If I’m diagnosed with one cancer, am I likely to get another?
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Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health.
Fear of cancer returning is one of the top health concerns. And managing this fear is an important part of cancer treatment.
But how likely is it to get cancer for a second time?
Why can cancer return?
While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms.
This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called metastasis.
Actor Hugh Jackman has gone public about his multiple diagnoses of basal cell carcinoma (a type of skin cancer) over the past decade.
The exact reason why cancer returns differs depending on the cancer type and the treatment received. Research is ongoing to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people.
What are the chances of cancer returning?
The risk of cancer returning differs between cancers, and between sub-types of the same cancer.
New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by 31-68%. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning.
For most types of cancer, the highest risk of cancer returning is within the first three years after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning.
Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed.
What about second, unrelated cancers?
Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) shortly after being treated for breast cancer.
Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one.
Australian research from Queensland and Tasmania shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population.
Who’s at risk of another, unrelated cancer?
With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer.
Reasons for such cancers include different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors.
The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is relatively small when compared with the (sometimes lifesaving) benefits of these treatment and procedures.
While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years.
Similarly, in a large US study only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years).
The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer.
People diagnosed with cancer as a child, adolescent or young adult also have a greater risk of a second, unrelated cancer.
What can I do to lower my risk?
Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment.
Maintenance therapy may be used to reduce the risk of some types of cancer returning. However, despite ongoing research, there are no specific treatments against cancer recurrence or developing a second, unrelated cancer.
But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of cancer returning and getting a second cancer.
Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, Walter and Eliza Hall Institute and Terry Boyle, Senior Lecturer in Cancer Epidemiology, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What Your Hands Can Tell You About Your Health
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Dr. Siobhan Deshauer tells us what our hands say about our health—she’s not practicing palmistry though; she’s a rheumatologist, and everything here is about clinical signs of health/disease.
The signs include…
“Spider fingers” (which your writer here has; I always look like I’m ready to cast a spell of some kind), and that’s really the medical name, or arachnodactyly for those who like to get Greek about it. It’s about elongated digits. Elongated other bones too, typically, but the hands are where it’s most noticeable.
The tests:
- Make a fist with your thumb inside (the way you were told never to punch); does your thumb poke out the side notably past the edge of your hand, unassisted (i.e., don’t poke it, just let it rest where it goes to naturally)?
- Take hold of one of your wrists with the fingers of the other hand, wrapping them around. If they reach, that’s normal; if there’s a notable overlap, we’re in Spidey-territory now.
If both of those are positive results for you, Dr. Deshauer recommends getting a genetic test to see if you have Marfan syndrome, because…
Arachnodactyly often comes from a genetic condition called Marfan syndrome, and as well as the elongated digits of arachnodactyly, Marfan syndrome affects the elastic fibers of the body, and comes with the trade-off of an increased risk of assorted kinds of sudden death (if something goes “ping” where it shouldn’t, like the heart or lungs).
But it can also come from Ehlers-Danlos Syndrome!
EDS is characterized by hypermobility of joints, meaning that they are easily flexed past the normal human limit, and/but also easily dislocated.
The tests:
- Put your hand flat on a surface, and using your other hand, see how far back your fingers will bend (without discomfort, please); do they go further than 90°?
- Can you touch your thumb to your wrist* (on the same side?)
*She says “wrist”; for this arachnodactylic writer here it’s halfway down my forearm, but you get the idea
For many people this is a mere quirk and inconvenience, for others it can be more serious and a cause of eventual chronic pain, and for a few, it can be very serious and come with cardiovascular problems (similar to the Marfan syndrome issues above). This latter is usually diagnosed early in life, though, such as when a child comes in with an aneurysm, or there’s a family history of it. Another thing to watch out for!
Check out the video for more information on these, as well as what our fingerprints can mean, indicators of diabetes (specifically, a test for diabetic cheiroarthropathy that you can do at home, like the tests above), carpal tunnel syndrome, Raynaud phenomenon, and more!
She covers 10 main medical conditions in total:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to read more?
- We Are Such Stuff As Fish Are Made Of ← because collagen comes up a lot in the video
- How To Really Look After Your Joints
Take care!
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Ketogenic Diet: Burning Fat Or Burning Out?
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In Wednesday’s newsletter, we asked you for your opinion of the keto diet, and got the above-depicted, below-described set of responses:
- About 45% said “It has its benefits, but they don’t outweigh the risks”
- About 31% said “It is a good, evidence-based way to lose weight, be energized, and live healthily”
- About 24% said “It is a woeful fad diet and a fast-track to ruining one’s overall health”
So what does the science say?
First, what is the ketogenic diet?
There are two different stories here:
- Per science, it’s a medical diet designed to help treat refractory epilepsy in children.
- Per popular lore, it’s an energizing weight loss diet for Instagrammers and YouTubers.
Can it be both? The answer is: yes, but with some serious caveats, which we’ll cover over the course of today’s feature.
The ketogenic diet works by forcing the body to burn fat for energy: True or False?
True! This is why it helps for children with refractory epilepsy. By starving the body (including the brain) of glucose, the liver must convert fat into fatty acids and ketones, which latter the brain (and indeed the rest of the body) can now use for energy instead of glucose, thus avoiding one of the the main triggers of refractory epilepsy in children.
See: The Ketogenic Diet: One Decade Later | Pediatrics
Even the pediatric epilepsy studies, however, conclude it does have unwanted side effects, such as kidney stones, constipation, high cholesterol, and acidosis:
Source: Dietary Therapies for Epilepsy
The ketogenic diet is good for weight loss: True or False?
True! Insofar as it does cause weight loss, often rapidly. Of course, so do diarrhea and vomiting, but these are not usually held to be healthy methods of weight loss. As for keto, a team of researchers recently concluded:
❝As obesity rates in the populace keep rising, dietary fads such as the ketogenic diet are gaining traction.
Although they could help with weight loss, this study had a notable observation of severe hypercholesterolemia and increased risk of atherosclerotic cardiovascular disease among the ketogenic diet participants.❞
~ Dr. Shadan Khdher et al.
On which note…
The ketogenic diet is bad for the heart: True or False?
True! As Dr. Joanna Popiolek-Kalisz concluded recently:
❝In terms of cardiovascular mortality, the low-carb pattern is more beneficial than very low-carbohydrate (including the ketogenic diet). There is still scarce evidence comparing ketogenic to the Mediterranean diet.
Other safety concerns in cardiovascular patients such as adverse events related to ketosis, fat-free mass loss, or potential pharmacological interactions should be also taken into consideration in future research.❞
~ Dr. Joanna Popiolek-Kalisz
Read in full: Ketogenic diet and cardiovascular risk: state of the art review
The ketogenic diet is good for short-term weight loss, but not long-term maintenance: True or False?
True! Again, insofar as it works in the short term. It’s not the healthiest way to lose weight and we don’t recommend it, but it did does indeed precipitate short-term weight loss. Those benefits are not typically observed for longer than a short time, though, as the above-linked paper mentions:
❝The ketogenic diet does not fulfill the criteria of a healthy diet. It presents the potential for rapid short-term reduction of body mass, triglycerides level, Hb1Ac, and blood pressure.
Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations.❞
~ Ibid.
The ketogenic diet is a good, evidence-based way to lose weight, be energized, and live healthily: True or False?
False, simply, as you may have gathered from the above, but we’ve barely scratched the surface in terms of the risks.
That said, as mentioned, it will induce short-term weight loss, and as for being energized, typically there is a slump-spike-slump in energy:
- At first, the body is running out of glucose, and so naturally feels weak and tired.
- Next, the body enters ketosis, and so feels energized and enlivened ← this is the part where the popular enthusiastic reviews come from
- Then, the body starts experiencing all the longer-term problems associated with lacking carbohydrates and having an overabundance of fat, so becomes gradually more sick and tired.
Because of this, the signs of symptoms of being in ketosis (aside from: measurably increased ketones in blood, breath, and urine) are listed as:
- Bad breath
- Weight loss
- Appetite loss
- Increased focus and energy
- Increased fatigue and irritability
- Digestive issues
- Insomnia
The slump-spike-slump we mentioned is the reason for the seemingly contradictory symptoms of increased energy and increased fatigue—you get one and then the other.
Here’s a small but illustrative study, made clearer by its participants being a demographic whose energy levels are most strongly affected by dietary factors:
The ketogenic diet is a woeful fad diet and a fast-track to ruining one’s overall health: True or False?
True, subjectively in the first part, as it’s a little harsher than we usually go for in tone, though it has been called a fad diet in scientific literature. The latter part (ruining one’s overall health) is observably true.
One major problem is incidental-but-serious, which is that a low-carb diet is typically a de facto low-fiber diet, which is naturally bad for the gut and heart.
Other things are more specific to the keto diet, such as the problems with the kidneys:
However, kidney stones aren’t the worst of the problems:
Is Losing Weight Worth Losing Your Kidney: Keto Diet Resulting in Renal Failure
We’re running out of space and the risks associated with the keto diet are many, but for example even in the short term, it already increases osteoporosis risk:
❝Markers of bone modeling/remodeling were impaired after short-term low-carbohydrate high-fat diet, and only one marker of resorption recovered after acute carbohydrate restoration❞
~ Dr. Ida Heikura et al.
A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise
Want a healthier diet?
We recommend the Mediterranean diet.
See also: Four Ways To Upgrade The Mediterranean
(the above is about keeping to the Mediterranean diet, while tweaking one’s choices within it for a specific extra health focus such as an anti-inflammatory upgrade, a heart-healthy upgrade, a gut-healthy upgrade, and a brain-healthy upgrade)
Enjoy!
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All In Your Head (Which Is Where It’s Supposed To Be)
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Today’s news is all about things above the neck, and mostly in the brain. From beating depression to beating cognitive decline, from mindfulness against pain to dentistry nightmares to avoid:
Transcranial ultrasound stimulation
Transcranial magnetic stimulation is one of those treatments that sounds like it’s out of a 1950s sci-fi novel, and yet, it actually works (it’s very well-evidenced against treatment-resistant depression, amongst other things). However, a weakness of it is that it’s difficult to target precisely, making modulation of most neurological disorders impossible. Using ultrasound instead of a magnetic field allows for much more finesse, with very promising initial results across a range of neurological disorders
Read in full: Transcranial ultrasound stimulation: a new frontier in non-invasive brain therapy
Related: Antidepressants: Personalization Is Key!
This may cause more pain and damage, but at least it’s more expensive too…
While socialized healthcare systems sometimes run into the problem of not wanting to spend money where it actually is needed, private healthcare systems have the opposite problem: there’s a profit incentive to upsell to more expensive treatments. Here’s how that’s played out in dentistry:
Read in full: Dentists are pulling healthy and treatable teeth to profit from implants, experts warn
Related: Tooth Remineralization: How To Heal Your Teeth Naturally
Mindfulness vs placebo, for pain
It can be difficult with some “alternative therapies” to test against placebo, for example “and control group B will merely believe that they are being pierced with needles”, etc. However, in this case, mindfulness meditation was tested as an analgesic vs sham meditation (just deep breathing) and also vs placebo analgesic cream, vs distraction (listening to an audiobook). Mindfulness meditation beat all of the other things:
Read in full: Mindfulness meditation outperforms placebo in reducing pain
Related: No-Frills, Evidence-Based Mindfulness
Getting personal with AI doctors
One of the common reasons that people reject AI doctors is the “lack of a human touch”. However, human and AI doctors may be meeting in the middle nowadays, as humans are pressed to see more patients in less time, and AI is trained to be more personal—not just a friendlier affect, but also, such things as remembering the patient’s previous encounters (again, something with which overworked human doctors sometimes struggle). This makes a big difference to patient satisfaction:
Read in full: Personalization key to patient satisfaction with AI doctors
Related: AI: The Doctor That Never Tires?
Combination brain therapy against cognitive decline
This study found that out of various combinations trialled, the best intervention against cognitive decline was a combination of 1) cognitive remediation (therapeutic interventions designed to improve cognitive functioning, like puzzles and logic problems), and 2) transcranial direct current stimulation (tDCS), a form of non-invasive direct brain stimulation, similar to the magnetic or ultrasound methods we mentioned earlier today. Here’s how it worked:
Read in full: Study reveals effective combination therapy to slow cognitive decline in older adults
Related: How To Reduce Your Alzheimer’s Risk
Take care!
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The Humor Habit – by Paul Osincup
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Ask not for whom the bell tolls… It could be tolling for anyone. Don’t worry about it.It’s probably fine.
More seriously (heh), laughter is good for healthy lifespan, also called healthspan. It eases stress and anxiety, gives our brains neurochemicals they need to function well, and is very pro-social too, which in turn has knock-on positive effects for our own mental health as well as those around us.
This book is a guide to cultivating that humor, finding the funny side in difficult times, and bringing a light-hearted silliness to moments where it helps.
The title suggests it’s about habit-building (and it is!) but it’s also about knowing where to look in your daily life for humorous potential and how to find it, and how to bring that into being in the moment.
The style is that of an instruction manual with a healthy dose of pop-science; first and foremost this is a practical guide, not a several-hundred page exhortation on “find things funny!”, but rather a “hey, psst, here are many sneaky insider tricks for finding the funny“.
Bottom line: this book is not only a very enjoyable read, but also very much the gift that keeps on giving, so treat yourself!
Click here to check out The Humor Habit, and strength your funny-bones!
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Millet vs Couscous – Which is Healthier?
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Our Verdict
When comparing millet to couscous, we picked the millet.
Why?
In terms of macros, they’re pretty much equal, and are both moderately high glycemic index foods so to abate that, it’s good to have them with some fibrous foods (e.g. some vegetables) and fats (e.g. perhaps sauté the vegetables with a little olive oil), to slow down the carbs a little. But, as there’s nothing meaningful between them in this regard, we declare this category a tie.
In the category of vitamins, millet has more of vitamins B1, B2, B3, B6, B7, B9, K, and choline, while millet has more of vitmains B5 and E. An easy win for millet here.
When it comes to minerals, it’s a similar story: millet has more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while couscous has more calcium and selenium. Another clear win for millet.
For those avoiding gluten, you want to be aware that millet is naturally gluten-free, while couscous is usually made of durum wheat and thus contains gluten.
For those avoiding oxalates (shouldn’t make any difference for most people, but if you have certain kidney problems, then it can matter), millet is low in oxalates and couscous is high in oxalates.
All in all, it’s a clear overall win for millet!
Want to learn more?
You might like to read:
Grains: Bread Of Life, Or Cereal Killer?
Enjoy!
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Good Health From Head To Toe
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It’s Q&A Day!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: I am now in the “aging” population. A great concern for me is Alzheimers. My father had it and I am so worried. What is the latest research on prevention?
Very important stuff! We wrote about this not long back:
- See: How To Reduce Your Alzheimer’s Risk
- See also: Brain Food? The Eyes Have It!
(one good thing to note is that while Alzheimer’s has a genetic component, it doesn’t appear to be hereditary per se. Still, good to be on top of these things, and it’s never too early to start with preventive measures!)
Q: Foods that help build stronger bones and cut inflammation? Thank you!
We’ve got you…
For stronger bones / To cut inflammation
That “stronger bones” article is about the benefits of collagen supplementation for bones, but there’s definitely more to say on the topic of stronger bones, so we’ll do a main feature on it sometime soon!
Q: Veganism, staying mentally sharp, best exercises for weight gain?
All great stuff! Let’s do a run-down:
- Veganism? As a health and productivity newsletter, we’ll only be focusing veganism’s health considerations, but it does crop up from time to time! For example:
- Which Plant Milk? (entirely about such)
- Plant vs Animal Protein (mostly about such)
- Making Friends With Your Gut (You Can Thank Us Later) (discusses one benefit of such)
- Staying mentally sharp? You might like the things-against-dementia pieces we linked to in the previous response!
- It’s also worth noting that some kinds of dementia, such as Alzheimer’s, can begin the neurodegenerative process 20 years before symptoms show, and can be influenced by lifestyle choices 20 years before that, so it’s definitely never too early be on top of these things!
- Best exercises for weight gain? We’ll do a main feature one of these days (filled with good science and evidence), but in few words meanwhile: core exercises, large muscle groups, heavy weights, few reps, build up slowly. Squats are King.
Q: I am interested in the following: Aging, Exercise, Diet, Relationships, Purpose, Lowering Stress
You’re going to love our Psychology Sunday editions of 10almonds! You might like some of these…
- Relationships: Seriously Useful Communication Skills!
- Purpose: Are You Flourishing? (There’s a Scale)
- Managing stress: Lower Your Cortisol! (Here’s Why & How)
- Also about managing stress: Sunday Stress-Buster
- Also applicable to stress: How To Set Your Anxiety Aside
Q: I’d like to know more about type 2 diabetic foot problems
You probably know that the “foot problems” thing has less to do with the feet and more to do with blood and nerves. So, why the feet?
The reason feet often get something like the worst of it, is because they are extremities, and in the case of blood sugars being too high for too long too often, they’re getting more damage as blood has to fight its way back up your body. Diabetic neuropathy happens when nerves are malnourished because the blood that should be keeping them healthy, is instead syrupy and sluggish.
We’ll definitely do a main feature sometime soon on keeping blood sugars healthy, for both types of diabetes plus pre-diabetes and just general advice for all.
In the meantime, here’s some very good advice on keeping your feet healthy in the context of diabetes. This one’s focussed on Type 1 Diabetes, but the advice goes for both:
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