific study of fingerprints has entered the repertoire of naturopathic practitioners using genetic markers: the shape of the epidermal ridge patterns are determined between four weeks and 5 months in utero. These patterns may represent developmental pathways underlying multi-organ syndromes. Further, the height of the fingerprint ridges are a sign of gut glycosylation; ridge atrophy gives an indication of the health of the gut mucosa, and many other associations - finger length, angle of palmar creases. Also under genetic control is the ability to taste phenylthiocarbamide, which has an association with thyroid overactivity, and ear wax type, which correlates with breast cancer. The audience duly assessed their own susceptibility to disease by inspecting their fingerprint cards received at the start of the conference, relieved that it was not a plot by the Institute for Human Individuality to register people following subversive alternative medical approaches.
Dr. Crinnion - BORN IN THE WRONG CENTURY: POLYMORPHISMS AND THE TOXIC ENVIRONMENT
As a specialist in environmental medicine, Dr. crinnion started his lecture by reviewing phase I and II detoxification systems and cytochrome P450. He then developed the subject of toxicogenomics with reference to the connection between toxin exposure and cancer risk. A survey carried out specifically for the lecture showed higher self-reporting of caffeine and drug sensitivity in ABO non-secretors than in secretors. Environmental illness may also be the result of polymorphisms, and testing is now widely available.
Always the naturopath at heart, Dr. Crinnion made reference to the 12 most pesticide-contaminated foods, encouraging people to buy organic. He concluded "Genetics points the gun, but the environment pulls the trigger".
Dr. Debra Wollner - IfHI RESEARCH UPDATE
There are currently three projects at the Southwest College of Naturopathic Medicine (SWCNM) relating to nutrigenomics. Dr. Wollner gave details of a study on the "Effect of Specific Lectins on Microbial-Epithelial Adhesion". The thinking behind this is that lectins may be able to alter the association between bacteria and red blood cells. Dr. Jami Kupperman, a SWCNM graduate and research fellow, described a pilot study on how a low carbohydrate diet may interact with genetic variability, obesity and cardiovascular disease. This type of study could be the proof that individuals may do better or worse on a low carbohydrate diet depending on their blood group.
Saturday night included a Drumming up Health session with Christine Stevens, who created a community spirit through percussion. Delegates entered a trance-like state during the session, and danced while beating their drums.
Dr. D'Adamo - USING THE SWAMI SOFTWARE
Dr. D’Adamo introduced his new software package SWAMI: ‘Serotyping With Amplification, Modification, Interpretation’ (although the choice of acronym is also "a lighthearted way of poking fun at all swamis and crystal ball gazers"). The presentation pulled together all the various aspects of the whole seminar. A freeware PC application based on MS Access, SWAMI asks for blood group and secretor status, biometric (such as head size) and dermatoglyphic (fingerprint) data and family history. Two ‘reaktors’ give a numerical value for lectin sensitivity and glycosylation index. The next version, ‘SWAMI pro’, will be available soon, and will contain a Diet Generator module that generates and prints out a clinically detailed and individualised diet for each patient, a Therapy Generator that designs supplement and treatment protocols specifically for that patient, and the ability to input lab tests and other non-biometric, yet clinically significant parameters (such as Traditional Chinese Medicine diagnostics). Further information can be found at: www.dadamo.com/SWAMI<br />
In summary, Dr. D’Adamo said that the Blood Type Diet (BTD) is now evolving into the Human Individuality Program (HIP). Overall the conference added significantly to assisting the clinical understanding of genetic and biometric uniqueness of patients, which can be put into current practice alongside blood type medicine.
A review of recent articles relating to cancer:
- Breast Cancer and Lewis Blood Group
- Genetic Links to Breast Cancer
- Breast Screening Ineffective?
- Hormone Replacement Therapy is a Carcinogen
- Obesity and Cancer
- Nanotechnology Kills Cancer Cells
- Pineapple and Cancer
Breast Cancer and Lewis Blood Group
This study in Breast Cancer Research shows a connection between the Lewis blood group and breast cancer.
It is well known that blood group antigens are often altered in the process of cells becoming cancerous. The Lewis blood group antigens (Lewis a and Lewis b) are used to determine secretor status from blood testing, and have isomers (compounds having the same molecular formula but different structures) called Lewis x and Lewis y. The Lewis y antigen is mainly expressed in the growing embryo, in adults it is mainly found in epithelium (tissue composed of a layer of cells, whose functions include secretion, absorption and protection).
Lewis y has been found to be over-expressed in most cancers originating from epithelial tissues, including breast, ovary, pancreas, prostate, colon and some lung cancers.
In the study the patients with invasive breast cancer and higher expression of Lewis y/b antigens tended to have more advanced tumours with a poorer prognosis. Of those patients with higher Lewis y/b expression, those without cancer cells in their lymph nodes were found to have significantly decreased survival.
This is significant for patients being treated for breast cancer who have been found to be lymph node negative, as in addition to their tumour size and grade those with higher Lewis y/b expression may have a poorer prognosis according to the research.
Breast cancer is already known to have a stronger association with ABH secretors (Lewis a-b+) as well as with individuals of blood group A.
High expression of Lewisy/b antigens is associated with decreased survival in lymph node negative breast carcinomas
Madjd Z, Parsons T, Watson NFS, Spendlove I, Ellis I, Durrant LG
Breast Cancer Research 2005, 7:R780-R787 (28 July 2005)
Hormone Replacement Therapy is a Carcinogen
The World Health Authority (WHO) has confirmed that Hormone Replacement Therapy (HRT) is cancer-causing. For women taking combined estrogen-progestogen HRT, after five years the risk of breast cancer is increased by four extra cases for every 1000 women.
The WHO also said that the combined estrogen-progestogen contraceptive pill slightly increases the risk of breast, cervix and liver cancer.
The British Medical Journal summarised the risks of using HRT as follows:
- Information about risk of breast cancer with hormone replacement therapy is conflicting
- Data that can be used to derive individual risk are presented to help decision making
- Cumulative absolute risk of breast cancer (to 79 years) falls with increasing age in women who do not take hormone replacement therapy
- Use of hormone replacement therapy increases a woman's cumulative risk only slightly
- The effect on the general incidence of breast cancer incidence would be greater
Incorporating biometric measurements of individuals, such as blood group, secretor status, dermatoglyphics and ear wax type could refine individual risk much further. Patients should not stop taking medication without consulting a licensed healthcare practitioner.
BBC News29th July 2005
Hormone replacement therapy and breast cancer: estimate of riskCoombs NJ, Taylor R, Wilcken N, Boyages J.BMJ 2005;331:347-349
Genetic Link to Breast Cancer
Scientists are finding more genes linked to the development and progression of breast cancer, and also when it is likely to spread to the lungs. Several genes, which are either inherited or altered during a woman's lifetime, have already been identified.
Inherited defective genes such as BRCA1 and BRCA2 account for fewer than 1 in 20 breast cancer cases. In addition a genetic connection links 9q34 (the ABO blood group locus) to breast cancer in individuals of blood group A.
Scientists have now pinpointed another fault which can develop - and have identified four genes which could be the culprit.
The study, in the journal Oncogene, found the fault in a quarter of breast tumours analysed. Researchers at the University of Cambridge examined the tissue of 33 breast tumours and also breast cancer cells grown in the laboratory, focusing on chromosome 8 which had previously been identified as a possible place for cancer-related gene faults. Using microarrays (DNA sequencing), they were able to narrow down which of the hundreds of genes were likely to be actively involved in tumour development.
Four candidate genes were identified on a specific area of chromosome 8. People should have two copies of the whole chromosome, but women with this genetic fault had multiple copies of this particular fragment containing the four potential culprit genes: FLJ14299, C8orf2, BRF2 and RAB11FIP. This pattern was seen in eight out of the 33 tumours studied.
Patients with multiple copies of these chromosome fragments may be at higher risk for having more aggressive tumours, and could be given more intensive treatment.
Another study published in Nature has found a genetic "signature" that could help predict when breast cancer is more likely to spread to the lungs. A "thumbprint" of genetic activity has been identified involving 54 genes that appeared to be particularly associated with lung metastasis.
More than half the patients with this "thumbprint" went on to develop lung metastases, compared with only 10% whose primary tumours did not carry the gene set.
Garcia MJ, Pole JC, Chin SF et. alA 1 Mb minimal amplicon at 8p11-12 in breast cancer identifies new candidate oncogenes.ncogene. 2005 Aug 4;24(33):5235-45.
Genes that mediate breast cancer metastasis to lungMinn AJ, Gupta GP, Siege PM, et. al.Nature 436, 518-524 (28 July 2005)
The Complete Blood Type Encyclopedia
Skin Cancer Court Claims?
Travel companies are in danger of being sued by holidaymakers who develop skin cancer.
People from the cold and cloudy UK who are suffering from skin cancer after holidaying abroad could soon start pushing claims through the courts for a failure of the industry to protect them from the effects of over-exposure to the sun.
A study from Cardiff University has warned that tourism could go the same way as the tobacco industry, who are being sued by smokers with lung cancer.
The sun is not the only influencing factor in skin cancer: research shows individuals of blood group O have a lower survival rate from melanoma than those of other blood groups. If travel companies offer warnings about the risks of the sun, they could also mention that a person's weight, sex and blood group can influence their susceptibility to and survival from melanoma, and recommend drinking green tea (see below, and previous commentary on melanoma). Some think that it is not sun exposure that increases risk of melanoma, but deficiency of antioxidants and other nutrients. Sun exposure is necessary for may people to boost levels of vitamin D.
Obesity and Cancer
Women who are obese are up to 36% more likely to develop cancer those of a healthy weight.
Research that looked at nearly 70 000 people in Sweden concludes that almost one in 14 cancers in women are due to overweight and obesity and are therefore avoidable, according to a study in the International Journal of Cancer
"In women, a positive association between BMI [Body Mass Index] and overall cancer risk emerged, mainly driven by the strong effects of elevated BMI on the incidence of endometrial, ovarian and colon cancers as well as melanoma".
This strong adverse effect of BMI on risk of uterine cancer is believed to be due to alterations in the synthesis of hormones caused by increased body fat: both obesity and uterine cancer risk have been associated with decreased synthesis of progesterone in premenopausal women and with increased circulating oestrogens after menopause.
In men no association between BMI and overall cancer risk was shown. This was probably due to the numbers of prostate and respiratory tract cancers, which accounted for more than 40% of all malignancies. Obese men were, however, at a higher risk of developing kidney cancer and colon cancer.
The authors point out that 12% of the men and women in the study were obese, a considerably lower proportion than in the general population in a number of countries, including the United Kingdom and the United States.
Body mass index and cancer: Results from the Northern Sweden Health and Disease CohortInternational Journal of Cancer Annekatrin Lukanova 1 2, Ove Björ 3, Rudolf Kaaks et. al.
Breast Screening Ineffective
Breast cancer screening in "real world" situations is not effective in preventing mortality, says a US case control study published in the Journal of the National Cancer Institute:
"Conclusions: In this community-based study, screening history was not associated with breast cancer mortality. However, potential limitations of this study argue for a cautious interpretation of these findings."
Randomised controlled studies have shown that breast cancer screening prevents deaths. Many organisations recommend screening by clinical examination and mammography every year or two for women aged 40 or older.
"We observed no appreciable association between breast cancer mortality and screening history, [regardless of age or risk level]... Our findings may, therefore, reflect a possible reduction in the accuracy of screening as it moves from highly controlled randomised trials to real-life clinical practice."
The study looked at the history of screening in the three years before their diagnosis of cancer in women who died of breast cancer. They compared these screening rates with those in a control group of cancer-free women. Screening rates in the two groups did not differ.
The screening was by clinical examination alone, mammography alone, or clinical examination and mammography. Mortality did not differ according to type of screening.
Despite the findings, the leader of the study Dr Joann Elmore said that she still recommended screening: "Some people say we should pay more attention to women at high risk, but the majority of women who develop breast cancer don't have risk factors."
An accompanying editorial said that breast cancer screening in the community may be less effective than in controlled trial situations because of problems implementing programmes.
Women are now more aware of the importance of checking out small lumps, and better treatment may mean that screening is less necessary than previously, because treatment of later stage cancers may still be effective.
Meanwhile in the New England Journal of Medicine a study showed how certain types of benign breast disease have a higher risk for breast cancer even if there is no family history of breast cancer. Although most non-cancerous breast lumps do not increase future risk of breast cancer, the researchers found faster growing and more abnormal types did.
Efficacy of Breast Cancer Screening in the Community According to Risk LevelJournal of the National Cancer Institute, Vol. 97, No. 14, 1035-1043, July 20, 2005
Benign Breast DisordersSanten RJ, Mansel R.NEJM, Volume 353:275-285
Nanotechnology Kills Cancer Cells
Carbon nanotubules half the width of a DNA molecule are being used to kill cancer cells.
Under normal circumstances near-infra red light passes through the body harmlessly. Researchers found that if they placed a solution of carbon nanotubules under a near-infra red laser beam, the solution heated up to about 70C in two minutes. They then placed the tubules inside cells, and found they were quickly destroyed by the heat generated by the laser beam.
The nanotubules were introduced into cancer cells, but not healthy cells.
The researchers did this by taking advantage of the fact that, unlike normal cells, the surface of cancer cells is covered with receptors for a vitamin known as folate. They coated the nanotubules with folate molecules, making it easy for them to pass into cancer cells, but unable to bind with healthy cells. Exposure to the laser then killed off the diseased cells, but left the healthy ones unharmed.
The researchers said: "Further research will be crucial to see whether these effects can be reproduced in the more complex environment of a tumour and, ultimately, the human body."
Pineapple and Cancer
Scientists at the Queensland Institute of Medical Research (QIMR) have discovered two molecules from pineapple stems that show anti-tumour activity in laboratory studies.
One molecule called CCS blocks a protein called Ras, which is defective in approximately 30% of all cancers. The other molecule called CCZ, stimulates the body's own immune system to target and kill cancer cells.
The team at QIMR discovered CCS and CCZ while investigating the properties of bromelain, a crushed pineapple stem extract. Bromelain is a rich source of enzymes and is widely used as a meat tenderiser, to clarify beer and tan leather hides. They discovered that bromelain also had some pharmacological properties and could activate specific immune cells while, simultaneously, blocking the immune function of other cells.
"CCS and CCZ are the first examples of proteases that have been shown to modulate cell signal transduction pathways and have specific immunomodulatory activities," said Dr Mynott.
"The way CCS and CCZ work is different to any other drug in clinical use today. Therefore, CCS and CCZ will represent a totally new way of treating disease and potentially a whole new class of anti-cancer agent. In general, products with novel mechanisms of action are more likely to represent real breakthroughs in the treatment or prevention of disease."
Bromelain is also known to have significant antitumour effects when injected directly into mice.
QIMRModulation of murine tumor growth and colonization by bromelaine, an extract of the pineapple plant (Ananas comosum L.).In Vivo. 2005 Mar-Apr;19(2):483-5.Beuth J, Braun JM.