Drinking coffee linked to decreased liver cirrhosis death risk

Chronic liver disease and cirrhosis is the 11th cause of death in the US, killing nearly 32,000 people in 2010. But now, researchers are suggesting that drinking two or more cups of coffee every day can reduce the risk of death from liver cirrhosis by 66%.

Published in the journal Hepatology, the study adds to growing evidence that coffee has real health benefits.

Medical News Today recently published a feature on how caffeine affects our health, listing benefits such as reduction of liver cancer risks and decreased risk of suicide.

One study recently suggested that consuming 200 mg of caffeine each day could boost long-term memory.

In this latest study, Dr. Woon-Puay Koh, from Duke-NUS Graduate Medical School Singapore and the National University of Singapore, led a team of researchers who investigated how coffee might help minimize deaths caused by liver cirrhosis. The World Health Organization say this condition is responsible for 1.3% of total deaths worldwide.

Dr. Koh notes that their study focused on the effects coffee, alcohol, black tea, green tea and soft drinks have on mortality risks from cirrhosis. However, only coffee decreased these risks, while heavy alcohol use - perhaps unsurprisingly - increased risk of death from this condition.

Study 'provides impetus to further evaluate coffee as therapeutic agent'

In the US, over 50% of people over the age of 18 drink coffee every day. America is a nation of coffee drinkers, who total around 100 million, and the amount spent importing coffee here each year totals around $4 billion.

Drinking two or more cups of coffee each day could lower risks of dying from cirrhosis of the liver.

With so much time and money centered around coffee, it is an added benefit that the beverage can be considered a healthy lifestyle choice for certain conditions.

To further investigate, the researchers used a prospective population-based study called The Singapore Chinese Health Study, which involved over 63,000 Chinese subjects living in Singapore who were between 45 and 74 years old.

These participants provided researchers with data on diet, lifestyle and medical histories through interviews and questionnaires between 1993 and 1998, and the researchers followed up with them for an average of 15 years.

The researchers recorded that a total of 14,928 of the study participants died in this time, of which 114 died from liver cirrhosis.

Overall results show that individuals who drank at least 20 g of ethanol (alcohol) each day had a greater risk of cirrhosis mortality, compared with non-drinkers. Meanwhile, coffee intake was linked with a lower risk of death from cirrhosis, and the researchers note this was particularly the case for non-viral hepatitis related cirrhosis.

In detail, participants who drank two or more cups of coffee each day had a mortality risk that was 66% lower than that of non-daily coffee drinkers.

The researchers note that drinking coffee was not linked with viral hepatitis B related cirrhosis mortality, however.

Dr. Koh says their study is the first to show a difference in coffee's effects on non-viral and viral hepatitis related cirrhosis mortality. He adds:

"This finding resolves the seemingly conflicting results on the effect of coffee in Western and Asian-based studies of death from liver cirrhosis.


Our finding suggests that while the benefit of coffee may be less apparent in the Asian population where chronic viral hepatitis B predominates currently, this is expected to change as the incidence of non-viral hepatitis related cirrhosis is expected to increase in these regions, accompanying the increasing affluence and westernizing lifestyles amongst their younger populations."

The authors conclude their study by noting that it "provides further impetus to evaluate coffee as a potential therapeutic agent in patients with cirrhosis."

Medical News Today recently reported on research from the Centers for Disease Control and Prevention that suggested though overall caffeine intake has not increased, kids in the US are consuming caffeine from more diverse sources, including both coffee and energy drinks.

Our article on the health benefits of coffee also explores some of the other ways that the beverage can be good for us.

Written by Marie Ellis

Medical News Today

Reference:

Coffee, alcohol and other beverages in relation to cirrhosis mortality: the Singapore Chinese Health Study, Woon-Puay Koh, et al., Hepatology, doi: 10.1002/hep.27054, published April 2014, Abstract.
Additional source: CDC Chronic Liver Disease and Cirrhosis, accessed 3 April 2014.
Additional source: Statistic Brain Coffee Drinking Statistics, accessed 3 April 2014.

http://www.medicalnewstoday.com/articles/275028.php

When the heart hurts

ATHEROSCLEROSIS (hardening and narrowing of the arteries) is mainly an inflammatory disorder that is the usual cause of heart attacks, strokes, and peripheral vascular disease – what together are called cardiovascular disease.

12 May 2014 

Steve Yap

ATHEROSCLEROSIS (hardening and narrowing of the arteries) is mainly an inflammatory disorder that is the usual cause of heart attacks, strokes, and peripheral vascular disease – what together are called cardiovascular disease.

Based on today's medical ­research, the key to ­understanding cardiovascular disease is to ­appreciate the roles inflammation plays in ­promoting this No.1 killer in the world.

Gum disease

The by-products of ­bacterial from periodontal (gum) disease such as ­lipopolysaccharides can lead to chronic low-grade ­inflammation and an increased arterial plaque accumulation.

Research studies have shown that periodontal ­pathogens could cause local ­infection and ­systemic (whole body) ­inflammation as ­evidenced by elevated blood ­markers such as ­hs-CRP and IL-6.

The J Endod (2009) reported that chronic dental ­infections could raise one's risk of heart attack.

Periodontitis (inflamed gum) promotes endothelial (artery wall) dysfunction even in people without cardiovascular risk factors since such a condition reduces nitric ­oxide needed for arterial health.

Furthermore, our body's ­antioxidant scavengers such as glutathione peroxidase, ­catalase and SOD are reduced.

H. Pylori infection

Besides promoting a significant percentage of gastric cancer, this bacterium living in both the stomach wall and in the gum can cause endothelial dysfunction.

The principal source of this infection is raw, uncooked fish and from cooked food contaminated with the ­bacterium.

Hepatitis

The viruses that cause chronic inflammation in the liver can set the stage for systemic low-grade inflammation that adversely affect arterial health.

Vaccination is one way to ­prevent these liver disorders. Herbs and nutrients beneficial to liver ­include licorice root containing ­glycyrrhizin, ­silybum, schisandra, ­cordyceps, alpha lipoic acid, artichoke, and L-cysteine.

Hepatitis A is an acute ­condition spread by a virus from an infected person's ­faeces to someone's food chain or cooking utensils.

Besides sex, hepatitis B may be transmitted through sweat coming into contact with the damaged skin of another ­person while ­sharing ­household items can even transmit hepatitis C.

Excessive drinking can lead to alcoholic hepatitis,­ eventually to fatty liver and then ­cirrhosis ­(hardening of the liver).

Epstein Barr virus (EBV)

The only symptoms from this viral infection may be chronic fatigue syndrome, nasal or lymph node tumour/cancer.

The incidence of nasal cancer in Malaysia is now one of the highest in the world with EBV ­infection believed to be a major contributing factor while inappropriate dietary habits help the virus knock out our immune defence.

The dietary aspects include over-consumption of salted or preserved food as well as excessive sugar intake which lowers our general immunity against all infections.

Fungal infection

Systemic ­fungal over-growth (candidiasis) is widespread in countries with warm and humid climates such as ours.

A large percentage of sore throats may be fungal-based rather than an ­infection.

Fortunately, nature has its own remedies in the form of herbs, spices, and oils that possess anti-­fungal ­properties.

Among them are ­oregano, garlic, cloves, ­turmeric, ­spearmint, virgin coconut oil, and palm seed oil.

Allergies and skin ­disorders

All forms of allergy including sinusitis and skin disorders such as eczema and psoriasis provoke reactions from our immune defence, resulting in chronic inflammation which adversely affect our arterial health.

This means that if you suffer from skin disorders or from asthma, and these ­conditions aren't adequately treated, the chances are high that the health of your heart arteries will be affected.

Chronic sinusitis and ­allergies stringly provoke our ­immune defence leading to ­production of a wide variety of ­inflammatory chemicals which can damage our arterial wall.

To treat chronic ­inflammation naturally, we need to look at dietary or lifestyle modifications and the use of nutraceuticals under the direction of a licensed nutritional therapist.

Regular sleep patterns of seven to eight hours per night and exer­cising to keep weight down are known to be ­beneficial to the heart.

Our body adipose tissues (fat cells) are also a major producer of inflammatory chemicals.

If you have a BMI of 27 and above, you will face an uphill battle with chronic inflammation.

Consuming excess ­refined carbohydrates and not ­exercising adequately may lead to insulin resistance, which is a strong predictor of cardiovascular disease.

Excess use of cooking oils rich in pro-inflammatory omega-6 or consumption of deep-fried food containing trans-fat or advanced glycated end-products (AGEs) ­promote atherosclerosis.

EPA/DHA can reduce ­periodontal disease by 20% while reducing inflammation by up to 50%.

CoQ-10 and vitamins D3 and E levels tend to be low in people with gum disease.

Adequate intake of folate-rich dark green leafy ­vegetables can reduce ­gingival bleeding. Ascorbic acid ­enhances gum healing and lowers risk of gingivitis.

Fermented soy such as natto is rich in the ­biologically active form of vitamin K2, which is also an anti-­inflammatory nutrient since it lowers the blood marker IL-6.

Using virgin coconut oil can lower ­incidence of viral and fungal infections. Foods rich in L-lysine including soy isolate can reduce viral ­replication in those affected.

http://www.thesundaily.my/news/1043547

Low blood sugar bad for marital bliss

LOW blood sugar isn't good for marital bliss because it makes spouses more prone to anger and aggression, says a new study out Monday.

17 April 2014


Low blood sugar isn't good for marital bliss. AFP RELAXNEWS

The findings are based on experiments with 107 married couples asked to monitor their glucose levels before breakfast and bed every day for 21 days.

In addition, researchers gave them voodoo dolls representing their significant other along with 51 pins. They were then told that, at the end each day over the three-week period, they should secretly stick pins into the dolls indicating how angry they were with their better half.

Turns out that the lower the spouse's blood sugar levels, the more pins he or she stuck into the dolls.

"When they had lower blood glucose, they felt angrier and took it out on the dolls representing their spouse," said lead study author Brad Bushman of Ohio State University.

"Even those who reported they had good relationships with their spouses were more likely to express anger if their blood glucose levels were lower."

Following that experiment, the couples were brought into a lab where -- split up in separate rooms -- they were told they would play a computer game against their spouse.

Each time they won, they were told, they would get to decide how loud of a noise would be blasted in the headphones of their significant other -- and for how long.

That actually didn't end up happening, and they weren't really playing against their spouse but against a computer that let them win about 50 percent of the time.

Still, the results showed that people with lower average levels of evening blood sugar "sent" louder and longer noise to their spouse.

What's more, further analysis determined that those who pricked their voodoo dolls with more pins were more likely to deliver louder and longer blasts of noise.

"We found a clear link between aggressive impulses as seen with the dolls and actual aggressive behaviour," Bushman said.

He added that glucose serves as fuel for the brain, an organ which consumes about 20 percent of our calories though it only makes up two percent of our body weight.

Self-control needed to handle anger and aggressive impulses requires energy that is partly provided by glucose, he noted.

"It's simple advice but it works: Before you have a difficult conversation with your spouse, make sure you're not hungry."

The findings appear in the Proceedings of the National Academy of Sciences. – AFP Relaxnews

http://www.thesundaily.my/news/1019297

Three Natural Ways To Stay At Ultimate Health

Control your lifestyle and living space and you control your health. While I plan on discussing your living space in the near future, right now I want to explain how shaping three important factors in your lifestyle can influence your health.

Dr. Mark Wiley | May 14, 2014

The Domino Effect

When it comes to wellness, health and quality of life our choices set up a kind of domino effect: Each choice affects another, and all the factors that determine your well-being are interrelated. I previously wrote about this topic in some detail,here.

The Cycle Of Three

While health and wellness can be broken down into dozens and dozens of categories, three of them stand out as essential:

• Sleep
• Nutrition
• Exercise. And these, of course, are all directed individually, by the choices we make, the lives we lead, each and every day.

Each of us has a fair amount of direct control of three of these important aspects of health and wellness.

What is interesting about sleep, diet and exercise is that each of them on its own has a profound effect on your health. However, the quality of one directly affects the quality of the others. This means that when you let one of these area slip a bit, the repercussion can be felt in the other two, and a larger negative wellness effect can be felt.

New Studies

I have been lecturing and writing about the direct relationship between our lifestyle choices and state of health for 15 years. And most people still don’t understand this concept.

I am not sure if people don’t want to assume responsibility for their own health, or they can’t face that they may be directly or indirectly making themselves sick. Maybe it is just easier to seek external care and take medications while making the same poor lifestyle choices.

In any case, a recent study published in the May issue of the Journal of Orthopaedic and Sports Physical Therapy shows direct cause and effect between the state of your health and how you manage your sleep, nutrition and physical activity. Let’s look at each of these a bit more. I have included links to other stories I have written to help you drill down to the information that you need, to better take back control of your health and wellness.

Sleep

Sleep is so important to health, that a steady decrease in sleep has been linked to heart disease, depression, chronic pain and other serious conditions. According to the study findings, “Less than 70% of adults get enough sleep. Poor sleep (less than 7 to 8 hours each night) is related to depression, work-related injuries, and weight gain.”

Sleep has such an effect on health that I have written several articles about it in the past. I previously wrote about how ample sleep leads to weight loss. That story is here.

And I explained that without proper sleep the brain fills with toxic waste. That story is here.

The most important ways to improve your sleep include:

1. Consistently sleep and wake up at the same time.
2. Do not consume sugar or caffeine after 6 p.m.
3. Do not exercise after 7 p.m.
4. Reduce your anxiety and stress.
5. Do not read or watch TV in bed.
6. Create the proper sleep space.
7. Use sleep aids as needed.

The details of these tips are here.

Nutrition

Until the 1960s, no mainstream medical experts seemed to believe that what we ate had an effect on how healthy we are. Crazy, I know, given what we all know now about fats, cholesterol, GMOs and so on.

Eating and drinking is so important for health that a diet loaded with dense nutrients (fruits and vegetables) with whole, fresh foods can do wonders for our body and mental states.

However, according to the study findings, “Only 30% of Americans are at a healthy weight. Poor nutrition… is linked to disease, depression, and inadequate sleep.” Believe me when I tell you diet is not a matter of calorie count, but of the quality and quantity of the food you consume.

I wrote here about how eating at the wrong times can actually derail your health. Here I wrote about the importance of reading labels and eating the right kind of foods for optimal health.

Physical Activity

Rounding off the big three subjects of lifestyle factors is physical activity.

You cannot be healthy if you do not move your body. Being active is essential to physical health, mental states and overall quality of life. Yet, according to the study findings, “Less than 45% of adults get the recommended 30 to 60 minutes of physical activity daily. Inactivity is tied to chronic disease, weight gain, and poor sleep.”

There are many ways to remain physically active. Yes, there are running, aerobics and sports; but there are also yoga, walking and biking. There is a physical activity and level for every age and level of fitness.

The Big Problem

It seems that everyone should know that sleep, diet and exercise are the most important pillars of health and wellness. The health danger of neglecting any of these threats is repeated all over in all forms of media and conversation. Yet, it is difficult for many of us to take control.

We are stuck sitting all day at work, staring at flat-screen computers, phones and televisions. We have no time for self-care, and we barely have time to eat and sleep and move — let alone set a firm sleep and exercise schedule and shop for healthy foods or prepare them ahead of time.

But there is hope. This story and the many article links provided should give you some tools to help you get on track and stay there. In addition, the study mentioned above noted how a panel of 36 experts from academia, government and the military gathered to discuss how to make the healthy choice the easy choice. Here are their six points of advice:

1. Remember that small changes in sleep, activity and nutrition can make a big difference in your health.
2. Challenge yourself weekly to gain a new healthy habit and break an old unhealthy habit.
3. Create an environment around you that supports your weekly challenges.
4. Set and track your goals.
5. Ask for support from friends and family.
6. Use technology (fitness trackers, apps and online tools) to motivate and support your efforts. Ask your physical therapist about more ways to make the healthy choice easier for you.

Here is additional advice on how to make better lifestyle choices. I have written offering even more advice, tricks and tips to help you sleep, eat and move in a more healthy direction.

Reference

http://www.ncbi.nlm.nih.gov/pubmed/24787329

http://easyhealthoptions.com/three-natural-ways-stay-ultimate-health/

Shingles - Not worth the pain

Sunday May 18, 2014

Known traditionally as “snake disease”, shingles is an extremely painful and debilitating rash. About 95% of adults over the age of 50 are at risk of shingles if they had previously contracted the chickenpox virus earlier in their lives.

The shingles campaign campaign is supported by the Malaysian Society of Geriatric Medicine, Dermatological Society of Malaysia, Malaysian Association for the Study of Pain and the Malaysian Healthy Ageing Society.

THE inaugural “It’s Not Worth The Pain” campaign to raise awareness of shingles among Malaysians was launched last month.

Organised by healthcare company MSD, the campaign is supported by the Malaysian Society of Geriatric Medicine (MSGM), Dermatological Society of Malaysia (PDM), Malaysian Association for the Study of Pain (MASP) and the Malaysian Healthy Ageing Society (MHAS).

Known traditionally as “snake disease”, shingles is an extremely painful and debilitating rash. About 95% of adults over the age of 50 are at risk of shingles if they had previously contracted the chickenpox virus earlier in their lives.

Both chickenpox and shingles are caused by the same varicella zoster virus. According to the US Centre for Disease Control and Prevention (CDC), one in three people will develop shingles in their lifetime.

Older adults who have had chickenpox face a higher risk of getting shingles as the varicella zoster virus never leaves their body. Rather, it remains inactive for many years in the nerve roots before flaring up again as shingles.

Shingles can, in fact, recur several times in a lifetime.

“Shingles impacts millions of elderly people and their families globally. We are committed to helping Malaysians learn more about shingles and avoiding the painful burden of this disease. We are thankful for the strong support shown by both leading medical associations and not-for-profit organisations. Their invaluable contribution will ensure that our community realises that shingles is really not worth the pain,” said MSD Malaysia managing director Annie Chin, during the nationwide campaign kick-off event.

According to MSGM chairman Prof Philip Poi, Malaysians still lack awareness and knowledge about the risks and complications of shingles.

“Many Malaysians still hold to the assumption that one can only be infected by the chickenpox-shingles virus once in their lifetime, and that they gain immunity thereafter. This has been proven to be untrue.

“On the contrary, the risk of getting shingles tends to rise at around age 50 because older adults are likely to have a weaker immune system,” said Prof Poi.

“There is no known cure for shingles, and neither are there ways to predict when the chickenpox-shingles virus will reactivate in the body. Furthermore, we cannot easily predict how severe the infection and resultant complications will be. One way to reduce the risk of developing shingles is to get vaccinated,” he added.

PDM reminds Malaysians to immediately seek medical advice at the earliest sign of shingles, which include itching, tingling or a burning sensation.

These symptoms will later develop into a rash with fluid-filled blisters, which may cause mild to severe pain.

“Shingles should not be dismissed as just a rash or skin condition that older people get.

“It is extremely crucial that shingles be diagnosed within 72 hours of infection for antiviral medicines to be effective in helping to reduce the severity of pain and duration of shingles.

“The shingles awareness campaign also serves as a perfect platform to help Malaysians recognise symptoms of shingles so that early action can be taken,” said PDM president Dr Najeeb Safdar.

MASP president Dr Mary Cardosa cautions that shingles can cause unbearable pain often described as burning, aching, stabbing and shock-like.

In up to 50% of patients, shingles could lead to further complications, one of them being postherpetic neuralgia, a long-term nerve pain that can last for months, or even years.

“Postherpetic neuralgia is a painful, chronic condition that can make people feel truly miserable.

In one study, 42% of patients referred to their worst shingles pain as excruciating. As a result of the persistent pain, the patient is likely to have a decline in physical and social functioning, as well as an increase in emotional distress.

“The campaign tagline resonates with Malaysians as pain is one of the most common side effects of shingles. We want to create wide awareness so that the public will seek preventive measures to avoid this debilitating disease.

“There is pain, and then there’s shingles pain,” she said.

Meanwhile, MHAS encourages all Malaysians to take preventive steps, including immunisation, if they want to truly enjoy their golden years.

“Staying healthy is a priority for all of us.

“Getting vaccinated is a simple, but important step to help prevent diseases that could lead to serious health problems and hefty medical bills.

“The campaign message is a clarion call for those who are at risk to gain full knowledge on shingles and avoid unnecessary psychological and financial burden,” said MHAS president Dr Lim Poh Hin.

http://www.thestar.com.my/Lifestyle/Health/2014/05/18/Not-worth-the-pain-A-shingles-awareness-campaign-kicks-off-in-Malaysia-with-the-message-that-prevent/

Thyroid Cancer: An Epidemic of Disease...Or Overdiagnosis?

Put the word cancer after anything—brain cancer...pancreatic cancer...lung cancer—and it raises everyone's level of alert, especially when a particular cancer appears to be on the rise. But the new alert that's sounding now, which centers around thyroid cancer, isn't really about an epidemic of the disease itself. Instead, what has many experts worried is a possible epidemic ofoverdiagnosis and overtreatment.

May 19, 2014

Why are they so concerned? Because most people diagnosed with thyroid cancer will never even develop symptoms, much less have their lives threatened by the disease. Yet they are being treated with surgery, radiation and/or medication—treatments that carry serious risks of their own. There's also considerable expense, inconvenience and anxiety associated with the diagnosis and treatment...all of which could be completely unnecessary in a significant number of cases.

Will you or a loved one wind up being pushed down that path? You could be, given that thyroid cancer is now the most commonly diagnosed endocrine cancer in the US. Here's what you should know before that happens...

LOOKING AT THE NUMBERS

The thyroid cancer diagnosis rate in this country has nearly tripled since 1975, going from 4.9 cases per 100,000 people to about 14.3 per 100,000 people. But despite the massive increase in the rate of people diagnosed with the disease, the rate of people dying from thyroid cancer hasn’t changed at all over the same time period.

More on Overdiagnosed Diseases

1. The Epidemic of Overdiagnosis: 
   Unnecessary Tests, Drugs and 
   Surgery. Watch Out!
2. Psychiatric Fads Lead to Overdiagnosis 
   of Mental Illnesses
3. Unnecessary Tests for Cancer Patients
4. Is It Really Alzheimer's?

You might assume that the explanation is that thyroid cancer treatment has improved so much over the past 30-plus years that essentially all of the additional cases have been successfully treated. But in fact, the treatment for thyroid cancer is pretty much the same as it has been. So the more likely explanation is a dramatic rise in diagnosis—or, as many experts now caution, in overdiagnosis. Here's why...

The numbers, the risks: More than 60,000 people will be diagnosed with thyroid cancer in the US this year, with women outnumbering men three to one. Almost all of these patients will have surgery to remove their thyroid glands, which carries a risk for nerve damage that can lead to permanent hoarseness or weak voice...and requires them to take medication for the rest of their lives to replace the hormones their thyroid glands previously produced. In addition, many of these patients will be given radioactive iodine to conquer any remaining thyroid cancer cells—a treatment that can cause dry eyes and altered taste and more than quintuple the risk of developing leukemia.

Those risks would be worth it if the treatments saved lives. But most of these patients would not have died of thyroid cancer anyway! Evidence: Studies involving autopsies have shown that thyroid cancer is detected in as many as one in three people who died from any other cause, yet in the US, thyroid cancer accounts for only about one in every 200,000 deaths overall! This means that the number of people who die with thyroid cancer—but not becauseof it—is staggering.

NOT ALL THYROID CANCERS ARE CREATED EQUAL

As cancers go, thyroid cancer is one of the least deadly, claiming fewer than 1,900 lives in the US each year. There are four different types of thyroid cancer...

• Papillary cancer accounts for 85% of cases and has an excellent prognosis, with 98% of patients alive 20 years after diagnosis.

• Follicular cancer accounts for 11% of cases and has a 10-year survival rate of more than 95% in patients younger than age 40 at diagnosis.

• Medullary cancer accounts for 3% of cases. It has a 10-year survival rate of 75% for those under age 40 at diagnosis, and 50% rate for older patients.

• Anaplastic cancer accounts for just 1% of cases. It is the most aggressive type, with a one-year survival rate of 20%.

WHAT'S REALLY DRIVING THE INCREASE?

According to Juan P. Brito, MBBS, an assistant professor of endocrinology at Mayo Clinic in Rochester, Minnesota, and coauthor of a recent study analyzing trends in thyroid cancer, it is papillary cancer (the least dangerous type) that's driving the increase in thyroid cancer diagnosis.

Rates of the other forms of cancer have barely changed. He pointed out several likely reasons why more papillary cancers are being found...

• More doctors are screening for the disease, looking for cancer in people with no symptoms. During a routine exam, the doctor might examine the patient's neck, feeling for thyroid nodules (solid or fluid-filled lumps within the thyroid gland), which are common. When the doctor’s fingers find a nodule, he then schedules an ultrasound to get a better look at it, and then perhaps a biopsy is taken with a needle. Thyroid cancer is found in about 10% of people with nodules.
• Thyroid nodules and cancers also are detected incidentally, during an imaging test for another condition—and these imaging tests are being done more and more often. For example, a CT exam of the chest or an ultrasound of the carotid artery can easily pick up a tiny two-millimeter nodule in the neck, Dr. Brito said. Such incidental findings explain, at least partially, why nearly 40% of thyroid cancers now being found are smaller than one centimeter across (technically called microcarcinomas)...whereas back in 1989, just 25% of known papillary cancers were smaller than one centimeter.
• The diagnostic cascade also explains some of the increased incidence. Example: A patient tells her doctor that she’s feeling sluggish and gaining weight. The doctor’s endocrine antenna goes up, and he suspects that an underactive thyroid gland is causing those vague symptoms. If a lump is felt in the thyroid or seen on an ultrasound, the doctor might order a biopsy, and then the results might show papillary cancer—even though the patient’s thyroid may have had absolutely nothing to do with the fatigue and weight gain.

SCARED PATIENTS IGNORING GUIDELINES?

The American Thyroid Association recommends against biopsies for thyroid nodules smaller than a centimeter, except for people with a family history of thyroid cancer...those who had previous head or neck exposure to radiation from, for instance, medical radiation therapy or heavy industrial exposure (not just dental x-rays)...or those in whom the lymph nodes or ultrasound of the neck seem particularly suspicious. For patients who meet one of these exceptions and for those with larger nodules, a biopsy is recommended.

If the biopsy reveals cancer, the patient is sent for surgery. For some, what's recommended is a total thyroidectomy (removal of the entire thyroid gland)...or, for some patients with the low-risk papillary cancer, what's suggested according to the guidelines is a partial thyroidectomy (removal of just the part of the thyroid with the nodule).

Despite these guidelines, however, many patients who are candidates for partial thyroidectomy instead opt for the complete thyroidectomy. Perhaps they feel nervous when they hear the word cancer and think, Take out the whole darn thing! And then they risk the treatment complications described previously. As Dr. Brito pointed out, “These patients would be better able to make informed choices if they understood the extremely low likelihood of ever developing symptoms or dying from thyroid cancer."

No one is suggesting that we simply ignore papillary cancer. But to cut back on overdiagnosis and overtreatment, we need...

Risk assessment. Doctors need better tools to identify which papillary cancers carry higher risks so they can send the right patients—rather than all of them—to the operating room. According to Dr. Brito, the signs that should raise the level of alert, especially in a patient with a family history of thyroid cancer, include a visible, palpable mass...radiation exposure during childhood...difficulty swallowing...a change in the voice...and certain features found during an ultrasound.

Large studies. Clinical trials showing what happens when people with small, low-risk papillary cancers choose to skip surgery and instead adopt an active surveillance ("watchful waiting") approach, similar to what's often done with prostate cancer, are needed in the US. In one study from Japan, patients with papillary microcarcinoma did not have surgery, but instead were followed with annual or biannual ultrasounds and measurements of blood markers for thyroid disease. Over the next 10 years, the tumors actually shrank in some patients. One-third of the participants ended up having thyroidectomies, mainly because their tumors had grown—but none of these patients had a recurrence of cancer after surgery and there were no deaths.

Renaming. Many experts think that it would be appropriate to call small, low-risk papillary tumors something other than cancer—to reduce the anxiety that comes with a cancer diagnosis and the subsequent overtreatment. According to Dr. Brito, a name such aspapillary lesions of indolent course (PLIC) might enable less emotionally charged conversations about the benefits and harms of the various treatment options. There's precedent for this. Such renaming has already occurred with other "cancers," he pointed out—for instance, what is now known as cervical intraepithelial neoplasia used to be lumped together with full-blown cervical cancer.

Self-defense: If you have a thyroid nodule or a small, low-risk papillary cancer, you do not need to rush into treatment, said Dr. Brito. Thoroughly discuss the pros and cons with your doctor—show him this article, if you need to, to get his full attention on the matter—and consider getting a second opinion from a thyroid cancer specialist.

Source: Juan Pablo Brito, MBBS, assistant professor and Health Care Delivery Scholar, division of endocrinology, diabetes, metabolism and nutrition, and coinvestigator of the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota. Dr. Brito's recent study on thyroid cancer was published in BMJ.

http://www.bottomlinepublications.com/content/article/health-a-healing/thyroid-cancer-an-epidemic-of-disease-or-overdiagnosis