Tag Archives: cancer

Marriage Tax Pay Off: Living a Longer Life

'Sanjeev's wedding' photo (c) 2006, Tom - license: http://creativecommons.org/licenses/by/2.0/You’ve probably heard of the “marriage tax.” It amounts to something like $10,000 per year if filing jointly instead of individually. But what Uncle Sam “taketh away,” you perhaps make up thanks to a healthier lifestyle.

A significant reduction in “lifestyle disease” among married couples is no huge surprise. One just has to consider, perhaps wistfully, your single life for a few seconds to make this clear. Single people tend to live life at the extremes. There typically is more drinking, smoking, not sleeping or eating right, and in general fast-lane living among the unattached. We might want to blame this on youthful exuberance, but we also see this behavior rediscovered in divorced middle-aged people. Married folks tend to moderate each other’s behavior and consequently the lifestyle diseases such as hypertension, diabetes and heart disease are significantly reduced.

All manner of traumatic death is also dramatically reduced in the married population. With a little more sleep, and less alcohol, motor vehicle fatalities are much lower among married people. I gave up skydiving once I got married, perhaps saving me a violent end. Other violent deaths like suicide are also much lower. Depression, perhaps not coincidentally, is lower in people with a soul mate.

If cancer is one of your big fears in life, marriage is one of your best defenses. The lifestyle cancers attributed to smoking and drinking are all understandably reduced, most notably lung cancer.

Interestingly enough, the cancers having no obvious connection to any specific human behavior are similarly reduced in the married population. Lymphoma, leukemia and pancreatic cancer are examples. In fact, the fatality rate from virtually any cancer you can name is lower among the married.

Most startling to me during my medical education was the lower death rate in married people goes across the vast spectrum of human disease and frailty. Pick the wildest thing you can think of – death by shark attack, getting hit by lightening – and you are less likely to die of that while you are married.

So let Uncle Sam take his cut, the pay off is married people have a better chance of living a longer, healthier life.

Take care.

Dr B

The New View on Sunscreen

After many years, the FDA has taken steps this week to clear up “some” of the confusion regarding the use and effectiveness of sunscreen products. Comparing the various products on the market is very challenging for consumers. Inconsistent and misleading claims have been tolerated for far too long. Although the recent changes in labeling regulations are welcomed, they do not completely clear all the discrepancies.

Dermatologists have long recommended regular use of sunscreen to prevent the damaging effects of the sun leading to skin cancer and premature wrinkling of the skin. The medical consensus has been that SPF of 15 was the minimal strength that provided protection. Now under the newest regulations no product can make claims of that cancer protection without being at least that strong. Sunscreen products will also be required to protect against both ultraviolet A and B rays (UVA& UVB). This will eliminate some confusion about which protection is provided. Both cause the damaging effects that lead to skin cancer.

After 30 years of wrangling, the FDA regulations have caught up with the medical science that an SPF higher than 50 is no better. The higher or more expensive products do not provide greater protection contrary to popular belief. The science behind this is well established.

No product will be allowed to claim being waterproof. However, manufacturers will be allowed to estimate how long their product may be water or sweat resistant.

This still allows some room for confusion as the reality of individuals and their activities can create vast differences in the product performance.

Typical outdoor activities with prolonged sun exposure require reapplication of sunscreen for adequate protection. Specialists have also advocated reapplication as frequently as every 20 to 30 minutes or after swimming or excessive sweating. At the very least, once every hour sunscreen should be reapplied. These activities simply dilute the product applied and make it much less effective. For adequate protection, it has to be reapplied.

It’s important to remember that none of these products completely block the damaging UV rays. They filter it and slow the burning, damaging process.

For common everyday use, a product with SPF 15 is probably adequate. For outdoor recreation or work in the sun, SPF of 40 to 50 is recommended. Product claims of outlandish performance will no longer be allowed.

There still are issues of controversy that remain unresolved. It is not clear whether there is any advantage of spray over lotion. There have been some questions raised regarding safety of aerosol propellants and the sunscreen chemicals themselves. More study is needed to determine answers to these questions.

Yet it is clear that sun damage accumulates in the skin over time causing potentially deadly cancers that are easily prevented. Even one or two episodes of sunburn dramatically increase the risk of skin cancer.

Enjoy the summer, but protect your skin – and your life.

Dr. Bruce Kaler

The Placer (Calif.) Herald: Sun can pose long-term danger to outdoor workers

By Dr. Donald Bucklin, U.S. HealthWorks

June 9, 2011

With the summer and its heat approaching, almost everyone will be out in the sun more than they were during the winter.

Is Cell Phone Use Linked to Brain Cancer?

Cell phones are in the news again. The World Heath Organization says they may be associated with brain cancer. This immediately brings to mind a picture of people with aluminum foil wrapped around their heads (probably from an old “Saturday Night Live” skit). Many of us probably would get out the aluminum foil before giving up our beloved cell phones.

Is cell phone radiation worth worrying about or simply the Alarming Headline of the Week?

Finding out increased risk for any exposure, including cell phones, is all about the numbers. Really big numbers give us the statistical power to find even tiny risks. There are 4.3 billion cell phone users on the planet. That should certainly be enough to find some answers.

Businessman on the phonephoto © 2010 yago1.com Yago Veith – Switzerland | more info (via: Wylio)One of the problems with the whole cell phone radiation-brain cancer debate is the use of the word “radiation,” which is used for anything from cell phones to Fukushima. Radiation from nuclear sources is ionizing radiation. This radiation breaks down DNA and is a known risk for cancer. Cell phones emit radiation of an entirely different type. Cell phones emit low-level microwave radiation which is non-ionizing.

You are surrounded by microwave radiation all day, and you practically can’t find a microwave-free place on the planet (maybe a really deep mine shaft, but that offers dangers of its own).

You probably heated your coffee this morning in a microwave oven, then drove to work listening to broadcast FM radio, which is a microwave signal. The GPS in your car works on a microwave satellite signal. Your computer could be hooked to a Wi-Fi network (microwave), and your Bluetooth mouse is also a microwave emitter. Your garage door opener uses microwaves as well as your satellite TV. Your cordless landline phone generates microwaves – all in addition to your cell phone.

If microwave radiation exposure was smoking, we would all be 100 packs-a-day smokers. At that level, it wouldn’t take three months to find a cancer risk. But interesting enough, the brain cancer rate is stable or decreasing over the last 30 years despite the enormous increase in microwave radiation.

The World Heath Organization came to its conclusion based on a small study by Swedish scientists. The study showed an apparent association between cell phone use and a brain tumor called gliomas.

This conclusion has generated tremendous controversy in the scientific community. To start, there is no theoretical basis for microwave radiation to cause tumors. We have a lot of experience with carcinogens, and they have mechanisms that make sense. They damage or modify DNA (the blueprint of life). Microwave radiation doesn’t affect DNA in any way known. So while the lack of a mechanism doesn’t disprove anything, it sure makes the scientific community question the finding.

Other studies, one involving 14 nations, found no increase in brain cancer from cell phone use.

Where do we go from here? One thing I know for sure: we can count on many more studies on this issue and a lot more conversation.

Take care,

Dr. B

Smokeless Tobacco: Safer or Still Risky?

The use of smokeless tobacco has grown over the last few years, primarily in the under 21 age group. As smoking has been socially less acceptable and the overwhelming amount of evidence of tobacco’s serious health effects are slowly acknowledged, tobacco companies have spent increasing amounts of advertising dollars on smokeless tobacco.

A significant portion of those users are adolescent males, and their numbers are growing by 30-50% since 2006. Of the estimated 10 million users of smokeless tobacco, 3 million are under the age of 21. Young users start as early as the sixth grade and are regular consumers by high school. The Center for Disease Control reports that the largest increases in smokeless tobacco use has been in the 18-24 age group.

A Lesson from the Pastphoto © 2010 Ted | more info (via: Wylio)

Smokeless tobacco contains nicotine and around 30 cancer-causing substances just like tobacco that is smoked. A common misconception is it is somehow different or safer. Nicotine is rapidly absorbed through the mucosa in the mouth, easily attaining higher and possibly longer-lasting nicotine levels than cigarette smoking. Manufacturers have packaged, flavored and marketed their smokeless products to entice young people. Due to the addictive nature of nicotine, surveys show that users commonly move to higher levels of use due to their increasing tolerance.

Many of these users simply do not understand the serious risks that ingesting tobacco retains. In many respects, it is equal to or worse than smoking tobacco.

The World Health Organization International Agency for Research on Cancer reported in 2008 that those who ingest tobacco have an 80% higher risk of developing oral cancer and 60% higher risk of contracting pancreatic and esophageal cancer. The high risks of developing ulcers of the esophagus or stomach, heart disease, high blood pressure, fetal abnormalities if used during pregnancy, are the same as smoking tobacco.

Smokeless tobacco wreaks havoc on the teeth, tongue and gums. More tooth decay and oral ulcers are common. A precancerous condition known as leukoplakia occurs in about half of all users within the first three years of regular use. If these white patches or plaques are identified early, it may be treated if tobacco use is stopped.

Quitting smokeless tobacco can be just as difficult as smoking due to the addiction to nicotine. The same options are available to users such as nicotine replacement products. Consult your healthcare provider to see if one of the prescription medications and counseling can help you quit.

Nicotine is a strong addiction and is difficult to overcome; nonetheless, it can be done with an organized approach. The profound and devastating health problems are entirely avoidable.

– Dr. Bruce Kaler

How to Quit Smoking

Smoking is basically a two part problem. The physical addiction to nicotine is very strong. If it wasn’t, it wouldn’t be so hard to quit. Medications (i.e. Chantix, Wellbutrin or Nicotine replacement in gum or patches) can be helpful to address the physiologic addiction.

Nicotine gum or patches substitute small amounts of nicotine to allow a weaning and gradual easing of withdrawal symptoms when quitting. Chantix and Wellbutrin work in a way that is both imperfect, not well understood, but probably most effective in fooling the center in the brain that controls nicotine desire. Neither has any nicotine but favorably affect neurotransmitters, chemical messengers between brain cells. This is similar to the way antidepressants have a positive effect on mood and anxiety. The net result is less interest in the seductive power of nicotine.

The second part of quitting is the habit or simple automatic behavior. Once you can see past the strong addiction to nicotine, you have to learn to cope with the stressors (boredom, anxiety, etc.) for particular situations in a different way. Changing your behavior is more straightforward but requires a plan and structure. Creating new habits in place of the old ones takes some persistence but is very attainable.

cigarettephoto © 2006 Bruce | more info (via: Wylio)

Here’s a simple behavior modification tip for quitting smoking:

1) Make a very specific list of the time of day “when” you smoke and “why” you smoke at that time. You can map out a typical day in writing. It should be in writing, but you need not share it with anyone. It is simply for your own edification. Writing it down allows you to be clear with all the tough moments throughout your day giving it careful review.

2) Then decide what you are going to do instead of smoking “at 9:40 a.m. when you have your break.” The structure and planning ahead provides a type of handrail to get through the difficult moment. Some ideas could be: eating hard candy, baby carrots, celery sticks, chewing gum, going for a walk, making a phone call. Any activity except for smoking will do. You must write it down so you can outline what you do accurately and make a definite plan in anticipation of the moment. Don’t leave it to the impulse of the moment.

Many people who quit smoking are not successful the first time. Anyone who has quit after the first try remains the lucky exception. Most people need a few times before they stop for good. So don’t view your past efforts as failures. The next time you are ready to give it a try, you are more likely than ever to succeed in being tobacco free – forever.

This small investment pays big dividends no matter what method you use to quit. Obviously, consult your physician to see if one of the helpful medications is right for you.

Ultimately, you have to change your behavior. It may seem daunting, but you can do it.

– Dr. Bruce Kaler

Radiation, Cancer and Medicine

Lately everybody is talking about the Japanese nuclear accident, radiation and the risk of cancer. In the midst of one of these conversations, I was asked, “If radiation causes cancer, how come cancer is treated with radiation?” Another version is, “Since radiation breaks down DNA, which can cause cancer, how come we give radiation to treat cancer? Doesn’t it just break down more DNA?” That actually is a pretty good question.

Radiation therapy is commonly used to treat cancer. It is pretty effective for cancers that are localized (in one place). It is also very effective at treating more widespread cancers like Hodgkin’s Lymphoma.

For localized disease, it’s all in the focus. Radiation therapy can be focused like a laser flashlight beam. Very high levels of radiation are put in the area of the tumor and not much anywhere else. So any damage from radiation therapy is limited to the tumor – not exactly, of course, but pretty closely. Damaging tumor cells is the point, and we hardly need to worry about tumor cells becoming cancerous.

Some radiation treatments expose much more of the body to radiation. Treatments for Lymphoma are one example of this. People are given what would be concerning amounts of radiation if they got it working in a Japanese damaged nuclear facility. Here’s the interesting part: cancer cells and normal cells react differently to radiation. The way radiation damages cells is by causing breaks in DNA, the blueprint of life. It turns out that cancer cells are not very good at repairing their DNA. Normal cells are much better at successfully repairing the damaged DNA. So the damaged cancer cells die, and most of the damaged normal cells don’t.

If this sounds a bit imprecise, it is. Usually the difference between the cancer cell and the normal cell isn’t 100%. Most cancer cells don’t survive high-dose radiation, and most normal cells survive, repair themselves or die a clean death – just as long as they don’t turn into cancer.

This actually is the basis of cancer treatment of any kind. An important difference between the cancer and normal cells needs to be found and capitalized on.

But radiation is radiation. It damages DNA, and occasionally DNA is repaired badly – sometimes so badly it acquires something unpleasant like uncontrolled growth.

Studies do suggest to an increased risk of disease 20 or 30 years after radiation treatment. Cancer usually occurs in the middle years and later so many patients are cured of their cancer and are at the end of their natural life span before enough years have gone by to see any ill effects from the radiation treatment.

But ultimately, we worry about today and let tomorrow take care of itself. The prospect of not treating today’s cancer is so bleak that a future risk seems a small price to pay. Radiation, like so many other things in life, has its pros and cons.

Take care,

Dr. B

Radiation Exposure in the Real World

Japan’s nuclear threats have us all thinking about radiation exposure; and I have an added interest since I was the medical director for 10 years at the Palo Verde Nuclear Generating Station, the largest nuclear plant in the nation.

But my first introduction to the hazards of radiation was as an elementary student. We, like all children around the U.S., were instructed to hide under our desks in the event of nuclear war. That seems a bit naive in retrospect.

Radiation is everywhere. The sun emits radiation, as does the earth, and probably the moon. The stars definitely do. Medical procedures like X-rays and CT scans involve radiation, as do TSA scanners. There is even a little radiation in the food we eat and the air we breathe. Like so many other things, radiation is all about dose.

Radiation is counted in millisievert (mSv), a word which keeps the non-PhDs like myself out of their field. Normally we are exposed to a background radiation total of 2.40 mSv per year. This is an additive scale. It’s like getting less than a penny’s worth of radiation per day and end up with $2.40 at the end of the year. This comes from solar radiation predominantly, and a small amount from man-made sources. Man-made sources range from the luminous hands on your watch, a chest X-ray, or nuclear testing from 60 years ago.

Some locations have higher normal background radiation due to more radioactive materials in the bedrock or simply high elevation like Denver. The normal range of background radiation is from 1 to 100, so a hundred-fold increase could still be in the normal range.

So why worry about radiation?

Radiation is bad because it can cause breaks in your DNA – the chain of life so to speak. You don’t go far with a broken chain. The body attempts to repair these breaks and is pretty successful, but nothing is 100%. Those few poorly repaired DNA chains may self-destruct and cause no mischief, or can code for unfriendly cells, like cancer.

Scientists have studied radiation exposure and calculated that normal background radiation will cause 1 person out of 100 to get cancer in his or her lifetime. Additional radiation exposure increases the risk.

There is also danger from large exposures to radiation that occur acutely, as opposed to 20 years of exposure. This is called radiation sickness. Here we are talking about nuclear accidents. Radiation sickness causes the most active cells to die first. The lining of your stomach and intestine are usually affected first, causing nausea, vomiting and bloody diarrhea. This might take 24 hours to develop in exposures of 3,500 mSv or 1 hour in more extreme exposures of 5,500 mSv. At 8,000 mSv acute exposure, the mortality rate is 50%. The cardiovascular system breaks down in high-level radiation exposure. If you survive those, the blood system is the next likely victim. Radiation can kill your blood-making cells. You would miss them.

These are the kind of dangers emergency workers who stayed at the damaged nuclear plant face.

What about people in Tokyo or the world?

“Dilution is the solution to pollution” was my organic chemistry’s professor’s favorite expression. The closer you are to the source, the higher the radiation exposure. Radiation goes down with distance. This assumes the radiation source doesn’t move.

The levels measured at the plant in recent days are high enough to cause radiation sickness. These are potentially dangerous in the short term as well as the long term. The levels measured 120 miles away in Tokyo are 10 times higher than normal, but you would get just as much radiation moving to Denver. Moving to Denver with its higher level of solar radiation (due to elevation) doesn’t seem like a particularly foolhardy thing to do.

But life gets more complicated if the radiation source moves around. Radioactive elements are rather dense and don’t move around too easily. All solids can be made liquid or gas, just like water. The fuel rods in the reactor are solids. They release huge amounts of heat energy because they are radioactive. If not cooled, this heat can build up to the point of making the uranium rods melt and become a liquid. This liquid is so dense and hot, it can melt though almost anything (picture trying to keep lava in a container).

The next step is going from liquid to gas. Uranium can be vaporized by explosion or intense heat. Now we have a cloud of highly radioactive material floating about. That is exactly what happened at Chernobyl 20 years ago. One of the radioactive elements to spread was radioactive iodine. Potassium iodide keeps your thyroid full and stops you from absorbing the radioactive variety. This helps prevent thyroid cancer, but nothing else.

So this triple (quadruple) meltdown is unprecedented in history, but the science is very well understood. Simply keeping distance between you and trouble, like so many other times in life, is all it takes. Today, you will get more radiation in Denver than in Tokyo.

Take care,

Dr. B

Prostate Screening at a Glance

With an aging population in the United States, many Baby Boomers are “coming of age.” Estimates are that 10,000 of them reach the age of 65 daily.

Prostate problems in general are very common and confusing. No doubt, the confusion will increase due to so many more men experiencing prostatic enlargement and possible cancers. More than 50% of men over age 50 are affected by prostate enlargement. By the age of 80 years, 90% of men will have an enlarged prostate.

The diagnosis and treatment of prostate problems has changed a great deal over the last 20 years but continues to lack clarity or consensus. Benign enlargement of the prostate gland causes urinary frequency, urinary retention and incomplete emptying of the bladder. Similar symptoms may be initial signs of prostate cancer as well.

Early detection of any cancer is key to successful treatment. The confusion is with testing procedures that are less than perfect. A wide variety of treatments, none of which achieve dominant success over other modalities, and some evidence that many of these cancers do not need to be treated because of their slow growth, confound diagnosis and management of prostate problems.

Let’s examine what we know.

The urethra (the tube you pee out of), unfortunately runs right through the middle of the prostate. So when the prostate swells, as they all do with increasing age, it chokes off the urine flow. Enlargement of the prostate is suspected when urinary symptoms such as the following are experienced: urinary frequency, stopping and starting urinary stream, straining to urinate, and getting up at night to urinate regularly. A weak urinary stream and dribbling may also indicate enlargement. The challenge is that prostate cancer, prostate infections or common urinary tract infections can also cause similar symptoms.

Discovery of prostate cancer can be as simple as the basic urine analysis, digital rectal exam, and Prostate-Specific Antigen (PSA) blood test. Normal findings in all of these tests are reliable in eliminating possible cancer; however, positive results raise the suspicion of cancer in men over 50 and need to be carefully evaluated. PSA tests in particular are well known for false positives due to the ability of benign prostatic enlargement to cause elevations in the results. Blood in the urine could be an early clue of cancer requiring further evaluation or biopsy.

Treatment of benign prostatic hypertrophy is usually with medications that can slowly reduce some of the problem of obstruction of urine outflow from the bladder by the prostate enlargement. Some herbal remedies have had some limited success as well; however, studies are unable to reproduce consistent benefit. Medications can help most men who struggle with small frequent urination, but side effects like dizziness and low blood pressure occur in some.

When medical treatment does not work or seem suitable, surgical procedures may be helpful. There are several minimally invasive treatments that can achieve good results with low risks and good improvement in urinary flow. Each case must be evaluated on an individual basis with a urology specialist to tailor the appropriate option to the individual patient.

Cancer detection in the prostate is still a challenge. It can be difficult to diagnose the presence of prostate cancer as well as whether it is a more aggressive or slow-spreading type. The PSA blood test is still the best screening test even though it has limitations. Following the progression of this test value with consideration for the individual, age, family history, along with other risk factors has the best predictive value.

There remains a difference of opinion among experts regarding watchful waiting for screening and active surveillance for cancer. There is additional uncertainty in prostate cancer treatment as many of these are very slow growing. An old adage suggested that older men died “with” prostate cancer rather than “of” prostate cancer. The amount and location of cancer detected (whether it has spread outside of the prostate gland), age of the patient, risk factors and other illness will strongly influence how aggressive treatment should be. Because of the variations of slow and more aggressive prostate cancer, treatment needs to be an individualized decision between each patient and his treating providers. Surgery, radiation, and chemotherapy are all tools that can bring a best outcome for any given individual.

With aging Baby Boomers, benign prostate enlargement and cancer will increase in prevalence. Thankfully, there have been many new developments in treatment. The particulars of screening and detection remain a controversial area, but being informed and vigilant is the best way to protect yourself and the aging males in your family.

– Dr. Bruce Kaler

Are TSA Scanners More Than Embarrassing?

As you may have heard recently, flying hasn’t been this exciting since the Wright brothers took off from Kitty Hawk.

That’s because now just getting through recently imposed security procedures requires considerable bravado. The new X-ray based devices give Transportation Security Administration (TSA) employees delightfully detailed pictures of your every physical nuance.

But what are the health risks of these new body scanners? Are they dangerous?

Peep Showphoto © 2008 Steve Jurvetson | more info (via: Wylio)

Interestingly enough, it is much easier to find a platitude than an actual value of radiation exposure for these scanners. Every official source having anything to do with the devices says that you get more radiation in an airplane flight at 30,000 feet in two minutes than in a backscatter scanner. But what in the world does that even mean?

As you probably suspected, radiation is bad for you. This is a rather recent discovery in medicine, dating back only 100 years. For those who still had doubts about radiation’s badness, 1945’s atomic bombing of Hiroshima and Nagasaki brought that point home.

The trouble with radiation, in any dose, is it can cause damage to DNA, which is pretty important stuff, maybe the most important stuff in the known universe. It’s literally the blueprint for your entire being. Damaged DNA can be non-viable or can even be the start of cancer.

The dose of radiation for a backscatter scanner has been measured between 0.005 and 0.009 milli-rem (mrem). This needs to be put in context. Background radiation is all around us, fortunately in low doses. We breathe low levels of Radon gas and spend time in the sun – both are radiation sources. For comparison, a chest X-ray is about 6 mrem, and a year of normal sunshine exposure adds up to a cumulative total of 60 mrem.

So the dose of radiation from backscatter scan is actually quite low. This scan adds some immeasurably tiny risk of cancer. The concern seems to be more a perception of risk, rather than actual risk. The average patient will happily undergo a chest X-ray, roughly 1,000 times the radiation of a scanner, when he has high fever, cough and can’t breathe. The difference between radiation from a chest X-ray and a scanner is perhaps the medical radiation dose gets you a good diagnosis and effective treatment. The scanner gets you nothing personally, unless you count not getting blown up.

Little doubt, the whole new security process will be re-thought, re-engineered and hopefully improved as more and more people voice their displeasure.

I can’t help thinking that a completely incompetent would-be terrorist, who couldn’t even blow up his underwear bomb, has altered the course of history.

Take care,

Dr. B