Newsletter 06/23/18 – Solstice Salutations

To My Patients,

Here are this week’s medical updates …enjoy!

Concussions very common in high school athletes

Approximately 15% of U.S. high school students have had at least one sports-related concussion in the last year, according to a recent report from the Centers for Disease Control, and 6% experience two or more sports-related concussions.  Concussions occur more frequently in males than in females and are more commonly seen in team sports participants.  Concussions are serious business: if not handled appropriately, they can lead to prolonged symptoms (post-concussion syndrome) and even long-term cognitive deficits.

Please be sure your students, trainers and coaches remain educated about the risks of concussion, proper protection measures, signs and symptoms to watch for, the importance of removing an athlete from play when he or she exhibits signs of a concussion, and proper protocols for safe return to play and school after a concussion.  For more useful information on this important topic, read here.

Breast cancer in men

Although we think of breast cancer as primarily a disease in women, the lifetime risk for breast cancer in men is approximately 1 in 1000, which is not trivial.  In 2018, it is estimated that we will see approximately 2,550 new cases of breast cancer in men, and approximately 480 men will die from the disease.

As with many cancers, breast cancer in men is age-related, and the risk is higher when there is a family history of breast cancer.  The most important risk factor for males is carriage of a BRCA gene mutation; other inherited genetic mutations (such as PALB2, CHEK2 and PTEN) may also be associated.  Risk factors also include heavy alcohol use, radiation exposure, liver disease, obesity, certain genetic syndromes (such as Kleinfelter Syndrome), some testicular conditions (such as undescended testes, history of adult mumps or of testicular removal).  Conditions or medical treatments associated with increased estrogen levels may also pose increased risk (for example: certain prostate cancer treatments).

To date, research does not support routine screening for breast cancer in men; however, the National Comprehensive Cancer Network guidelines recommend that men who carry a BRCA mutation receive breast self-examination training and undergo yearly breast exams starting at age 35, and should consider prostate cancer screening starting at age 45.  There are currently no recommendations for routine imaging (mammography, ultrasound or MRI) for these men, however.  It’s worth noting that BRCA gene mutations can also be associated with ovarian, pancreatic, and testicular cancers.  So for men with a relevant family history, it would be reasonable to carefully discuss the pros and cons of genetic screening with a qualified professional who has expertise in this complex and evolving field.

Another inconvenient truth

Although this may not come as a surprise to many, we have medical evidence proving that ultra-processed foods really aren’t good for us.  Irritable bowel syndrome (IBS) is a common diagnosis that affects up to 25% of people in the U.S.  IBS symptoms can include abdominal cramping or bloating, excessive gas, diarrhea or constipation and mucus in stools.  The syndrome can vary in its severity, but in extreme cases it can be debilitating.  Yet everyone who is reading this knows somebody who suffers from IBS.  A study recently published in the American Journal of gastroenterology has found that adults with diets high in ultra-processed foods and beverages (shelf-durable packaged convenience foods and drinks chock full of additives and artificial ingredients) are at increased risk for developing IBS.  All nutritional concerns aside (although they matter tremendously), this represents one additional solid rationale for avoiding these products.  My basic take-home message:  the longer the list of ingredients on the package, the less likely it is that your body will recognize it as actual food and will therefore rebel.

Vitamin D and colon cancer

A study recently published in the Journal of the National Cancer Institute has determined that higher levels of vitamin D in the blood are associated with a reduced risk for colon cancer in women (for reasons which are not clear, the same association was not found for men in this study).  How we define the optimal level of vitamin D remains an area of controversy in medicine, and groups differ as to whether or not vitamin D levels should be checked on a regular basis.  However, these researchers concluded that optimal levels of vitamin D for the prevention of colon cancer are likely higher than those generally recommended for maintaining bone health.  Although this study does not prove cause-and-effect,  it would be reasonable to ask your doctor about ways in which you can optimize your vitamin D level.

Be moderate

The reviews on alcohol intake have generally been mixed.  Previous studies have demonstrated that drinking moderate amounts of alcohol (guidelines suggest up to one drink per day for women and up to two for men… sorry ladies) can improve heart health.  However, other studies have demonstrated harms, including increasing cancer risk.  A recent collaborative study involving researchers at the National Cancer Institute found a direct correlation between alcohol intake and dying from cancer.  Heavy drinkers were found to be at greatest risk.  For example, liver and esophageal cancers are more common in men who drink three or more servings of alcohol per day.  Colon cancer and breast cancer are also associated with increased alcohol intake (see above).  And we all already know about the risks that excessive alcohol intake poses to our livers, hearts and brains, so I’ll keep it short… please think moderation while you enjoy those summer cocktails!

That’s all for now… have a great (safe) weekend!