Tips For Health

New research shows that women who regularly use pain relief medications, particularly aspirin, have a decreased risk of serous ovarian cancer—an aggressive carcinoma affecting the surface of the ovary. The study published in Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology, reports that non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), or other analgesics did not decrease ovarian cancer risk.

Ovarian cancer is the deadliest gynecological malignancy and the fifth-leading cause of death by cancer for women in developed countries. Previous studies report that Denmark has one of the highest incidence and mortality rates at 11 and 7 per 100,000 women, respectively. According to the Centers for Disease Control and Prevention (CDC), each year 20,000 women in the U.S. are diagnosed with ovarian cancer, with 90% of cases occurring in women older than 40 years of age and the greatest number in those 60 years or older.

"Ovarian cancer has a high mortality. Understanding what factors are involved in the development of this disease and investigating preventative interventions for women are vitally important," said lead author Dr. Susanne Kjær with the Danish Cancer Society Research Center. "Our study examined the role of analgesics in development of ovarian cancer."

For the present study, researchers used data from the malignant ovarian cancer (MALOVA) study, a population-based, case-control study investigating this cancer in Danish women between 1995 and 1999. The team analyzed data from 756 women with epithelial ovarian cancer, classified by type of glandular tumors (adenocarcinomas); 447 were serous, 138 were mucinous, and 171 were other types. A random sample of 1564 women between the ages of 35 and 79 were drawn from the general population as controls. Personal interviews were conducted to determine analgesic drug use.

Findings indicate that women taking aspirin on a regular basis decreased their risk of serous ovarian cancer (odds ratio, OR=.60). Researchers did not find a decrease in ovarian cancer risk in women who regularly used non-aspirin NSAIDs, acetaminophen, or other types of pain relievers.

Dr. Kjær concludes, "Our findings suggest a potential protective effect of analgesic use on ovarian cancer risk, but that benefit should be balanced against adverse effects of pain medication use, such as risk of bleeding and peptic ulcers." The authors recommend that larger studies, which accurately assess dosage, frequency and duration of pain medications, are necessary to understand the impact of analgesic use on ovarian cancer.

In his editorial, also published in this months issue, Dr. Magnus Westgren from Karolinska University Hospital in Stockholm, Sweden concurs with the study authors that strategies for preventing ovarian cancer are imperative. Dr. Westgren discusses preventive procedures such as bilateral salingectomy (BSE)—a removal of the fallopian tubes—in women at risk for ovarian cancer.

"If we informed women about the possibility of performing BSE at repeat cesarean section for ovarian cancer prevention, it is likely that many women would opt for this procedure," writes Dr. Westgren. He suggests that gynecology professionals discuss changing policies and setting up randomized trials to further understand how BSE could reduce ovarian cancer risk.

High levels of high density lipoprotein (HDL), also known as the "good cholesterol," are thought to protect against heart disease. However, what’s good for one disease may not be good for another. High levels of HDL have also been linked to increased breast cancer risks and to enhanced cancer aggressiveness in animal experiments. Now, a team of researchers led by Philippe Frank, Ph.D., a cancer biologist in the Department of Biochemistry and Molecular Biology at Thomas Jefferson University, has shown that an HDL receptor found on breast cancer cells may be responsible for this effect, proposing a new molecular target that could help treat the disease.

"If we can block the activity of the HDL receptor in breast cancer, we may be able to limit the harmful effects of HDL, while maintaining levels that are beneficial for blood vessels," says Dr. Frank. The work was published online September 24th in the journal Breast Cancer Research.

To study the effect of HDL on cancer cells at the molecular level, Dr. Frank and colleagues exposed breast cancer cell lines to HDL and noticed that signaling pathways involved in cancer progression were activated, and that the cells began to migrate in an experimental model mimicking metastasis.

The researchers then limited the expression of the HDL receptor called SR-BI in the cells using silencing RNA to reduce the receptor’s levels. In response, the activities of the signaling pathways that promote tumor progression were reduced. In addition, cells with fewer SR-BI receptors displayed reduced proliferation rates and migratory abilities than cells with normal SR-BI levels. Most importantly, reduced SR-BI levels were associated with reduced tumor formation in a mouse model of tumorigenesis. The researchers then blocked the SR-BI receptor in a breast cancer cell line with a drug called BLT-1 and noticed reduced proliferation and signaling via proteins linked to tumor formation.

This study supports the idea that HDL plays a role in the development of aggressive breast cancers and that inhibiting its function via SR-BI in breast cancer cells may stall cancer growth.

Additional studies will be needed to develop more specific drugs to inhibit SR-BI. "Also, we need to understand what levels of cholesterol are required by the tumor before trying to reduce or modify lipid levels in cancer patients," says Dr. Frank. “We hope this study will lead to the development of new drugs targeting SR-BI or cholesterol metabolism and eventually preventing tumor progression,” he adds.

Critique 096: Frequency of alcohol consumption and cardiovascular risk factors: implications for drinking guidelines 20 November 2012

Read the full critique here: http://www.bu.edu/alcohol-forum/critique-096-frequency-of-alcohol-consumption-and-cardiovascular-risk-factors-implications-for-drinking-guidelines-20-november-2012/

The purpose of this paper was to examine whether drinkers who consume lower-risk amounts on more frequent occasions have favourable risk factor profiles compared with those who drink more per occasion but less frequently. The authors also discuss implications for the larger debate about the limitations of non-randomized studies about moderate drinking and the development of low-risk drinking guidelines. As stated by the authors, "many observational studies suggest that increased drinking frequency is associated with reduced mortality among those with low-dose alcohol consumption." Indeed, previous epidemiologic research has clearly shown that the healthiest outcomes occur among regular, moderate drinkers who do not binge drink. Further, almost all studies have adjusted for a large number of socio-economic factors that are known to be potentially confounding factors for evaluating the association of alcohol consumption with health outcomes.

As expected, the present study shows that regular drinkers tend to consume less alcohol per occasion, and are less likely to binge drink. Further, such individuals tend to have better socio-economic status and lower levels of most cardiovascular risk factors. Most previous researchers have interpreted the better educational status and economic levels of moderate drinkers to be important causes of their more moderate lifestyle factors (including avoiding abusive drinking). Further, most previous research, including many basic science interventions and limited trials in humans, have shown that the administration (intake) of moderate amounts of an alcoholic beverage leads to more favourable cardiovascular risk factors, and numerous mechanisms have been identified (higher HDL-cholesterol, improved vascular reactivity, improved platelet and other coagulation factors, etc.).

The authors of this paper take an unusual turn when it comes to discussing the implications of their results. They tend to down-play any potential health benefits that may be caused by alcohol or the pattern of drinking and infer instead that the favourable risk factors themselves may lead to the drinking pattern. Forum members disagreed with the implications of the authors on a number of factors: (1) the lack of randomized trials of low-dose alcohol consumption; (2) levels of evidence; (3) drinking frequency and alcohol intake; (4) clustering of lifestyle behaviours; (5) alcohol consumption and CVD-related biomarkers; (6) alcohol intake, cancer and total mortality. Further, Forum reviewers cite a large body of scientific research that utes some of the conclusions of the authors, which imply that regular moderate alcohol intake does not relate to improved cardiovascular risk factors.

Forum reviewers agree with a concluding statement of the authors about using caution before recommending drinking to the general public. However, they believe that the arguments presented in this paper are not based on a balanced appraisal of available scientific data, and should not be used to support changes in guidelines for the public.

Penn States mascot goes on the prowl for a good wellness program

Listen to this NPR report and its easy to conclude that another employer-based health promotion program has gone amok. Reporter Jeff Brady implies rising health care costs have led Penn State University to force its employees into an intrusive wellness initiative, pitting David-like faculty members against the Goliath-Administration.

What can wellness architects and service providers learn from this imbroglio?

Heres the facts:

Penn State provides health benefits to over 45,000 employees and dependents. Its self-insured (administered by Highmark), which means the University, not some remote insurer, is on the hook for any unanticipated health care costs. 

Those costs have led to a whopping $217 million health care budget for 2013-2014 and a long term $3 billion pension liability. In response to the threat of budgetary "crowd out," the University made some important changes to the insurance benefit that included a high deductible option and value-based benefits.

It also hatched a health promotion initiative. It checked in with the Faculty Benefits Committee in the early spring of 2013 and then used the summer to unveil a "comprehensive wellness-focused strategy."  This included the "Take Care of Your Health" program that packaged biometric screening (some labs, weight blood pressure), an on-line WebMD wellness survey and preventive health exam. Failure to complete that screening, survey and exam will result in a $100 per month payroll deduction in 2014.

The plan didnt sit well with everyone. Faculty members Matthew Woessner fretted about privacy and penned a "call for action and civil resistance," Barry Ickes doubted the economics and Larry Backer invoked eugenics, human dignity and sinister profit-motives.  Brian Curran used the Change.Org website to post an anti-wellness petition for "employees, alumni and friends" that has reached 2000 signatories.  Naturally, wellness gadflies Vik Khanna and Al Lewis were unable to resist and used The Health Care Blog to pile on any wellness program with the temerity to not use their consulting services.

The Disease Management Care Blog speculates on lessons learned......

While worksite wellness programs have a reputation for increasing employee morale, it stands to reason for that any stressed organization (and heres why that may be true here), it runs both ways: low employee morale can hinder acceptance of a wellness program. The faculty backlash may be as much of a symptom as a problem.

Lesson: Health promotion programs should tread lightly in times of organization turmoil.  This is no time for "big bang" multidimensional interventions, especially if they involve a $100 per month penalty.

There is good evidence that employer-sponsored wellness programs save money, but its unlikely that any health promotion will be enough to tame a $217 million budget.  To Penn States credit, they simultaneously made some health insurance benefit changes, but thats been lost in this controversy.

Lesson: If youre fighting high health care cost trends, dont let the positive return on investment (ROI) from health promotion take the lead. It wont work that well, and employees will think this about reducing your costs, not about increasing their well-being.

Similar on-line WebMD wellness assessments for Pittsburgh city employees and the Mennonite Church have gone without any substantial privacy concerns.

Lesson: If there are two employee groups with a special talent for indignant paranoiac outrage over any employer-sponsored health initiative, its medical providers and university faculty. There are plenty of reasons, but the DMCB suspects both are victims of the decades-long twin cultures of 1) autonomy and 2) abundance in health care and higher education.  Stopping by a Faculty Benefits Committee is not enough to secure buy-in.

Interestingly, Penn States College of Medicine has a long standing agreement with Highmark that includes the joint development of evidence-based health, wellness and prevention programs.  Unless thats been cancelled, the medical science facultys silence is deafening.

Lesson: Search for and engage employee subgroups that can be your allies in launching a health promotion initiative. Their advocacy may really help.

There are wellness service providers like this and this with established records of performance that can successfully reconcile employee and employer needs.

Lesson: Theres nothing wrong with perring to "build" over "buy," but only if both options are caully considered at the outset.  External wellness providers are often subject to financial performance and recruitment standards. If the petition gains traction, the latter would sure come in handy here.

Critics of wellness programs in general and this one in particular say that they lead to unnecessary testing.

Lesson: The science is still evolving, but here is one answer to that criticism: its not wellness per se but our societys love of technology.  Wellness programs can use initiatives like Choosing Wisely to develop even better programs.

As a self-insured entity, Penn State technically already has access to all the employees insurance and claims information.  The WebMD privacy concern is silly.

Lesson: Now would not be a good time for Penn States administration to point that out.

Hi,

Im in the middle of my 24-hr fast today and just wanted to blog at this point in time. It has been interesting and it is slightly different than the 16-hour fasts I had been doing. I seem to be more hungry but water and tea, which are permitted, are very satisfying, so Im indulging as I feel the need. I drank a 12-oz bottle of water upon waking and had another when taking my supplements and one prescription. I made a cup of hot green tea but it is so warm out that I per to let it cool down to tepid before drinking it.

I started last night at 5 p.m. and will eat again today at 5 p.m. so it is not like Im starving and dont know where my next meal will come from. I live in the USA and in a part of the city that has three fast food joints in a row about half a mile from my house. There are more across the street. There is no lack of food available. And THAT may be the problem.

I got out my copy of "Eat Stop Eat" for a resher as I began and I was reminded that fasting is a normal part of the human experience. I believe that small meals must have been part of that too. We have access to so much food in the USA that we have forgotten what the real human food experience of our distant ancestors really was like.There are people in the world who still eat that way, but not so much here in the US. We do still have a few religious folk who fast but, as far as I know, there is not must fasting going on here. When was the last time you fasted?

We think of dieting as managing our food intake, or eating a certain kind of food, but have not noticed that "not eating" is actually a part of that, too. It is like type on a page. We notice the black words strung out in paragraphs but dont notice that the white space around them is what makes them usable.

To lose weight you have to eat less food. Short fasts that you do from time to time is a way to eat less food. Fasting also lowers insulin and sugar levels and allows the body to use some of its "storage." Gee, what a good idea!! Use up some of the storage. If taken to extremes fasting can cause problems but you are not going to suddenly become unhealthy because you missed a meal or two or even a whole day of food.

Some of us remember parents who sent them to bed without dinner as a punishment for misbehavior, usually at the dinner table or just before. Nobody died from missing one meal. My parents did not use that particular punishment. Maybe they should have! LOL. The point is that we often forget the simplest form of calorie reduction is to stop eating for a short time. Skip a meal every once in a while.

Brad Pilons extensive research on fasting is contained in his book, "Eat Stop Eat" and makes for excellent reading. In it he offers his once-a-week 24-hour fast as a way to reduce weight without all the "fuss." He answered every question about fasting and health that I could think of and some I didnt think of. He is selling his PDF online for about $10 at this URL: http://www.eatstopeat.com  Well worth the small price. He covers all the misconceptions we may have about fasting and also points out the extensive health benefits, too.

There are really only two states a person can be in, in relation to eating. You are either eating, or not eating. Thats it. Normally we spend more hours not eating than eating, but if things have gotten out of hand and youve been eating too much, extending the "not eating" time is actually good for the body and the mind. It can give the body a real rest from always processing food.

It is now about 1 p.m. and my fast ends at 5 p.m. so I have about four more hours to complete this fast. So it has been about 20 hours since Ive eaten anything and, yes, Im feeling it. But it is not really so bad. Im thinking some of what Im feeling may be because I took my supplements on an empty stomach. Perhaps when Im fasting I should leave them out temporarily, too. I felt fine until I drank half of my tepid green tea. Im not usually a tea drinker so maybe that is it.

Im keeping the reason in mind. The reason Im fasting is to use up a little of my fat. Im thinking about how successful I will feel when I come to the five oclock hour and then break my fast. It is only once a week. I will see if it actually helps me to reduce my weight. If it works, it is a lot easier than counting every calorie I put in my mouth the rest of the week. Im still planning on doing my snack/meal/snack the rest of the time. This is my introduction to a possible new life style.

It always boils down to: you wont know if you dont try it out. Who knows... maybe this is the last time Ill have to try something new. If it works, Ill just plug along at it. If it does not work, well, Ill cross that bridge if I come to it.

Be back soon,

Marcia