Health

What Black Dads Need To Know About Prostate Cancer

July 2008

(BlackDoctor.org) -- Did you know that African American men are at a higher risk, than any other ethnic group for developing and dying from prostate cancer? If you did know this, did you know that it has less to do with race than the lack of access to routine health care?

According to HealthDay News, while black men face a greater than 60 percent higher risk for prostate cancer than whites, prior efforts to explain that disparity have focused on a mix of genetic predisposition, poor education, and a general distrust of the medical system among the black community.

A new study, published in the April 15 issue of Cancer, reveal that black American men are, in fact, well-educated when it comes to prostate cancer risk. Instead, the authors find that, compared with white Americans, black men too often lack health insurance or a regular relationship with a primary care doctor. In those cases, the diagnosis and treatment of prostate trouble falls behind.

According to the study's lead author, the findings counter what he called the "blame-the-victim, paternalistic take on African-Americans and prostate cancer."

"To explain worse outcomes among African-Americans, there's been this idea that 'these uneducated people don't get it,' " said Dr. James A. Talcott, director of the Center for Outcomes Research at Massachusetts General Hospital Cancer Center and a professor at Harvard Medical School in Boston. "That they just have wacky beliefs about treatment and doctors, and don't appreciate the risks. And, if anything, it is the opposite. It isn't about cultural beliefs, and it isn't that they're uneducated or uninformed. It is that many are poor, lack insurance, and have lousy access to health care."

Risk for Prostate cancer rises with age. More than 65 percent of all cases occur among men 65 and older. Black Americans are almost 2.5 times more likely to die of the disease than whites.

Talcott collaborated with fellow colleagues at the University of North Carolina at Chapel Hill School of Medicine to survey 84 black American men and 253 white men from North Carolina, all of who had been diagnosed with localized prostate cancer between 2001 and 2004.

The questions centered on prostate cancer screening history, family history, access to care, general attitudes toward health and health care providers, physician relationships, treatment experience, co-existing disease, and symptoms.

According to the study, while 55 percent of blacks earned below $40,000, just 23 percent of the white men fell into that income bracket. Black participants were also more likely to have blue-collar jobs, lower educational backgrounds, co-existing disease, and to be jobless as a result of illness or disability.

Survey results indicated that black men fared much poorer in terms of health insurance. While only three percent of whites lacked insurance altogether and almost one-third had some private Medicare supplementary coverage, eight percent of black men lacked any coverage and just 17 percent carried a Medicare supplement.

The study found that Black men were also twice as likely to seek care at a public clinic or emergency room and less likely to see the same primary care provider from visit to visit. They also found that black patients were three times as likely to say they didn't seek care for a health issue, even when they thought they might need it.

At the same time, black men also reported a greater sense of responsibility for their health and were less likely to trust their doctors. Many expressed the suspicion that doctors based their decisions more on the basis of cost than the patient's health.

Based on the data from the study, researchers believe that black American men are as informed about prostate cancer risk and the need for treatment as whites. However, other barriers, such as lack of insurance, weaker established ties to physicians, and poor access to convenient and affordable care, often prevent them from taking action.

"So, the bottom-line is, you don't have to scare the heck out of African American men or work hard to convince them that they should seek regular health care," Talcott said. "You don't have to browbeat them. They get it and they understand the deal. The problem is that many are not getting screened, because they have jobs that don't provide insurance, and because they don't have a regular doctor, and because they simply can't go to an ER for five hours to get looked at."

"So, we have to improve access and trust in the health care system by making sure that these men can build relationships with doctors and access medical care when they need it. That's the answer," he said.

One expert wasn't surprised by the findings.

"We know from past research, such as work in military settings, that where access to prostate cancer care is reasonably equal, outcomes are equal in terms of race," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society. "Of course, there are other relevant factors that may come into play, including even biologic differences in disease risk and progression. But access to care is the major issue."

"So, it's important that this study shows these men are aware of the risk and aware of the issues," he said. "And it's certainly not that we don't know what to do about it. We've made great progress in research and treatments. But we do not have equal access to health care in this country, and we need to address that. And until we do, we're not going to make the progress we could in terms of the treatment of cancer."

By John Williams, BDO Staff Writer

Why Are African Americans At Risk For Diabetes?

July-2008

BlackDoctor.org) -- Every time I read an article about African Americans and diabetes, I am consistently reminded that I am at high risk for this condition. What these articles usually lack is a good explanation, outlining why I and other African Americans are at risk for this and so many other diseases. Let’s examine the many reasons why African Americans are at risk for diabetes.

Being overweight is one of the main risk factors for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to your own insulin. Still, it's not just a matter of how much you weigh. It also depends on where the weight is distributed. If you have extra weight in the upper part of your body, particularly around your abdomen, you're especially at risk. The good news is that many people with type 2 diabetes who are overweight can improve their glucose levels simply by losing weight.

The less active you are, the greater your risk is of developing type 2 diabetes. Physical activity helps you control your weight, uses up glucose, makes your cells more sensitive to insulin, increases blood flow and improves circulation in even the smallest blood vessels. Exercise also helps build muscle mass. That's important because most of the glucose in your blood is absorbed into your muscles. When you have less muscle tissue, more sugar stays in your blood.

The risk of type 2 diabetes increases if you have a parent or sibling with the disease. In fact, researchers have confirmed that a variant in a particular gene increases the risk of developing type 2 diabetes. In a July 2006 study, the risk of developing diabetes was about 80 percent higher for participants who inherited two copies of the newly identified gene variant than for participants who didn't carry the variant.

The risk of type 2 diabetes increases as you get older, especially after age 45. Often, that's because people tend to exercise less, lose muscle mass and gain weight as they age. But diabetes is also increasing dramatically among children, adolescents and younger adults.

As you can see there are a few risks that heighten your chances of developing type 2 diabetes. We can’t control all of these risks, but we can control some of them. Let’s make a commitment to control the risks we can and empower ourselves by being proactive about our health.

John Williams, BDO Staff Writer

What Every Black Woman Should Know About Heart Disease

July-2008

Almost 400,000 women die of heart disease in the United States each year, and a large percentage of them are black females. In fact, diseases of the heart and circulation, which include heart attacks, stroke, heart failure, kidney disease, hypertension, and diabetes, are responsible for killing more black women than anything else in our society. That includes cancer, although women tend to be more afraid of developing cancer than of getting heart trouble.

African American women are especially affected by heart disease in a negative manner. They have a higher mortality or death rate than white women and black men under the age of 55 years. The mortality rate from coronary heart disease is 69% higher than for white women. In addition, the first heart attack occurs at an earlier age in black women and is more likely to be fatal than is the case in white women. And pre-menopausal women who have hypertension, which is more common in black women, have 10 times the heart attack risk of those without high blood pressure.

The purpose of this article is to put African American women on notice that they are at great risk of dying or being disabled by what we call cardiovascular disease, or CVD, and that they need to take some precautionary steps to avoid being affected by these problems. Over the past several years, we have developed a knowledge base of information which allows us not only to look back and see what has happened to so many black women who have been affected by these disorders, but also to look ahead and to project what will happen to our women if certain corrective and preventive actions are not taken. An organization which I founded 30 years ago, called the Association of Black Cardiologists, has collected a great deal of that information and is currently conducting research on the subject through its Women’s Center in Atlanta, Georgia. More information about this organization and others that you may want to contact for more resource data is provided at the end of the article.

What we will do is to give you some very basic information about the heart and circulation as well as the disorders which can potentially affect you---and in fact, may already be doing so. In all cases, remember that this is being provided to alert you to the possibility of CVD dangers in yourself, and you should consult your doctor or health care provider for further information and possible needed action.

Understanding the Cardiovascular System

The cardiovascular system consists of a network of organs, including the heart and kidneys, which are connected by a vast conglomeration of blood vessels, mainly arteries, veins, and capillaries, through which blood flows in a closed system which never connects to the outside unless it is by means of trauma (injury) or deliberate surgery. The heart beats normally on a regular schedule, propelling the blood through the blood vessels to deliver oxygen and nutrients to all of the body’s tissues and organs and picking up wastes such as carbon dioxide, which are produced by metabolism within the body. One of the organs that is serviced by the cardiovascular system is the heart itself. For example, if it does not receive the oxygen supply that it needs because a coronary (heart) artery is clogged and blood flow is decreased, the heart muscle, which is called the myocardium, may become damaged. When it becomes partially starved of oxygen, we say that myocardial ischemia exists. When it becomes completely deprived of oxygen, the heart muscle will die, and we say that myocardial infarction (a heart attack) has occurred. The same thing can happen to the brain, leading to a stroke, or the kidneys, causing renal insufficiency. If the heart and blood vessels become overloaded with fluid, heart failure or high blood pressure (hypertension) may result. Of course, this is an oversimplification of what actually happens, but the main idea is that the cardiovascular system is very delicately balanced and if its function is disturbed, disease can occur. This is what African American women are prone to, and now we will explore some of the reasons for this.

Risk Factors in African American Women

Black women have the highest rates of what are called risk factors for cardiovascular disease in the country, when they are compared to men and women of their own race as well as other races. When you have a risk factor, which means that you are unusually likely to develop CVD, as opposed to people who have none. In addition, the more risk factors you have, the greater are the chance that you will have an adverse event involving the cardiovascular system such as a heart attack or a stroke. It has been well documented that African American women have the highest rates of the following risk factors:

Smoking: 26% of black women smoke
High blood pressure: about one-third of black women have hypertension
Obesity: two-thirds of black women are overweight or obese
Physical inactivity: the majority of black women do not exercise regularly

In addition, diabetes, which causes so many heart attacks that it is now considered a cardiovascular disease and a CVD risk equivalent, is found in a very high percentage of African American women.

It is interesting that women have a built-in protection against CVD when they are young or premenstrual. The protective element is estrogen, a sex hormone that occurs naturally in the body but declines as the woman grows older. As a result of estrogen’s protective action, women have their heart attacks about ten years later than men. However, smoking and diabetes completely nullify the protective advantage conferred by estrogen, and women who smoke and /or have diabetes may have heart attacks equal to the rate seen in men, and at the same age as men. Obviously, therefore, it is foolish for black women to smoke, especially if they have diabetes or any other risk factor, because then the risk of a cardiovascular event is multiplied. It has also been documented that the cardioprotective effects of aspirin are nullified by smoking.

In addition to the risk factors named above, there are others such as high cholesterol levels. Cholesterol is a sticky substance that plugs up the arteries of the body when it gets out of control, and when this happens to the coronary arteries that supply blood and oxygen to the heart or brain, a heart attack or stroke can occur. Cholesterol is in many of the foods that we eat, and it is also manufactured by the body. It is known as a lipid or blood fat. Some of the foods that contain high amounts of cholesterol are red meat, eggs, butter, and whole milk. There are many others. Trans fats, which are fats processed in a manner that preserves food longer, is especially dangerous, and you should avoid margarine and any food that contains it. Potato chips, fast food hamburgers, and many other products have it. If it is on the label of any food that you are thinking about buying, you should not buy that product. In general, any fried food you eat will contain excessive amounts of cholesterol, and these should be avoided. You can’t tell if your cholesterol is high unless you get it checked by a blood test done by a doctor. Fortunately, there are very effective medicines available to lower your cholesterol if needed, and eating the right diet definitely helps.

High blood pressure is very common in African Americans. It has multiple causes, one of which is heredity. It tends to run in families, and almost every African American person either has it or has a relative who does. Eating too much salt is definitely linked with hypertension, and this is something that is characteristic of the black diet. Fast foods and fried foods contain a lot of salt, too. A diet called the DASH diet (Dietary Approaches to Stop Hypertension) showed particular benefit in black women and was based on the use of low-salt foods, fruits, nuts, whole grains, and vegetables.

Blood pressure is a measure of the force that the blood exerts on the arteries carrying it, and it is recorded in two components, called the systolic pressure, which is caused by the beating of the heart, and the diastolic pressure, which is caused by the squeezing effect of the arteries on the blood inside of them. Systolic is the upper figure and diastolic is the lower figure in the blood pressure recording. For example, 120/80 is considered normal. Your doctor knows how to interpret your particular blood pressure and can tell you if it is high, and he will advise you on what to do about it. Again, there are many very effective medicines he can give you if your blood pressure is out of control. If left undetected and uncontrolled, high blood pressure can lead to heart attacks, stroke, kidney failure, and blindness. More than 71,000 African Americans die each year from hypertension. It can also aggravate diabetes if it is present and make it more difficult to control.

Obesity is another risk that black women have to contend with. As stated above, the majority of them are overweight or obese, and there is definitely a connection with heart disease, stroke, hypertension, and diabetes. Obesity tends to be aggravated by poor dietary habits such as eating fattening foods with a high caloric content. Although there has been controversy over which of several popular diets (Atkins, Ornish, Mediterranean, Weight Watchers, etc.) is best for losing weight, in actual fact, no particular diet has an advantage over the other, according to a recently published medical study. All will cause weight loss---the big battle is staying on the diet and maintaining the loss. Your doctor can definitely help with this, but there is a lot that you can do on your own. You can avoid fast foods, check the fat and carbohydrate grams in the foods before you buy them, and concentrate on eating whole grains, nuts, low fat or skim milk, fruits, vegetables, fish, skinless poultry, and poly-unsaturated fats and oils such as canola and olive oil. Again, avoid trans-fats, which are in preserved and processed foods including potato chips and margarine, and stay away from saturated fats which are heavily concentrated in red meat.

Regular physical exercise is a must to be used in conjunction with the diet. Any amount of exercise such as brisk walking will help, but the greatest benefit is seen when the exercise is performed at least three times a week in an aerobic fashion that is done for at least 20-30 minutes to the point of sweating.

When you go to the doctor, ask him to measure your waist. If it is more than 35 inches around (in circumference), you have a very high risk of suffering a cardiovascular event and dying from it within five years, so you must do everything you can to reduce that waist! (The critical waist circumference is 40 inches for men.)

Warning Signs for Black Women

Unfortunately, CVD often strikes without warning, and the first hint of it may be sudden death, a heart attack, or a stroke. However, there are some things that may tip you off that you are headed for big trouble. These are called symptoms and signs. For instance, pain in the chest is a classic symptom of an impending heart attack, and it means that your heart is literally crying out for help. It is called angina. Black women do not experience it as commonly as white women, for reasons that are not entirely clear. It may also occur in locations other than the chest such as the back, arm, and even the jaw. It may or may not be associated with activity. If it does occur, it may be misinterpreted as indigestion or an upset stomach. The best advice is, don’t take a chance---go to the nearest hospital right away to be checked to make sure you are not having a heart attack. This is crucial, because half of the people who have a heart attack die on the first occasion. You may not get a second chance if you are having a heart attack and don’t get immediate medical attention. So use 911---that’s what it’s there for. Better safe than sorry. Shortness of breath, a fast heartbeat, excessive sweating, unexplained weakness and tiredness, nausea and dizziness may also occur.

High blood pressure may not cause any signs or symptoms warning you of its presence until something happens, such as a stroke or heart attack. For this reason, it is called the “silent killer”. You really do need to get that blood pressure checked by a doctor, and more than one time. When hypertension does cause symptoms, they may include headache, dizziness, rapid heartbeat (palpitations), or blurred vision. But don’t wait until these symptoms occur, because by then, dangerous complications stemming from damage to major organs may already be in progress.

Stroke is caused when the blood supply to the brain is interrupted, and it can also be caused by blood clots in these arteries or whenever a brain artery is ruptured or bursts, causing cerebral hemorrhage, which commonly occurs in black people who have hypertension. Strokes generally occur suddenly, often without warning. Some of the warning signs may be sudden numbness or weakness of the limbs or face, especially on one side, sudden confusion, difficulty speaking or walking, difficulty focusing the eyes, and headache. If any of these things happen, you should get to the hospital right away, because brain damage progresses within minutes and is usually permanent and irreversible unless treated very quickly. Call 911 immediately. You don’t even have time to get dressed.

Conclusions

In this brief article, I have tried to provide some information that will give African American women some “heads-up” guidelines to the prevention, detection and management of cardiovascular disease, which is our greatest killer. It is not possible in this small space to give more than a comprehensive overview of the problems, but hopefully, you have gotten the most important message of all, which is to get yourself checked out by a doctor and to heed the advice given. Your life and health are literally on the line. Remember, only you can take the steps necessary to save yourself. Black women are the greatest assets that we have in the African American community, and we must make every effort to preserve them. It is my hope that this advice will really be taken to heart.

If you would like to read more on the subject of heart health for African Americans, please visit the website of the Association of Black Cardiologists (the ABC) at www.abcardio.org, where several excellent references may be accessed. You may also call this organization at 800-753-9222. Another excellent reference is a book called The Heart of the Matter, by Hilton Hudson, M.D., published by Hilton Publishing Co. You can go on-line to check it out. In the local Los Angeles area, the Charles R. Drew Medical Society may be contacted to reach several outstanding African American physicians who know how to treat you. They can be contacted at 310-714-5476.

For more information on African American Health, visit www.BlackDoctor.org your trusted resource for healthier, happier living.

By Richard Allen Williams, M.D., BDO Contributing Writer
Clinical Professor of Medicine, UCLA
President/CEO, The Minority Health Institute, Inc. (MHI)
Chair, Institute for the Advancement of Multicultural and
Minority Medicine (IAMMM)
Founder, The Association of Black Cardiologists, Inc. (ABC)
E-mail address: mhinst@aol.com
8306 Wilshire Blvd., Suite 288,
Beverly Hills, CA 90211

Tamoxifen Protects Black Women At High Risk For Breast Cancer

July-2008

(HealthDay News) -- Tamoxifen helps prevent breast cancer in women at high risk for the disease who have also had their ovaries removed as part of a hysterectomy, researchers report.

The new study, "reaffirms that tamoxifen is still a tremendous drug for prevention of breast cancer in women who are at a high risk for development of the disease," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. He was not involved in the trial.

The study -- an extended follow-up of the Italian Randomized Tamoxifen Trial -- is published in the May 2 issue of the Journal of the National Cancer Institute.

The initial findings of the trial found tamoxifen offered no reduction in women's risk for breast cancer. Nor had some other European trials, some of which looked at women with different risk profiles.

But an earlier and much larger study, the National Surgical Adjuvant Breast and Bowel Project (NSABP) Breast Cancer Prevention Trial, had shown that tamoxifen could cut the risk of estrogen-receptor-positive breast cancer -- tumors that grow in the presence of estrogen. In fact, that trial was halted early, because the risk reduction in invasive breast cancer was so striking.

Here, the authors presented 11-year follow-up data on more than 5,400 women who had undergone a hysterectomy (including having both ovaries removed) and who had been randomly assigned to receive tamoxifen or a placebo for five years.

Ovaries make estrogen, so removing them ensures that no extra estrogen -- which can fuel some breast cancer tumors -- is being produced.

For women at low risk for breast cancer, disease rates were similar whether or not they took tamoxifen, the researchers reported.

The situation was different for higher-risk women. In that case, women taking tamoxifen had lower rates of hormone-receptor-positive breast cancer than those taking a placebo: 1.5 per 1,000 women-years in the tamoxifen group versus 6.26 per 1,000 women-years in the placebo group.

There was also a greater reduction in risk for tumors that were both progesterone- and estrogen-receptor positive, than for tumors which were estrogen-receptor positive and progesterone-receptor negative.

Women in the tamoxifen group also had more side effects, including hot flashes and heart problems. These are noted side effects of the drug. A woman's cardiac risk needs to be assessed before she is started on tamoxifen, the authors stated.

The new study "reaffirms the pioneering work that the NSABP did back in the '90s," Brooks said. "Tamoxifen is still an excellent drug for prevention of breast cancer and is underutilized," he added.

Another expert said newer drugs can help, too.

"Tamoxifen does decrease the risk of invasive breast cancer," said Dr. Alison Estabrook, chief of breast surgery at St. Luke's-Roosevelt Hospital in New York City. "We're hoping that the new aromatase inhibitors which are being tried now for prevention will reduce the risk of breast cancer, which they should."

Aromatase inhibitors, which lower the amount of estrogen in the body by blocking a key enzyme, have far fewer side effects than tamoxifen. Another drug, raloxifene, also has fewer side effects but does not prevent noninvasive breast cancer, whereas tamoxifen works on both, Brooks said.

In other findings, reported in the same issue of the journal, a team at Baylor College of Medicine in Houston used a three-drug combo to block the growth of aggressive breast cancers in mice.

The team added two cancer drugs, gefitinib and pertuzumab, to Herceptin (trastuzumab) to help slow the growth of tumors with higher levels of a protein called HER-2. Herceptin was designed to block HER-2 but proved much more effective with the addition of the other two agents, the researchers found.

A clinical trial will begin soon, said co-investigator Dr. Kent Osborne, director of the Breast Center and Dan L. Duncan Cancer Center at Baylor. "We are very excited to see if our laboratory results can be translated to patients with the more aggressive types of breast cancer," he said in a statement.

More information
There's more on tamoxifen at the U.S. National Cancer Institute.

By Amanda Gardner, HealthDay Reporter

Raising 'Good' Cholesterol Levels Still a Worthy Goal

July-2008

(HealthDay News) -- Despite the death of Pfizer's new cholesterol drug, researchers say they are not abandoning their quest to find ways to prevent heart disease by raising levels of "good" cholesterol.

Reducing LDL, or "bad" cholesterol, has been the main focus of cardiology in recent years, but boosting its counterpart, HDL, also has a salutary effect.

Indeed, Pfizer was intending to market the new drug with Lipitor, a cholesterol-lowering statin that happens to be the world's best-selling drug. But the development of the drug, torcetrapib, was hurriedly shut down on Dec. 2 because of an unexpected number of deaths and cardiovascular problems in patients participating in clinical trials. Pfizer, the world's largest drug maker, had already poured $800 million into the venture.

Increasing HDL lowers event rates, while lowering LDL cholesterol does the same, explained Dr. Robert Myerburg, a professor of medicine and physiology at the University of Miami's Miller School of Medicine. "That's pretty well-established. There's good supporting data, and the rationale is there."

"It's a valid strategy," added Dr. Daniel Fisher, a clinical assistant professor of medicine at New York University School of Medicine in New York City.

While HDL is not as important as LDL in controlling heart disease, it's still a player, experts say.

"There are six major factors that we've designated that are vastly important in the prevention and control of heart disease, and HDL has never made that cut," explained Dr. Gerald Fletcher, a spokesman for the American Heart Association and a professor of medicine at the Mayo Clinic College of Medicine, in Jacksonville, Fla. "HDL has never been established as that important compared to LDL, but it's certainly important."

Other drugs that are similar to torcetrapib are currently in various stages of development, but it's not clear if the problems that cropped up with torcetrapib will reappear with those medications.

"We don't know the class effect or the potency of the drugs," Myerburg stated. "And we don't know how much added benefit they will provide to the person taking multiple drugs."

In the meantime, doctors and patients already have Niaspan, an extended-release version of niacin. Niaspan is less potent than torcetrapib.

"Niaspan also raises HDL but to a lesser extent," Fisher said. "It's not even in the same ballpark."

And because Niaspan also lowers LDL, it's hard to tease out what's causing the good. "Which is a major player in improving event rates?" Myerburg asked. "We don't know where the benefit is coming from."

And Niaspan, which works by a completely different mechanism than torcetrapib, causes uncomfortable skin flushing that can prompt some patients to discontinue taking their medication. A government-sponsored trial is currently looking at how Niaspan works in combination with statins.

Drugs called fibrates can also boost good cholesterol but, in combination with statins, can have undesirable muscle and liver effects, Fisher said.

Statins themselves raise HDL as well, but to a much lesser extent than either Niaspan or torcetrapib.

There are other things patients can do that don't involve taking another pill, experts added.

"A regular, dedicated exercise program will elevate HDL, but it has to be a long-term thing," Fletcher said.

More information
Visit the American Heart Association for more on cholesterol.

By Amanda Gardner, HealthDay Reporter

SOURCES: Daniel Fisher, clinical assistant professor, medicine, New York University School of Medicine, New York City; Robert Myerburg, M.D., professor, medicine and physiology, University of Miami School of Medicine; Gerald Fletcher, M.D., professor, medicine, Mayo Clinic College of Medicine, Jacksonville, Fla.

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