Cancer

New study adds caution to testosterone therapy for “low T”

Patrick J. Skerrett, Executive Editor, Harvard Health

Mass marketing of testosterone therapy may have men eager to try this seemingly simple fix. But the latest science should have them scratching their heads and putting away the credit card—at least for now. A new study published in the online journal PLOS One shows an increase in the risk of having a heart attack in the months after starting testosterone therapy. The potential for danger was highest in older men. A report in the November 6, 2013, issue of JAMA showed that men who used testosterone therapy didn’t fare as well after artery-opening angioplasty as men who didn’t take testosterone. Neither was the type of study that can prove cause and effect. They can only show associations, or links. That means there’s no smoking gun here that testosterone therapy is harmful. But the studies do suggest caution. Given the uncertainly over the benefits and risks of testosterone therapy, what’s a man to do? Take a cautious approach, advises the Harvard Men’s Health Watch.

Stephanie Watson

Radiation for breast cancer can increase heart risks

Radiation, on its own or coupled with other treatments, has helped many women survive breast cancer. Yet radiation therapy can cause the appearance of heart disease years later. New research published in JAMA Internal Medicine estimates that the increased lifetime risk for a heart attack or other major heart event in women who’ve had breast cancer radiation is between 0.5% and 3.5%. The risk is highest among women who get radiation to the left breast—understandable, since that’s where the heart is located. The heart effects of radiation begin emerging as soon as five years after treatment. However, future heart risk should not be the reason to abandon this important component of treatment. Cancer experts are doing more and more to minimize the amount of radiation the heart receives.

Howard LeWine, M.D.

Doctors often don’t reveal cancer test overtreatment and harms

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

There’s no question that tests to detect cancer before it causes any problems can save lives. But such tests can also cause harm through overdiagnosis and overtreatment. A study published yesterday in JAMA Internal Medicine indicates that the majority of people aren’t informed by their doctors that early warning cancer tests may detect slow-growing, or no-growing, cancers that will never cause symptoms or affect health. Undergoing surgery, chemotherapy, or radiation for such cancers provides no benefits and definite harms. The researchers found that only 9.5% of people were informed by their doctors of the risk of overdiagnosis and possible overtreatment. Compare that to 80% who said they wanted to be informed of the possible harms of screening before having a screening test. Informing patients about the risks of screening isn’t easy to do in a brief office visit. It’s complicated information. And the researchers suggest that many doctors don’t have a good grip on relative benefits and harms of screening.

Robert Shmerling, M.D.

Studies reinforce life-saving benefits of colon cancer screening

Robert Shmerling, M.D., Faculty Editor, Harvard Health Publications

Checking seemingly healthy people for cancer—what doctors call screening—seems like a simple process: Perform a test and either find cancer early and cure it or don’t find it and breathe easy. It works for colon, breast, and cervical cancers, but not for others. For colon cancer, there are several effective screening tests: colonoscopy, sigmoidoscopy, and stool testing. Two new studies in yesterday’s New England Journal of Medicine help further quantify their benefits. In the studies, all three types of test reduced the risk of developing or dying from colon cancer. Colonoscopy worked best, followed by sigmoidoscopy and then stool testing. The biggest challenge for colon cancer screening is getting people to have the available tests. About 50,000 Americans die of colon cancer each year—many of these can be prevented with early screening.

Daniel Pendick

Prostate cancer lives as it is born: slow-growing and benign or fast-growing and dangerous

In many men diagnosed with prostate cancer, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity. Instead of embarking on immediate treatment, a growing number of men choose active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading. A new Harvard study shows that the aggressiveness of prostate cancer at diagnosis remains stable over time for most men. If confirmed, then prompt treatment can be reserved for the cancers most likely to pose a threat, while men with slow-growing, benign prostate cancer—which is unlikely to cause problems in a man’s lifetime—can reasonably choose active surveillance.

Robert Shmerling, M.D.

Tattoos, moles, and melanoma

Robert Shmerling, M.D., Faculty Editor, Harvard Health Publications

A new report suggests that skin cancer can sometimes hide in a tattoo. Writing in JAMA Dermatology, three German clinicians describe the case of a young man who wanted to remove large, multicolored tattoos on his arms and chest. During the removal process, his doctors discovered a suspicious mole inside the tattoo. It turned out to be cancerous—stage II melanoma. Tattoos may make it difficult to evaluate moles. Laser removal therapy is also problematic when moles are present. If you are considering getting a tattoo, either make sure it will be applied to skin that is free or moles or birthmarks, or have your doctor check any moles in the to-be-tattooed area beforehand. If you are planning to have a tattoo removed, check for moles within the tattoo. If you see any, ask your doctor or dermatologist to check them out before starting laser therapy.

Howard LeWine, M.D.

Expert panel proposes annual lung cancer test for some

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

Proposed recommendations from the influential U.S. Preventive Services Task Force call for annual CT scans for some current and former smokers. Implementing these recommendations could prevent an estimated 20,000 deaths per year from lung cancer. The task force suggests annual testing for men and women between the ages of 55 and 79 years who smoked a pack of cigarettes a day for 30 years or the equivalent, such as two packs a day for 15 years or three packs a day for 10 years. This includes current smokers and those who quit within the previous 15 years. According to the draft recommendations, which were published today in the Annals of Internal Medicine, the benefits of annual checks in this group outweighs the risks. According to the Task Force recommendations, not all smokers or former smokers should undergo yearly CT scans. This group includes smokers or former smokers who are younger than 55 or older than 79, who smoked less or less often than a pack of cigarettes a day for 30 years or the equivalent, who quit smoking 15 or more years ago, or who are too sick or frail to undergo treatment for lung cancer. These draft recommendations have been posted for public comment until August 26, 2013.

Howard LeWine, M.D.

Taking aspirin linked to lower risk of colorectal cancer

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

Aspirin has many uses, from easing a headache or cooling a fever to preventing heart attacks and the most common kind of stroke. It may be time to add “preventing colorectal cancer” to the list. New results from the Women’s Health Study, a clinical trial that evaluated the benefits and risks of low-dose aspirin and vitamin E among nearly 40,000 women, show that aspirin reduces the risk of developing colorectal cancer by 20%. The effect isn’t immediate, but instead takes ten to 20 years to be seen. Aspirin isn’t without its drawbacks, including gastrointestinal bleeding and ulcer formation. Both occurred slightly more often among women taking aspirin. Although the Women’s Health Study results sound promising, don’t go reaching for the aspirin bottle just yet. Taking aspirin—and any other drug—is really a balancing act between benefits and risks.

Howard LeWine, M.D.

Fish oil: friend or foe?

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

News out of Seattle is sure to fuel confusion about fish oil supplements. A study by scientists at the Fred Hutchinson Cancer Research Center in Seattle linked eating a lot of oily fish or taking potent fish oil supplements to a 43% increased risk for prostate cancer overall, and a 71% increased risk for aggressive prostate cancer. Fish oil loaded with omega-3 fatty acids, which play important roles in health. Deficiencies in them have been linked to a variety of health problems, including cardiovascular disease, some cancers, mood disorders, arthritis, and more. But that doesn’t mean taking high doses translates to better health and disease prevention. Despite this one study, you should still consider eating fish and other seafood as a healthy strategy. Twice a week is a good goal.

Howard LeWine, M.D.

HPV transmission during oral sex a growing cause of mouth and throat cancer

Howard LeWine, M.D., Chief Medical Editor
Internet Publishing, Harvard Health Publications

Actress Angelina Jolie recently went public with her double mastectomy to prevent breast cancer. Governor Chris Christie told us his reasons for gastric bypass surgery. And now actor Michael Douglas is shining the spotlight on the human papilloma virus (HPV)—the number one cause of mouth and throat cancer. In an interview published in The Guardian newspaper in London, Douglas mentioned that his own throat cancer could have been brought on by oral sex, a common way to become infected with HPV. HPV transmitted by sexual contact often doesn’t become active enough to cause symptoms. When it does become active, it tends to invade mucous membranes, such as those covering the lining of the vagina, cervix, anus, mouth, tongue, and throat. An HPV infection can cause warts in and around these tissues. Most people sexually exposed to HPV never develop symptoms or health problems, and most HPV infections go away by themselves within two years. But the infection can persist and cause long-term problems. These include cervical cancer in women, penis cancer in men, and in both sexes some cancers of the anus and oropharyngeal cancer (cancer in the back of throat, including the base of the tongue and tonsils).