Dr. Moyad: PSA Screening
by Mark A. Moyad, MD, MPH
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The U.S. Preventive Services Task Force (USPSTF), which is a diverse authoritative medical group, basically discouraged routine mammograms a few years ago. Now, the USPSTF discourages routine PSA screening. This recommendation by USPSTF did not come as a surprise because a large recent study in Europe and the United States did not show a clear benefit for PSA screening, in general. The USPSTF had a knee-jerk reaction, a move that was not unexpected by the medical community.
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However, the big story on screening was completely missed! It has been known for a long time that if a man (or woman) is in very good health then the probability that cancer screening might be beneficial is much greater as compared to a man (or woman) who is not heart healthy or has multiple other health problems. This is going to make sense if you think about it.
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If you have heart disease or another serious medical condition and you are likely to die young, then PSA screening for prostate cancer is not likely to make a difference in your life expectancy. On the other hand, if you are very healthy and likely to live a long life, then your prostate cancer risk will more often impact your life expectancy.
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Since cardiovascular disease (CVD) has been the leading cause of death in men and women for over 100 years, it makes sense for men (and women) to try and reduce their cardiovascular risk to as close to zero as possible by working with their doctors and other health care professionals. Further, to increase men’s life expectancy even more, we need to aggressively reduce alcoholism, diabetes, infections, obesity, smoking, and the number of accidents and violent acts affecting men. Men should be encouraged to consider carefully screening tests, such as colon and prostate cancer screening, or other high-risk selective screenings, such as skin cancer for those at an elevated risk. These messages deserve as much, if not more, attention as the current PSA recommendation from the USPSTF.
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We have to accept the fact that some men have been over-diagnosed and over treated for prostate cancer, but we also have to recognize the fact that screening has saved the lives of many HEALTHY men. Perhaps we need to talk about triaging preventive medicine similarly to how an emergency room evaluates patients. In other words, take care of conditions with the highest probability of causing death first and then work on the rest of the items over time. With that in mind, reduce your cardiovascular risk to as close to zero as possible and then let’s reignite the discussion on cancer screening. You should have some candid discussions with your doctor to determine what best fits you based on your overall health profile. Remember that, overall, healthier patients may benefit more from screenings.
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The Bottom Line
Perhaps you heard that the U.S. Preventive Services Task Force (USPSTF) is now discouraging routine PSA (Prostate Specific Antigen) screening, but there is more to the story on who may or may not benefit from a PSA screening test. Turns out, if you are really healthy then PSA screening could save your life, but if you are very unhealthy then PSA screening might not improve your life expectancy.
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REFERENCES:
Crawford ED, et al. Comorbidity and mortality results from a randomized prostate cancer screening trial. J Clin Oncol 2011, 29:355–361.
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This article was excerpted from Dr. Moyad’s Promoting Wellness Newsletter—Winter 2012. Sign up to receive free newsletters from Dr. Moyad and Spry Publishing here.
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Mark A. Moyad, MD, MPH, is the primary author of over a hundred medical articles and numerous books. He maintains a consulting practice on complementary medicine at the University of Michigan Medical Center, Department of Urology.
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Do You Enjoy Soy?
by Mark A. Moyad, MD, MPH
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Traditional soy products are heart healthy (may reduce cholesterol), one of the highest quality types of plant protein in the world, and the latest research suggests that they may have a role in preventing breast cancer, and preventing breast cancer from returning when consumed with or after conventional treatment. However, soy is not without controversy, as others believe that it can abnormally change thyroid hormone levels. To consider soy fully, we need to first review what is in traditional soy products, such as soybeans, soymilk, soy protein powder, tempeh, and tofu.
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Dr. Moyad’s Top Picks
What Makes Soy Healthy?
- Low calories and high in fiber
- High-quality protein
- Rich in omega-3 fatty acids
- Source of natural vitamin E and B vitamins
- No cholesterol and low in saturated fat
- Contains calcium and enzymes (proteases)
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You may want to give a try to some lightly salted edamame, green soybeans harvested before they are fully mature. A cup has 17 grams of protein (37 percent of RDA)! Soy protein powder provides a wonderful source of soy when mixed with water. Consider trying it several times a week after exercising (see article on protein earlier in the newsletter). Sorry folks, soy sauce is not an adequate source of soy, but it does taste pretty good occasionally with sushi!
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On the other hand, soy does contain compounds known as “plant estrogens,” which are also called “isoflavones.” These compounds look similar to estrogen, but they are so weak in potency that they rarely have the ability to increase estrogen levels in women or men unless they are consumed in megadoses daily. Still, health-care professionals have voiced a concern for breast cancer patients that consuming soy products may increase the risk of breast cancer returning or reduce the ability of conventional medicine to treat breast cancer. This had never been adequately studied, but the idea was to be “safe rather than sorry,” which is completely understandable.
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However, things began to change recently as some well-respected studies were completed. For one, a study of more than 5,000 surgically treated breast cancer survivors in China was conducted. Surveys were conducted 18, 36, and 60 months after diagnosis with breast cancer. The women were divided into 4 groups, based on how much soy they consumed. The low-dose soy group consumed about a half a cup of soymilk per day, while the high-dose group ingested about 3 cups per day. After 4 years, 7.4 percent of those who ate the most soy died as compared to 10.3 percent of those who ate the least soy. There were also somewhat similar reductions in the risk of cancer returning recorded. In other words, there was approximately a 30 to 40 percent reduction in risk of dying earlier or of cancer coming back.
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What these results suggest is that it is probably safe for women with breast cancer to consume natural or whole-food sources of soy. However, results do not consider if soy dietary supplements are safe, so they are best avoided at this time. Some researchers believe that soy may work by acting somewhat like a breast cancer drug and not allowing estrogen to stimulate breast cancer cells. The most amazing finding of the study is that the reduction in risk was not just found in estrogen-receptor-positive breast cancer patients and tamoxifen users, but also those with estrogen-receptor-negative or more aggressive breast cancers, and in pre- and post-menopausal women!
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Perhaps the reason dietary soy is beneficial relates to the health properties of soy listed earlier. Soy may also reduce the risk of breast cancer. However, it is also important to know that the women consuming the most soy exercised more, consumed more cruciferous vegetables (broccoli, brussels sprouts, kale), ate more fish, drank tea, and used vitamin supplements. They also consumed more meat, so soy food was generally associated with a healthier lifestyle. Meat consumption itself was not related to breast cancer survival. A recent study of California breast cancer survivors found somewhat similar results, especially for estrogen-positive breast cancers.
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We do need to also keep in mind that in many Asian countries soy consumption starts very early in life and continues into older age, so the benefits may be greater from life-long consumption as compared with recent consumption of these foods. This may account for why the strongest positive results for soy and breast cancer prevention comes from Asian population studies and the results have not been as impressive in Western population studies.
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This study should not make anyone want to stop their prescription breast cancer medications, but it may make someone want to consider combining their medication with daily soy product intake. Talk to your doctor about the latest research and what is best for your individual situation.
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As a final note on soy, I receive questions about soy and the impact on thyroid levels. This has received a lot of hype! In recent study results, soy consumed in moderation really has been found to have minimal or no impact on thyroid levels, including in women who are pregnant. Talk to your doctor about this if you are concerned, but, in general, I do not believe that soy has any effects on thyroid function (positive or negative).
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Ultimately, we are not exactly sure why most breast cancers occur, but researchers agree that maintaining a healthy weight and staying heart healthy is one of the best ways to potentially prevent breast cancer. It may also help patients being treated for breast cancer. While soy does not have any magical powers, it may be associated with a diet that is low in calories and that can help some folks lose weight and remain heart healthy.
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The Bottom Line
In one of the largest studies of breast cancer survivors, increasing soy consumption from food (not from dietary supplements) up to 11 grams of soy protein per day (or soy isoflavone intake up to 40 mg/d) reduced the risk of breast cancer returning and reduced the risk of dying from breast cancer.
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REFERENCES:
Dong JY, Qin LQ. Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies. Breast Cancer Res Treat 2011, 125:315–323.
Maskarinec G, Ollberding NJ, Conroy SM, et al. Estrogen levels in nipple aspirate and serum during a randomized soy trial. Cancer Epidemiol Biomarkers Prev 2011, 20:1815–1821.
Zhang CX, Ho SC, Cheng SZ, et al. Effect of dietary fiber intake on breast cancer risk according to estrogen and progesterone receptor status. Eur J Clin Nutr 2011, 65:929–936.
Shu XO, Zheng Y, Cai H, et al. Soy food intake and breast cancer survival. JAMA 2009, 302:2437–2443.
Li J, Teng X, Wang W, et al. Effects of dietary soy intake on maternal thyroid functions and serum anti-thyroperoxidase antibody level during early pregnancy. J Med Food 2011, 14:543–550.
Mittal N, Hota D, Dutta P, et al. Evaluation of effect of isoflavone on thyroid economy and autoimmunity in oophorectomised women: a randomized, double-blind, placebo-controlled trial. Indian J Med Res 2011, 133:633–640.
Guha N, Kwan ML, Quesenberry CP Jr, et al. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology Study. Breast Cancer Res Treat 2009, 118:395–405.
Hilakivi-Clarke L, Andrade JE, Helferich W. Is soy consumption good or bad for the breast? J Nutr 2010,140:2326S–2334S.
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This article was excerpted from Dr. Moyad’s Promoting Wellness Newsletter—Winter 2012. Sign up to receive free newsletters from Dr. Moyad and Spry Publishing here.
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Mark A. Moyad, MD, MPH, is the primary author of over a hundred medical articles and numerous books. He maintains a consulting practice on complementary medicine at the University of Michigan Medical Center, Department of Urology.
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Welcome to the Spry Wellness Blog!
Welcome to the Spry Wellness Blog! Thanks for joining us.
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I’m Jeremy Sterling, Director of Marketing at Spry Publishing. It’s with great pleasure and honor that I am writing this inaugural post for our new Wellness Blog.
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Our organization has been blessed with such an abundance of useful information! Our publishing program, which specializes in patient support and medical resource books on a wide variety of health-related topics, has opened doors that enable us to work with a truly extraordinary group of authors, each of whom is among the top minds in his or her respective field. We strive to ensure that the books and ancillary materials we publish with our authors are timely, useful, and educationally valuable, but even the world’s best and longest book could barely begin to scratch the surface of the wealth of knowledge that these individuals have to offer.
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Throughout this blog, we hope to share some of this beneficial but yet unpublished wisdom that we have at our fingertips. Topics will vary, but a few primary areas of focus will include general health and wellness, diet and nutrition, diabetes, prostate and other forms of cancer, advancements in clinical research and medical technology, new drugs and treatment options, parenting and child development, books, literacy, and the ever-evolving publishing industry. You may also expect to see a somewhat random sprinkling of current events, contests and quizzes, and the occasional spotlight on an amazing individual with an incredible story that shouldn’t be missed.
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I’ll be serving as the main moderator for the blog and will also be one of the regular posting contributors. In addition, we’ll feature information from some of my colleagues here at Spry Publishing, articles from our authors and editors, as well as guest posts from other bloggers and different authorities on the various subjects that we’ll be discussing.
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Your participation and candid feedback are HIGHLY ENCOURAGED! Without readers, this blog has no reason to exist. We’ll be glad to hear from you any time at all, so please feel free to contribute to the discussion in the posts, email us directly, or visit us on Facebook and Twitter and join the dialogue there. Those pages will be integrated with this blog, but they will continue to host exclusive posts, links, media, and other information daily.
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We hope you enjoy the information you find here, and that you find it inspiring and educational. Please don’t hesitate to drop me a line and let me know how we’re doing. We look forward to hearing from you!
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