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Cell Phone and Cancer Risk

Cell Phone and Health Concern
Cell phones have become a part of human civilizations, especially in methods of communications, with cell phone the distances doesn't matter. With the increasing number of cell phones user, the amount of time people use it, issues health concern about it.

Cell phones emit radiofrequency energy (radio waves), a form of non-ionizing radiation. Tissues nearest to where the phone is held can absorb this energy.
So the research is directed to recognize the health effects after exposure of long term radiofrequency energy.

Usually cell phone is used near the skull while receiving the call. Thus most of the study about the cell phone and cancer are linked to brain cancer.


Brain cancer incidence and mortality rates have changed little in the past decade. In the United States, 22,340 new diagnoses and 13,110 deaths from brain cancer are estimated for 2011.

The 5-year relative survival for brain cancers diagnosed from 2001 through 2007 was 34.8 percent. This is the percentage of people diagnosed with brain cancer who will still be alive 5 years after diagnosis compared with the survival of a person of the same age and sex who does not have cancer.

The risk of developing brain cancer increases with age. From 2000 through 2008, there were fewer than 5 brain cancer cases for every 100,000 people in the United States under age 65, compared with approximately 19 cases for every 100,000 people in the United States who were ages 65 or older
Cell Phone potential Dangerous


Radiofrequency Energy
Radiofrequency energy is a form of electromagnetic radiation. Electromagnetic radiation can be categorized into two types: ionizing (e.g., x-rays, radon, and cosmic rays) and non-ionizing (e.g., radiofrequency and extremely low-frequency or power frequency).

Ionizing radiation, such as from radiation therapy, is known to increase the risk of cancer. While the radiofrequency is known to cause heating as it biological effect. The ability of microwave ovens to heat food is one example of this effect of radiofrequency energy. Radiofrequency exposure from cell phone use does cause heating; however, it is not sufficient to measurably increase body temperature.

A recent study showed that when people used a cell phone for 50 minutes, brain tissues on the same side of the head as the phone’s antenna metabolized more glucose than did tissues on the opposite side of the brain.

Radiofrequency and Cancer
In development of cancer, there is a need for DNA damaged prior to cancer. However, radiorequency energy, unlike ionizing radiation, does not cause DNA damage in cells, and it has not been found to cause cancer in animals or to enhance the cancer-causing effects of known chemical carcinogens in animals.

Several types of epidemiologic studies already conducted in order to investigate the possibility of a relationship between cell phone use and the risk of malignant (cancerous) brain tumors, such as gliomas, as well as benign (noncancerous) tumors, such as acoustic neuromas (tumors in the cells of the nerve responsible for hearing), most meningiomas (tumors in the meninges, membranes that cover and protect the brain and spinal cord), and parotid gland tumors (tumors in the salivary glands).

In one type of study, called a case-control study, cell phone use is compared between people with these types of tumors and people without them. In another type of study, called a cohort study, a large group of people is followed over time and the rate of these tumors in people who did and didn’t use cell phones is compared. Cancer incidence data can also be analyzed over time to see if the rates of cancer changed in large populations during the time that cell phone use increased dramatically. The results of these studies have generally not provided clear evidence of a relationship between cell phone use and cancer, but there have been some statistically significant findings in certain subgroups of people.

The International Agency for Research on Cancer (IARC), a component of the World Health Organization, has recently classified radiofrequency fields as “possibly carcinogenic to humans,” based on limited evidence from human studies, limited evidence from studies of radiofrequency energy and cancer in rodents, and weak mechanistic evidence (from studies of genotoxicity, effects on immune system function, gene and protein expression, cell signaling, oxidative stress, and apoptosis, along with studies of the possible effects of radiofrequency energy on the blood-brain barrier).

The American Cancer Society (ACS) states that the IARC classification means that there could be some risk associated with cancer, but the evidence is not strong enough to be considered causal and needs to be investigated further. Individuals who are concerned about radiofrequency exposure can limit their exposure, including using an ear piece and limiting cell phone use, particularly among children.
Health effects of Cell Phone

Conclusion
Until now, we still can't find any association between cell phone usage and brain cancer, because there is limited evidence that support it.
However, several health institutions stated that still needed further researchs about it, and categorized cell phone as possibly carcinogenic.
Thus they recommend the usage of cell phone:
- Reserve the use of cell phones for shorter conversations or for times when a landline phone is not available.
- Use a hands-free device, which places more distance between the phone and the head of the user.

Hands-free kits reduce the amount of radiofrequency energy exposure to the head because the antenna, which is the source of energy, is not placed against the head.
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Aspirin Potential in Cancer Therapy

In my previous post about aspirin and prostate cancer, I already told about potential benefit of aspirin in cancer therapy.

Now, i will further emphasize on aspirin usage in cancer therapy.
Cancer Cell

Cancer Therapy
Cancer therapy is one of the most challenging part of medical knowledge, especially in advanced stage. Since the complete understanding of its pathogenesis isn't clear yet.
Cancer cells often have mutation in short-time, causing drug resistance, further progression, and hard to predict. Because of that, rarely advanced stage or inoperable cancer is curable with chemotherapy or radiotherapy.

So, most scientists and doctors agree that early detection of cancer give better treatment option and better survival.

"We will achieve an improvement if we still use the same method" this quote from my senior (Johan Kurnianda, an Oncologist).
So we have to look another option of treatment especially in advanced stage of cancer.

Aspirin is a new paradigm in cancer therapy, a pathway that has been overlooked for many years.

Aspirin in Cancer
Eventhough the knowledge that cancer tissue impair our body coagulation system by several pathways, causing several thrombosis event in vessels.
But, it is rarely, an approved drug to use against it.

Aspirin is an anti-platelet agent, cheap, over-the counter, commonly prescribed especially for people with vascular disease.

Recently, it has published that taking aspirin over a long period of time can substantially cut the risk of dying from a variety of cancers, according to a study showing that the benefit is independent of dose, gender, or smoking. It also found that the protective effect increases with age. The study is by Peter Rothwell, MD, PhD, FRCP, of John Radcliffe Hospital in Oxford, England, and colleagues, and has been published online by the journal the Lancet.

Aspirin showed a 21% reduction in the number of deaths caused by cancer among those who had taken aspirin, compared with people who had not. The investigation also showed that the benefits of taking aspirin increased over time. After five years, death rates were shown to fall by 34% for all cancers and by 54% for gastrointestinal cancers.

The fall in the risk of death broke down according to individual types of cancer:
Esophageal cancer (60%)
Colorectal cancer (40%)
Lung cancer (30%)
Prostate cancer (10%)
Reductions in pancreatic, stomach, and brain cancers were difficult to quantify because of smaller numbers of deaths, the authors say.

From the study, we can see that aspirin give better prognosis to several cancer. How can Aspirin give better prognosis since it doesn't kill the cancer cells?

That's true that aspirin never able to kill cancer cell. Aspirin work in different pathway in cancer therapy. Using its anti-platelet potential.
Cancer cells usually surrounded by platelets during migration in blood vessels, thus using platelets to protect them from immune system and to adhere to target site of metastasis.
Aspirin is used to counter that, thus lower metastasis rates and its complications.

Cancer cells also promotes thrombosis event in vessels, aspirin maybe useful to prevent the thrombosis event.
Aspirin cartoon

So, Aspirin is used to support the standard treatment (chemotherapy or radiotherapy) in order to achieve better outcome.

But, usage of aspirin should be carefully taken, since of bleeding complication. It should be calculated benefits and hazard before using aspirin in therapy.

But after all, this new paradigm is another way to help cancer patient.




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Percutaneus Coronary Disease vs Coronary Artery Bypass Grafting in Severe Coronary Artery Disease

Background
Cardiovascular disease (CVD) has risen world consent about it. Since cardiovascular disease is the leading cause of death worldwide. According to WHO data, it's estimated about 17.5 millions people die from CVD annually.

Coronary artery disese causing severe morbidity and poor quality of life since limitation of activities, pain, long-term care. There are many modalities in treatment for coronary artery disease, such as PCI and CABG. Both of them aims at improving coronary blood flow and prevention of recurrent heart attack.

Coronary-artery bypass grafting has became the standard of care for symptomatic patients with coronary artery disease since its introduction in 1968. Recent advances and innovation in coronary surgery e.g., off-pump CABG, smaller incisions, enhanced myocardial preservation, use of arterial conduits, and improved postoperative care have reduced morbidity, mortality, and rates of graft occlusion.

Percutaneous coronary intervention (PCI) was introduced in 1977. This approach has been developed in technology, has made it possible to treat increasingly complex lesions and patients with a history of clinically significant cardiac disease, risk factors for coronary artery disease, coexisting conditions, or anatomical risk factors.
PCI procedure
adopted from http://seniorjournal.com/NEWS/Health/2007/7-10-04-Angioplasty.htm

Several trials has been done to compare efficacy of bare-stents PCI with CABG in patients with multivessel disease. The results showed similar survival rates but higher re-intervention rates among patients with bare-metal stents at 5 years duration. Some researchs have shown a significant long-term survival advantage with surgical approach.

New technique PCI, with drug-eluting, using anti cell-proliferation agents such as Taxus, has been developed. Randomized trials comparing drug-eluting stents with bare-metal stents have shown significant reductions in the
rate of repeat intervention, with similar rates of death and myocardial infarction. These data is used as a base line for expanding PCI usage in patients with complex coronary anatomical features, though most randomized trials such patients.
According to current guidelines, CABG remains the treatment of choice for patients with severe coronary artery disease, including those with left main coronary artery disease and those with three-vessel disease.

Since, widely used of PCI in severe case of Coronary artery disease with lack of evidence. There is needed to do systematic comparison between PCI and CABG. The results of the trials perhaps can be used as basic for choosing proper treatment for the patients. Or The Right Treatment for The Right Patients

Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial, researchers assessed the optimal revascularization strategy for patients with
previously untreated three-vessel or left main coronary artery disease and defined the populations of patients for whom only one revascularization
method will be effective.
CABG procedure
adopted from http://www.cumc.columbia.edu/dept/cs/pat/cardiac/cabg.html

Summary of trials
The SYNTAX trial was designed as a noninferiority trial with the primary endpoint of death, stroke myocardial infarction (MI), or repeat evascularization at 12 months. The study planned to evaluate the outcome of the subgroup of patients with three-vessel or left main separately if the overall trial demonstrated noninferiority.

The study showed that PCI is associated with higher re-intervention procedures rates compare with CABG group. However, the rates of death and heart attack were not different between two group. While stroke is higher in CABG group compare with PCI.

Although this is not an expected result, further analysis showed that the extent of disease was an important factor, as those with the most complex coronary disease did better with CABG, while those with an intermediate or low scores showed similar outcomes between the groups.

Take Home Message
With the recent 5 year follow up study after procedures, the result showed that LM Stenting is still showing equivalent in mortality, the results may shift balance more toward to PCI. But, CABG is associated with lower re-intervention procedures compare with PCI..

By the way, in subgroup analysis PCI-with drug-eluting showed significant efficacy in patient with Left-Main Artery disease or same outcome with CABG. There will be endless debate on this issue, but PCI will be preferred and most utilized therapy for unprotected left-main lesions in the future. Meanwhile, the treatment decisions should be individualized and clinically relevant, with careful informed consent before making a choice.
Endless Debate
adopted from http://evolution.berkeley.edu

The higher stroke rate in CABG is also an important concern for patients undergoing CABG and should impact patient selection. Importantly, the two groups showed no difference in death, cardiac death, or MI. But the SYNTAX has limitation due to its only 1 year follow up, compare the others research such MAIN-COMPARE trial about 5 year follow up.
But, from this data, we can keep in our mind that patient selection and the extent of the disease, patient preference, complications of the procedures are important factor in determining treatment choice.

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Dual Inhibiton: New Strategy for Lowering Cholesterol

Intro
Cardiovascular disease (CVD) has risen world consent about it. Since cardiovascular disease is the leading cause of death worldwide. According to WHO data, it's estimated about 17.5 millions people die from CVD annually.

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Stem Cells May Improve Heart Bypass Results

Is That True?
On Nov 17th 2008, German Researchers publish their result of their studies.
They said that Patients who received bone marrow stem cell transplants during coronary bypass surgery (CABG) experienced "excellent long-term safety and survival


[ Click here to read more ]
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