Walking, even minimal, lowers death risk!

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1 Max Institute of Cancer Care Shalimar Bagh, Volume 1 Walking, even minimal, lowers death risk! Regular walking, even when it's below the minimum recommended levels for physical fitness, is associated with lower mortality as compared with inactivity. In a new study published online in the American Journal of Preventive Medicine. Alpa Patel, lead author and a researcher at the American Cancer Society said: "There is a tremendous health benefit to simply going out for a walk." Various US guidelines call for adults to perform either more than 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity a week to pursue optimal health. These are recommended minimum amounts. But the new study showed that 120 minutes or less of weekly moderate-intensity walking is also a boon to one's lifespan. Dr. Patel and colleagues reviewed data on more than 62,000 men, and 77,000 women enrolled in the Cancer Prevention Study II, which surveyed participants repeatedly via mailed questionnaires. The primary endpoint of the study was death from any cause between 1999 and In the study, 5.8% of men and 6.6% of women reported no moderate to vigorous physical activity at baseline in These inactive individuals were 26% more likely to die prematurely compared with study participants who walked some, but less than the minimum recommended levels mentioned above (hazard rate ratio, 1.26). Conversely, higher levels of walking were associated with a 20% lower risk of mortality. "Clearly, the more you walk, the better. But doing any walking is better than doing none. Being completely inactive is the worst," Dr. Patel summarized. Dr. Peush Bajpai says: Senior Consultant Department of Medical Oncology Obesity is a known risk factor for cancer in the western world and now even in our population is partly because of this. Modulation of energy balance via increased physical activity has shown to be essential in reducing cancer risk, particularly breast, colon and prostate cancers. The various hypothesis stated are that exercise could modify carcinogen activation event or enhance the clearance of oxidative products. It is not only prevention, but cancer patients also benefit as any physical activity reduces side effects of treatment and decreasing fatigue. Editor : Dr. Saurabh Gupta

2 Long-term PPI Use Doubles Risk for Gastric Cancer In an observational study published in October 2017, Dr. Wai Keung Leung (MD, from Queen Mary Hospital, Hong Kong) said, "the clear dose-response and time-response trend in PPI use and gastric cancer risk observed, suggests the need for caution when prescribing long-term PPIs to these patients even after successful eradication of H. pylori." H.pylori eradication has been shown to reduce the risk for gastric cancer by 33% to 47%, but many patients develop gastric cancer even after eradication of H. pylori. PPI therapy, although considered safe, is associated with worsening gastric atrophy, particularly in H. pylori-infected patients. A recent meta-analysis found a 43% increased risk for gastric cancer among long-term PPI users, but it was unable to adjust for H pylori, the major confounding factor." During a median follow-up of 7.6 years, 153 (0.24%) people developed gastric cancer after H. pylori eradication therapy, mostly in noncardia regions (62%). None of the patients with gastric cancer tested positive for H. pylori at diagnosis, but all had long-standing gastritis. The median age at cancer diagnosis was 71.4 years, and the median time from H. pylori eradication to gastric cancer was 4.9 years. People taking PPIs at least weekly had a greater than a twofold increased risk for gastric cancer development. Gastric cancer risk increased with longer duration of PPI use. More frequent use was also associated with greater risk. When compared with the reference group (less than weekly use), gastric cancer risk progressively increased with more frequent PPI use. Dr. Leung and colleagues write that, to their knowledge, "this is the first study to demonstrate that long-term PPIs use, even after H. pylori eradication therapy, is still associated with an increased risk of gastric cancer. This is likely related to the profound acid suppression of PPIs that worsens atrophic gastritis, particularly in those patients with established gastric atrophy as a result of chronic H. pylori-induced inflammation." Dr. Rudra Prasad Acharya says: Associate Director Department of GI oncology Era of PPI s have decreased incidence of peptic ulcer, but acid suppression environment created by PPIs leads to atrophic gastritis which in turn converts to gastric cancer. Avoid prolonged use of PPIs. They can be used off & on as per need but not as a routine for months or years.

3 Night Shifts Increase Breast Cancer Risk, Especially in Nurses A meta-analysis of international data confirms a positive association between long-term night shift work and increased overall risk for cancer in women, particularly breast cancer. In North America and Europe, working the night shift was associated with a 32% increased risk for breast cancer overall. But the risk was even higher in one specific group. Night nurses were found to have a remarkable 58% increased risk for breast cancer. For every five years, a woman spent working nights, breast cancer risk increased by 3.3%. The review, published online in Cancer Epidemiology, Biomarkers & Prevention, was led by Xuelei Ma, Ph.D., from the West China Medical Center of Sichuan University, Chengdu. More research is needed to understand the mechanisms behind this association and to protect better women working night shifts against increased cancer risk. The meta-analysis conducted by Dr. Ma and colleagues, looked at the association between long-term night shift work and the risk for 11 types of cancer using data from 26 cohort studies, 24 case-control studies, and 11 nested case-control studies. The 61 studies, updated to October 2016, included nearly 4 million women with cancers of the breast, lung, skin, and digestive and reproductive systems. The overall risk for cancer increased by 19% among women working in night shifts, compared with those who did not, in North America, Europe, Australia, and Asia. In addition to the increased risk for breast cancer already noted above, the risk for skin cancer also increased by 41% and risk for gastrointestinal cancer by 18% in women who worked night shifts. Of all the professions occupied by women, nursing appeared to be the most vulnerable to the carcinogenic effects of regular night shift work. A secondary analysis carried out by Dr. Ma and colleagues looked at long-term night shift work in female nurses and the risk for six types of cancer. It showed that night nursing was also associated with a 35% increased risk for gastrointestinal cancer and a 28% increased risk for lung cancer. "Nurses who worked the night shift were of a medical background and may have been more likely to undergo screening examinations," Dr. Ma noted. "Another possible explanation for the increased cancer risk in this population may relate to the job requirements of night shift nursing, such as more intensive shifts." Working at night leads to disruption in circadian rhythm and suppression of nocturnal melatonin secretion, the study authors note. Over the long term, circadian rhythm disruption and nocturnal melatonin suppression function as carcinogens that increase tumor incidence. The prolonged circadian disturbance has also been associated with increased risk for cardiovascular disease, as well as neuropsychiatric and endocrine system disorders. Lifestyle changes, such as irregular eating hours, reduced physical activity, and work-related stress, may also contribute to this increased cancer risk. Dr. Veda Padma Priya says: Senior Consultant Department of Surgical Oncology Night shifts disrupt the normal circadian rhythm and lead to abnormal levels of melatonin secretion. This circadian rhythm alteration on a regular basis might be attributed to the increased risk of breast cancer among night shift nurses even though the study has not explored the direct postulation of melatonin and breast cancer.

4 Just One Drink a Day Raises Breast Cancer Risk Drinking as little as one small glass of wine or beer a day (about 10g of alcohol) can increase the risk for breast cancer by 5% in premenopausal women and by 9% in postmenopausal women. This latest warning comes from a new report issued by the American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF). It reviewed 119 studies from around the world, with a total cohort of more than 12 million women and over 260,000 cases of breast cancer. On the flip side, the report also found that vigorous exercise (such as running or fast cycling) reduced the risk for breast cancer in both pre and postmenopausal women, and substantial evidence confirmed earlier findings that moderate exercise (such as walking and gardening) also decreases the risk in postmenopausal women. For cancer prevention in general, the authors recommend maintaining a healthy weight, keeping physically active for at least 30 minutes every day, and avoiding high-calorie foods and sugary drinks. Dr. Waseem Abbas says: Consultant Department of Medical Oncology The incidence of breast cancer has been increasing over the past few decades in India. One of the major causes of breast cancer risk is attributed to changes in lifestyle and alcohol. This study has driven home the point that alcohol even in moderation is not a safe bet.

5 Alcohol Ups Mortality and Cancer Risk; No Net Benefit Drinking alcohol does not result in a net health benefit, in fact it increases the risk for alcohol-related cancers by 51% as per a study of almost 115,000 people from 12 countries. It also showed that heavy drinking increases the risk for death by 31% to 54%.The results were published online in the Lancet. The study suggests no overall benefit from alcohol consumption. Importantly, "the highest magnitude of increases in risk were seen in lower-income countries, where harmful alcohol use was most top," said first author Andrew Smyth from McMaster University, in Ontario, Canada. The prospective cohort study involved 114,970 adults with no history of heart disease, stroke, or cancer. Participants lived in 12 countries on five different continents and were part of the Prospective Urban Rural Epidemiological (PURE) study. The participants were categorized into income groups on the basis of country of residence.12,904 from Canada and Sweden were categorized as high income (11%), 24,408 from Argentina, Brazil, Chile, Poland, South Africa, and Turkey were categorized as upper middle income (21%), 48,845 from China and Colombia were categorized as lower middle income (43%), and 28,813 from India and Zimbabwe were classified as lower income (25%). The researchers assessed potential confounders such as high-density-lipoprotein cholesterol, body mass index, education, diabetes, hypertension, physical activity, diet, and smoking. Level of consumption was categorized as low (up to 7 drinks a week), moderate (7-14 drinks in women and 7-21 drinks in men), or high (14 or more drinks in women and 21 or more drinks in men). Consumption of five or more drinks in one sitting at least once per month was considered heavy episodic drinking. The risk for cancer was 38% higher in wine drinkers than in non-drinkers (HR, 1.38; 95% CI, ). 69% higher in spirit drinkers (HR, 1.69; 95% CI, ), and 20% higher in beer drinkers (HR, 1.20; 95% CI, ). People with high alcohol intake had a 31% increased risk of death (HR, 1.31; 95% CI, ). Those with heavy episodic drinking had a 54% increased risk of mortality (HR, 1.54; 95% CI, ). More than sufficient evidence is available for governments to give increased public health priority to reducing alcohol-related disease burden in low-income and middle-income countries. Dr. Saurabh Gupta says: Consultant Department of Surgical Oncology Alcohol plays a very important role in the society, predominantly in developing nations. Besides its role as cancer-causing agent, alcohol abuse is directly related to the socioeconomic status, literacy rate, and the crime rate. As the number of youth with alcohol abuse rises, the productivity of the nation comes down. We need strict regulation of alcohol use. This should be done by implementing the most effective population policies to discourage harmful drinking namely, increasing the price of alcohol and reducing its availability, especially to younger drinkers, and preventing the alcohol industry from promotion of frequent drinking to intoxication.