Surgery can dramatically reduce genetic cancer risk

Updated 16 May 2013
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Surgery can dramatically reduce genetic cancer risk

Women whose genes put them at a high risk of contracting breast cancer can dramatically reduce the danger by having a double mastectomy — but not eliminate it altogether, experts say.
The issue has been thrown into the spotlight with Hollywood star Angelina Jolie’s announcement that she had her breasts surgically removed after tests revealed she carried a genetic mutation that can lead to cancer.
Rocker Ozzy Osbourne’s wife, Sharon, did the same last year.
About 0.2 percent of women carry a harmful mutation in the BRCA1 or BRCA2 gene that boosts their lifetime risk of contracting breast cancer to as much as 80 percent compared to about 10 percent for women without the gene. “This is what many people would consider a sky-high risk,” epidemiology professor Per Hall of Sweden’s Karolinska Institutet told AFP. “For the few women who are carriers (of the mutation) this is definitely a good option,” he said of surgery.
Having a double mastectomy reduces a mutation-carrier’s risk by about 90 percent to a level lower than that of women who don’t carry the genetic flaw. But it but can never eliminate the danger entirely.
“Even the most skilled surgeon will leave some tiny part of breast tissue behind,” said Hall.
An estimated 458,000 women died of breast cancer — the most common cancer type among women — in 2008, according to the World Health Organization (WHO).
Survival rates vary greatly, from 80 percent in the developed world to under 40 percent in poor countries that have fewer early-detection programs. The cost of genetic screening can be prohibitive — ranging from several hundred to several thousand dollars, says the US-based National Cancer Institute.
On its website, the WHO says early detection remains the “cornerstone” of its cancer strategy as preemptively screening asymptomatic people was a “far more complex undertaking.”
DNA, the blueprint for life, comprises four basic chemicals called A (adenine), C (cytosine), T (thymine) and G (guanine) strung together in different combinations along a double helix.
Sometimes a “spelling mistake” in the A, C, T, G combinations can cause problems in gene function.
But carrying a mutation does not necessarily mean a person will develop cancer — factors like lifestyle also play a role. A study in 2005 concluded that a fifth of breast cancer deaths worldwide could be attributed to alcohol use, excessive weight and physical inactivity.
Delayed pregnancy and not breastfeeding are factors considered to increase one’s chances of contracting breast cancer.
Age is a major factor — most breast and ovarian cancers occur in women over 50, though women with the BRCA mutations often get ill at an earlier age.
Mutations in the BRCA (BReast CAncer susceptibility) genes, which normally act as tumor suppressors, also increase ovarian cancer risk.
Clinical geneticist Clare Turnbull at the Royal Marsden Hospital in London said women who carry the mutation are generally offered intensive MRI and mammogram screening so any cancer can be caught and treated early.
“That is one option, and for many women particularly young women, that’s the option they choose,” she told AFP.
“Other women feel that they would like to take a more interventional approach and try and reduce the likelihood of them getting cancer in the first place,” such as a double mastectomy.
“It is not uncommon.”
The London-based Breast Cancer Campaign said Jolie’s openness would help raise crucial awareness of genetic breast cancer risk.
“Deciding whether to have preventative surgery is a heart rending decision for women like Angelina but we know it’s a vital way of saving lives,” the campaign’s chief executive Delyth Morgan said.
“This is a stark reminder of how much more research we need to do to give women more knowledge, choice and life-saving options to reduce their risk.”


Take a healthy approach to the issue of nutritional supplements

Updated 21 April 2018
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Take a healthy approach to the issue of nutritional supplements

JEDDAH: There is a growing need for dietary supplements in Saudi Arabia, given the increasing popularity of junk food and the effective role supplements can play in treating diseases caused by mineral and vitamin deficiencies.

A recent study found that 22 percent of Saudi people take nutritional supplements. It is no surprise, then, that many Saudi businesses have forged partnerships with international dietary-supplement companies.

Dr. Rowaidah Idriss, a Saudi dietitian with a Ph.D. in nutrition, said dietary supplements can be defined as substances that provide the human body with a nutrient missing from a person’s regular diet. However, she stressed that they are not intended to replace healthy eating.

She also warned against taking them without first talking to a doctor or dietitian, as some products can have side effects, especially if taken before surgery or with other medicines. 

“They can also cause problems if someone has a history of certain health issues,” she added.

A blood test can determine which nutrients we are not getting enough of in our diet, and therefore which supplements might be beneficial. Nutritional supplements are also used to help treat certain health conditions. 

“Vitamin C, for example, is often used to reduce cold symptoms,” said Idriss. “Fish oil is taken to lower elevated blood triglycerides.”

She suggested four daily essentials that can bridge nutritional gaps in our diet: a multivitamin, vitamin D, calcium and omega-3 fatty acids. 

“I routinely recommend a daily multivitamin and mineral supplement to my clients after consulting with their doctors,” she said. 

“For menstruating women, who require 18 milligrams of iron each day, a daily supplement helps boost iron intake.”

She said people over the age of 50 are advised to take a multivitamin to ensure they are getting enough B12, which plays a key role in the functioning of the nervous system and the development of red blood cells. 

“Older adults are more vulnerable to B12 deficiency because they are more likely to have decreased production of stomach acid, which is needed to release B12 from the proteins in food.” said Idriss. 

“It is also a good idea to take a daily multivitamin if one is following a low-calorie diet.”

She also pointed out that a high intake of DHA and EPA, the two omega-3 fatty acids found in fish oil, are linked with a lower risk of heart disease and Type 2 diabetes. A deficiency of DHA might also increase the risk of Alzheimer’s. 

“A daily intake of 1,000 milligrams of both DHA and EPA is equivalent to eating 12 ounces of salmon a week,” said Idriss.

The dietitian believes that the Saudis who take food supplements often do so more to benefit their appearance than their health. 

“Saudi women consume more dietary supplements than other people in Saudi Arabia,” she said. 

“They do so either to lose weight or to care for their hair and nails. Bodybuilders also take large amounts of supplements.”

However, both groups, according to Idriss, tend to take supplements on the recommendation of friends and trainers, not doctors. 

She warned that commercials and social-media rumors can persuade people to buy supplements online that may not be approved as safe by the Saudi Food and Drug Authority, and advised people to get as much of their daily nutrient needs as possible from healthy eating.

Dr. Rowaidah Idriss

“Along with vitamins and minerals, a healthy diet provides fiber and hundreds of protective phytochemicals, something a supplement cannot do,” she said, adding that the body absorbs natural food more effectively than supplements.

In addition, combining supplements with medications can have dangerous, even life-threatening, effects. 

“Drugs for heart disease and depression, treatments for organ transplants, and birth-control pills are less effective when taken with herbal supplements,” she said.

“Taking an anticoagulant, aspirin, and a vitamin E supplement together may increase the potential for internal bleeding or even stroke.”

 

Natural sources

With the spread of fast-food restaurants and their alluring ads, the long-term health of the Saudi people is in danger, as children and young people snub natural sources of nutrients, such as fruit and vegetables. 

“This can lead to many deficiency diseases. Moreover, vegetarians can develop similar illnesses due to the absence of meat in their diet,” she said.
Dr. Ashraf Ameer, a family-medicine consultant, said the importance of nutritional supplements lies in treating mineral and vitamin deficiency, especially for pregnant women, growing children, diabetics, people with chronic diseases, and the elderly. 

“However, these products should come from reliable companies and meet Saudi food and drug requirements,”he added.

Mohammed Yaseen, who has a food supplements business, said his company works with a leading British health-care company to provide the Saudi market with high quality products.

“With this we hope we can contribute to the national transformation program by raising private-sector spending in health care from 25 percent to 35 percent, which in turn would lead to the sector’s financial sustainability and boost economic and social development in the Kingdom,” Yaseen said.

Decoder

Vitamin Terms

DHA stands for docosahexaenoic acid. EPA stands for eicosapentaenoic acid.  Phytochemical is a biologically active compound found in plants.