The Princess of Wales wants to stay cancer-free. What does this mean?
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Catherine, Princess of Wales, has announced she has now completed a course of preventive chemotherapy.
The news comes nine months after the princess first revealed she was being treated for an unspecified form of cancer.
In the new video message released by Kensington Palace, Princess Catherine says she’s focused on doing what she can to stay “cancer-free”. She acknowledges her cancer journey is not over and the “path to recovery and healing is long”.
While we don’t know the details of the princess’s cancer or treatment, it raises some questions about how we declare someone fully clear of the disease. So what does being – and staying – “cancer-free” mean?
What’s the difference between being cancer-free and in remission?
Medically, “cancer-free” means two things. First, it means no cancer cells are able to be detected in a patient’s body using the available testing methods. Second, there is no cancer left in the patient.
These might sound basically the same. But this second aspect of “cancer-free” can be complicated, as it’s essentially impossible to be sure no cancer cells have survived a treatment.
It only takes a few surviving cells for the cancer to grow back. But these cells may not be detectable via testing, and can lie dormant for some time. The possibility of some cells still surviving means it is more accurate to say a patient is “in remission”, rather than “cancer-free”.
Remission means there is no detectable cancer left. Once a patient has been in remission for a certain period of time, they are often considered to be fully “cancer-free”.
Princess Catherine was not necessarily speaking in the strict medical sense. Nonetheless, she is clearly signalling a promising step in her recovery.
What happens during remission?
During remission, patients will usually undergo surveillance testing to make sure their cancer hasn’t returned. Detection tests can vary greatly depending on both the patient and their cancer type.
Many tests involve simply looking at different organs to see if there are cancer cells present, but at varying levels of complexity.
Some cancers can be detected with the naked eye, such as skin cancers. In other cases, technology is needed: colonoscopies for colorectal cancers, X-ray mammograms for breast cancers, or CT scans for lung cancers. There are also molecular tests, which test for the presence of cancer cells using protein or DNA from blood or tissue samples.
For most patients, testing will continue for years at regular intervals. Surveillance testing ensures any returning cancer is caught early, giving patients the best chance of successful treatment.
Remaining in remission for five years can be a huge milestone in a patient’s cancer journey. For most types of cancer, the chances of cancer returning drop significantly after five years of remission. After this point, surveillance testing may be performed less frequently, as the patients might be deemed to be at a lower risk of their cancer returning.
Measuring survival rates
Because it is very difficult to tell when a cancer is “cured”, clinicians may instead refer to a “five-year survival rate”. This measures how likely a cancer patient is to be alive five years after their diagnosis.
For example, data shows the five-year survival rate for bowel cancer among Australian women (of all ages) is around 70%. That means if you had 100 patients with bowel cancer, after five years you would expect 70 to still be alive and 30 to have succumbed to the disease.
These statistics can’t tell us much about individual cases. But comparing five-year survival rates between large groups of patients after different cancer treatments can help clinicians make the often complex decisions about how best to treat their patients.
The likelihood of cancer coming back, or recurring, is influenced by many factors which can vary over time. For instance, approximately 30% of people with lung cancer develop a recurrent disease, even after treatment. On the other hand, breast cancer recurrence within two years of the initial diagnosis is approximately 15%. Within five years it drops to 10%. After ten, it falls below 2%.
These are generalisations though – recurrence rates can vary greatly depending on things such as what kind of cancer the patient has, how advanced it is, and whether it has spread.
Staying cancer-free
Princess Catherine says her focus now is to “stay cancer-free”. What might this involve?
How a cancer develops and whether it recurs can be influenced by things we can’t control, such as age, ethnicity, gender, genetics and hormones.
However, there are sometimes environmental factors we can control. That includes things like exposure to UV radiation from the sun, or inhaling carcinogens like tobacco.
Lifestyle factors also play a role. Poor diet and nutrition, a lack of exercise and excessive alcohol consumption can all contribute to cancer development.
Research estimates more than half of all cancers could potentially be prevented through regular screening and maintaining a healthy lifestyle (not to mention preventing other chronic conditions such as heart disease and diabetes).
Recommendations to reduce cancer risk are the same for everyone, not just those who’ve had treatment like Princess Catherine. They include not smoking, eating a nutritious and balanced diet, exercising regularly, cutting down on alcohol and staying sun smart.
Amali Cooray, PhD Candidate in Genetic Engineering and Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research) ; John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research) , and Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Dark Calories – by Dr. Catherine Shanahan
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You may be wondering: do we really need a 416-page book to say “don’t use vegetable oils”?
The author, who was a biochemist before becoming a family physician, takes a lot of care to explain in ways the non-chemists amongst us can understand (with molecular diagrams very well-labelled), exactly why certain seed/vegetable oils (both of those names being imprecise and unhelpful as umbrella terms) cause metabolic problems for us, when in contrast olive oil, avocado oil, and even peanut oil, do not.
Understanding is, for many, the root foundation of compliance. We are more likely to abide by rules we understand the logic behind, than seemingly arbitrary “thou shalt not…” proclamations.
So that’s an important strength of the book, demystifying various fats and how our body responds to them on a biochemical level, not just “is associated with such-and-such, based on observational population studies”. This kind of explanation clears up why, for example, seed oils correlate with obesity more than calories, sugar, wheat, or beef—having as it does to do with affecting our body’s ability to generate and use energy.
She also offers practical tips/reminders throughout, such as how “organic” does not necessarily mean “healthy” (indeed, many poisonous plants can be grown “organically”), and nor does “organic” mean “unrefined”, it speaks only for the conditions in which the raw product was first made, before other things were done to it later.
We learn a lot, too, about the processes of oxidation, the biochemistry behind that (more diagrams!), and of course the inflammatory response to same (an important factor in most if not all chronic disease).
The style is mostly very easy-to-read pop-science, though if you’re not a chemist, you’ll probably need to slow down for the biochemistry explanations (this reviewer certainly did).
Bottom line: this is more than just a litany against vegetable oils; it’s a ground-upwards education in metabolic biochemistry for the layperson, and what that means for us in terms of chronic disease risks.
Click here to check out Dark Calories, and learn what’s going on with these oils!
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The Other Significant Others – by Rhaina Cohen
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As we get older, it’s a function of statistics that increasingly many of us are divorced or widowed. While some will—after whatever time seems right to them—get back into dating, what about those of us who decide that we won’t?
Rhaina Cohen explores the importance of friendship, mutual support, and (Platonic!) closeness and yes, even kinds of intimacy (for that too can be Platonic!) as we go on.
Even from a purely evolutionary approach, we are fundamentally social creatures, and while as individuals we may exist on a spectrum from reclusive to extroverted, we all thrive better when we at least have access to community and friends.
The style of the book is easy-reading and exploratory, and is very compelling as a call-to-arms for those who may wish to give/receive support to/from those with whom we are not necessarily sleeping.
Because at the end of the day, why should sex and/or romance be a required feature for legal protections? Aren’t we adults who can make our own decisions about whom we trust to care for us?
Bottom line: if you’re happily partnered and expect to pre-decease your partner, this book might not be directly important for you (it might for your partner, though). Everyone else? This book may be important at some point. That point might even be now already; only you know.
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From Strength to Strength – by Dr. Arthur Brooks
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For most professions, there are ways in which performance can be measured, and the average professional peak varies by profession, but averages are usually somewhere in the 30–45 range, with a pressure to peak between 25–35.
With a peak by age 45 or perhaps 50 at the latest (aside from some statistical outliers, of course), what then to expect at age 50+? Not long after that, there’s a reason for mandatory retirement ages in some professions.
Dr. Brooks examines the case for accepting that rather than fighting it, and/but making our weaknesses into our strengths as we go. If our fluid intelligence slows, our accumulated crystal intelligence (some might call it “wisdom“) can make up for it, for example.
But he also champions the idea of looking outside of ourselves; of the importance of growing and fostering connections; giving to those around us and receiving support in turn; not transactionally, but just as a matter of mutualism of the kind found in many other species besides our own. Indeed, Dr. Brooks gives the example of a grove of aspen trees (hence the cover art of this book) that do exactly that.
The style is very accessible in terms of language but with frequent scientific references, so very much a “best of both worlds” in terms of readability and information-density.
Bottom line: if ever you’ve wondered at what age you might outlive your usefulness, this book will do as the subtitle suggests, and help you carve out your new place.
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Greek Yogurt vs Cottage Cheese – Which is Healthier?
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Our Verdict
When comparing Greek yogurt to cottage cheese, we picked the yogurt.
Why?
These are both dairy products popularly considered healthy, mostly for their high-protein, low-carb, low-fat profile. We’re going to assume that both were made without added sugars. Thus, their macro profiles are close to identical, and nothing between them there.
In the category of vitamins, both are a good source of some B vitamins, and neither are good source of much else. The B-vitamins they have most of, B2 and B12, Greek yogurt has more.
We’ll call this a small win for Greek yogurt.
As they are dairy products, you might have expected them to contain vitamin D—however (unless they have been artificially fortified, as is usually done with plant-based equivalents) they contain none or trace amounts only.
When it comes to minerals, both are reasonable sources of calcium, selenium, and phosphorus. Of these, they’re equal on the selenium, while cottage cheese has more phosphorus and Greek yogurt has more calcium.
Since it’s also a mineral (even if it’s usually one we’re more likely to be trying to get less of), it’s also worth noting here that cottage cheese is quite high in sodium, while Greek yogurt is not.
Another win for Greek yogurt.
Beyond those things, we’d be remiss not to mention that Greek yogurt contains plenty of probiotic bacteria, while cottage cheese does not.
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No Time to Panic – by Matt Gutman
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Matt Gutman is not a doctor or a psychologist. He’s a journalist, accustomed to asking questions and then asking more probing questions, unrelenting until he gets the answers he’s looking for.
This book is the result of what happened when he needed to overcome his own anxiety and panic attacks, and went on an incisive investigative journey.
The style is as clear and accessible as you’d expect of a journalist, and presents a very human exploration, nonetheless organized in a way that will be useful to the reader.
It’s said that “experience is a great teacher, but she sends hefty bills”. In this case as in many, it’s good to learn from someone else’s experience!
By the end of the book, you’ll have a good grounding in most approaches to dealing with anxiety and panic attacks, and an idea of efficacy/applicability, and what to expect.
Bottom line: without claiming any magic bullet, this book presents six key strategies that Gutman found to work, along with his experiences of what didn’t. Valuable reading if you want to curb your own anxiety, or want to be able to help/support someone else with theirs.
Click here to check out No Time To Panic, and find the peace you deserve!
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The Great Cholesterol Myth, Revised and Expanded – by Dr. Jonny Bowden and Dr. Stephen Sinatra
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The topic of cholesterol, and saturated fat for that matter, is a complex and often controversial one. How does this book treat it?
With strong opinions, is how—but backed by good science. The authors, a nutritionist and a cardiologist, pull no punches about outdated and/or cherry-picked science, and instead make the case for looking at what, statistically speaking, appear to be the real strongest risk factors.
So, are they advocating for Dave Asprey-style butter-guzzling, or “the carnivore diet”? No, no they are not. Those things remain unhealthy, even if they give some short-term gains (of energy levels, weight loss, etc).
They do advocate, however, for enjoying saturated fats in moderation, and instead of certain polyunsaturated seed oils that do far worse. They also advocate strongly for avoiding sugar, stress, and (for different reasons) statins (in most people’s cases).
They also demystify in clear terms, and often with diagrams and infographics, the various kinds of fats and their components, broken down in far more detail than any other pop-science source this reviewer has seen.
Bottom line: if you want to take a scientific approach to heart health, this book can help you to focus on what will actually make the biggest difference.
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