RACHEL'S ENVIRONMENT & HEALTH WEEKLY #630 December 24, 1998 HEADLINES THE NEWS OF 1998, PART 1
Evidence continued to accumulate during 1998 that your diet can drastically alter your chances of getting heart disease and cancer, including breast cancer.
The good news is that eating monounsaturated fats (the kind found in olive oil, canola oil, and nuts) seems to have a protective effect against these major diseases. The nuts highest in monounsaturated fats are hazelnuts, macadamias, pecans, almonds, pistachios, Brazil nuts, walnuts, and peanuts.
The bad news is that hydrogenated vegetable oil and partially hydrogenated vegetable oil can have major harmful effects, increasing your chances of heart attack and cancer, including breast cancer. It is the trans-fatty acids in hydrogenated vegetable oils that seem to be the culprits.
Hydrogenated vegetable oils are mainly found in margarine and vegetable shortening, which in turn are common ingredients of bread, cookies, crackers, chips, candy bars, and many baked goods such as doughnuts. Many french fries are now cooked in hydrogenated vegetable oils. If you eat a normal American diet, it is hard to avoid large doses of hydrogenated or partially-hydrogenated vegetable oils, but the evidence is mounting that they are really bad news and should be avoided whenever possible.
Alberto Ascherio at the Harvard School of Public Health estimates that trans-fatty acids are now killing at least 30,000 Americans every year. Read the label and purchase wisely.
Breast Cancer Prevention
During 1998, evidence continued to accumulate indicating that a significant portion of female breast cancer is preventable because it is caused by exposure to cancer-causing agents (chemicals and radiation -- including hydrogenated vegetable oils) added intentionally or unintentionally to the environment and food. About 182,000 new cases of breast cancer occur in American women each year, and 46,000 deaths occur annually from the disease. In the U.S., the occurrence of breast
cancer has increased steadily at the rate of one percent each year for the past 40 years.
The "cancer establishment" -- the cluster of government agencies and private corporations that controls the flow of cancer research dollars -- is feeling tremendous pressure to demonstrate a preventive approach to breast cancer.
Accordingly, the National Cancer Institute announced in April that a drug called tamoxifen had cut the occurrence of new breast cancers by 45% in a group of 13,388 women who were thought to have a high probability of getting the disease. Government regulators acted swiftly and the news media trumpeted the story. A committee of the U.S. Food and Drug Administration (FDA) announced in September that it was recommending that the FDA approve tamoxifen as a drug for "reducing the risk" of breast cancer. A spokesperson for the FDA told the NEW YORK TIMES that "potentially tens of millions of women" could be candidates for tamoxifen treatments at a cost of $80 to $100 per month per person. Tamoxifen is marketed under the name Nolvadex by Zeneca, the chemical company that sponsors Breast Cancer Awareness Month each year. Tamoxifen has been used for breast cancer chemotherapy for two decades.
The FDA committee carefully avoided using the words "prevent" or "prevention" because it said tamoxifen may merely delay the onset of cancers and not actually prevent them; it is too early to tell. Still, the message from the cancer establishment was unmistakably one of prevention. The NEW YORK TIMES ran a front-page story saying tamoxifen's approval by FDA "would be a milestone in efforts to prevent cancer." Even before the tamoxifen study was published, the TIMES wrote an editorial about it, calling tamoxifen "a breast cancer breakthrough." "For the first time, scientists have demonstrated that breast cancer can not only be treated but actually prevented," the TIMES editorial said.
Unfortunately, it is not clear that tamoxifen represents a real victory for most women. The TIMES acknowledged in its editorial that, if 1000 women took tamoxifen for 5 years, 17 breast cancers would be avoided, and bone fractures from osteoporosis would be reduced; however in the same 1000 women during the 5 years tamoxifen would cause an additional 12 endometrial cancers (cancers of the lining of the uterus) and at least 10 potentially-fatal blood clots. The published study also reported
an increase in strokes and eye cataracts among those treated with tamoxifen, compared to a control group.
In its news story, the TIMES reported that the FDA committee "said it did not yet have enough information to determine which women were at high enough risk of breast cancer to make the drug's hazards, including potentially fatal blood clots as well as cancer of the uterine lining, worth its benefits."
The National Cancer Institute has released a computer "risk disk," a diskette containing a program intended to help women judge their risk of getting breast cancer. The diskette is available in both PC and Macintosh formats; telephone 1-800-4-CANCER or sign up to receive the diskette by mail at http://cancertrials.nci.nih.gov.
Of course, no one should rely on a computer program -- or on information they read in the news media -- to make decisions about their health without consulting a qualified medical specialist.
Two smaller studies of tamoxifen and breast cancer were published in September and neither of them showed any benefits from tamoxifen treatments. Differences in criteria for recruiting women into the studies may have produced the contradictory results. Nevertheless, definitive evidence of tamoxifen's benefits and dangers must await further study.
In late April, the NEW YORK TIMES reported on two unpublished studies of a drug called raloxifene. According to the TIMES, both studies show that raloxifene can reduce a woman's chances of getting breast cancer without increasing her chances of getting endometrial cancer. A study is now under way to compare the effects of raloxifene vs. tamoxifen.
To us, the tamoxifen and raloxifene studies reveal a curious shift in the cancer establishment's view of "prevention." To most people, cancer prevention means preventing exposures to cancer-causing agents. Instead cancer "prevention" is coming to mean treating a woman with a potent drug year after year, in an attempt to counteract the effects of her lifelong exposure to carcinogens. The eagerness of the NEW YORK TIMES to promote this new view of prevention on page 1, and in its editorial columns (often relying on preliminary data from unpublished studies), is, itself, curious and worrisome. It is as if the cancer establishment has abandoned the struggle to get carcinogens out of the environment and the nation's food supply, relying instead on drug treatments. It occurs to us that there is simply no money to be made in old-style prevention. It is
hard to make a living by reducing women's exposures to radiation and carcinogenic chemicals. But getting FDA approval for a new drug can be extremely lucrative even if its benefits hardly outweigh its dangers.
To us, the most interesting study of 1998 was never reported in the NEW YORK TIMES or any other of the mass media. In September, researchers at the University of Birmingham in England reported exposing pregnant rats to small amounts of dioxin on the 15th day of pregnancy. [Dioxin is a highly-toxic, chlorinated byproduct of combustion, incineration, metal smelting, and the manufacture of many chemicals, including pesticides. All Americans carry amounts of dioxin in their bodies that the U.S. Environmental Protection Agency considers dangerous. The female offspring of the dioxin-exposed pregnant rats were born normal, but by the time they were 7 weeks old, their mammary glands had developed an unusually high number of "terminal end buds" -- the places in a breast where breast cancers develop. Four studies have shown that there is a direct correlation between the number of terminal ends buds in a breast and its susceptibility to breast cancer.
The Birmingham researchers went on to expose these young rats (and a control
(dimethylbenz[a]anthracene). Sure enough, the dioxin-exposed young rats developed many more breast cancers than did the control group.
This elegant study shows that (a) timing of exposure to dioxin (and presumably to other toxicants) is critical; (b) exposure to a chemical before birth can predispose an animal to breast cancer later in life even if the chemical itself is known to INHIBIT breast cancer when exposure occurs later in life, as is the case with dioxin; (c) present methods of testing chemicals for their cancer potential are missing the boat, failing to ask the right questions about the dangers of the cancer-causing chemicals we are all legally exposed to year after year.
There are important opportunities to prevent breast cancers, and other cancers, in this world, and they do not require us to expose tens of millions of women to powerful chemotherapy drugs year after year. They simply require us to develop the political will to clamp down on the murderous practices of industrial polluters and the food industry.
These are some answers to frequently asked questions about pancreatic cancer.
Q: What is the pancreas? A: The pancreas is a glandular organ, located deep in the abdomen. It is behind the stomach and in front of the spine. The pancreas is about 6 inches long and has a wide head with a body that tapers to a narrow tail. The pancreas makes enzymes and hormones. The enzymes mix with bile to help with the digestion of food, especially fats, sugars, and proteins. The pancreas makes the hormones insulin and glucagons. These hormones help the body control the level of sugar in the blood. Both of these hormones help the body use and store the energy it gets from food. Q: What is cancer of the pancreas? A: Pancreatic cancer is cancer that starts in the pancreas. No one is entirely sure why people get this type of cancer. It is thought that normal cells undergo a series of changes, leading to permanent cell changes, and eventually cancer. Q: What are the different types of pancreatic cancer? A: Most cancers of the pancreas start in the ducts that carry pancreatic juices. They are called adenocarcinomas. These are less common types of pancreatic cancer.
These types are named after the way they look under the microscope. A rare type of pancreatic cancer starts in the cells of the pancreas that make insulin and other hormones. These cells are called islet cells. Cancers that begin in these cells are called islet cellcancers, or endocrine tumors of the pancreas. Q: What are the symptoms of pancreatic cancer? A: Pancreatic cancer can grow inside a person’s body for a long time before symptoms appear. These are the most common symptoms.
Weight loss over several months that is unexpected
An enlarged abdomen, from a swollen gallbladder
Digestive problems often happen if the tumor blocks the release of pancreatic juices into the intestines. If this happens, people can have problems digesting fatty foods. This can cause stools to be pale, greasy, bulky, and foul smelling. The stools may also float in the toilet.
Q: What is the treatment for pancreatic cancer? A: Doctors treat pancreatic cancer in these 3 ways.
People may have these treatments alone or combined.
Q: What is a pancreaticoduodenectomy? A: This is the most common type of surgery used to remove tumors from the pancreas. It is also called the Whipple procedure. The surgeon removes all of these during the procedure.
After surgery, bile from the liver, food from the stomach, and digestive juices from the remaining part of the pancreas all enter the small intestine.
Q: Should everyone get a second opinion for a diagnosis of pancreatic cancer? A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. These are some of the reasons.
The person is not comfortable with the treatment decision.
There are different ways to treat the cancer.
The person is not able to see a cancer expert.
Q: How can someone get a second opinion? A: These are some ways to get a second opinion. Talk with a primary doctor. He or she may be able to recommend a specialist. This might include a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs. Ask the Cancer Information Service (1-800-4-CANCER) for help. It can provide treatment facilities, cancer centers, and other programs supported by the National Cancer Institute. Get names of doctors fromother sources. Check with a local medical society, a nearby hospital, a medical school, local cancer advocacy groups, or other people who have had pancreatic cancer.
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