Risk of Cancer After Nuclear Accidents

With the recent Fukushima disaster (pictured above), the topic of nuclear disasters is at the forefront of all of our minds.  Nuclear accidents are a terrible tragedy on so many levels, from the damage done to the environment, to the effects on wildlife, the people, the society, and the economy of the country affected.    Once the initial period of damage control and clean up is tended to, the work and surveillance of the population from a health standpoint has only just begun.  A recent article in the Canadian Medical Association Journal provides a poignant reminder of this fact.

The article by Dmytriw and Pickett describes the case of a man who developed a glioblastoma brain tumor which occurred 24 years after his exposure to the Chernobyl nuclear disaster in 1986.  The Chernobyl power plant disaster remains the worst accident at a nuclear power plant in history, resulting in radioactive fallout covering large parts of the western former Soviet Union.  While the studies in the 4 years after Chernobyl found an increased incidence of leukemia, thyroid cancer did not show to be significantly increased until 16 years after the Chernobyl accident, at which time the risk was found to be 4.3 times that of the general population.  These papillary thyroid cancers were also found to be more aggressive in their behavior than typical papillary thyroid cancers.

Going beyond this time frame into today, now 27 years after Chernobyl, it is hard to quantify the risk of tumors caused by Chernobyl, as follow up of people who lived in the affected area becomes very difficult.  An increased risk of breast cancer and brain tumors has been suggested, but difficult to prove definitively.  In terms of distance from Chernobyl that can put a person at risk, the United Nations Scientific Committee on the Effect of Atomic Radiation (UNSCEAR) has indicated that individuals who lived as far as 2,000 km away from Chernobyl may develop cancer beyond the minimum latency times normally associated with exposure to radiation.

The bottom line?  As health care providers, we must remember to ask about exposure to nuclear accidents, remembering that tumors can develop more than 20 years after exposure.  If you are a person that has been exposed to a nuclear disaster such as Chernobyl or Fukushima, make sure your health care providers over the long term are aware.

Finally, cases of cancer that arise among people who were exposed to nuclear accidents should be reported to the appropriate authority, with the patient's consent.

The Fukushima Registry for cases of cancer amongst people who were living in Japan at the time of the Fukushima disaster is accessed by emailing ftiiki@fmu.ac.jp.

The Chernobyl Registry for cases of cancer amongst people who were living in Ukraine, Belarus or Russia around the time of the Chernobyl disaster is accessed by emailing info@nrer.ru (for Russia or Belarus) and moz@mov.gov.ua (for the Ukraine).

Twitter @drsuepedersen

www.drsue.ca © 2013

Read more...

Aircraft Noise Exposure May Increase Heart Disease and Stroke Risk

Regular readers will know that I often talk about pollutants and chemicals in our environment that may adversely affect our health (from water bottles to soup cans to the soap we use, and many more).  I came across some interesting articles in my reading this week that add to the literature suggesting that even noise pollution may be dangerous to our health.

In the recent edition of the British Medical Journal, there are two studies and an editorial review discussing the risk of stroke and heart disease for people who live in proximity to airports.

As Dr Fiona Godlee, editor in chief of the journal writes:


The first study compared hospital admissions and mortality rates for stroke, coronary heart disease, and cardiovascular disease from 2001-05 in 12 London boroughs and nine districts west of London. The researchers found increased risks of stroke, coronary heart disease, and cardiovascular disease for both hospital admissions and mortality, especially among the 2% of the study population exposed to the highest levels of daytime and night time aircraft noise.

In the second study, researchers at the Harvard School of Public Health and Boston University School of Public Health analysed data for over six million older American Medicare recipients (aged 65 years or more) living near 89 US airports in 2009.
The researchers found that, on average, zip codes with 10 decibel (dB) higher aircraft noise had a 3.5% higher cardiovascular hospital admission rate. The association remained after adjustment for socioeconomic status, demographic factors, air pollution, and roadway proximity.

An accompanying editorial says the results have implications for planners when extending airports in heavily populated areas or planning new airports.


As noted in the editorial by Professor Stansfeld, 

These studies provide preliminary evidence that aircraft noise exposure is not just a cause of annoyance, sleep disturbance, and reduced quality of life but may also increase morbidity and mortality from cardiovascular disease. The results imply that the siting of airports and consequent exposure to aircraft noise may have direct effects on the health of the surrounding population. Planners need to take this into account when expanding airports in heavily populated areas or planning new airports.


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2013

Read more...

Do Group Classes Work to Improve Diabetes Control?

As the sheer numbers of people who develop diabetes continues to climb, we as health care providers need to look at creative ways to provide the in depth information and teaching that is required to help patients take the best possible care of their diabetes.   One of these approaches is to teach about diabetes in the form of group classes.  The question is, has the group teaching approach been proven to improve diabetes control?

Many studies have actually been done on this subject, ranging from observational studies to randomized controlled trials.  A meta-analysis in the Canadian Medical Association Journal by Housden et al, which looks at all of the literature on this topic to date, found that the class teaching approach improves hemoglobin A1C (a marker of overall diabetes control) by -0.46%.  While this is only a modest improvement in diabetes control, it is not much different than the A1C improvement we may expect to see in a patient who is close to A1C targets but not quite there, following addition of another oral medication.  

Anecdotally, I have often had my patients report back to me that they have really enjoyed being part of a diabetes education class, as it not only provides excellent information, but it also provides the opportunity for diabetics to support each other, and talk to each other about their experiences.  Knowing that you are far from alone in your diagnosis of diabetes can often go a long way to feeling secure and empowered in your journey towards improving upon your health!

If you are a diabetic and interested in group education classes, ask your doctor what is available.  Most centres of diabetes care (including our own) offer group classes free of charge.  Give it a try!


Follow me on twitter! @drsuepedersen

www.drsue.ca © 2013

Read more...

Ending The Diet Debate

If you're a person looking for dietary advice to embark on a successful weight management journey, it can be an overwhelming and confusing task to try to navigate all the information that is out there.   I am often asked by my patients about the Zone, Atkins, Paleo, South Beach Diet, and many others.  The question is, is there a certain type of food, or proportion of protein, carbohydrate, and fat that makes up the magical formula to successful weight loss?

The answer to this question, as summarized in a recent article by Dr Sherry Pagoto in JAMA, is that research does not support that any one diet composition is better than another to result in successful weight loss.  As Dr. Pagoto notes,

"The ongoing diet debate exposes the public to mixed messages emanating from various trials that have yielded little but have heavily reinforced a fad diet industry."

What does matter is adherence - in other words, when you start a food plan, can you stick to it in the long term?   I don't use the word 'diet' when I'm counselling my patients - I use the words 'permanent lifestyle change'.    Don't bother making a change unless it is a change that you can stick to for the rest of your life - doing a certain program for the short term may help you to lose weight, but when you stop the program, what will happen?  The reality is that about 95% of people will regain the weight, and then some.

Remember that it's not about dropping weight fast - a plan that results in rapid weight loss is probably quite drastic, and is unlikely to be a permanent lifestyle change.  Successful weight management is about gradually losing weight (1-2lb per week) with permanent lifestyle change, and keeping it off by making those changes permanent.

Remember that for someone with obesity, losing 5% of your body weight and keeping it off decreases the risk of developing complications of obesity and prolongs lifespan - the greatest success of all!

@drsuepedersen

www.drsue.ca © 2013

Read more...

Could Obesity Surgery Increase the Risk of Colon Cancer?

As for any medical treatment or surgery, the decision to undergo bariatric surgery requires that the benefits and risks are carefully evaluated by the patient and the health care team.  Amongst the list of benefits, several studies have suggested that bariatric surgery decreases the risk of cancer amongst women.   Now, a new study suggests that the risk of colorectal cancer may actually be increased after obesity surgery.

The study was an evaluation of the population database in Sweden, looking at the colon cancer incidence rates amongst men and women who had obesity surgery (gastric bypass, gastric banding, and an older procedure called vertical banded gastroplasty), compared to patients with obesity who did not have bariatric surgery.  They found that amongst those who had had bariatric surgery, the risk of colon cancer was 60% higher than those who hadn't had surgery (though the absolute numbers were fairly low - 70 out of 15,095 patients, or 0.46% of patients who had obesity surgery developed colon cancer).  Ten years after bariatric surgery, the risk of having colon cancer was double compared to people with obesity who hadn't had bariatric surgery.

These results need to be taken with a grain of salt, as there are a number of limitations to this database analysis - for example, other risk factors associated with colon cancer such as smoking, diabetes, family history etc were not available (the interested reader can read more about this here).  The study does seem to contradict the overall protective effect that bariatric surgery is thought to have on cancer risk (for women, at least) - but then again, most previous studies have not followed up patients for as long as this one, and colon cancer is known to be a very slow growing tumor.

Following gastric bypass surgery, it has been suggested that the lining of the intestine may change (called 'mucosal hyperproliferation'), and an increase in a pro-tumor chemical has been found (a cytokine called 'macrophage migration inhibitory factor'), though other tumor inducing chemicals (such as TNF alpha and interleukin 6) have been shown to decrease after bariatric surgery.  The population of intestinal bacteria change after surgery as well, and there is still much we don't know about the effects of these changes (though there appear to be metabolic benefits of these post-surgery bacterial changes).

So where does this leave us?  Well, there are still many questions to be answered about the long term efffects of bariatric surgery, which only time will teach us.  In the meantime, we must continue to carefully weigh the benefits and risks of obesity surgery, and for patients who have had bariatric surgery, colon cancer screening and surveillance should be undertaken.

@drsuepedersen

www.drsue.ca © 2013

Read more...

Weight Discrimination and Bullying

I really have to hand it to my fellow author Dr Rebecca Puhl for writing a fantastic chapter in our ‘Complications of Obesity’ textbook, about the effect of obesity stigmatization and bullying on both children and adults.  Here are some jaw-dropping and very sobering statistics and facts that she shares with us:

Discrimination in the workplace:  for the same work performed, obese women earn 6% less than healthy weight women, and obese men earn 3% less than thinner men.

Some studies have shown that managers are more willing to hire a less qualified thinner candidate, than a more qualified overweight candidate.

Health care discrimination: 69% of women report being stigmatized about their weight by their own doctor (eg feeling disrespected, dismissed, and/or upset about comments made by their MD)

One study reported that 68% of women with obesity delayed their medical care due to feeling embarrassed about being weighed, disrespected by health care providers,  and because gowns, examination tables, and other medical equipment were too small for them.

A vicious cycle:  79% of women in one study reported coping with weight stigma by eating more food.

People closest may hit the hardest: 60% of overweight people report friends, and 47% name their own spouses, as perpetrators of weight bias.

And the two that hit me the hardest:

Suicide risk in youth: over 50% of girls who experienced weight based bullying by peers or family contemplated suicide.

Suicide risk in youth: 13% of boys who were teased by family members about their weight reported attempting suicide (more than three times the risk compared to those who were not teased).

As I have blogged many times before, the stigmatization against people with obesity desperately needs to STOP.  As Dr Puhl concludes:

The stigmatization, bullying, and discrimination of obese children and adults are pervasive and lead to damaging consequences for individuals who are targeted… The adverse psychological, social, and health consequences resulting from weight stigmatization must also be prioritized in efforts to prevent and treat obesity.

@drsuepedersen

www.drsue.ca © 2013

Read more...

How Does Exercise Affect Your Hunger?

Each of us is created as a unique and beautiful person - and with that uniqueness, there is also a 'Best Weight' for each of us - a realistic weight goal (which is different for everyone) that optimizes metabolic health and overall wellbeing.  This Best Weight is at least partially genetically determined, with a number of factors likely to be players, including the weight at which the balance of our hunger and satiety hormones leave us feeling satisfied.

In keeping with this hypothesis, a new study shows us that exercise affects hunger hormones and feelings of fullness differently in people who are thin, compared to people who struggle with their weight.

The study had lean and obese participants walk for an hour on a treadmill in the evening, and served them a meal the following morning.  On a separate day, they offered the participants the same breakfast, but without exercising the night prior.

In the lean people, they found that the hunger hormone ghrelin was decreased the morning after exercise.  When the lean people were served breakfast, they felt just as full from the breakfast whether or not they had exercised the night before.

In the people with obesity, there was no decrease in the hunger hormone ghrelin after exercise (as there was for the lean people), and they felt markedly less full after breakfast when they had exercised the night prior.

The Bottom Line: another study to add to the list that teaches us that weight struggles are SO much more than calories in and calories out.

www.drsue.ca © 2013 @drsuepedersen

Read more...