More evidence of powerful breast cancer prevention

We have previously pointed to the strong evidence that use of selective estrogen receptor modulators (SERMs) substantially reduces risk of breast cancer. New updated data has been published in the British journal Lancet (May 25, 2013). The original data from all patients in a number of trials of these agents for prevention for breast cancer were combined using common analytic methods. The authors report that across 9 prevention trials and 83,339 women randomized to SERMS and followed for an average of 65 months, had a significant 36% reduction in invasive breast cancer. The reduction in risk is stronger for estrogen receptor positive breast cancer.

New insights in this report include the protection from taking SERMs persists for 5 or more years after stopping. Also risk of vertebral (spine) fractures was significantly reduced by 34%. This improves the benefit to risk trade-off that this and other drug based prevention strategies require.

The good news is that the adverse effects form taking SERMs are now well documented and low frequency.

From this analysis the authors draw on the extended follow-up and estimate that for every 42 women treated with a SERM for 5 years one case of breast cancer will be prevented within 10 years of beginning therapy.  This is similar to our early post in which we pointed to our paper from 2008 showing that for 5 years of use among women 65 to 69 one case of invasive breast cancer would be prevented for every 43 women treated, and for women 60 to 64 in the top 10% of breast cancer risk in the population, one case would be prevented for every 53 women given the chemoprevention drug.

We recently noted that use of SERMs is much lower than might be expected given the substantial reduction in breast cancer with use of these drugs. The FDA approved the use of Tamoxifen for primary prevention of breast cancer in both premenopausal and postmenopausal women at high risk. This approval was in 1998. In 2007, the FDA approved Raloxifene for primary prevention of breast cancer among postmenopausal women.

See earlier posts: Cancer News in Context: Breast Cancer Prevention

And for breast cancer prevention, see: Cancer News in Context: Breast cancer prevention

Why It's Important That Many of Us Underestimate Fast Food Calories

A study published last month in the British Medical Journal (BMJ) showing that people regularly underestimate the amount of calories contained in fast food meals garnered a good deal of media attention (paper) and remains a "most read" listing on the BMJ.com site.  With good reason.  While moves are being made to prominently list the calorie contents of foods in restaurants, and the obesity epidemic is showing few signs of abating, the researchers from Harvard Pilgrim Health Care in Boston found that a large proportion of people underestimated the number of calories in their meals by a very large amount -  500 calories or more.  What makes this so significant is that even small imbalances in the calories we bring in versus what we burn through daily activity can lead to weight gain over time.  Seeing reality-versus-perception numbers as large as 500 calories for a single meal can make health care professionals shudder.

Of course, underestimating the calorie content of a meal doesn't directly translate to weight gain.  Just because someone thought their meal was 500 calories, and it was actually 1,000, doesn't mean they'll eat any more or fewer calories over the course of the day than if they had better calorie estimation skills.  But it's certainly possible, especially if someone thought they were making a lower-calorie, healthy choice (and actually weren't).

And this relates to one of the most interesting findings in the study.  Of the five fast food chains included in the analysis, the one with the largest discrepancy between estimated and actual calorie content of meals was Subway (figure) - the restaurant that through its promotions and spokesman, Jared, is most often linked to healthy choices and weight loss.  This "health halo," as the authors describe it, can lead people  to think they're making healthy choices when in fact they may be eating many more calories than they think they are.

While there are a number of important healthy eating tips that can lower the risk of diseases like diabetes, cancer, heart disease, and stroke, one overarching tip is to keep calories in check.

Weight gain and obesity are major risk factors for all kinds of major diseases, so keeping calories in check, and therefore, weight in check should be a primary health goal for everyone.  And it doesn't matter where the food comes from, really - fast food restaurant, fancy restaurant, farmers' market, grocery store - a calorie is a calorie is a calorie, and it's important to not eat too many of them.

Poverty and Tobacco: A Time for Grand Visions

Tracking the health news over the past few months, there's been one very intriguing trend that has stood out to us here at CNiC:  Grand Visions.

 

Two examples of this that have huge implications for health are the push for eliminating extreme global poverty by 2030 and very serious discussions about moving toward an endgame for tobacco - pushing tobacco use nationally and globally toward, or very near, zero.  

For each, the stage seems set for success.

In a moving speech on Poverty, Health, and Human Future to the World Health Assembly this month, World Bank President, Jim Yong Kim, made the compelling case that visions for a poverty-free world are possible by 2030. Speaking, he said:

 A generation must rise that will drive poverty from the earth. We can be that generation. A generation must rise that will end the scourge of inequality that divides and destabilizes societies. We can be that generation. A generation must rise that will bring effective health services to every person in every community in every country in the world. We will be that generation, and you—members of this Assembly—will lead the way.

Yes, I’m optimistic. I’m optimistic because I know what global health has already achieved—what you have achieved.

Such a goal does take optimism, yet the numbers seem to point toward will and hard work as the deciding factors rather than hope and luck.  Even the often staid Economist wrote that there's an "astonishing chance to take a billion people out of poverty by 2030." 

Astonishing, as well, would be the elimination of tobacco from the national and global landscape, and a supplemental issue of the British Medical Journal: Tobacco Control is dedicated to a serious discussion of real moves in that direction.  In the opening editorial, Elizabeth Smith writes:

The need for an endgame comes from the recognition that we do not have to accept the industrial marketing of tobacco, and that current policies—successful as they have often been—will likely not make the tobacco problem disappear. Those policies were never intended to eliminate the tobacco industry; the best case scenario they offer involves endless skirmishes with the industry's ongoing attempts to expand its markets and thwart regulation. Discussion of an endgame can inspire new visions of the possible.

Even though great strides have been made against tobacco over the last number of decades, it remains a scourge on public health and is used and sold at rates that should be unthinkable.  It's encouraging to see that the time has finally come to consider tobacco's endgame - a process that is likely to be long and difficult, but one that should remain a goal as we all move forward.  

A world free of extreme poverty and tobacco is hard for most of us to imagine today, but the seeds are there and starting to grow.  The positive impact such achievements would have on national and global rates of disease and mortality would be truly astounding.

Let the endgames begin.

New Report Makes Case for Physical Activity and Physical Education in Schools

In a time when school budgets are stressed and school performance is judged more and more on standardized test scores, it's understandable that certain aspects of the school day that can seem less-critical get cut back or cut out altogether.  Student physical activity and physical education has been one of those things slowly reduced over the years to make time and resources available for more classroom instruction.

While this can certainly seem to make sense given the academic mission of schools, a new report out from the Institute of Medicine (IOM) argues forcefully that such cuts in active time for students is a short-sighted fix that can ultimately hurt students and schools, since active kids are more productive, healthier, and perform better academically (see video below).

With half of students not meeting recommended levels of daily physical activity, reintegrating activity and physical education back into the school environment could have large payoffs not only in terms of short-term health and academic success but also in students' later adult lives, helping them be more productive and active members of their communities.

So important is regular activity, that the IOM recommends that it be recognized by the federal government, states, and school systems as a "core subject" because it is foundational to learning. And the new report provides a number of recommendations for integrating or improving the physical activity and physical education in schools.

Though there is no such thing as a magic bullet for good health, physical activity is as close to one as we'll ever get.  It lowers the risk of many important diseases, keeps weight in check, keeps people agile as they age, and provides a good boost to mental mood.  Laying the foundation for a life filled with enjoyable exercise and activity can't start too early, and the school setting is one of the best places to do this.

New Phase of CDC's No-Holds-Barred Anti-Smoking Campaign: "Talk with your doctor for help"

As we wrote about earlier this spring, the new "TIPS from a former smoker" campaign from the US Centers for Disease Control and Prevention is gaining a lot of attention for its no-holds-barred effort to shock non-smokers into staying smoke-free and smokers into to quitting smoking - hopefully for good.

One primary thrust of the campaign is to get smokers to hook up with local, state, and federal resources (like 1-800-QUIT-NOW and smokefree.gov) for tools to help them quit.  While many smokers are able to quit cold turkey, there's very good evidence that smokers who get some kind of external help have a greater chance of eventually succeeding in dropping smoking once and for all.

As was recently highlighted in a nice piece in the Journal of the American Medical Association (JAMA), the second phase of the TIPS campaign is just rolling out and builds on this approach by encouraging smokers to talk to their doctors about getting help quitting.  While most physicians today do a good job asking patients about their smoking history, there is still a lot of room for improvement - both in asking about a patient's smoking history and in effectively helping them quit.  Prompting patients to actively talk with physicians for help quitting can only further cement smoking as a key part of the patient-doctor relationship, kicking up the rate of successfully quitting along the way.

"Shared decision-making" is a key ideal of medical care moving forward - patient and doctor working together to make decisions that are best for the patient across a number of issues.  Talking together about the best way to quit smoking could be a great way to open that conversation or keep it going.

Are High Schoolers Making the Grade When it Comes to Sun Smarts?

Memorial Day Weekend is Here. How Do You Stack Up When It Comes to Being Sun-Safe?