Ian Gawler Blog: Research, daily life and cancer

Groups, mushrooms, CD47, surgeons, PSA tests, mistletoe and coconut oil.
What do they have in common? They all feature in important research that throws light on what might make for a good choice if you or someone you love has cancer – or wants to avoid it. So this week, some compelling reading that just might help to save a life.

Plus Ruth and I start our tour of New Zealand next week, so more details of the talks and retreats, but first

Thought for the day
If I die
I want to be the healthiest person ever to die of this disease
                           One of the women in my Friday cancer group

Yes, that dot in the middle is me speaking at the Happiness and its Causes Conference in Perth last week; some highlights next week.

1. Attending a therapeutic group halves the risk of recurrence and the risk of dying from breast cancer
This study is a few years old now, but very significant all the same.

After a median of 11 years of follow-up, this study involving 227 women showed that those women provided with a psychological intervention via small groups that included strategies to reduce stress, improve mood and alter health behaviours, were found to have around halved the risk of both breast cancer recurrence (hazards ratio [HR] of 0.55; P=.034) and death from breast cancer (HR of 0.44; P=.016).

Follow-up analyses also demonstrated that women in the groups had a 50% reduced risk of death from all causes (HR of 0.51; P=.028) during the time of the study.
The authors concluded that psychological interventions can improve breast cancer survival.

Reference: Andersen BL et al, Psychologic Intervention Improves Survival for Breast Cancer Patients - A Randomized Clinical Trial.  Cancer. 2008; 113:3450-3458

2. Psychological and behavioural variables can have profound effects on cancer. 
In a related study, a meta-analysis (analysis of a large number of studies) revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality.1

Reference: Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475. [PubMed]

3. CD47: The cancer breakthrough I believe may really happen
Many of those who attend my workshops may remember I have been speaking hopefully of CD47 for some time. Here is an update.

CD47 is a kind of protein that is found on the surface of many cells in the body. It tells circulating immune cells called macrophages not to eat these cells. The body uses the CD47 protein to protect cells that should be protected and to help dispose of cells that are aged or diseased.

Unfortunately, some cells that should be destroyed are not. Researchers at Stanford discovered that nearly every kind of cancer cell has a large amount of CD47 on the cell surface. This protein signal protects the cancer against attack by the body's immune system.

Stanford investigators have discovered if they block the CD47 "don't-eat-me" signal through the use of anti-CD47 antibodies, macrophages will consume and destroy cancer cells. Deadly human cancers have been diminished or eliminated in animal models through the use of anti-CD47 antibody.

For the last year, many people have been working to make clinical trials in humans possible. Stanford is hopeful that the first human clinical trials of anti-CD47 antibody will take place in mid-2014, and clinical trials may also be done in the United Kingdom. Stay tuned; this one just might work!

4. Mushrooms – cook them and reap the rewards!
Some will know that mushrooms have been under something of a cloud (OK – bad pun ) and even on the Gerson banned list. I have never been able to find a satisfying rationale for this avoidance and more recent research indicates that maybe the problem was eating them raw, while cooking them seems quite beneficial.

In 2009 a study of 2,018 women correlated a large decrease of breast cancer in women who consumed common white button mushrooms (Agaricus bisporus). Women in the study who consumed fresh mushrooms daily were 64% less likely to develop breast cancer, while those that combined a mushroom diet with regular green tea consumption reduced their risk of breast cancer by nearly 90%.

Some studies have revealed that raw A. bisporus - along with some other edible mushrooms - contain small amounts of carcinogens. However, this research also noted that when cooked, these compounds were reduced significantly.

Reference: Zhang, M et al;  "Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women". International Journal of Cancer 124 (6): 1404–1408.

HERE IS THE INVITATION

Pause,  focus on the scene below,  take a deeper breath or two,  bring yourself into this present moment     :-) 

then read on

Photo taken near the river at the Gawler Foundation's Yarra Valley Living Centre where we conducted the training /retreat with Dr Nimrod Sheinman recently and where Ruth and I will lead next year's pre-Easter retreat Meditation in the Forest

5. Would you travel to save your life? Surgeons and survival
A fairly well kept secret is that when it comes to cancer surgery, particularly the more complex, complicated surgery, your surgeon’s experience levels can drastically affect your chances of long-term survival. This is an excellent thing to know BEFORE you might ever need it. Tell anyone you care for about it!

This proposition has been further validated recently by a well-funded Swedish prospective cohort study in which all patients who underwent eosophagectomy between 1987 and 2005 were followed until 2011.

Results demonstrated that surgeons who performed above the Swedish median number of operations per year had a 20% reduction in mortality. The median number was about 10 operations per year. What that means is that if you had been operated on by a surgeon who was doing more than 10 esophagectomies per year, you would have had a 20% reduction in mortality.

What should we make of this? Seek an experienced surgeon if you need a tricky operation.

Reference: Derogar M et al. Hospital and surgeon volume in relation to survival after esophageal cancer surgery in a population-based study. J Clin Oncol. 2013;31:551-557.

6. Are PSA tests more trouble than they are worth?
Here we go! This is really going Out on a Limb! PSA testing for prostate cancer seems to ignite untold passions in many of those involved, but speaking in The Age recently, health reporter Julia Medew pointed out

“PSA tests are controversial because they can cause "overdiagnosis" of prostate cancer that is so slow-growing it was never going to cause men harm. It is now estimated that for every man thought to be saved by the test, another 12 to 47 will be diagnosed with cancer that will not kill them. Many will have surgery and other interventions that can lead to sexual impotence and incontinence.”

A recent Australian review has called into question one of the major studies that is used to support PSA screening and in doing so, adds more caution to taking that test.

Here is the Abstract of the paper so that if you are interested you have some facts.

Major clinical trials using prostate-specific antigen (PSA) as the screening test to detect localized early-stage prostate cancer and to attempt to change its natural history with early intervention have yielded conflicting interpretations.

The US Prostate, Lung, Colorectal, and Ovarian (US PLCO) cancer screening trial concluded that PSA-based screening conferred no meaningful survival benefit, whereas the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the GOTEBORG clinical trial (GOTEBORG) trials claimed statistically significant life-saving benefits.

These divergent outcomes have not provided physicians with clarity on the best evidence-based treatment. To determine the extent to which these divergent outcomes are clinically meaningful, we evaluated these data and those of a long-term prospective cohort study in the context of the clinically documented harms of androgen deprivation therapy (ADT) (hormone treatment).

We noted the unheralded fact that in both European trials far more patients received hormonal treatment in the control than the prostatectomy arm, whereas hormonal therapy in the US trial was balanced between arms. We examined this imbalance in ADT treatment and prostate cancer–related deaths in the contexts of contamination, stage migration, and attribution of cause of death, all of which impinge on data interpretation.

The ERSPC and GOTEBORG data are compatible with the hypothesis that ADT treatment contributes differentially to an increase in prostate cancer deaths in control patients. If so, the claim of a reduction in prostate cancer deaths in the screened cohort requires reappraisal.

The conventional interpretation that PSA screening and radical treatment intervention are the major contributors to the results of these two studies needs more rigorous scientific scrutiny, as does the role of ADT treatment of nonmetastatic disease.

Reference: Haines I, Miklos G et al; Prostate-Specific Antigen Screening Trials and Prostate Cancer Deaths: The Androgen Deprivation Connection JNCI J Natl Cancer Inst, Vol 105; 20, 1534-1539.


To read The Age report: CLICK HERE: 

7. Mistletoe doubles survival in advanced pancreatic cancer
Advanced pancreatic cancer is a tough disease and while over the years I have seen a number of people actually survive for long periods following our approach, often the side-effects of any medical treatments are outweighed by any benefits. This then is an interesting study as although the times were still disappointingly short, the mistletoe injections almost doubled survival. Also, mistletoe has been one of those controversial treatments often labelled as "alternative", so it is good to see it being evaluates scientifically and that it does seem to have some efficacy.

Abstract: The unfavourable side-effects of late-stage pancreatic cancer treatments call for non-toxic and effective therapeutic approaches. Over 12 months, we compared the overall survival (OS) of patients receiving an extract of Viscum album Mistletoe (VaL) or no antineoplastic therapy.

Findings: We present the first interim analysis, including data from 220 patients. Patients in both groups received best supportive care. Median OS was 4.8 for VaL and 2.7 months for control patients (prognosis-adjusted hazard ratio, HR = 0.49; p < 0.0001). Within the ‘good’ prognosis subgroup, median OS was 6.6 versus 3.2 months (HR = 0.43; p < 0.0001), within the ‘poor’ prognosis subgroup, it was 3.4 versus 2.0 months respectively (HR = 0.55; p = 0.0031). No VaL-related adverse events were observed.

Conclusion: VaL therapy showed a significant and clinically relevant prolongation of OS. The study findings suggest VaL to be a non-toxic and effective second-line therapy that offers a prolongation of OS as well as less disease-related symptoms for patients with locally advanced or metastatic pancreatic cancer.

Reference: Tro ̈ger W. et al., Viscum album [L.] extract therapy in patients with locally advanced or metastatic pancreatic cancer: A randomised clinical trial on overall survival, Eur J Cancer (2013), http://dx.doi.org/10.1016/j.ejca.2013.06.043
 

RELATED BLOGS
Let your food be your medicine - more dietary research

Multi-vitamins and cancer

Who needs prostate surgery?

NEWS UPDATE
I am being asked in workshops why coconut oil melts at room temperature, around 22 -24C, yet Prof George Jelinek in his guest blog on coconut oil (Coconut oil- are you nuts?) says the simple, obvious reason not to use coconut oil is that it contains saturated fats that are solid at body temperature - 37C.

At first glance this may seem confusing, but here is the detail, and again, I quote George:

The explanation for this melting point of the oil is pretty simple. Coconut oil is a complex mixture of fats; while 88.7% is saturated fat, there are also mono- and poly-unsaturated fats in the oil, as with other oils.

So the melting point of the oil depends on the relative proportions of the various fats making up the oil, and is lower than the individual melting points of the saturated fats referred to in the blog because of the lower melting points of some of the other shorter chain saturated fats, mono-unsaturated fats, and poly-unsaturated fats.

However, coconut oil does not get absorbed whole, but rather as the individual fatty acids, and it is the melting point of each of those individual fatty acids that is the important factor when they are incorporated into cell membranes.

By way of example, butter melts at 32-35C despite being composed of 63% saturated fats, most of them with melting points higher than body temperature, yet no-one would recommend it for good health.

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand
in November/December.

There are a range of events in Auckland, Rotorua, Christchurch and Nelson.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit -  all the details are on my new public Facebook page: Dr Ian Gawler,    or the website.

Cancer, immunity and survival

Who said the immune system was useless in cancer medicine? Is a biologically elegant, one drug answer to cancer possible?

For years we have known some people have experienced medically unexpected, remarkable recoveries from difficult cancers. How these recoveries have occurred has received very little mainstream attention.

More than this, one popular notion, that a reactivated immune system may be behind these recoveries, was for many years denied as being even remotely possible by leading immunologists and oncologists. They claimed that the immune system did not have the capacity to identify cancer cells, and therefore could not, or would not attack them. I suspect there would be very little of that vehement denial these days as immunological principles, research and therapies have become better explored and implemented.

Also, recent ground- breaking new research points at a remarkable new possibility. A one drug answer to cancer. Well at least the theory sounds good, and here is how it would work.

Basically cancer is triggered by specific genetic damage. All healthy cells have what are called oncogenes and when these particular genes are damaged, and the cells that contain them reproduce, instead of producing another healthy cell, they produce a cancer cell.

Now if you think about it, cancer cells are pretty useless. They are primitive in their nature, they have no purpose or function, they grow out of control and would be of little consequence except for the fact they tend to get in the way and as such have the potential to be fatal.

What cancer cells do have going for them is their ability to convince the body’s defence system that they are not to be attacked.  Essentially, cancer cells have the ability to camouflage themselves from our immune systems. Without this protection, they would be identified as the problem they are and destroyed quickly and effectively.

This destruction would be very similar to what happens when we are faced with a bacterial infection. When foreign bacteria enter our bodies, the immune system recognizes the potential threat, is activated, destroys the bacteria and returns us to good health.

If the immune system and other components of the body’s defence system could detect and recognize cancer, it could and would act swiftly. So having a strong immune system is the starting point, but then getting past the camouflage is the vital issue.

Exciting new research published in January this year in the Proceedings of the National Academy of Science has demonstrated that a single drug can shrink or cure human breast, ovary, colon, bladder, brain, liver, and prostate tumours that have been transplanted into mice. The treatment, an antibody that blocks the cancer cells’ ability to conceal themselves, enables the immune system to destroy the cancer cells.

How is this possible? Ten years ago it was discovered that leukemia cells produce higher levels of a protein called CD47 than do healthy cells. CD47 is also displayed on healthy blood cells where its function is to block the immune system from destroying them. The breakthrough has been the discovery that all the cancers tested so far use CD47 to camouflage themselves from the immune system. The research indicates that the amount of CD47 a tumour made could predict the survival odds of a patient, while blocking it could lead to an immune system inspired recovery.

In mice, blocking CD47 with an antibody cured some lymphomas and leukaemias by stimulating the immune system to recognize the cancer cells as invaders. But the new research suggests that the CD47-blocking antibody may have a far wider impact than just blood cancers.

To determine whether blocking CD47 was beneficial, the scientists exposed cancer cells to macrophages, a type of immune cell, and anti-CD47 molecules in artificial tissue culture mediums. Without the drug, the macrophages ignored the cancerous cells; with it the macrophages engulfed and destroyed cancer cells from all tumour types.

Next, the team transplanted human tumours into the feet of mice, where they can be easily monitored. When they treated these mice with anti-CD47, the tumours shrank and did not spread to the rest of the body. In mice given human bladder cancer cancer, 10 of 10 untreated mice had cancer that spread to their lymph nodes. Only one of 10 mice treated with anti-CD47 had a lymph node with signs of cancer. Moreover, colon cancers transplanted into the mice shrank to less than one-third of their original size, on average. And in five mice with breast cancer tumours, anti-CD47 eliminated all signs of the cancer cells, and the animals remained cancer-free 4 months after the treatment stopped.

Although macrophages also attacked blood cells expressing CD47 when mice were given the antibody, the researchers found that the decrease in blood cells was short-lived; the animals turned up production of new blood cells to replace those they lost from the treatment.

Cancer researcher Tyler Jacks of the Massachusetts Institute of Technology in Cambridge says that although the new study is promising, more research is needed to see whether the results hold true in humans. "The microenvironment of a real tumour is quite a bit more complicated than the microenvironment of a transplanted tumour," he notes, "and it's possible that a real tumour has additional immune suppressing effects."

Another important question, Jacks says, is how CD47 antibodies would complement existing treatments. "In what ways might they work together and in what ways might they be antagonistic?" Using anti-CD47 in addition to chemotherapy, for example, could be counterproductive if the stress from chemotherapy causes normal cells to produce more CD47 than usual.

The research team has received a $20 million grant from the California Institute for Regenerative Medicine to move the findings from mouse studies to human safety tests.

So that is something of the science and the potential for a new drug. In the media we hear of so many potential new cancer breakthroughs that eventually come to nothing. This one sounds very exciting to me.

But even more exciting, what if some of the remarkable survivors had found a way to mess up their CD47? What if their meditation or imagery disrupted it? What if something they ate or drank did the job. How good would it be if people who are living much longer than expected had their CD47 levels checked?

And what if these survivors were triggering other biologically elegant mechanisms to turn the tables on their cancers? What if they were producing angiostatins that prevented cancers from developing a blood supply and so starved them to death? What if their meditation somehow switched their faulty oncogenes off? What if… ???

Surely people who stand out, people with cancer who do live much longer than expected warrant investigation. It amazes me how many people I have helped who became long-term survivors and went back to their doctors feeling quite elated, only to be told they must have been misdiagnosed. I was one of them. This response seems to me to be intellectual laziness of the highest order, but it is probably worse. It probably reflects a negligence and lack of commitment to true scientific enquiry that is both scarey and dangerous. Scarey because true science advances when unexpected phenomena are investigated, and dangerous because if the survivors’ experiences could be reproduced, less people would die of the disease.

Clearly what is needed is a dedicated research body that looks into the phenomena of long-term cancer survivors. At the same time, such a body could give attention to the outcomes of lifestyle based programs as these programs are associated with so many remarkable recoveries. All we need is a few million dollars to get it going!

To link to the research paper, click here.

NEWS

1. Chemotherapy appears safe for pregnant women’s babies.

Pregnant women and their doctors can be reassured that chemotherapy does not appear to have long term effects on children prenatally exposed to the treatment, according to research published in the Lancet Oncology.

Dutch and Belgian researchers looked at 68 pregnancies subjected to over 230 cycles of chemotherapy, assessing the children at birth and at regular intervals up to the age of 18. They tested for neurological, cognitive, auditory and cardiac functioning as well as school performance, sporting activities and general health.

 “We show that children who were prenatally exposed to chemotherapy do as well as other children,” the authors concluded.

The study could reassure pregnant women and their physicians the benefits of maternal treatment did not seem to be outweighed by any long-term consequences for the exposed fetus.

Prevalence was expected to rise in developed countries as women give birth later, but prognosis was in general not affected by pregnancy, and with the exception of haema- tological cancer, termination was unlikely to improve prognosis either.

The full paper: The Lancet Oncology 2012; doi: 10.1016/S1470-2045(11)70363-1

2. Website update

My personal website, iangawler.com is currently being upgraded, so some of the old features are not yet visible. In the next few weeks, the Information section will have advice for people with cancer and MS, as well as research findings and Frequently Asked Questions. Please pardon any inconvenience, but the new website looks much better, will have more information and will be easy to navigate and use.

RESOURCES

BOOK

Surviving Cancer by Paul Kraus – stories of long–term survivors who attended Gawler Foundation programs – very inspiring and informative.

CD

The Gawler Cancer Program by Ian Gawler – in which I explain how cancer develops, including looking at how the oncogenes can be damaged and what happens after that, then how the body can be helped to reverse the process.

PROGRAMS

The Gawler Foundation