Hormone Disorders

Calcium seems to protect high-risk people from developing
the polyps that can lead to colorectal
cancer and the benefits appear to last long after calcium
supplementation ends.

Patients with a history of nonmalignant polyps took either 1,200 milligrams
of calcium in supplement form or a placebo daily for four years in a study
previously reported by researchers from Dartmouth Medical School. Calcium use
was associated with a 17% lower relative risk for polyp recurrence.

This risk reduction not only persisted in the years after treatment ended,
but it seemed to strengthen, the Dartmouth researchers report in a newly
published follow-up that included 822 of the 930 original study subjects.

During the first five years after the end of treatment, 31.5% of patients in
the calcium group developed new polyps, compared with 43.2% of the study
participants who did not take calcium. The protection did not appear to extend
beyond five years, however.

The findings are published in the Jan. 17 issue of the Journal of the
National Cancer Institute.

“It really does look like calcium interferes with carcinogenesis [cancer
development] in the large bowel,” researcher John A. Baron, MD, tells
WebMD. “The fact that this reduction in risk persisted for years after
people stopped taking calcium is really amazing.”

Polyps are growths in the colorectal area. Some polyps can become cancerous
tumors.

But Baron says it is still not clear if the benefits of taking calcium
supplements outweigh the risks among men because some studies have linked the
treatment to an increase in prostate cancer
risk.

Calcium Recommendations

The American Cancer Society recommends that adults aged 19 to 50 take in
1,000 milligrams per day of calcium and that those over 50 get 1,200
milligrams. But the guidelines stress that the calcium should come primarily
from food sources and not supplements.

The nutrition
guidelines, which were updated in 2006, also state that because of the possible
increased risk of prostate cancer
with high calcium intake, “it may be wise for men to limit their daily
calcium intake to less than 1,500 milligrams per day until further studies are
done.”

University of Arizona epidemiology professor Maria Elena Martinez, PhD,
worries that the findings from the Dartmouth follow-up study will drown out
this warning.

“Americans tend to think that if some is good then more is better,”
she tells WebMD. “But for men at least, we have to keep in mind that more
isn’t better in this case and that taking calcium supplements in high doses may
even be dangerous.”

Colonoscopy Best Risk Reducer

Another concern, Martinez says, is that people will get the idea that all
they need to do to prevent colorectal
cancer is take calcium supplements or eat calcium-rich foods.

Though the Dartmouth findings show calcium to be modestly protective against
colorectal cancer, another major study published in 2006 failed to show a
protective benefit.

Calcium and vitamin D supplements proved to be somewhat protective for bone
density in the Women’s Health Initiative (WHI) trial. But no
difference in colorectal cancer risk was seen for an average of seven years of
follow-up among women who took calcium and vitamin D and those who did not.

In an editorial accompanying the Dartmouth study, Martinez points out that
despite the fact that polyp removal through screening is a highly effective way
to prevent colorectal cancer, most people either aren’t getting the message or
are ignoring it.

“If you want to prevent colon cancer, the best thing you can do is get a
colonoscopy when you turn 50 and make sure that you have follow-up
colonoscopies as needed,” she tells WebMD. “That isn’t as easy as
popping a pill, but it is true.”

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An anticancer drug that starves tumors of a blood
supply can help delay progression in patients with advanced colon cancer.

In a study of more than 1,400 patients, those who took the drug Avastin in
addition to standard chemotherapy remained alive without worsening of their
disease about one-and-one-half months longer than those with chemotherapy
alone, says researcher Leonard B. Saltz, MD, a member of the Gastrointestinal
Oncology Service at Memorial Sloan-Kettering Cancer Center in New York
City.

While an extra month or two might not sound like much, the tens of thousands
of people whose colon cancer has started to spread throughout their body face a
fairly bleak outlook.

In the study, those given standard chemotherapy alone remained
progression-free for an average of only eight months.

In contrast, cancer didn’t progress for nearly nine-and-a-half months when
Avastin was added to the treatment.

“Avastin controls the cancer longer,” Saltz tells WebMD. “It’s a
modest advance, but an advance.”

Neal J. Meropol, MD, director of the Gastrointestinal Cancer Program at Fox
Chase Cancer Center in Philadelphia, says many doctors are already offering the
drug to patients with advanced disease.

“The study validates the use of Avastin as a component of front-line
therapy with [standard] chemotherapy for metastatic colon cancer,” he tells
WebMD.

Cancer’s Comeback Delayed

The study, one of the largest ever conducted in people with metastatic colorectal cancer, was presented here at the 2007
Gastrointestinal Cancer Symposium.

All study participants were given one of two standard chemotherapy
treatments, either Xeloda plus Eloxatin or a combination of 5-FU,
leucovorin, and Eloxatin.

Then, half were also given Avastin.

Saltz’s group is still analyzing the data to determine whether Avastin
actually extends lives.

He expects to present those findings in June at the annual meeting of the
American Society of Clinical Oncology.

Drug Cuts off Blood Supply

Avastin which is also approved to treat advanced lung cancer was the first of a new kind of
cancer therapies that work by cutting off the blood to a tumor.

This starves the tumor, slowing or even stopping tumor growth in its
tracks.

Side effects in the study were due primarily to the Eloxatin-based
chemotherapy and included pain, numbness and tingling, lowered resistance to
infection, fatigue, and diarrhea.

While other studies have linked Avastin to an increased risk of potentially
fatal blood clots, there was no difference in the number of people who
developed clots in the Avastin and non-Avastin-groups.

Nevertheless, the drug should be avoided by people with a history of blood
clots and those who have suffered a heart attack or stroke, Saltz says.

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An anticancer drug that starves tumors of a blood
supply can help delay progression in patients with advanced colon cancer.

In a study of more than 1,400 patients, those who took the drug Avastin in
addition to standard chemotherapy remained alive without worsening of their
disease about one-and-one-half months longer than those with chemotherapy
alone, says researcher Leonard B. Saltz, MD, a member of the Gastrointestinal
Oncology Service at Memorial Sloan-Kettering Cancer Center in New York
City.

While an extra month or two might not sound like much, the tens of thousands
of people whose colon cancer has started to spread throughout their body face a
fairly bleak outlook.

In the study, those given standard chemotherapy alone remained
progression-free for an average of only eight months.

In contrast, cancer didn’t progress for nearly nine-and-a-half months when
Avastin was added to the treatment.

“Avastin controls the cancer longer,” Saltz tells WebMD. “It’s a modest
advance, but an advance.”

Neal J. Meropol, MD, director of the Gastrointestinal Cancer Program at Fox
Chase Cancer Center in Philadelphia, says many doctors are already offering the
drug to patients with advanced disease.

“The study validates the use of Avastin as a component of front-line therapy
with [standard] chemotherapy for metastatic colon cancer,” he tells WebMD.

Cancer’s Comeback Delayed

The study, one of the largest ever conducted in people with metastatic
colorectal cancer, was presented here at the 2007 Gastrointestinal Cancer
Symposium.

All study participants were given one of two standard chemotherapy
treatments, either Xeloda plus Eloxatin or a combination of 5-FU,
leucovorin, and Eloxatin.

Then, half were also given Avastin.

Saltz’s group is still analyzing the data to determine whether Avastin
actually extends lives.

He expects to present those findings in June at the annual meeting of the
American Society of Clinical Oncology.

Drug Cuts off Blood Supply

Avastin which is also approved to treat advanced lung cancer was the
first of a new kind of cancer therapies that work by cutting off the blood to a
tumor.

This starves the tumor, slowing or even stopping tumor growth in its
tracks.

Side effects in the study were due primarily to the Eloxatin-based
chemotherapy and included pain, numbness and tingling, lowered resistance to
infection, fatigue, and diarrhea.

While other studies have linked Avastin to an increased risk of potentially
fatal blood clots, there was no difference in the number of people who
developed clots in the Avastin and non-Avastin-groups.

Nevertheless, the drug should be avoided by people with a history of blood
clots and those who have suffered a heart attack or stroke, Saltz says.

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Researchers report that Gardasil protects
against 10 additional strains of HPV that are leading causes of cervical
cancer.

Gardasil came on the market last year for preventing infection with two
strains of human papillomavirus (HPV), 16 and 18, that are responsible for up
to 70% of all cervical cancers, and HPV 6 and 11, which account for 90% of
genital warts.

The new study, which involved about 11,000 young women aged 15 to 26, shows
that the vaccine is also 38% effective against 10 additional HPV types, which
are responsible for an additional 20% of cervical cancers.

“The new study shows that Gardasil affords an extra degree of protection for
young women,” says researcher Darren R. Brown, MD, professor of medicine,
microbiology and immunology at the Indiana University School of Medicine in
Indianapolis.

Gardasil Guards Against 10 More HPV Strains

Brown’s previous research, presented at a major cancer meeting earlier this
year, showed that Gardasil continues to offer nearly 100% protection against
HPV types 16 and 18 five years following administration.

The new study, presented here at a meeting of the American Society for
Microbiology, shows that the vaccine also:

Is 38% effective against 10 additional strains of HPV that cause cervical
cancer
Provides 45% protection against persistent infection from types 45 and 31,
two other HPV strains linked to cervical cancer
Is 62% effective in preventing serious precancerous lesions from those two
strains

Brown says that it’s not a surprise that the vaccine offers protection
against additional types of HPV, as they are all close cousins.

“They’re related genetically, so you would expect some, but not complete,
protection against additional subtypes, which is what we found,” he tells
WebMD.

The Cervical Cancer Debate

The vaccine has been the center of hot debate since it came on the market,
with proponents calling for routine vaccination of young women and critics
charging that the vaccine promotes promiscuity and denies parents of their
rights.

The CDC
recommends the HPV vaccine for all 11- and 12-year-old girls, but it can be
given as young as age 9. The vaccine is also recommended for girls and women
aged 13 through 26 who have not been previously vaccinated or completed the
vaccine series.

Texas is the first and only state to mandate the vaccine.

Brown says he thinks the new findings will propel more parents to get their
teenaged girls vaccinated.

But even if you are vaccinated, it’s still imperative to get regular
checkups and Pap tests to look for any signs of precancerous lesions or cancer,
he stresses.

‘Important Information for Women’

Scott M. Hammer, MD, chief of the division of infectious diseases at
Columbia University in New York City and chairman of the committee that chose
which studies to highlight at the meeting, says, “This is really important
information for women.

“We knew this vaccine was safe and effective for HPV types 6, 11, 16,
and 18, but we didn’t know if it worked beyond that.

“The new study offers strong support that Gardasil is about 35% to 40%
effective in preventing infection with other types of human papillomavirus that
cause cervical cancer,” he tells WebMD.

More than 11,000 new cases of invasive cervical cancer will be diagnosed in
2007, with more than 3,600 deaths, according to the American Cancer
Society.

The study was sponsored by Gardasil maker Merck & Co. Inc.

Eating lots of fruit and little meat may help prevent
precancerous colon polyps, a new study shows.

The take-home message: “Eat more fruit, eat less meat, and don’t stop
eating your vegetables,” Gregory Austin, MD, MPH, tells WebMD.

Austin is a gastroenterology fellow at the University of North Carolina at
Chapel Hill. He and his colleagues studied the dietary patterns of 725 adults
who got colonoscopy.

In colonoscopy, doctors guide a thin, flexible tube with a tiny camera
through the colon, looking for abnormalities including colon cancer and polyps.
Some polyps can become cancerous.

Most people in Austin’s study were in their 50s or 60s. Colonoscopy showed
that 203 participants had at least one adenoma, a colon polyp. The other 522
participants had no adenomas.

Within three months of colonoscopy, the patients were interviewed about
their diet and lifestyle.

Dietary Pattern

Austin’s team analyzed the amount of fruit, vegetables, and meat that
participants said they usually ate.

Participants’ dietary patterns fell into three groups.

The largest group included people who ate a lot of meat and skimped on
fruits and vegetables. That’s the typical American diet, Austin says, adding
that a little more than half of the participants ate that way.

The second-largest group included 181 people who reported eating a lot of
fruit, little meat, and a moderate amount of vegetables.

The smallest group included 119 people who reported eating a lot of
vegetables and moderate amounts of meat and fruit.

Fruit Eaters’ Advantage

“The group that had the lowest risk of having an adenoma was the group
that ate a lot of fruit and avoided meat, basically,” Austin says.

He notes that “meat” didn’t just refer to red meat, but included
beef, pork, veal, chicken, fish, frankfurters, and luncheon meat. The study
didn’t focus on specific foods.

Adenomas were more common and were found at roughly the same rate among the
other two dietary pattern groups.

The results held when the researchers took other factors into
consideration.

Vegetable Findings

“Some studies have found that high vegetable intake can be protective
[for the colon], while others haven’t. Our study didn’t find that,” Austin
says.

However, he doesn’t rule out the possibility that eating lots of vegetables
protects against adenomas.

Participants who ate the most vegetables also ate a moderate amount of meat.
Their meat intake may have offset the vegetables’ protective effect, Austin
notes.

“What would be ideal is if we had a high-vegetable, low-meat group, but
that just wasn’t something we had in our study,” he says.

White House spokesman Tony Snow is facing a recurrence of
colon cancer.

Snow, 51, had surgery on Monday to remove a growth in his abdomen. Lab tests
show that the growth is cancerous and that the cancer had spread. Doctors have
found cancer in his liver.

“It’s a recurrence of the cancer that he thought that he had
successfully dealt with in the past,” President George W. Bush says in a
statement issued yesterday. “His attitude is, one, that he is not going to
let this whip him, and he’s upbeat,” Bush says.

White House spokeswoman Dana Perino said yesterday that Snow and his doctors
found the growth which was about the size of the tip of a pinky finger in
a recent series of CAT scans, PET scans, and MRIs.

Before the surgery, Snow had been getting checkups every three to four
months and said he felt fine, Perino told reporters.

Colon Cancer Recurrence

The growth was located in the same spot in the abdomen as Snow’s previous
cancer, Perino said. Snow had his colon removed and underwent six months of
chemotherapy in 2005 to treat the colon cancer.

Snow, whose mother died of colon cancer, had just reached the two-year mark
of supposedly being cancer free, Perino said.

Perino said she did not know where Snow’s new cancer had spread, apart from
Snow’s liver.

“He’s a fighter,” Perino said of Snow. “He plans to take this on
with the advice of his doctors. They are in consultation right now, talking
about an aggressive treatment to go after the cancer.”

That treatment “will likely include chemotherapy but could include other
things, as well,” Perino said.

American Cancer Society’s Comments

The American Cancer Society issued a statement from its chief medical
officer, Harmon Frye, MD.

“The news that Tony Snow has suffered a recurrence of colon cancer,
coming on the heels of Elizabeth Edwards’ announcement last week that her
breast cancer has returned, points to why recurrence is such a worrisome issue
for cancer patients,” Frye says.

“As with breast cancer, recurrence of colon cancer can be serious,
particularly when that recurrence occurs in another organ. Still, when the
disease recurs, cures can be achieved. This involves surgery combined with
chemotherapy.

“In the last 10 to 15 years, major advances in chemotherapy have
broadened the options available to patients. We’ve gone from having only one or
two drugs with survival in patients with metastatic disease measured in months,
to having seven to eight very good drugs available, with survival often
measured in years, and some patients live many years after having recurrent
disease,” Frye says.

“This change is an example of cancer becoming a ‘chronic disease’ that
people can live with in addition to those patients whose disease is cured with
initial treatment. But these advances should not distract from the fact that
cancer recurrence is a serious situation,” Frye says.

“Finally, colon cancer remains the third leading cause of cancer deaths
in both men and women, and the best defense is early detection. Every American
should be tested for colon cancer beginning at age 50,” says Frye.

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Men who have had a potentially precancerous
polyp removed during colonoscopy are more likely to develop new polyps than are
women, a new study shows.

Obese people and those over age 65 are also at increased risk for having
recurrent new growths that can lead to colon cancer, says researcher Adeyinka
Laiyemo, MD, a cancer prevention fellow at the National Cancer Institute.

Laiyemo tells WebMD that doctors already knew that people who have three or
more polyps removed are at significantly increased risk of developing new
polyps. In fact, current guidelines, developed by the U.S. Multi-Society Task
Force on Colorectal Cancer and the American Cancer Society, recommend that
people with three or more polyps receive another colonoscopy within three
years.

Colonoscopy a Powerful Prevention Tool

Though Laiyemo doesn’t suggest altering the guidelines based on one study,
he says he hopes the findings will propel more at-risk people to get a
colonoscopy in the first place.

“Men, in particular, never like going for the procedure. Women need to
encourage their men to go,” he says

“After age 65, your risk really takes off, so it shows the importance of
having colonoscopies as we age,” Laiyemo says. “And since obesity is a risk
factor as well, it offers another reason to get those extra pounds off.”

Session moderator Alan Kristal, DrPH, of Fred Hutchinson Cancer Research
Center in Seattle, agrees.

“Colonoscopy is one of our most powerful tools for prevention because by
having polyps removed, you can prevent cancer. This offers a nice overall
package of factors that affect risk, telling us who should be targeted for
surveillance,” he tells WebMD.

Men, Older People at Increased Risk

For the study, the researchers analyzed data from nearly 2,000 participants
in the Polyp Prevention Trial, designed to assess the impact of a low-fat,
high-fiber diet on polyp recurrence.

All the participants had at least one polyp removed before they started
following the low-fat diet mandated in the study.

Over the next four years, 524 of the participants developed new polyps.

Results showed that:

People who had multiple polyps removed the first time around were 2.5 times
more likely to have a recurrence than those who had one polyp removed.
Men were 76% more likely to have a recurrence than women.
People aged 65 to 69 were at 87% increased risk compared with younger
adults; those aged 70 to 74 had four times the risk of younger adults.
Obese people were 55% more likely to have a recurrence than nonobese
people.

The findings were presented at the annual meeting of the Association for
Cancer Research.

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Colon cancer survival rates are worse for blacks than
whites, and that may largely be due to social and economic factors, according
to a new research review.

The reviewers, who work in Houston at the University of Texas Health Science
Center, included Xianglin Du, MD, PhD.

They note that colon cancer killed 27 per 100,000 blacks compared with 19
per 100,000 whites from 2000-2003 in the U.S. During the same period, the
five-year colon cancer survival rate was almost 55% for blacks, compared with
65% for whites.

Many factors may affect colon cancer survival rates, including genetics,
access to medical care, exposure to cancer-causing substances, and lifestyle
habits.

Du’s team took a closer look at the black-white race gap in colon cancer
survival to gauge the influence of social and economic (socioeconomic)
factors.

The reviewers pooled data from 10 U.S. studies on colon cancer, race, and
socioeconomic factors.

Each study was designed differently. Together, the studies included more
than 96,400 people who were diagnosed with colon cancer from 1977-1997 who were
followed for up to 17 years.

Adjusting for socioeconomic factors and for colon cancer treatment erased
much of the black-white race gap in colon cancer survival rates.

The reviewers conclude that closing the social and economic gaps may narrow
the colon cancer survival race gap.

“Because treatment and socioeconomic factors are modifiable, efforts to
eliminate racial disparities in health care and to minimize disparities in
socioeconomic status have the potential to reduce racial inequalities in colon
cancer survival,” write Du and colleagues.

Their report appears in the June 1, 2007 edition of Cancer.

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Five years of daily, full-dose aspirin cuts colon cancer
risk by as much as 74%, a U.K. study suggests.

The finding contradicts earlier U.S. studies that saw no effect of aspirin
on a person’s risk of getting colon cancer.

University of Oxford researchers Enrico Flossman, MRCP; Peter M. Rothwell,
MD, PhD; and colleagues studied the effects of aspirin by combining data from
two large clinical trials. Neither trial was specifically designed to study
colon cancer.

However, pooled data from the studies suggests that people who took a
full-dose aspirin tablet every day for at least five years had as much as a 74%
lower risk of colon cancer 10 to 14 years later. In the U.S., a full-dose
aspirin tablet contains 325 milligrams of the drug.

“Randomized trials show that regular use of at least 300-milligram
aspirin daily for about five years seems to be effective in the primary
prevention of colorectal cancer, with a latency of about 10 years,”
Flossman and colleagues conclude.

Aspirin can help prevent heart attack in high-risk individuals, but it can
have life-threatening side effects. Nobody should take aspirin regularly
without a doctor’s advice. Usually, doctors recommend low-dose or baby aspirin
for disease prevention.

That may be why U.S. studies found no link between aspirin use and colon
cancer. One major study looked at doses of 162.5 milligrams; the other looked
at doses of 50 milligrams.

“Lower or less frequent doses of aspirin (than 300 milligrams per day)
might be less effective, but long-term follow-up of randomized trials of
low-dose aspirin is needed,” Flossman and colleagues suggest.

The Flossman study appears in the May 12 issue of The Lancet. An
editorial by Andrew T. Chan, MD, MPH, assistant professor of medicine at
Harvard Medical School in Boston, accompanies the report.

“These findings are not sufficient to warrant a recommendation for the
general population to use aspirin for cancer prevention,” Chan warns.
“More work is needed to characterize those for whom the potential benefits
of aspirin outweigh the hazards.”

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In the future, getting screened for colon cancer may be as
simple as taking a pill.

Researchers say they are encouraged by early results from an ongoing study
comparing a pill-delivered imaging device with colonoscopy for detection of
colon polyps and colon cancer screening. Colon polyps are growths that can
become cancerous.

Similar imaging devices, called PillCams, are already being used to screen
for esophageal and small intestine disease.

But it is not yet clear if the same technology will prove to be a useful
tool for colon cancer screening.

The camera ‘pill’, which is the size of a large multivitamin, travels though
the body capturing images along the way at a speed of four images per second
in the case of the colon cam.

Pill-based endoscopy requires at least as much prep to clean out the colon
as is needed with colonoscopy, but the actual test involves little more from
the patient than swallowing a pill.

Not as Accurate as Colonoscopy

Interim findings from an ongoing European trial with a target of 329
patients were presented Tuesday in Washington at an international meeting of
digestive disease specialists.

Researcher Jacques Deviere, MD, of Brussel’s Erasme University Hospital
reported on results from 84 patients who had the capsule imaging procedure
followed by colonoscopy screening.

Standard preparation techniques for colonoscopy screening resulted in
excellent to good imaging with the ingestible endoscopy technique in two-thirds
of patients and fair to poor imaging in the remaining third.

The PillCam did not detect as many polyps as colonoscopy, but Deviere and
colleagues concluded that it is accurate enough to be a useful tool for colon
cancer screening.

A spokesman for the Israeli company that makes the pill camera, Given
Imaging Ltd, tells WebMD that the goal is not to replace colonoscopy, but to
offer an alternative to patients who are unable or unwilling to undergo the
invasive procedure.

“It is not quite as good as colonoscopy, but it is much easier on the
patient,” says Mark Gilreath. “There is no sedation and no
hospitalization.”

Gilreath says the company hopes to win approval to sell the colon imaging
device in the United States by the end of the year.

Many Patients May Need Both Tests

Philadelphia gastroenterologist and Gregory Ginsberg, MD, calls the concept
of wireless capsule-delivered colon screening “compelling,” but he remains
skeptical about the potential impact of the imaging technique.

“I am not optimistic that this will play a significant medical role,” he
says.

Unlike colonoscopy, which can both find and remove suspicious polyps or
abnormalities for biopsy, the colon pill camera’s only role is detection.

That means patients with suspicious areas detected with the camera device
will end up having both procedures, each requiring time-consuming and
uncomfortable prep to cleanse the colon.

About 30% of patients who undergo colonoscopy screenings have polyps that
require biopsy, Ginsberg says. He is director of endoscopic services at the
University of Pennsylvania School of Medicine.

“Theoretically, this could help us identify people who do and do not need
[colonoscopy] screening, but there are many unanswered questions,” he says.

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