Good vitamin D status can prevent cancer, improve prognosis of several cancers

A good vitamin D status is beneficial both in cancer prevention and in the prognosis of several cancers, according to a new research review.

The anti-cancer effects of vitamin D are especially pronounced in the prevention and treatment of colon cancer and blood cancers. In addition, high vitamin D responsiveness can be linked to a smaller cancer risk. Vitamin D responsiveness varies between individuals, affecting their need for vitamin D supplementation.

The review article, published in Seminars in Cancer Biology and written by Professor Carsten Carlberg from the University of Eastern Finland and Professor Alberto Muñoz from the Autonomous University of Madrid, provides an update on the molecular basis of vitamin D signaling and its role in cancer prevention and therapy.

Vitamin D is commonly known for its crucial role in bone health, but the authors point out it also regulates the immune system, and its anti-cancer effects are mediated mainly by immune cells, such as monocytes and T cells. Vitamin D exerts its effects via the vitamin D receptor (VDR), which is a transcription factor involved in the expression and epigenetic regulation of numerous genes.
According to the review, studies focusing on the effect of vitamin D on different types of cancers provide the strongest evidence of its benefits in colorectal cancer and in blood cancers, such as leukemias and lymphomas.

Vitamin D is important both for the differentiation of blood cells during hematopoiesis as well as adult stem cells in rapidly regenerating tissues, such as colon or skin. A too low vitamin D status leads to a suboptimal function of the VDR and in an increased risk that these cells are not fully differentiating and start to turn into uncontrolled growing cancer cells.

Even in other types of cancer, such as breast and prostate cancer, a low vitamin D status, measured as the level of 25-hydroxyvitamin D in the blood, has been associated with a higher cancer incidence and a poorer prognosis. However, vitamin D supplementation has not been consistently shown to reduce cancer mortality in randomized controlled trials.

According to the authors of the review, the impact of vitamin D could be shown more clearly if the participants were stratified according to their individual vitamin D responsiveness and the health outcomes analyzed in relation to changes in individual vitamin D status.

Professor Carlberg's research group has earlier shown that individuals differ in their molecular response or sensitivity to vitamin D supplementation. For example, 25% of the Finnish population seem to be low responders, needing a higher dose of vitamin D supplementation to reach the full clinical benefit. In terms of cancer risk, being a high responder can be expected to have a protective effect.

According to the review, a good vitamin D status is beneficial in general cancer prevention. There is less evidence of its usefulness in the treatment of cancer.

Many factors influence decisions to withdraw life-support brain injury patients

There are several factors that determine the decisions to withdraw life support treatments in critically ill patients with severe brain injury, says a recent study.

The study provides a new understanding of the decision-making processes for this patient population, which accounts for most hospital deaths from trauma.

One of the researchers said, many clinicians struggle to make recommendations to withdraw life-sustaining treatments because decision-making is often complicated by uncertainty from trying to match family or caregiver opinions about  what they think the patient would have wanted in terms of quality of life and how well physicians can predict a prognosis.

The death rate in critically ill patients with severe traumatic brain injury is generally high as it occurs after a decision to withdraw life-sustaining treatments.

This patient population differs from the general intensive care unit (ICU) population as most patients were healthy before admission to the ICU, as compared with older patients who may already have a poorer quality of life due to pre-existing illness.

Therefore, decisions to withdraw life-sustaining treatments are made differently, mainly based on long-term prognosis and quality of life.

The researchers performed a descriptive qualitative study of interviews with critical care physicians from across Canada to understand the factors that determine a critical care physician's decision to discuss with families the withdrawal of life-sustaining treatments in patients with severe traumatic brain injury.

Results show that several factors are accountable including the patients' pre-expressed wishes and the family's wishes, severity, and location of the injury, along with evidence.

Past physician experience, legislation, opinions of colleagues and time are additional factors influencing decisions. The incidence of withdrawal of life-sustaining treatments and of death in critically ill patients with traumatic brain injury varies between hospitals.

Better evidence, tools to help predict patient outcomes, standardisation, better ways to integrate patient values and preferences into decision-making, improved training during critical care fellowships and more time to estimate prognosis are some things that could improve decision-making whether to withdraw life-sustaining treatments.

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Gene therapy can help correct heart rhythm disorder

A novel gene therapy uses an implanted LED device to reset a racing heart immediately and automatically, paving the way for pain-free treatment for patients with heart rhythm disorder.

The therapy detects fast arrhythmias in the atrium of a rat's heart and sends a signal to a LED device placed near the heart. 

"The flash of light from this LED then causes the heart to generate an electric current itself to halt the arrhythmia," said the lead author of the study.


"This is made possible by using gene therapy to introduce specific light-sensitive proteins into the heart. This restores the heart's normal rhythm immediately and automatically," he added.

According to the researchers, this could represent a great improvement on the current way of stopping atrial fibrillation.
 
Atrial fibrillation is the most common heart rhythm disorder in clinical practice. The current treatment, known as cardioversion, is based on administering an electric shock to the heart, which has to be done in the hospital under general anaesthesia because of pain.


For many patients, this is the only treatment to immediately stop atrial fibrillation because drugs or an operation are ineffective.




 "The bio-electronic defibrillator can stop atrial fibrillation without an electrical shock. In this way, the heart can be reset in a fully automated manner and at any time," he said recently.
 
"We anticipate that this treatment for atrial fibrillation could improve both the patient's quality of life and their prognosis," he added.

However, considerable research is still needed before a treatment can be arrived at that is suitable for human patients, the researchers noted.

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New prognostic tool may predict prostate cancer risk

A team of researchers have developed a genetic prognostic tool that may help predict the age of onset of aggressive prostate cancer in men. 

 The new polygenic hazard score is intended to better inform men whether and when to undergo Prostate-Specific Antigen (PSA) Test, widely used for prostate cancer screening.

Since an individual's genotype does not change with age, the polygenic hazard score can be calculated at any time and used as a tool for men deciding whether and when to undergo screening for prostate cancer.

The score involves survival analysis to estimate the effect of individual genomes for small variations, called single-nucleotide polymorphisms (SNPs), on age at diagnosis of aggressive prostate cancer.

This is especially critical for men at risk of developing prostate cancer at a very young age, before standard guidelines recommend consideration of screening.

"The polygenic hazard score is very versatile and can be applied to many age-related diseases," said a researcher.

"In this case, the polygenic hazard score of prostate cancer captures the age variations of aggressive prostate cancer."

The score has already been proven to be very useful in predicting age of onset for Alzheimer's disease, the researchers said.

When men with a high polygenic hazard score were compared to those with average polygenic hazard score, their risk of aggressive prostate cancer was at least 2.9 times greater, the researchers said, adding that this kind of genetic risk stratification is a step toward individualised medicine.

Further, PSA tests are much more predictive of aggressive prostate cancer in men with high polygenic hazard score than in those with low polygenic hazard score. This suggests that the score can help physicians determine whether to order a PSA test for a given patient.

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Vitamin D is the best thing, even for breast cancer

Apart from maintaining healthy bones, higher levels of vitamin D in the blood may also significantly improve survival in one-third of women diagnosed with breast cancer -- the most common form of cancer in women, a study has found.

A deficiency in the vitamin D levels -- commonly found in sun exposure, fatty fish oils, vitamin supplements, and fortified milks and cereals -- has been associated with the risk for several cancers, the study said.

“We found that women with the highest levels of vitamin D levels had about a 30 per cent better likelihood of survival than women with the lowest levels,” said Lawrence H. Kushi, Research Scientist with the Kaiser Permanente -- a not-for-profit health care company in California, US.

This study adds to the evidence that vitamin D may play a key role in cancer prevention and prognosis and is also an important nutrient, Kushi added. 

According to researchers, the link between vitamin D and breast cancer may be related to the vitamin role in promoting normal mammary-cell development, and inhibiting the reproduction of and promoting the death of cancer cells.

In the study, the team included 1,666 participants who had a diagnosis of invasive breast cancer in 2006 to examine whether levels of a blood biomarker of Vitamin D - 25-hydroxyvitamin D (250HD) - at the time of breast cancer diagnosis were associated with survival.

Higher 250HD blood levels were associated with better overall survival. In premenopausal women, the association of higher blood levels of 250HD and overall survival was stronger.

The study was published online in the journal JAMA Oncology.
 

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Kidney Cancer Drugs Equal in Prolonging Survival

The drug pazopanib (Votrient) works as well as sunitinib (Sutent) for treating advanced kidney cancer, but it has milder side effects, a new study finds.

Although both drugs are approved by the U.S. Food and Drug Administration as first-line treatments for kidney cancer and both boost survival, pazopanib had the edge in improving the quality of life, the researchers reported.

"Kidney cancer has long been considered one of the most difficult-to-treat cancers, and is associated with a poor prognosis when it's metastasized [or spreading]," said lead researcher.

Now there are drugs that attack a gene that is responsible for turning kidney cells into cancer cells, he said. "There has been tremendous progress in the treatment of this disease since 2005 with these targeted drugs,"he said. "The first of these drugs was sunitinib, which is considered the standard in first-line treatment for kidney cancer."

This new trial was a head-to-head comparison of sunitinib and pazopanib. The researchers found both had a similar safety profile and survival benefit, but there were milder side effects with pazopanib, Motzer said. These included less fatigue and fewer sores on the bottom of the feet, he noted.

"The data also suggest that patients on pazopanib have a better quality of life than patients on sunitinib," he said. Both drugs cost about the same -- about $6,500 a month -- and are covered by Medicare and many private insurers.

"Both these drugs are good options for first-line treatment," he said. "They allow for us to individualize treatment for patients. In my own practice, I have changed my preferred drug from sunitinib over to pazopanib, because most patients appear to have a better quality of life with pazopanib compared with sunitinib."

A urologist , said that "this study shows that there is more than one option for first-line therapy for renal [kidney] cancer."

According to him, 65,000 people are diagnosed with kidney cancer each year in the United States. "It's the sixth most common cancer," he said. And because it is often diagnosed late, 30 percent to 50 percent of the patients develop metastasis, he added. "It's one of the top 10 cancer killers," he noted.

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Actinic keratosis

Solar keratosis; Sun-induced skin changes - keratosis; Keratosis - actinic (solar)

Last reviewed: October 8, 2010.

Actinic keratosis is a small, rough, raised area found on skin that has been exposed to the sun over a long period of time.

Over many years, some actinic keratoses may develop into a type of skin cancer.

Causes, incidence, and risk factors

Actinic keratosis is caused by sun exposure, but it takes many years or decades to develop.

Risk factors for actinic keratosis include:

• Having fair skin, blue or green eyes, or blond or red hair
• History of kidney or other solid organ transplant (people who take medicines that suppress the immune system)
• Long-term, daily sun exposure (for example, if you work outdoors)
• Multiple, severe sunburns early in life
• Older age
  On the arm, this is how it looks like

  Symptoms

  Actinic keratosis is usually found on the face, scalp, back of the hands, chest, or other sun-exposed areas.

  They may be gray, pink, red, or the same color as the skin. Often, they have a white or yellow scale on top.

  • They begin as flat and scaly areas
  • Later they develop a hard and wart-like or gritty, rough, and "sandpapery" surface -- may develop a horn-like texture

  The skin lesion may be easier to feel than to see.

  Signs and tests

  The health care provider makes the diagnosis based on the appearance of the skin growth. A skin biopsy may be done for larger and thicker actinic keratoses to make sure no cancer is present.

  Treatment

  Because about 5% of actinic keratoses go on to develop into squamous cell skin cancer, have them examined promptly. Follow your health care provider's advice for treatment.

  Growths may be removed by:

  • Burning (electrical cautery)
  • Scraping away the lesion and using electricity to kill any remaining cells (caled curettage and electrodesiccation)
  • Cutting the tumor out and using stitches to place the skin back together (called excision)
  • Freezing (cryotherapy, which freezes and kills the cells)

  When many actinic keratoses are found, treatments that cause irritation and redness over a larger area are used:

  • A laser treatment called photodynamic therapy
    • Chemical peels
    • Creams such as 5-fluorouracil (5-FU) and imiquimod

    Expectations (prognosis)

    Actinic keratosis itself is harmless ( benign), but about 5% develop into skin cancer.

    Removal of the growth is usually effective.

    Complications

    • Irritation and discomfort of the skin growth
    • Scarring from the treatment
    • Squamous cell carcinoma

    Calling your health care provider

    Call for an appointment with your health care provider if areas of persistent roughness or scaliness develop in sun-exposed skin.

    Prevention

    Reduce sun exposure and protect your skin from the sun:

    • Wear protective clothing such as hats, long-sleeved shirts, long skirts, or pants.
    • Try to avoid sun exposure during midday, when ultraviolet light is most intense.
    • Use high-quality sunscreens, preferably with a sun protection factor (SPF) rating of at least 15. Pick a sunscreen that blocks both UVA and UVB light.
    • Apply sunscreen before going out into the sun, and reapply often.
    • Use sunscreen year-round, including in the winter.
      • Avoid sun lamps, tanning beds, and tanning salons.
      Other important sun safety facts to keep in mind:
      • Sun exposure is stronger in or near surfaces that reflect light, such as water, sand, concrete, and areas painted white.
      • Sun exposure is more intense at the beginning of the summer.
      • Skin burns faster at higher altitudes.
        Some of the symptoms in different parts of the body

        •