Tag Archives: New England Journal of Medicine

Obesity linked to increased cancer risk

Two out of three adult Americans are at greater risk for getting cancer — and for dying of it — than they need to be, according to a story in the Chicago Tribune. Not because of smog in their air or radon in their basements. Not because of tobacco in their cigarettes or mutations in their genes.

No, the particular cancer risk shared by these 150 million or so Americans comes from having too many calories in their diet and too little exercise in their daily lives.

In other words, from being overweight.

It’s widely known that simply being overweight, let alone obese, dramatically increases the risk for high blood pressure, heart attacks, strokes and diabetes. But according to a 2009 survey by the American Institute for Cancer Research, only about 50 percent of Americans know that size also matters when it comes to cancer.

The risk is not trivial. The same institute estimates that every year about 100,000 Americans get a cancer they wouldn’t have gotten if they had kept their weight in check. And researchers have estimated that about 14 percent of cancer deaths in men and 20 percent in women could be avoided by this same restraint.

Obesity can raise the risk for a number of major cancers — colon, postmenopausal breast, endometrial, kidney and esophageal — the National Cancer Institute says, and when paired with physical inactivity, it can be held liable for 25 percent to 30 percent of cases of those cancers. Obesity has also been linked to a number of other cancers, including liver, gallbladder, pancreatic and ovarian.

“Obesity is almost like the new smoking,” says Dr. Anne McTiernan, director of the Prevention Center at the Fred Hutchinson Cancer Research Center in Seattle. “The effect isn’t as big for most cancers, but it’s so prevalent that it will have a huge impact.”

Indeed, the National Cancer Institute estimates that smoking accounts for 37.5 percent cancer deaths in men and 22.8 percent in women. But smoking does most of its dirty work in lung cancer victims. When lung cancer is taken out of the picture, smoking can only be blamed for 12 percent of cancer deaths in men and 6 percent in women — fewer than can be chalked up to excess pounds.

No one knows for sure exactly how weight increases cancer risk, but it’s likely that it does so in multiple ways, with the precise mechanism differing from cancer to cancer. High levels of estrogen, insulin and inflammatory compounds are among the suspects that have been implicated in research to date.

A more precise understanding of the biology behind all this may someday lead to drugs that can mitigate the damage. In the meantime, of course, there’s an excellent way to avoid the obesity risk, and that’s to never become obese at all.

“That would require major lifestyle changes for many of us, and making such changes is exceedingly hard,” said Dr. John Glaspy, an oncologist at UCLA’s Jonsson Comprehensive Cancer Center.

“Sure, we could make it a death penalty offense to sell sugared drinks. But short of such extreme modes of encouragement, a widespread thinning of America is not to be expected anytime soon.”

Not only is there strong evidence that if you’re overweight, you’re more likely to die of cancer. It’s also been shown that the more overweight you are, the more deadly the trend gets, according to a landmark study published in the New England Journal of Medicine in 2003.

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Relief may be available for irritable bowel syndrome

An antibiotic widely used to treat diarrhea in travelers may also provide some relief to people with the common and difficult-to-treat condition known as irritable bowel syndrome (IBS), according to a pair of new studies in the New England Journal of Medicine.

The Food and Drug Administration (FDA) has not yet approved the antibiotic, rifaximin, for use in IBS, which affects as many as 1-in-5 U.S. adults. The agency is currently reviewing the drug for that purpose and is expected to make a decision in March.

In the studies, 1,200 IBS patients took rifaximin or a placebo pill three times a day for two weeks. Roughly 40 percent of the patients who took the antibiotic reported substantial relief from symptoms such as bloating, abdominal pain, and loose stools for at least two weeks during the subsequent month, compared to a little under one-third of the patients taking placebo.

All of the patients in the studies had a form of IBS that does not involve constipation.

“It made all the symptoms of irritable bowel syndrome better, which we don’t see too often in studies,” says the lead researcher, Mark Pimentel, MD, a gastroenterologist at Cedars-Sinai Medical Center, in Los Angeles.

Rifaximin, sold under the brand name Xifaxan for travelers’ diarrhea, appears to be safe and doesn’t seem to foster resistance among gut bacteria, meaning it can be used over and over, Dr. Pimentel said.

That could be important, because the number of study participants who reported lasting relief from their two-week rifaximin regimen gradually declined in the 10 weeks following treatment.

Study: Tai chi may give relief to fibromyalgia sufferers

The ancient Chinese practice of tai chi may be effective as a therapy for fibromyalgia, according to a study published on Thursday in The New England Journal of Medicine, according to a story in the New York Times.

A clinical trial at Tufts Medical Center found that after 12 weeks of tai chi, patients with fibromyalgia, a chronic pain condition, did significantly better in measurements of pain, fatigue, physical functioning, sleeplessness and depression than a comparable group given stretching exercises and wellness education. Tai chi patients were also more likely to sustain improvement three months later.

“It’s an impressive finding,” said Dr. Daniel Solomon, chief of clinical research in rheumatology at Brigham and Women’s Hospital in Boston, who was not involved in the research. “This was a well-done study. It was kind of amazing that the effects seem to carry over.”

Although the study was small, 66 patients, several experts considered it compelling because fibromyalgia is a complex and often-confusing condition, affecting five million Americans, mostly women, according to the Centers for Disease Control and Prevention. Since its symptoms can be wide-ranging and can mimic other disorders, and its diagnosis depends largely on patients’ descriptions, not blood tests or biopsies, its cause and treatment have been the subject of debate.