By Roni Caryn Rabin, NY Times

Many Americans take aspirin to lower their risk of heart disease, but a new study suggests a remarkable added benefit, reporting that patients who took aspirin regularly for a period of several years were 21 percent less likely decades later to die of solid tumor cancers, including cancers of the stomach, esophagus and lung.

As part of the new study, published online Monday in the journal Lancet, researchers examined the cancer death rates of 25,570 patients who had participated in eight different randomized controlled trials of aspirin that ended up to 20 years earlier.

Participants who had been assigned to the aspirin arms of the studies were 20 percent less likely after 20 years to have died of solid tumor cancers than those who had been in the comparison group taking dummy pills during the clinical trials, and their risk of gastrointestinal cancer death was 35 percent lower. The risk of lung cancer death was 30 percent lower, the risk of colorectal canceresophageal cancer death was 60 percent lower, the study reported. death was 40 percent lower and the risk of

The specific dose of aspirin taken did not seem to matter — most trials gave out low doses of 75 to 100 milligrams — but the participants in the longest lasting trials had the most drastic reductions in cancer death years later.

“This is important as a proof of principle that a single simple compound like aspirin can reduce the risk of cancer substantially,” said the study’s lead author, Dr. Peter M. Rothwell, professor of neurology at the University of Oxford. “There’s been a lot of work over the years showing that certain compounds can increase the risk of cancer, but it’s not been shown before that we can reduce the risk with something as simple as aspirin.”

But even as some experts hailed the new study as a breakthrough, others urged caution, warning people not to start a regimen of aspirin without first consulting a doctor about the potential risks, including gastrointestinal bleeding and bleeding in the brain (hemorrhagic strokes).

“Many people may wonder if they should start taking daily aspirin, but it would be premature to recommend people starting taking aspirin specifically to prevent cancer,” said Eric J. Jacobs, an epidemiologist with the American Cancer Society.

While Dr. Jacobs said the study design was valid, relatively few women were included in the trials, making it difficult to generalize the results to women.

“It’s hard to assess effects on mortality from just one study,” he said.

The findings do not come entirely as a surprise, Dr. Rothwell said, because aspirin has been found to slow or prevent the growth of tumor cell lines in the laboratory. Observational studies have reported that people who took aspirin were at lower risk for colorectal cancer recurrences, while other studies have pointed to similar reductions in cancers of the lung, stomach and esophagus.

“There have been hints of this before, but the quality of this study is the gold standard because it is based on randomized clinical trials,” said Dr. Alan A. Arslan, an assistant professor of obstetrics and gynecology and environmental medicine at New York University School of Medicine, who did an observational study several years ago reporting that women who had taken aspirin regularly had a lower risk of ovarian cancer. “Randomized controlled trials carry more weight.”

The strong results “add to the accumulating evidence that aspirin may be protective against various cancers,” Dr. Arslan said.

There are several ways in which aspirin may work to slow the development of cancers, experts say. Inflammation may play a role in cancer, and aspirin blocks the synthesis of prostaglandins, which are mediators of inflammation, and may affect early tumor promotion.

Aspirin may also induce the death of early cancer cells before they become aggressive, Dr. Arslan suggested.

By Ranit Mishori, The Washington Post
September 27, 2010

There was a time when “cancer” was a word that was only whispered in polite society. It was the devastating, invidious illness that almost nothing could be done about. Death from cancer was ugly, unavoidable and best not thought about until you absolutely had to. Preventing it was thought to be, in most cases, out of the realm of possibility.

Today, we know a great deal more about cancer and have made advances in its treatment. Yet many of us are still in denial, reluctant to engage the topic in our daily lives.

In fact, there are a number of common-sense ways to reduce your risk of getting certain kinds of cancer. No guarantees, but there are steps you can take now to improve your odds.

And guess what? They’re the same things you do to avoid getting heart disease. That’s right: Watching your weight, avoiding junk food and getting exercise – which you already knew will would help to fend off a heart attack – also greatly reduce your chances of getting cancer.

According to the American Cancer Society, about a third of the 550,000 American cancer deaths each year are linked to obesity, poor diet and inactivity. Another third are due to smoking.

In other words, one of the biggest contributors to cancer risk is lifestyle – and that’s something over which you have control.

The numbers behind this statement? “Forty percent of breast cancer cases in the U.S. – about 70,000 cases a year – could be prevented” by changes in behavior, says Susan Higginbotham, director of research for the American Institute of Cancer Research.

A German study published last year in the Archives of Internal Medicine showed a 36 percent reduction in cancer risk overall among people who changed to more-healthful habits. A Harvard School of Public Health study described 44 percent of cancer deaths as avoidable in a report that appeared in BMJ, a British medical journal.

None of this is easy, but bad habits can be changed, and it’s good to know which ones count when it comes to reducing your risk of cancer. So here they are:

Obesity
More than 100,000 cancer cases each year – cancers of the uterus, esophagus, pancreas, kidney, gallbladder, breast and colon – are linked to being overweight, according to the AICR. Scientists believe it partly has something to do with estrogen stored in and produced by our fat cells.

In women, “fat cells are a major source of estrogen after menopause,” says Michael Thun, vice president emeritus of epidemiology and surveillance at the American Cancer Society. That estrogen, he notes, “promotes the development of uterine and breast cancer.”

Fat also increases the concentration of a substance called insulin-like growth factor, which has also been linked to cancer. Furthermore, recent studies have looked at chronic inflammation – to which obesity contributes – and its role in various cancers, including those of the liver, esophagus and gallbladder. “It is a combination of the effects of hormones, mechanical and chemical inflammation,” Thun says.

Here’s the catch, though. There’s little evidence that losing excess weight will improve your odds of avoiding cancer. The key, says Thun, is to avoid weight gain in the first place.

Recommendation: Maintain a healthy body weight, beginning in childhood.

Physical inactivity
“The sedentary lifestyle is a big contributor to cancer, we now think,” says Higginbotham – and not just because it leads to weight gain. Research is suggesting there’s something risky about inactivity itself.

The strongest evidence involves colon cancer. One review found that just getting exercise reduced colon cancer risk by 50 percent, regardless of the intensity of the workout. Even moderate exercise, such as brisk walking for three to four hours per week, was shown in one study to lower colon cancer risk. Thun believes exercise may speed up your digestive processes, so that food moves faster through your system. The quicker the transit times of food through the colon, the lower the risk of cancer.

With breast cancer, a 2003 study in the Journal of the American Medical Association reported that as little as 30 minutes a day of walking could mean a 20 percent reduction in risk. The effects were strongest among women in the normal weight range, where the study showed a 37 percent risk reduction. The National Cancer Institute has linked lack of physical activity to other cancers as well, including cancers of the esophagus, kidneys and uterus.

Recommendation: Exercise regularly. If possible, aim for at least 30 minutes every day.

Drinking past moderation
“Heavy drinking increases the risk of about five cancers in your upper airway and digestive tract,” says Thun. The organs affected are the mouth, esophagus, pharynx, larynx and liver.

Even moderate amounts of alcohol have recently been linked to an increased risk for breast cancer in women who are in menopause. The mechanisms for this observed association are still unclear: Researchers are looking into a possible effect of estrogen levels and into genetic differences among individuals in an enzyme that breaks down alcohol.

Recommendation: No more than two drinks a day for men and one for women.

Smoking
This should be old news. Smoking is by far the most researched and proven cause of cancer, a true slam dunk, going back to the 1964 Surgeon General’s report. According to the National Cancer Institute, more than 180,000 Americans die every year from cancer related to tobacco: smoking, chewing or breathing in somebody else’s smoke. Thun notes that smoking has been linked to 15 types of cancer, including mouth, throat, esophagus and lung, liver, stomach, colon, kidney, bladder and even cervix. It is no surprise, he says, because cigarette smoke has “40 different known carcinogens.” If you’re a smoker, the younger you quit, the better your odds.

Recommendation: Obvious.

Playing it safe
A study in the September issue of Cancer Epidemiology, Biomarkers & Prevention showed that eating a variety of fruits and vegetables could decrease the risk of a certain type of lung cancer, especially among smokers.

What about reducing your consumption of specific foods or your use of certain products, as a hedge against cancer? Here’s a list of choices you can make to play it safe, though evidence for some is significantly weaker than the evidence in the studies mentioned above.

Sun Exposure
Cancer link: Skin, eye.

Sun exposure has been a well-known cause of skin cancers, from the less serious basal cell carcinoma to the deadlier melanoma. In recent months, various organizations and experts have turned the heat up on tanning beds and tanning lamps, calling for restrictions on their use. In the largest study of it kind, published in the May issue of Cancer Epidemiology, Biomarkers & Prevention, authors noted that tanning beds increased the risk of melanoma between twofold and fourfold, depending on the device.

Sugary drinks
Cancer link: Pancreas.

A recent study in the journal Cancer Prevention showed that people who drank two or more soft drinks a week had a higher risk of pancreatic cancer, one of the deadliest forms of the disease. At this point, there are not enough studies to prove an association or a cause, and this topic remains, according to Higginbotham, a “very contentious and active area of research.”

Talcum
Cancer link: Ovaries, uterus.

Talcum – used in body, facial and baby powders – has been linked to tumors of the ovaries. A recent study in Cancer Epidemiology, Biomarkers & Prevention suggests its use in the genital area may increase the risk of cancer in the lining of the uterus. Overall, however, studies have been inconsistent.

Radon
Cancer link: Lung.

Radon is an odorless and colorless radioactive gas, often found in soil, that can seep into buildings through cracks in foundation walls and floors. If the buildings are insufficiently ventilated, levels of the gas can accumulate. The Environmental Protection Agency says exposure to radon in the home is responsible for an estimated 20,000 lung cancer deaths each year in the United States. There are home tests for radon; for confirmed readings of 4 picocuries per liter or higher, the EPA recommends taking corrective action.

Pesticides
Cancer link: Various.

Studies of individuals exposed to pesticides at work, such as farmers, certain factory workers and crop-dusters, have shown that high levels were associated with cancers of the blood and lymph system, as well as cancers of the lip, stomach, lung, brain, prostate and skin.

Cellphones
Cancer link: Face, neck, brain.

A long-awaited study was published in May by the World Health Organization’s International Agency for Research on Cancer. The report looked at the association of cellphone use and two types of brain cancers, and found it to be inconclusive. It did, however, suggest that using cellphones for more than 30 minutes every day increased the risk of glioma, a benign type of brain tumor. Call duration seemed to be riskier than the number of calls made each day, according to the authors.

Red and processed meat.
Cancer link: Colon.

Several studies have linked meat consumption to cancer of the colon. The risks, Thun says, are not “in the same league” as the risk from smoking or being obese, but they are worth considering, especially since meat is a major component of the U.S. diet.

Let’s be clear. These are guidelines, not a promise you’ll never get cancer if you follow this advice. Genetics count. So do things in the environment over which you have no control.

Cancer also afflicts nonsmoking slim people who eat well and work out often. But many of these lifestyle changes come with so many other benefits, beyond helping prevent cancer – weight loss to feel good, sunscreen for less-wrinkled skin – that it makes sense to adopt them anyway.

By Marilynn Marchione, Ap Medical Writer

A blood test so sensitive that it can spot a single cancer cell lurking among a billion healthy ones is moving one step closer to being available at your doctor’s office.

Boston scientists who invented the test and health care giant Johnson & Johnson announced Monday that they are joining forces to bring it to market. Four big cancer centers also will start studies using the experimental test this year.

Stray cancer cells in the blood mean that a tumor has spread or is likely to, many doctors believe. A test that can capture such cells has the potential to transform care for many types of cancer, especially breast, prostate, colon and lung.

Initially, doctors want to use the test to try to predict what treatments would be best for each patient’s tumor and find out quickly if they are working.

“This is like a liquid biopsy” that avoids painful tissue sampling and may give a better way to monitor patients than periodic imaging scans, said Dr. Daniel Haber, chief of Massachusetts General Hospital’s cancer center and one of the test’s inventors.

Ultimately, the test may offer a way to screen for cancer besides the mammograms, colonoscopies and other less-than-ideal methods used now.

“There’s a lot of potential here, and that’s why there’s a lot of excitement,” said Dr. Mark Kris, lung cancer chief at Memorial Sloan-Kettering Cancer Center in New York. He had no role in developing the test, but Sloan-Kettering is one of the sites that will study it this year.

Many people have their cancers diagnosed through needle biopsies. These often do not provide enough of a sample to determine what genes or pathways control a tumor’s growth. Or the sample may no longer be available by the time the patient gets sent to a specialist to decide what treatment to prescribe.

Doctors typically give a drug or radiation treatment and then do a CT scan two months later to look for tumor shrinkage. Some patients only live long enough to try one or two treatments, so a test that can gauge success sooner, by looking at cancer cells in the blood, could give patients more options.

“If you could find out quickly, ‘this drug is working, stay on it,’ or ‘this drug is not working, try something else,’ that would be huge,” Haber said.

The only test on the market now to find tumor cells in blood — CellSearch, made by J&J’s Veridex unit — just gives a cell count. It doesn’t capture whole cells that doctors can analyze to choose treatments.

Interest in trying to collect these cells soared in 2007, after Haber and his colleagues published a study of Mass General’s test. It is far more powerful than CellSearch and traps cells intact. It requires only a couple of teaspoons of blood and can be done repeatedly to monitor treatment or determine why a drug has stopped working and what to try next.

“That’s what got the scientific community’s interest,” Kris said. Doctors can give a drug one day and sample blood the next day to see if the circulating tumor cells are gone, he explained.

The test uses a microchip that resembles a lab slide covered in 78,000 tiny posts, like bristles on a hairbrush. The posts are coated with antibodies that bind to tumor cells. When blood is forced across the chip, cells ping off the posts like balls in a pinball machine. The cancer cells stick, and stains make them glow so researchers can count and capture them for study.

The test can find one cancer cell in a billion or more healthy cells, said Mehmet Toner, a Harvard University bioengineer who helped design it. Researchers know this because they spiked blood samples with cancer cells and then searched for them with the chip.

Studies of the chip have been published in the journals Nature, the New England Journal of Medicine and Science Translational Medicine. It is the most promising of several dozen that companies and universities are rushing to develop to capture circulating tumor cells, said Bob McCormack, technology chief for Veridex.

The agreement announced Monday calls for Veridex and J&J’s Ortho Biotech Oncology unit to work on improving the microchip, including trying different designs and a cheaper plastic to make it practical for mass production. No price goal has been set, a company official said, but the current CellSearch test costs several hundred dollars.

The companies will start a research center at Mass General and will have rights to license the test from the hospital, which holds the patents.

In a separate effort, Mass General, Sloan-Kettering, University of Texas M.D. Anderson Cancer Center in Houston and Dana-Farber Cancer Institute in Boston will start using the test this year. They are one of the “dream teams” sharing a $15 million grant from the Stand Up to Cancer telethon, run by the American Association for Cancer Research.

Already, scientists have been surprised to find that more cancer patients harbor these stray cells than has been believed. In one study, the test was used on men thought to have cancer confined to the prostate, “but we found these cells in two-thirds of patients,” Toner said.

This might mean that cancer cells enter the blood soon after a tumor starts, or that more cancers have already spread but are unseen by doctors.

Or it could mean something else entirely, because researchers have much to learn about these cells, said Dr. Minetta Liu, a breast cancer specialist at Georgetown University’s Lombardi Comprehensive Cancer Center. She led a session on them at the recent San Antonio Breast Cancer Symposium and has been a paid speaker for Veridex. She hopes the cells will someday aid cancer screening.

“The dream is, a woman comes in for her mammogram and gets a tube of blood drawn,” so doctors can look for cancer cells in her blood as well as tumors on the imaging exam, she said.

That’s still far off, but Mass General’s test already is letting doctors monitor patients without painful biopsies. Like Greg Vrettos, who suffered a collapsed lung from a biopsy in 2004, when he was diagnosed with lung cancer.

“It had spread to both lungs and they couldn’t operate,” said Vrettos, 63, a nonsmoker and retired electrical engineer from Durham, N.H. Tests from the biopsy showed that he was a good candidate for the drug Iressa, which he has taken ever since. He goes to Boston every three months for CT scans and the blood test.

“They could look at the number of cancer cells and see that it dropped over time. It corresponded with what the scans were showing,” Vrettos said of doctors looking at his blood tests.

The test also showed when he had a setback last January and needed to have his treatment adjusted.

“I think it’s going to be revolutionary,” he said of the test.

By Mehmet Oz, TIME magazine

What is minimally invasive surgery? Some argue that this benign-sounding concept just transfers the pain of the operation from the patient to the surgeon. Others can’t even agree on a definition of the term, believing that any procedure that causes less morbidity is by nature minimally invasive.

I think that the definition question at least should be left up to the patient. When the person who will have to undergo the procedure asks, “Do I have to?” it’s a good bet you’re talking about something invasive. If the patient responds, “Why not?” chances are the procedure is worthy of the “minimally invasive” label.

Surgeons are often deaf to patients’ compelling desire for less invasive options. We focus on long-term results and minimize short-term penalties like pain. That insensitivity is rooted deep in our professional past. Remember, the first surgeons were barbers and would tie their bloodied bandages outside the shop to dry. (The windblown bandages wrapping around poles gave rise to the traditional barber-pole emblem.)

Historically, an operation meant healing with steel and pain — an unpleasant pairing that limited the growth of the surgical specialty until the advent of general anesthesia in 1846. Massive progress in understanding infections and physiology followed. Surgical innovations steadily improved patient prognoses, but post-op pain and morbidity associated with violating what should be inviolable body cavities persisted. We had plateaued again, and in some ways we’re still stuck.

A surgeon’s perspective of “minimally invasive” often involves just minor modifications to the normal procedure: perhaps a smaller incision carved into the abdomen or a novel instrument elegantly piercing through the rib cage and fracturing fewer bones. Patients often find these approaches plenty invasive and share those insights as they request more pain medications.

But two advances have changed the status quo. Robotic surgery, for one, now allows manipulation of tissues and sutures inside the body with no need for large, traumatizing incisions. This has helped my cardiac-surgery colleagues perform reconstructive procedures, including valve repairs and bypass grafts, on the heart. Ablative — or tissue-eliminating — procedures like removal of the prostate are now common. (To be clear, robotic devices aren’t really robots but micromanipulating tools that serve as slaves to a surgeon sitting at a console.) But the ability to perform open-heart surgery with a closed chest challenges every paradigm of our surgical forefathers.

Still, I believe robotic surgery is being leapfrogged by a second advance: the use of more-elegant instruments inserted through body orifices or into blood vessels in the groin and threaded to distant sites in the body. Instead of seeing with our eyes, we visualize with radiological imaging. Instead of manipulating with forceps and scalpels, we use clips and stents at the tips of catheters.

My first insight into this new world occurred in Bergamo, Italy, more than a decade ago, when a surgeon shared a new single-suture technique to repair the heart’s mitral valve. If one precisely placed stitch could fix the valve, I wondered, why couldn’t a catheter placed through the groin be used to put the suture in place, avoiding a chest incision and stoppage of the heart? I wrote a patent for such a technique on the flight home, and the product created around the concept is now widely available in Europe and has completed FDA trials. Companies have sprouted with similar dreams of fixing heart valves even as our most poetic organ is still beating. Early results are encouraging, which is impressive considering that the task is similar to repairing a car engine while it is still running. These percutaneous (placed through the skin) catheter approaches often allow patients to go home within a day with little pain medication.

Patients can’t tell if long-term results promised by physicians will come to pass, but they can easily assess the short-term penalty of any approach that leaves them in bed wrestling with pain. And if a less invasive approach turns out not to work as well on some patients, they can at least have made that choice with the often correct belief that they can pick a more invasive option later. This brings us much closer to the world of “Why not?”

Mehmet Oz is vice chairman and professor of surgery at Columbia University, a best-selling author and the host of the nationally syndicated television talk show The Dr. Oz Show

National Institutes of Health

Acupuncture is a traditional medicine that’s been practiced in China and other Asian countries for thousands of years. Its proponents say it can do everything from relieving pain to bringing a general sense of wellness. Others think the only benefits you get from acupuncture are in your head. Recent studies have found that both sides may have a point. Acupuncture can be effective for certain health problems, such as some types of chronic pain. But how it works is something of a mystery.

Acupuncture is the stimulation of specific points on the body. The methods can vary, but the most well known type in the United States is the insertion of thin metal needles through the skin. At least 3 million adults nationwide use acupuncture every year, according to the latest estimates.

Acupuncture is part of a family of procedures that originated in China. According to traditional Chinese medicine, the body contains a delicate balance of 2 opposing and inseparable forces: yin and yang. Yin represents the cold, slow or passive principle. Yang represents the hot, excited or active principle. Health is achieved through balancing the 2. Disease comes from an imbalance that leads to a blockage in the flow of qi—the vital energy or life force thought to regulate your spiritual, emotional, mental and physical health. Acupuncture is intended to remove blockages in the flow of qi and restore and maintain health.

Researchers don’t know how these ideas translate to our Western understanding of medicine, explains Dr. Richard L. Nahin of NIH’s National Center for Complementary and Alternative Medicine. But the fact is that many well-designed studies have found that acupuncture can help with certain conditions, such as back pain, knee pain, headaches and osteoarthritis.

“In many research studies, it’s clear that if you’re comparing acupuncture to usual care, the acupuncture group almost always does better,” Nahin says. The problem, he explains, is that when researchers have compared acupuncture to carefully designed “control” treatments, the picture becomes more complicated.

Well-designed clinical trials need control groups—people who get a sham or simulated treatment called a placebo. Placebos might come in the form of a sugar pill or a saline injection. They give researchers something to compare the real treatment with. But designing a placebo for acupuncture is a challenge.

“I don’t really think you can come up with a great placebo needling,” says Dr. Karen J. Sherman, an NIH-funded acupuncture researcher at Group Health Research Institute in Seattle.

For example, when researchers have compared inserting needles with just pressing a toothpick onto acupuncture points, they’ve often found both treatments to be successful. But Sherman questions whether these are really controls. Many traditional acupuncturists would consider them true treatments, too. The important thing, in their view, is to hit the right spot, not necessarily how deep you go.

Another option for a placebo would be to test a different location. But Sherman says that would be inappropriate for treating pain because acupuncturists traditionally needle tender points. “To me, there’s no place on the back, if you have back pain, where you can say you have a great control,” Sherman says, “so I don’t think that’s a really solid idea.”

Further complicating things is that acupuncture treatments are about more than just needles. “There’ll be needles,” Sherman says, “but there’ll probably be other things they do in the course of the treatment. Acupuncturists will talk to you in a particular way. They might give you dietary advice or exercise advice that stems from a non-Western theoretical construct. They’ll try to engage you in your own healing. They might give you a different model for thinking about your health.”

“It’s hard to design placebo-controlled studies of acupuncture when we don’t understand what the active component of the intervention is,” explains Dr. Richard E. Harris, an NIH-funded researcher at the Chronic Pain and Fatigue Research Center in Ann Arbor, Michigan.

Treatment for pain is the best-studied aspect of acupuncture. Many parts of the brain are connected in the processing of pain, and how much pain you feel partly depends on context. “If a person has an injury in battle, they might not feel it,” Sherman explains, “but if they have a similar injury just walking down the street, they might just think it was dreadful.”

“If you look at some of the data, what you find is that sham acupuncture and true acupuncture both produce some pain relief in whatever condition they’re looking at,” Nahin says. “But while both treatments turn on areas of the brain, they turn on different areas of the brain.”

Harris and his colleagues, in studies of fibromyalgia patients, have found differences at the molecular level as well. “We were able to show that sham acupuncture and real acupuncture both reduced pain in fibromyalgia patients equally,” he says, “but they do it by different mechanisms.”

If acupuncture truly works by a different mechanism than sham acupuncture, Harris says, then they’re not the same thing, even if they both help relieve pain. Harris and others are now trying to get to the bottom of what acupuncture is actually doing. Their ultimate goal is to see if other treatments might pair well with acupuncture to reduce pain better than either alone.

Should you try acupuncture? Studies have found it to be very safe, with few side effects. If you’re thinking about it, talk to your doctor. “We tell people they really need to talk to their primary care provider and discuss whether acupuncture is a viable option for them,” Nahin says. “While you could go to an acupuncturist independent of a medical practitioner, we feel that an integrated approach to care is always the best approach.”

“Find somebody who’s dealt with your problem before,” Sherman advises. “Talk to the practitioner about your specific situation and then see if it’s something you can live with because it might not be the right treatment for you.”

If you do decide to try acupuncture, she adds, “You need to know that you should give it some time. You can’t expect one session will tell you whether it works or not. Be open minded and willing to at least entertain some of the notions that the acupuncturist brings up. Give it a try if you’re open to it.”

Dr. Merrell’s answer:

It’s likely — 70 to 75 percent of women are deficient in vitamin D. To know for sure, request a simple blood test (called 25-hydroxy-vitamin D) from your doctor; your levels should be between 40 and 100. Vitamin D is critical: Its deficiency is linked to osteoporosis, low immunity, and coronary artery disease. It’s also an important nutrient in the prevention of several cancers (including breast and prostate).

So many people are deficient because the only way that our bodies can produce vitamin D is by exposure to the sun. But if you live north of the 35th parallel (which runs from southern California through North Carolina), the sun’s rays are not strong enough during the winter months for vitamin D production, and even below that latitude, it takes much longer in the winter to get the amount you need. During the summer, we necessarily wear sunscreen to prevent skin cancer, but this also prohibits vitamin D production.

For people who are deficient, I start them off at 2,000 units a day, and often two days of the week I give them 20,000 units. Once they’re back up to the optimal range, I recommend a minimum daily supplement of 1,000 units, which is the equivalent of 10 to 15 minutes of exposure to strong sunlight.

Note: People with calcium and kidney stone problems need to be taking extra vitamin D, and it’s always important to clear any new supplement with your doctor before taking it.

Dr. Merrell – drmerrell@bodyandsoulmag.com – answers reader questions about making healthy and active lifestyle and medical choices in Whole Living: Body + Soul – www.wholeliving.com.  You can read more at: Ask Dr. Merrell: Your Health Questions Answered.

You can have vulvar cancer without having any symptoms, but some possible, common symptoms of vulvar cancer are:

• Vulvar itching that does not improve.
• A change in skin color around the vulva. Your skin may become more red, lighter, or darker in color than the surrounding skin.
• A change in the feel of your skin around the vulva. Your skin may feel thicker, scalier, rougher, or bumpier than surrounding skin.
• Wartlike bump or bumps, cauliflowerlike growths, or ulcers or sores on the vulva or clitoral area.
• Pain when urinating.
• Burning or bleeding and discharge not related to your menstrual cycle.
• Enlarged glands in your groin.

One type of vulvar cancer, melanoma of the vulva, has different symptoms. These are some of the possible signs of vulvar melanoma.

• A new mole on the vulva or a change in a mole that has been present for years.
• An abnormal mole. It may be asymmetrical, meaning one half doesn’t match the other. The mole may have an irregular or lacy border, meaning the edges are ragged, or it may also be irregular in color. A mole that is wider than 1/4 inch may be of concern as well.

These symptoms may be signs of other problems, including noncancerous changes. See your doctor to know for sure.

Vulvar cancer is rare. It accounts for 4% of reproductive cancers and only 0.6% of all cancers in women.  Nearly 90% of vulvar cancers begin in the squamous cells.  Squamous carcinomas that are small and have not spread are highly curable by surgery alone.  The second most common type of vulvar cancer is melanoma.  Only a small percentage of vulvar cancers are adenocarcinomas.  These cancers may develop from Bartholin’s glands, which are at the opening of the vagina or sweat glands in the vulvar skin.  If adenocarcinoma cells are found in the vulvar skin, it is called Paget’s disease of the vulva.  These cells sometimes may invade deeper tissues.

Doctors don’t know what causes vulvar cancer, but have identified many possible risk factors. Unlike other cancers such as breast or ovarian cancer, there is no hereditary risk for vulvar cancer. This list will help you understand some of the risk factors for vulvar cancer.

Diabetes is a risk factor for vulvar cancer, but doctors do not quite understand the reason why. If you have diabetes and have symptoms of vulvar cancer, such as persistant itching or burning, please see your doctor for an examination.

If you are age 70 or older, you are more at risk for squamous cell carcinoma, the most common type of vulvar cancer. Many women diagnosed with this cancer are in their 70’s or older. So if you are of a mature age and have the symptoms of vulvar cancer, please see your doctor.

Human papillomavirus (HPV) can cause genital warts or precancer of the vulvar without visible warts. HPV may also increase the risk for vulvar cancer.

Smoking increases your risk for vulvar cancer. If you smoke and also have genital warts or human papillomavirus (HPV) infection in your genital tract, your risk is even greater for vulvar cancer.

Vulvar intraepithelial neoplasia (VIN) is a precancerous condition that causes a change in the cells on the surface of the vulva. It may or may not be visible, but having it may increase your risk for the most common type of vulvar cancer, squamous cell carcinoma. It is usually diagnosed with a special test called a colposcopy that is performed by an expert.

Lichen sclerosis, which makes your vulvar skin itchy and thin, slightly increases your risk of getting vulvar cancer.

A family history of melanoma may mean you have a higher risk of getting a melanoma of the vulva. This is a rare kind of vulvar cancer but one that can be quite aggressive. There is no known hereditary risk for other types of vulvar cancer. Any new mole, freckle, or dark spot on the vulva should be checked by your doctor.

Chronic vulvar infections or irritations may also be a risk factor for vulvar cancer. Work with your doctor at improving hygiene or managing infections.

Human immunodeficiency virus (HIV) increases your risk for vulvar cancer.

Symptoms
There are often no symptoms in the early stages of vaginal cancer, before cancer has spread. Many women with invasive vaginal cancer have symptoms such as those listed below.  But they may also be caused by less serious, non-cancerous conditions.  If you have any of these symptoms, talk to your doctor.

• Vaginal bleeding after menopause
• Vaginal bleeding after intercourse
• Abnormal vaginal discharge
• A mass in the vagina that can be felt
• Pain during sex
• Pain when urinating
• Constipation
• Constant pain in the pelvis

Prevention
There is no known way to prevent vaginal cancer. The best thing for a woman to do is to avoid the risk factors listed above.  Women should especially avoid HPV infection. This can be done by not having sexual intercourse at a very young age, by having protected sex, and by avoiding sex with many people or with those who have had many sexual partners. There is the very real possibility that widespread use of HPV vaccines will provide protection from vaginal cancer in the future.

Vaginal cancer is rare. It accounts for about 3% of all reproductive cancers in women.  About 2,420 women will be diagnosed with the disease this year.

Doctors do not know what causes vaginal cancer and there is no known way to prevent it. Certain factors can make you more likely to get this type of cancer than another woman, but most women who develop it have no known risk factors at all. The risk factors that have been found only slightly raise your chances of getting the disease. Still, tell your doctor if you agree with any of the bolded statements.

I am older than 60.  Most women are older than 60 when diagnosed with vaginal cancer.

I have HPV infection that doesn’t go away.  Human papillomaviruses (HPV) are a group of viruses that can cause genital warts or precancerous disease. If you are infected with certain subtypes of HPV, you may be more at risk for vaginal squamous cell carcinoma.

I have cervical or vulvar cancer. Having cervical cancer or a precancerous condition of the cervix may increase your risk for squamous cell carcinoma of the vagina. Having vulvar cancer may also increase your risk.

I smoke.  Just as smoking increases the risk for cervical cancer, it may also increase the risk for vaginal cancer.

My mother took DES.  If your mother took the drug diethylstilbestrol (DES) when pregnant with you, you may be more at risk for getting clear cell adenocarcinoma of the vagina. DES is a drug that helped prevent miscarriages and was generally taken by pregnant women in the 1940’s to 1960.

I have vaginal adenosis. This is a change in the cells lining the vagina. Normally, the cells of the vaginal lining are flat squamous cells. But, in some women, areas of the vagina may develop cells that look more like those found in either the glands of the lower uterus or the upper uterine lining. It happens in almost all women who were exposed to DES in utero. In women with adenosis who were not exposed to DES, the risk for clear cell adenocarcinoma is not known.