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First link between bisphenol-A exposure during adulthood and prostate cancer risk

MD-FM Thursday March 6, 2014


SARAH: MD-FM, medical news from around the world with Peter Goodwin.


SEGMENT 1: PROSTATE CANCER: Adult exposure to bisphenol-A could promote cancer development


PETER: Hello, and with me is Sarah Maxwell. For the first time a link has been demonstrated between prostate cancer and exposure to the synthetic compound bisphenol-A, that’s the one used everywhere in plastic bottles and things like epoxy resins and that has hormone-like properties.



Yes, among 60 male urology patients those with prostate cancer had urine BPA levels 2 to 4 times higher than those without prostate cancer. That was in a study just published in the journal PLoS One. Lead author Shuk-mei Ho gave us the details:



There are overwhelming experimental data showing connections between BPA and various kinds of cancers, to type 2 diabetes and also obesity, and this probably is the first study that is connecting urinary BPA with prostate cancer in men. So maybe now we should conduct larger studies to validate that this is true.



Dr. Shuk-mei Ho, director of the Cincinnati Cancer Center and Chair of Environmental Health at the University of Cincinnati College of Medicine, who told us the study suggests that trying to reduce BPA exposure as much as possible might be wise...


Actually some countries are taking more active measures to keep BPAs out of the food chain…Like banning them from baby bottles and water containers for instance:



Yes. And that’s good news because working in isolated human prostate cells in the lab, the Cincinnati team showed that even extremely low BPA levels induced the sort of abnormalities often observed in cancers. Dr. Gail Prins, who didn’t participate in the study, gave us a comment:



The focus of work in this field has more been towards what does early life exposure do and this data suggests that exposure to BPA in adult life can continue to be harmful and can help to promote prostate cancer growth or make it behave more aggressively than if BPA is not present –at very low doses. So this was important new information.


SARAH: That was Dr. Gail Prins, from the University of Illinois in Chicago.

SEGMENT 2: Yoga reduced stress hormone levels in women with breast cancer


PETER: Yoga might provide more than just relaxation for women with breast cancer! A randomized study in the Journal of Clinical Oncology has reported that breast cancer patients who practiced yoga regularly during their radiation treatment had steeper declines in their cortisol levels through the day than those who practiced standard stretching exercises or no activity at all. This throws some interesting light on why higher stress hormone levels throughout the day have been linked to worse outcomes in breast cancer.


SEGMENT 3: Anticoagulation with warfarin can be beneficial in patients with atrial fibrillation and chronic kidney disease



Anticoagulation with warfarin could be beneficial in patients with atrial fibrillation even if they have chronic kidney disease...



Yes. A Swedish study in JAMA reports that patients with AF and chronic renal disease who were discharged on warfarin after a heart attack had lower risks of death, myocardial infarction and ischemic stroke at one year compared to those who weren’t. Also, warfarin didn’t increase bleeding. Lead study author Dr. Carrero:



We went from mild, moderate to severe end stage renal disease and we observed that warfarin treatment, in each stage of chronic kidney disease, was associated with a lower rate of events.



That was Juan Jesus Carrero, from the Karolinska Institutet in Stockholm. And he explained that, in the past two to three years, practitioners have backed off from warfarin treatment in these patients after a few studies suggested it might increase the risk of bleeding, stroke and death in patients on dialysis. In an editorial comment in JAMA, Dr. Mintu Turakhia pointed out that the benefits of warfarin might not have been spotted in another setting:



Sweden does better with managing warfarin than any other country, anywhere. In the United States, we are significantly worse at managing warfarin and it’s not clear that the same benefits would be shown.



That was Mintu Turakhia from Stanford University, in California, who told MD-FM this was a step forwards:



I think the reason this advances things is: don’t be dismissive of chronic kidney disease as a reason to not anticoagulate. These patients are at high risk for stroke, we know that, and although the data is observational, it’s a well done study and they’ve shown that you can accomplish meaningful reductions in stroke and avoid excess bleeding if you manage the warfarin carefully.



Mintu Turakhia, from Stanford in the USA.


SEGMENT 4: Rheumatologists should not recommend herbal cannabis for relief of chronic pain


Rheumatologists have no rational basis for recommending herbal cannabis to relieve chronic pain. This is what the authors of an article in Arthritis and Research warn after reviewing the literature on the benefits of marijuana in the context of rheumatoid arthritis. Lead author Dr. Mary-Ann Fitzcharles from Quebec, where medical marijuana is authorized, gave us the background:



Most persons using herbal cannabis report that they are using it for musculoskeletal conditions… Although herbal cannabis has been somewhat studied in neurological disease, in conditions where patients have severe nausea, vomiting etc., there has never been a single study examining herbal cannabis in patients with any rheumatic disease.



But Dr. Fitzcharles wants to see more scientific studies on marijuana in the context of rheumatic diseases:



I think the use has been driven by anecdote and a tremendous groundswell of public advocacy that has overtaken good scientific evidence. These molecules probably do have very important effects but just throwing at the body a mass of molecules and hoping that you’ll sort of hit the right one, I don’t think, in the 21st century, represents good medicine. We need to understand the individual molecule, the dosing, what the levels in the bloodstream represent and we need many proper studies looking for the positive and the negative effects.



Mary-Ann Fitzcharles, from McGill University in Montreal, Quebec.


SEGMENT 5: First evidence that genome editing made patients with AIDS more resistant to HIV



For the first time, researchers have managed to make a few patients with AIDS more resistant to HIV by infusing genetically-modified immune cells.


SARAH: Yes. A report in the New England Journal of Medicine describes how state of the art genetic engineering was harnessed to shut down the expression of a gene, called CCR5, that codes for a receptor that enables HIV to infect immune cells. We already know that the rare people who naturally have one mutated CCR5 copy are more resistant to HIV, and those with two copies are immune to it! The investigators infused these genetically modified cells into 12 patients already taking antiretroviral treatment. Carl June, senior author of the study:



So the main issue would be: would it be safe? And there were no significant side effects and the first patient was treated in July of 2009 and still has had no side effects and still has engraftments –meaning we can still find the genetically modified cells that are HIV resistant.


SARAH: Dr. Carl June, from Philadelphia. And he also told us that the infused cells survived and were more resistant to HIV than the patients’ own cells, even in those who were taken off ART for 3 months. The researchers are now going to increase the dose of infused cells and test the safety of longer treatment interruption.


PETER: Mark Kay wrote an editorial in the New England Journal of Medicine on this and he said that pre-transfer engineering has room for improvement.



The technology is such that the number of cells that probably had both copies of the gene knocked out was pretty low and, ultimately, to get this to work on a level that could be used in patients for a real therapeutic benefit, would probably require an approach that would allow both genes to be knocked-out. You could then have much more resistance or total resistance to most HIV strains.



Dr. Mark Kay from Stanford University in California.


IN BRIEF 1: Certain gut microbes may influence the development of colon cancer


PETER: Finally, in brief: It may one day be possible to reduce the risk of colorectal cancer by removing certain types of gut bacteria. That’s according to an animal study published in The Journal of Experimental Medicine. The researchers treated mice carrying polyp-causing mutations with antibiotics. This prevented polyp formation and it suggests that bacteria are essential for early tumour development. Further research is now needed to identify which cancer-promoting bacteria are involved.


IN BRIEF 2: People at cardiovascular risk could benefit from early prevention with lipid-lowering drugs


PETER: In another study in mice, reported in PLoS Genetics, scientists showed how atherosclerosis was reversed by lowering LDL-cholesterol. While early-stages regressed completely, later-stages of atherosclerosis were resistant to treatment. The authors conclude that humans at high risk of cardiovascular disease would benefit from early prevention using lipid-lowering drugs. They also discovered new molecular targets that could help improve responsiveness to LDL-cholesterol therapy in advanced atherosclerosis.


PETER: That's all from MD-FM for now. Do join us for more next week.  Until then, from Sarah Maxwell and from me Peter Goodwin, good-bye!









Previous editions


Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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