Category Archives: Skin Cancer

Good news for coffee drinkers: the health benefits outweigh the risks for most people

By Morgan Wharton and Jessica Cote
Updated 2015

latte-249102_640Most Americans drink coffee every day.1 The caffeine in coffee helps us stay alert but also may cause jitteriness and interfere with sleeping. A few studies suggest that decaffeinated coffee also has health benefits, perhaps because of antioxidants or acids in the coffee bean.2

What Are The Health Benefits Of Drinking Coffee?

For years medical experts advised people to drink less coffee, mostly because of research suggesting coffee might increase the risk of heart disease. However, numerous studies conducted recently have discovered coffee’s unexpected health benefits. Like all well-designed research, most of these studies considered the impact of age, sex, body mass index (BMI), physical activity, tobacco use, and whether family members had developed cancer. By controlling for those factors, researchers made sure they could separate coffee’s impact on health from the effects of people’s lifestyle, family history, and previous health problems.

Colorectal Cancer

Meta-analyses are a kind of statistics that combine data from several comparable studies to make one very large study. These results are usually more accurate than any one study can be. Taken together, three meta-analyses suggest that drinking about four or more cups of coffee per day may reduce the chances of getting colorectal cancer by 11-24%.345

Endometrial (uterine) Cancer

Using data from 67,470 women who participated in the Nurses’ Health Study, researchers found that women who drank four or more cups of coffee per day were 25% less likely to develop endometrial cancer than women who drank only one cup of coffee per day. Compared to women who did not drink any coffee, those who drank four cups or more per day were 30% less likely to develop endometrial cancer. Decaffeinated coffee was just as effective as caffeinated coffee, but caffeinated tea did not lower the risk of endometrial cancer.6

Liver Cancer And Cirrhosis (Scarring of the Liver/Chronic Liver Disease)

One study found people who drank one or two cups of coffee per day had a slightly lower risk of getting the most common type of liver cancer compared to non-drinkers, but people who drank three or four cups of coffee were about half as likely as non-drinkers to get this kind of liver cancer. Meanwhile, people who drank five or more cups per day had an even lower risk than that (about one-third the risk of non-drinkers).7

Similarly, a study in Japan found a 76% decrease in the risk of that type of liver cancer in people who drank at least five cups of coffee per day compared to those who did not drink coffee. The strongest benefit was seen in individuals with hepatitis C, a disease which increases a person’s risk of developing liver cancer, although the researchers were not sure why.8

A study of 120,000 Americans over an 8-year period found a 22% decrease in the chances of developing cirrhosis for each daily cup of coffee. In Norway, a 17-year study of 51,000 citizens found that those who drank two or more cups of coffee per day were 40% less likely to develop cirrhosis compared to those who did not consume coffee.9

Skin Cancer

Using data from two enormous studies, the Nurses’ Health Study and the Health Professionals Follow-up Study, researchers found that men and women who drank more than three cups of caffeinated coffee per month were 17% less likely to develop basal cell carcinoma compared to people who drank less than one cup per month. Basal cell carcinoma is the most common and least dangerous type of skin cancer. Drinking decaffeinated coffee did not affect basal cell carcinoma.10

A 2014 study in the Journal of the National Cancer Institute found that the more coffee participants drank, the less likely they were to develop malignant melanoma over a 10 year period. Melanoma is the most dangerous form of skin cancer. Almost 450,000 whites, aged 50-71, participated in the study. Researchers found that drinking four or more cups of coffee per day was linked to a 20% lower risk of getting malignant melanoma. Once again, drinkers of decaffeinated coffee lost out. Their risk of getting melanoma was no different from that of non-coffee drinkers. Coffee drinking, however, did not affect the least dangerous form of melanoma, called melanoma in situ.

Remember that no matter how much coffee with caffeine you drink, the best way to prevent skin cancer is still to limit your time exposed to the sun and ultraviolet light! 11

Type 2 Diabetes

People in Finland consume more coffee than almost any other nation, and a study of 14,000 people over 12 years  found that men who drank 10 or more cups of coffee daily had a 55% lower risk of developing type 2 diabetes than men who drank 2 cups of coffee a day or fewer.  Even more dramatic, women who drank 10 or more cups per day had a 79% lower risk of developing type 2 diabetes than those who drank fewer than 2 cups daily.12

A different Finnish study of 5,000 sets of identical twins found that individuals who drank more than seven cups of coffee per day had a 35% lower risk of type 2 diabetes than their twins who drank two cups or fewer per day.13 Because identical twins are so biologically similar, the difference in disease risk is very likely caused by coffee consumption levels. Studies of fewer people in other countries have found less dramatic but similarly positive results.

Parkinson’s Disease

A study of more than 8,000 Japanese-American men found that men who did not drink coffee at all were three to five times more likely to develop Parkinson’s disease within 30 years than men who drank four and a half cups or more of coffee per day.14

Suicide

Because suicide may be related to alcohol intake, medications, and stress levels, suicide studies took those factors into account.  A 10-year study of 128,000 people in California found that the risk of suicide decreased by 13% for every additional cup of coffee consumed per day. Even one cup of coffee per day seemed to reduce the risk of suicide. A different 10-year study of 86,000 women found a 50% lower risk of suicide for those who drank two or more cups of coffee per day compared to women who did not drink coffee.15

Brain Power and Aging

A study of 676 healthy men born between 1900 and 1920 suggested that coffee helped with information processing and slowed the cognitive decline typical of aging. Cognitive functioning was measured by the Mini-Mental State Examination, a 30 point scale. Men who regularly consumed coffee experienced an average decline of 1.2 points over 10 years, while men who did not drink coffee saw a decline of 2.6 points over 10 years. Men who drank three cups of coffee per day declined only 0.6 points over 10 years.16

Even old mice are sharper with caffeine: a study using a mouse model of Alzheimer’s disease showed that coffee actually reversed the cognitive decline and slow-down in processing that occurred with age. Mice given caffeine in their water showed signs of recovering their memory during testing.17

What about the risks?

Childbearing

Two separate studies found that 300 mg of caffeine (two to three cups of coffee) decreased a woman’s chances of getting pregnant by more than a third. This same amount of coffee also increased the chances of women having low birth-weight babies by 50%. These studies took into account potentially influential  factors such as contraception used in the past and infertility history.18

Hip Fracture

According to data from the Nurses’ Health Study, women aged 65 and over who drank more than four cups of coffee per day had almost 3 times as many hip fractures over the next six years as women who did not drink coffee. Researchers took important factors into consideration such as how much calcium the women consumed each day.19

Parkinson’s Disease among post-menopausal women taking estrogen-only hormone therapy

Other researchers used data from the Nurses’ Health Study to evaluate the risk of Parkinson’s disease among women who drank coffee while using estrogen medication after menopause. For women who were NOT using estrogen therapy, those who drank four or more cups of coffee per day were about half as likely to develop Parkinson’s disease as women who did not drink coffee. For women who did use post-menopausal estrogen, however, those who drank four or more cups of coffee were about twice as likely as those who didn’t drink coffee to develop Parkinson’s.20

Heart Disease

Two different meta-analyses found that people who drank five or more cups of coffee per day were 40-60% more likely to develop heart disease compared to those who did not drink coffee at all. Other studies have also shown that high coffee use (five to ten cups per day) increases the risk of heart disease, while moderate consumption (three to four cups daily) was not associated with a higher risk. Only coffee drinkers who consumed more than nine cups a day had a greater risk of dying from heart disease.21 It is important to consider that people drinking close to 10 cups of coffee a day are likely to have other health problems, such as stress or sleep deprivation, and this could contribute to higher risk of heart disease and death regardless of coffee use.

Bottom line

For most people, drinking coffee seems to improve health more than harm it. Many of coffee’s health benefits increase with the number of cups per day, but even one cup a day lowers the risk of several diseases. However, women who want to get pregnant or already are pregnant and women over 65 should probably limit their coffee intake because, in their case, the risks may outweigh the health benefits.

Even though many studies show coffee has benefits, it’s still not clear why. How can one popular beverage help metabolism (for example, lowering the risk of type 2 diabetes) and also protect against a range of cancers? Until further research can solve that puzzle, most adults should continue to enjoy their cup (or two, or three) of Joe. Finally, remember that nearly all studies on coffee and health have been done on adults. Coffee may affect children and teens differently.

Which sunscreen should you use?

By Isabel Platt and Laura Gottschalk, PhD
Updated 2016

Sunscreen-infographic

 

Other than the 15 minutes of sunshine we all need for our daily requirement of vitamin D, staying out of the sun should always be the first choice for skin cancer prevention.  However, there are ways to reduce the damage your skin gets from the sun. Wearing protective clothing, hats, and limiting sun exposure during the sunniest parts of the day are all great ideas. When sun exposure can’t be avoided, however, sunscreen can also help protect from some of the damaging effects of the sun.

But what kind of sunscreen is best? Spray or lotion? SPF 15 or SPF 70? Waterproof or moisturizing? It seems like new rules come out every year. To clear up mixed messages, here is a guide to choosing the best sunscreen for you and your family.

SUNSCREEN PREVENTS CANCER

Spending too much time in the sun puts you at risk for skin cancer. There are three types of skin cancer: basal cell, squamous cell, and melanoma. Basal cell cancers, the most common, are slow growing and are the easiest to treat. Squamous cell cancers detected at an early stage are curable and cause minimal damage. Melanoma is the least common but most dangerous kind of skin cancer. If not caught early, it can spread throughout the body and become fatal.

Most melanomas result from sun exposure.22 The number of men and women in the U.S. diagnosed with melanomas increased by nearly 2% each year between 2000 and 2009, and even more among Caucasians.1 23 24 If you have fair skin, you are especially likely to get melanoma from sun exposure. The easiest way to reduce your risk of melanoma is to apply sunscreen to exposed areas every day as part of your morning routine, but don’t forget that it only lasts about 2 hours so you may need to apply it again later in the day.25 If you need another reason to wear sunscreen, a new study found that applying sunscreen every day reduces aging of the skin by 24%.26

Protecting your kids from sunburns is especially important. Getting sunburns during childhood increases the risk of cancer later in life.1 So get your kids into the routine of applying sunscreen every morning (after they brush their teeth) before going to school or to camp, no matter how cloudy it is outside.

WHICH SPF TO USE?

Sun protection factor (SPF) choices range from SPF 8 all the way up to SPF 100+. According to the Food and Drug Administration (FDA), SPFs below 15 protect against sunburns, but they do not prevent damage that can cause skin cancer.27 On the other hand, very high SPFs are misleading since SPF 30 protects against 97% of UV rays, SPF 50 protects against 98%, and SPF 100 protects against 99%. Sunscreens with the highest SPFs cost more and provide little additional protection, and they also encourage people to stay out in the sun longer and reapply less frequently. For effective sun protection, look for an SPF between 15 and 50.

In addition, make sure to choose “broad-spectrum” sunscreen, which guards against both UVB and UVA rays. While only 10% of UV radiation from the sun is UVB, this type of radiation is the primary cause of sunburns, wrinkling, and skin cancer.1 UVA rays penetrate deep into the skin to cause premature aging, and with enough exposure can also damage DNA to cause cancer.

You may be surprised to learn that the FDA does not check the ingredients in sunscreens to test if they are safe and effective. Many of the active ingredients in sunscreens have been used for so long that they are generally believed to be safe and effective, but that is different from being proven to actually be safe and effective. The FDA is currently working on a plan to start testing sunscreen ingredients for safety and effectiveness.

Consumer Reports rated the effectiveness of sunscreens but not their safety.  This is the list of the top sunscreen lotions and sticks from their 2016 report.  However, all of them are made with endocrine disrupting chemicals.  The sunscreens that are made with the safer ingredients (zinc oxide and titanium dioxide) scored very poorly in the Consumer Reports report.

Lotions

1. La Roche-Posay Anthelios 60 Melt-in Sunscreen Milk (note that this is much more expensive than other sunscreens listed)

2. Pure sun Defense Disney Frozen SPF 50

3. Coppertone Water Babies SPF 50

4. Equate (Walmart) Ultra Protection SPF 50

5. Ocean Potion Protect & Nourish SPF 30

6. Aveeno Protect + Hydrate SPF 30

Sticks

1. Coppertone kids stick SPF 55

2. Up & Up (Target) Kids stick SPF 55

LOTION OR SPRAY? WATERPROOF OR WATER-RESISTANT?

Avoid powder makeup and instead use liquid makeup products that contain SPF. Loose powders contain zinc and titanium that can be carcinogenic if inhaled.28 For this reason, the FDA no longer allows the manufacture of powder make-up with SPF, but some of these products are still on the market.

In addition, be sure to avoid sunscreen sprays, especially for kids. Sprays make it easy to inhale the chemicals that are found in the sunscreens. This can pose a safety issue, especially for small children who tend to squirm a lot while sunscreen is put on them. The FDA has also expressed concern about sprays but has not yet limited their use.8 Sunscreen lotion provides better protection against burns that cause skin cancer and aging, without the risk of inhaling dangerous chemicals. If a spray sunscreen is the only available option, first spray it in your hands before applying it to children. Do the same before applying it to the face of adults.

Waterproof sunscreens are no longer for sale. The FDA issued new guidelines that sunscreens can only be labeled as “water resistant” and must say whether they protect for 40 or 80 minutes while sweating or swimming.7 So be sure to reapply your water resistant sunscreen right after getting out of the water.

WHICH INGREDIENTS TO AVOID?

Even when sunscreens are approved by the FDA it does not mean that all the chemicals in them are entirely safe. Try to stay away from Vitamin A and oxybenzone. Vitamin A is found in about 25% of sunscreens because manufacturers claim that it prevents skin aging.29 However, the National Institutes of Health (NIH) has shown that the combination of sunlight and Vitamin A on the skin can increase your risk of cancer.30 The Environmental Working Group (EWG) recommends avoiding oxybenzone, which can potentially cause allergic reactions and interfere with hormones.31

THE BOTTOM LINE

So what should you do to prevent sunburns, aging, and skin cancer? Apply a generous amount of SPF 15 – 50 sunscreen lotion every morning, wear a hat and sunglasses, and generally try to stay in the shade. Reapply your sunscreen after extended sun exposure, sweating, and swimming. Always check the expiration date on sunscreens before you buy and use them, and stay away from tanning beds and sun lamps. If you are fair-skinned or have a family history of skin cancer, be extra careful.

Every year, the Environmental Working Group researches sunscreens on the market and rates them for safety and how well they work. To see how your sunscreen compares, visit their website. If your sunscreen is poorly rated, you can browse their site to find good alternatives.

Treatment of Melanoma

Jenny Markell, Cancer Prevention and Treatment Fund

Melanoma is the most serious form of skin cancer. If caught early, melanoma has high cure rates. But, after it has spread, it can be very difficult to treat successfully. While melanoma accounts for only 2% of skin cancers, it causes more deaths than any other type of skin cancer.[1,2]

Patients with melanoma have various treatment options. The type of treatment is based on individual circumstances such as stage of disease, genetic influences, rate of tumor growth, thickness, whether cancer has spread, and overall health. Standard treatments are available, as are clinical trials using experimental treatments.

Standard melanoma treatments include:

  • Surgery
  • Chemotherapy
  • Radiation Therapy
  • Targeted Therapy
  • Immunotherapy

Surgery

Surgery to remove the tumor is often the primary treatment for early-stage melanoma.[3] The surgery removes all of the cancer and some of the healthy tissue surrounding it. The amount of scarring and the size of the excision will depend on the thickness of the tumor.[4]

In order to see whether the cancer has spread to the lymph nodes, a biopsy is needed. A sentinel lymph node biopsy with lymph node mapping may be chosen.[5] During this procedure, the physician injects a blue dye and/or radioactive substance near the tumor. The substance flows to the lymph nodes, and the first lymph node to receive the dye is removed. This is often the sentinel lymph node. A pathologist then biopsies the removed lymph node to see whether or not cancer has spread to the lymph nodes. If cancer cells are found, a lymphadenectomy, also known as lymph node dissection, is performed and more lymph nodes are removed and checked for cancer.[5]

Even if doctors remove all cancer that they see during the surgery, chemotherapy may be given to patients after surgery to ensure that the cancer doesn’t come back. This is called adjuvant therapy.[5]

If the cancer has spread to other organs (metastized), surgery is not likely to cure the cancer. However, in some cases surgery is done on patients with metastatic melanoma to try to slow down the spread of cancer.

In all cases, be sure to talk to the doctor and make sure you understand the benefits and risks of any suggested treatments.

Chemotherapy

Chemotherapy (chemo) are the drugs used to try to kill the cancer cells. The drugs can be taken in a pill or injected into a vein. Chemotherapy is called systemic therapy because the drugs can enter the bloodstream and reach cancer cells in all parts of the body.[4]

Regional chemotherapy is when the drugs are injected directly into the cerebrospinal fluid, an organ, or a body cavity to target the cancer cells in that specific area. Isolated limb perfusion is a common type of regional chemotherapy used to treat melanoma that is confined to the arm or leg. The blood flow of the arm or leg is temporarily separated from the rest of the body with a tourniquet, and chemotherapy drugs are targeted to that one region.[5]

Chemotherapy is not as effective for advanced melanoma as it is for other types of cancers and is not normally the primary form of treatment.  Common side effects of chemotherapy include hair loss, fatigue, and nausea. Side effects tend to go away after treatment is completed.

Radiation Therapy

Radiation therapy uses x-rays, or other types of rays, to stop cancer cells from growing or to kill them. External beam radiation, which is used to treat melanoma, uses a machine outside the body to send radiation onto the tumor.[3]

Targeted Gene Therapy

With greater understanding of how melanoma cells differ from other cells, researchers have developed therapies that target the gene changes (mutations) in melanoma cells. Targeted therapy drugs are different from chemotherapy drugs because rather than attacking all dividing cells, they only attack the cells undergoing these specific mutations.

  • Researchers have discovered that 50 percent of patients with melanoma have mutations in the BRAF gene, making it the most common mutation in melanoma.[6] Drugs have been developed to target this specific gene and related proteins.
  • The FDA has approved two drugs in the past 5 years for people with BRAF mutant metastatic melanoma: Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar). They have shown to improve the length of survival in about half of patients with BRAF mutant melanoma.
  • Drugs that block MEK proteins have also been shown to help patients with BRAF mutant melanoma. The FDA approved Trametinib (Mekinist) in 2013, which targets MEK, for people with BRAF mutant melanoma.[6]
  • Recently, studies have shown that using a combination of BRAF and MEK targeted therapies is more effective than therapies using only one of these treatments.[7]

Targeted therapies have increased survival rates by a number of months, but have only delayed rather than cured the cancer. However, these treatments are all very new and many studies are underway to try to find a longer-term solution to metastatic melanoma.

 

Immunotherapy

Immunotherapy, also called biologic therapy, uses the patient’s immune system to help fight the cancer. Several different types of immunotherapy are used to treat melanoma:

  • Interferon alpha and Interleukin-2 were both approved by the FDA in the 1990s and a small percentage of patients have benefited greatly from their use. However, they also can have severe side effects.[3]
  • Ipilimumab was approved by the FDA in 2011 and helps boost the immune system by targeting a protein on T-cells. This has helped patients live up to a few months longer, on average.[8]

There have recently been major advances in clinical trials for immunotherapy treatment for melanoma. An April 2015 study in the New England Journal of Medicine found that a combined immunotherapy treatment may extend length of survival even further.[9]

 

Clinical Trials

Clinical trials are used to help find new treatments for cancer. These are experiments that can help patients or harm them. Patients can enter clinical trials at different stages of their cancer treatment, but some trials may only be open to patients who have not yet started other treatment. Click here for NCI’s list of clinical trials

References:

  1. Cancer.Net. “Melanoma: Statistics.” Accessed June 04, 2015. http://www.cancer.net/cancer-types/melanoma/statistics High exposure to UV radiation from sunlight or tanning beds can greatly increase one’s risk of developing melanoma.
  2. Mayo Clinic. Melanoma: Definition.” Accessed June 05, 2015. http://www.mayoclinic.org/diseases-conditions/melanoma/basics/definition/con-20026009
  3. Mayo Clinic. “Melanoma: Treatments and drugs.” Accessed June 04, 2015. http://www.mayoclinic.org/diseases-conditions/melanoma/basics/treatment/con-20026009.
  4. American Cancer Society. “How is Melanoma Cancer Treated?” Accessed Jun 04, 2015. http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-treating-surgery.
  5. National Cancer Institute. “Melanoma Treatment.” Accessed June 04, 2015. http://www.cancer.gov/types/skin/patient/melanoma-treatment-pdq#section/_135
  6. Kudchadkar, R.R., Smalley, K.S.M., Glass, L.F., Trimble, J.S and Sondak, V.K. (2013). Targeted Therapy in Melanoma. Clinics in Dermatology 31(2): 200-208.
  7.  Long, G.V., Stroyakovskiy, H., Gogas, H. et al. (2014). Combined BRAF and MEK Inhibition versus BRAF Inhibition Alone in Melanoma. N Engl J Med. 371(20): 1877-1888.
  8. National Cancer Institute. “FDA Approval for Ipilimumab.” Accessed June 04, 2015. http://www.cancer.gov/about-cancer/treatment/drugs/fda-ipilimumab.
  9. Michael A. Postow, Jason Chesney, Anna Pavlick, Caroline Robert, Kenneth Grossmann, David McDermott, Gerald Linette, Nicolas Meyer, Jeffrey Giguere, Sanjiv Agarwala, Montaser Shaheen, Marc S. Ernstoff, David Minor, April K. Salama, Matthew Taylor, Patrick A. Ott, Linda M. Rollin, Christine Horak, Paul Gagnier, Jedd D. Volchok, and F. Stephen Hodi. Nivolumab and Ipilimimumab versus Ipilimumab in Untreated Melanoma. New England Journal of Medicine 373: 23-34.