US life expectancy reached a record high in 2007 according to the CDC.   A veteran treated at the Miami VA Health Center is suing the US government because of HIV infection allegedly contracted during a colonoscopy.

Research Reports

• In a Japanese study, long term outlook was excellent when all lung tumors that had spread from a colorectal cancer were completely removed surgically (R0 resection). Nearly 7 out of 10 patients (67.8 percent) were alive five years later.  Almost all (94 percent) of those with a low CEA level less than 5 ng/ml before surgery and no cancer spread from lungs to lymph nodes lived five years.  Previous surgery for liver tumors or repeated lung surgeries had no impact on survival.  The surgical oncology team led by K. Watanabe reported their results in the British Journal of Surgery, online August 11, 2009.
• Doctors find more polyps (adenomas) when colonoscopies are done in the morning than in the afternoon.  In the morning about 30 of every 100 patients had at least one polyp found during their colonoscopy.  In the afternoon polyps were only found in 25 of every 100 patients.  The adenoma detection rate tended to go down with each hour of the day.  Whether or not this is due to physician fatigue or some other factor isn’t yet clear.  Madhusudhan R Sanaka MD and the team at the Cleveland Clinic discuss their study in the July 2009 issue of the American Journal of Gastroenterology.
• Higher levels of vitamin D in the blood led to better survival after colorectal cancer diagnosis.  In the Nurses’ Health Study and Health Professionals Follow-Up Study, the 20 percent of patients with the highest levels of vitamin D in their blood after diagnosis had a 50 percent greater chance of not dying of colorectal cancer and a 38 percent better chance of being alive five years after their diagnosis. Kimmie Ng and colleagues in Boston report the results of their work in the British Journal of Cancer online august 18, 2009.

Other Headlines

• Life expectancy in the United States reached a record high of almost 78 years (77.9)in 2007 according to the Centers for Disease Control.  Over the past ten years  US life expectancy has increased 1.4 years.  Women live about five years longer then men, with life expectancy of 80.4 years compared to 75.3 for men.  Black men had life expectancy of 70 years. About half of all deaths came from cancer or heart disease.  Although infant mortality rose in 2007, the rate of increase was not statistically significant.  More information is available from the CDC National Center for Health Statistics.
• Army veteran Juan Rivera has filed notice that he is suing the federal government for $20 million.  He claims he was infected with HIV during a colonoscopy in May 2008.  Equipment used in the exam was allegedly not properly sterilized.  In March, the Miami Veterans Administration Health Care System notified over 3,200 patients that tubing used during colonoscopies was rinsed but not disinfected between procedures raising the risk of HIV or hepatitis infection. More details of Rivera’s case were in the Miami Herald on August 19, 2009.

Over the last three years, folic acid has been shown to increase growth of polyps, and in patients with metastatic disease  it may shorten life. The protective value of vitamin E has been questioned, and there was evidence that it might increase prostate cancer risk. Selenium did not show benefit.

So we are down to calcium. This supplement has been shown repeatedly to benefit patients by reducing cancer risk for a variety of solid tumors including colon cancer. A recent publication by Dr. Yikyung Park from the National Cancer Institute showed that supplementation of 1200 mg calcium in women and men over the age of 50 decreased cancer risk by 17% for men and 23% for women (Archives of Internal Medicine, February 23, 2009). These were cancers of the gastrointestinal tract mainly colon cancers.

The usual source for calcium in our diet is milk products (yogurt, cheese, etc) as well as meat. The calcium pathway is very interesting because it requires activity of vitamin D. Without vitamin D it is difficult to absorb calcium and put it into the organs where we need it, but to make sure we have sufficient vitamin D we need some sun exposure (vitamin D is activated in the skin) and we need a functional kidney.

When vitamin D was tested in patients with colon cancer it was found by Dr. Charles Fuchs in the Journal of Clinical Oncology published in June last year that the patients with the highest vitamin D levels lived longer suggesting that low levels may be associated with shorter survival. Since there are very rare side effects from either vitamin D or calcium supplementation, I recommend all my patients take 1500 mg of calcium and 1000-3000 units of vitamin D daily.

I have one funny story from one of my patients giving him the spiel of calcium supplementation which he loved and started right away. About three months later he was admitted with kidney stones. He had inflammatory bowel disease which has higher risk of kidney stones which was further aggravated by calcium supplementation. Therefore if you have a history of kidney stones or inflammatory bowel disease please check with your doctor first before starting calcium supplements.

Analyzing published studies of blood levels of vitamin D, researchers found a 30 percent decrease in the risk of adenomas among people with the most circulating vitamin D compared to those with the least.  The highest vitamin D intake decreased adenomatous polyp risk by 11 percent.

In addition, there appeared to be an even stronger relationship between both blood levels and vitamin D intake for advanced adenomas, with the highest risk of cancer.  Higher blood levels decreased risk of advanced adenomas by 46 percent, greater intake of vitamin D by 23 percent.

Melissa Wei and her colleagues concluded,

Both circulating 25(OH)D and vitamin D intake were inversely associated with colorectal adenoma incidence and recurrent adenomas. These results further support a role of vitamin D in prevention of colorectal adenoma incidence and recurrence.

SOURCE: Wei et al., Cancer Epidemiology, Biomarkers, and Prevention, Volume 17, Number 11, November 2008.