Marc Garnick, M.D., Harvard Medical School's Comments
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Mar 20, 2009 | comments: 5
Thanks so much for these important comments. The issue about diet is correct. We do think that dietary intake of correct foods may be able to decrease the incidence of colon cancer. In particular, avoidance of red meats is important.
I am deeply sympathetic to Sharon’s story and I wish her family member the best. While one of the medicines may not necessarily be the correct one for your sister, there are many different medicines that may be of benefit. It sounds like her physician is very up to date and should hopefully be able to offer sound guidance.

Please continue to share your thoughts with us on these important issues.
Mar 20, 2009 | comments: 5
Marc Garnick, M.D., Harvard Medical School Mar 20, 2009, 10:18am EDT
Do you know anyone who has been recently been diagnosed with colon cancer who may benefit from this information?
Feb 24, 2009 | comments: 10
Marc Garnick, M.D., Harvard Medical School Feb 28, 2009, 10:29pm EST
I am really appreciative for the thoughtful comments that each of you made. Mr. Olson apprpriately raises skepticism relating to the "conventional" treatments for cancer -- chemotherapy and radiation-- and brings up the important aspect of their side effects and their risk benefit ratio -- VERY important considerations, indeed. The use of chemo and radiation that are generally recommended for patients with cancer have undergone rigorous testing, using established scientific and clinical guidelines and undergo rigorous scurtiny by both physicians, insurance companies, and regulatory groups before the go-ahead is given. These are all performed to establish a risk - benefit relationship.
There would equal enthusiasm to use dietary supplements as well if these agents underwent the same testing. Unfortunately, when many supplements have been tested, they have not measured up – and hence the skepticism.

One good example of a nutritional supplement was something called PC Spes- a Chinese Herbal remedy that was touted as a “cure all” for prostate cancer. Unfortunately, there were a variety of adulterated substances that were contained in this unregulated substance, necessitating its removal from the market. Other supplements, such as saw palmetto, for benign prostate disease, was shown to be no more effective than placebo. Thus, I am all for supplements and nutricueticals, as long as there are data to support their safe use.
The issue about using radiation to treat cancer when it can cause cancer is a very important issue. Again, we come to risk benefit ratios. The potential for a second cancer to develop from the use of radiation is a daily issue cancer specialists face. However, the greater good and benefit of the use of radiation to eliminate the cancer outweighs the possibility of a second cancer developing, perhaps decades later.

The pomegranate intake is probably ok with either the juice or fruit form, but further research needs to be done to fully understand how the body handles this substance in its differing forms.

The habits of our other readers are commendable -- ingestion of a good diet, with fruit, vegetables and other nutritious goodies makes excellent sense to me.

Please continue to share your thoughts with us. And let us know if you have any other questions about nutrition and cancer and its prevention.

Marc B. Garnick MD
Sep 11, 2008 | comments: 16
I am personally overwhelmed by the response to this article. It points out that AD is a disease that affects not only patients but the familes that love them in different ways. From the comments about being concerned about "getting the disease" to the difficulties patiens with AD face in nursing homes, makes us aware that this is indeed a major problem of great magnitude. I really believ that there is hope. On the horizon are some tests that may help identify individuals at a heightened risk for developing the disease. Hopefully interventions earllier in these may make a difference, but we simply do not know yet. The issue about aluminum is of importance, as some studies have suggested a link of AD with excessive aluminum intake or exposure. Again, this information is not definitive.

Given the interest elicited from this article, I will be sure to continue to update it as more information becomes available. In the meantime, The Alzheimers's Association, the Harvard Mental Health Letter and the Harvard Medical School Special Reports continue to provide important and timely information of patiets and their families.

Please continue to write about your personal experiences with this very difficult disease.

Marc B. Garnick MD
May 5, 2008 | comments: 4
Mr. Romanoff: thanks for writing. The costs you are experiencing are very concerning, and oftenltimes are beyonld the means of may patients. It is important for our insurers to cover cancer drugs, regardless of whether they are taken by mouty or by injection and affordable insurance coverage of medicines not necessarily covered by governmental insurance is needed. There are mechanisms that pharmaceutical companies provide to provide medicines that are not covered by insurance and that the patient cannot afford, anld I would suggest that this be considered as well. These are very important issues and ones which should get more national attention especially in this electlion year.
Marc B. Garnick MD
Apr 14, 2008 | comments: 9
Thanks to all who took the time to share their comments, all of which are very enlightening. For those in the midst of quitting, keep going! I hope that our article continues to inspire you. For David's comments, a very interesting thought.
whether there will ever be such laws is doubtful, but the idea of identifying very high risk groups should continue to generate a lot of research.



Marc B. Garnick MD
Mar 17, 2008 | comments: 8
Marc Garnick, M.D., Harvard Medical School Mar 26, 2008, 11:11am EDT
Thanks to all for writing. You all seem to genuinely appreciate the importance of limiting sun exposure, and using sun blocks. This is very good advice. Please let us know if you have any other questions relating to skin cancers.
Marc B. Garnick MD
Feb 25, 2008 | comments: 13
Thanks so much for these important observations and comments. I tend not to recommend artificial light treatments to correct Vitamin D deficiency. Taking a supplement if you are not getting enough dietary intake is probably better advice. Kathryn's comment has been observed by others and in general, her seemingly healthy life style is to be commended. As more research is conducted, we will keep our readership up to date on the most recent advances. In the meantime, I would adhere to the advice provided in the article.

Marc B. Garnick MD
Feb 18, 2008 | comments: 3
Happy to provide that information. Marc B. Garnick
Feb 11, 2008 | comments: 5
Marc Garnick, M.D., Harvard Medical School Feb 18, 2008, 12:57pm EST
The comments of Kathryn and Ruth point out the difficulties in trying to determine what to do about being tested for prostate cancer and what treatments are best. The likelihood of preserving the nerves associated with surgical removal of the prostate gland vary form patient to patient and surgeon to surgeon. That being stated, in certain circumstances, sparing of the nerves can be done and some reports suggest that the maintenance of potency can be maintained, although my personal experience and other question this finding.

The only way to definitively diagnose prostate cancer is through a biopsy. The other tests that are mentioned are promising, but none can definitively determine whether a person does or does not have prostate cancer. Sexual activity can definitely raise the PSA value, usually for no more than 48 hours and usually not more than 0.2-0.4 units. Free PSA testing us usually more useful for total PSAs that are between 4 and ten. PCA 3 is slowly getting introduced into practice but not enough is known yet to fully recommend its use. Whether to have a biopsy is a discussion about the pros and cons with your urologist. Only then can you make an informed decision about going ahead with the test and if cancer is found, what to do about it. These are complicate issues and we will be discussing them in further editions of our column.

Thanks again for writing.

Marc B. Garnick MD
Jan 28, 2008 | comments: 4
Thanks so much for taking the time to write. One of the continued and great challenges for patients who have been diagnosed with cancer is living with the uncertainty of the future. In my practice, there is often as much anxiety about repeat doctor's visits once treatments have been completed.. We are continuing to research the best recommendations to try and maintain patients from remaining cancer free. This is an active area of research and we will be reporting important breakthroughs and "dos and don'ts" as they become available.
Jan 21, 2008 | comments: 21
Finally, Timothy V and Dorine Houston raise the important issue of missing red meat in the diet and the perception that fish or chicken are not as tasty or poor substitutes. While few can argue with the appreciation that many have in their enjoyment of red meat, my advice is to practice moderation. I am not firmly recommending complete elimination, but rather a reduction in consumption if your diet is heavy on red meat. Try to reduce it by a third and then by half; and then by three quarters as you substitute chicken, fish or other sources of protein. Life is a balance that requires a lot of compromises- here I think such a change is wise.

Please let us know if you have any other questions and thanks again for taking the time to share your important comments with us.
Jan 21, 2008 | comments: 21
In expanding on the multitude of causes of cancer, Michelle C's comments are very important. Patients who have either ulcerative colitis or Chron's disease, so called inflammatory bowel disease, are at a significant increased risk of developing colon cancer compared to the unaffected population without these disorders. The risk goes up the longer these diseases are active or that require treatment. It makes sense that known factors that may increase the risk of colon cancer in the unaffected population may be even more significant in those individuals with a known predisposition to the development of the disease. Hence, the efforts to eliminate the red meat from the diet is commendable.
Jan 21, 2008 | comments: 21
The response to this article has been very gratifying, and each of the respondents poses either excellent comments or very important questions. The issue about our ancestors' consumption of red meat and what seems to be a perception that the cancer incidence was less has several explanations; first, our population today is living significantly longer than our ancestors, which puts us at a higher risk of developing cancer. Second, the development of cancer is a multifactorial process, involving the interaction of many; chemicals, drugs, toxins, pollutants, and foods. The information presented in our blog was based upon population based statistics that encompass large populations of patients, rather than individual ones; and our ability to determine the attribution for the cause of death is more sophisticated than before. These may all help explain the discrepancies outlined by Donald H.
Jan 4, 2008 | comments: 7
Thanks to Vivian, Dianne, Jill, Roxanne, John, and Janet B. for writing. Inadequate news coverage or simply incomplete news coverage may sometimes prove confusing to consumers, especially about our environment and things in the environment that may be potentially harmful. That being said, it is important for all of us to appreciate the establishing a cause and effect of a suspected environmental cancer-producing substance actually causing cancer may in some instances take a serious research effort. We are trying very hard to provide on this Living With Internet Site objective information that makes a difference to you- our reader – in living a healthier and more medically sound life. Please keep your comments coming in and we pledge to provide objective information, based upon our most sound understanding of the scientific and medical evidence of what is good and what should be avoided.

Marc Garnick MD
Dec 10, 2007 | comments: 6
Marc Garnick, M.D., Harvard Medical School Dec 19, 2007, 11:41am EST
Todd, while I am sorry to hear that you contracted pneumonia, I am very pleased and congratulate you on "kicking the habit". It is not uncommon for an illness to decrease the body's desire for cigarettes, and in your case, you had the combined illness and will power to cease altogether. This is a first and important step in enjoying a healthier lifestyle and thanks so much for sharing your experience with our readers.

Marc B. Garnick MD
Dec 3, 2007 | comments: 6
Nanci,

The ability of an immature maternal cell crossing to the fetus and causing cancer is theoretically possible, but unlikely. More likely is the possibility of the maternal contribution to the fetus, in terms of the maternal DNA to have possible defects that may eventually heighten the offspring's likelihood of developing cancer, later in life.
Dec 3, 2007 | comments: 6
Debbie G.,

The hormones that are associated with pregnancy, notable estrogen and progesterone, are definite drivers of certain types of cancers, especially breast and possibly ovarian cancer. In the case of breast cancer, a mainstay of treatment is to block the effects of estrogen by giving anti estrogens or substances that block the production of estrogen, or in some cases, removing the ovaries, which in turn eliminates the source of estrogen. There is a possibility that other hormone related cancers, such as endometrial cancer, can be affected in an opposite way by hormones as well. Fro example, one of the effects of some medicines to treat breast cancer can actually cause an increase in endometrial cancer. The chemical relationship among hormone responsive or hormone induced cancers is complex, and requires a physician to help counsel patients regarding this issue.
Nov 12, 2007 | comments: 9
Amy B- if there is a significant family history of colon cancer, you should consider being evaluated by a genetic counselor. We have recently found that certain forms of hereditary colon cancer can also extend a parsons' risk for cancers outside of the gastrointestinal tract, such as gynecologic cancers and skin cancers.
Nov 12, 2007 | comments: 9
Kathryn- your comments are right to the point. Avoiding any artificial substances and keeping fruits and veggies as an integral part of the diet seem to make good sense and go along with guidelines and may positively affect overall health as well.
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