quarters and dry air, which makes the undergo major surgery within a month
blood “thicker” and “stickier.” after a long flight have an increased risk
Diet and DVTs
Mobility is the key. Whenever pos- of postoperative blood clots. A 2007 report from the Atherosclero-
sible, get an exit row, bulkhead, or aisle Passengers at extra risk should con- sis Risk in Communities Study sug-
seat to give you more leg room. Don’t sider breaking up very long flights into gests that your diet may influence
cross your legs. Stretch, massage your shorter segments. Below-the-knee elas- your risk of developing a DVT. Scien-
lower legs, and pump your feet up tic compression stockings can also help. tists evaluated 14,962 middle-aged
and down for about 30 seconds every Look for a pair that applies pressure of Americans over a 12-year period.
They found that eating fish one or
30 minutes. Take a walk in the aisle 20 to 30 millimeters of mercury (mm more times a week was linked to
at least once every hour or so. Drink Hg); they are available at hospitals and a 30% to 45% reduction in the risk
plenty of fluids; water and juice are bet- large drugstores. Passengers who have of DVTs. A high intake of fruits and
ter than alcoholic or caffeinated bever- significant problems with arteries or vegetables also appeared protective,
ages, which will fill your bladder nearly nerves in their legs should check with but large amounts of red meat and
as much as your stomach. their doctors. processed meats were associated
with increased risk.
DVTs are uncommon on flights of Aspirin is readily available, but al-
less than four hours, but the risk in- though it’s a very effective way to
creases with longer trips, particularly prevent clots in arteries, its value for it comes to your veins, keep the blood
those of eight hours or more. The risk is deep-vein thrombosis is far less certain. flowing to prevent DVTs, pulmonary
also higher in people who have had re- People who need the fullest protection emboli, and the post-phlebitic syndrome.
cent surgery, especially hip or leg oper- should ask their doctors about an in- At home or in an airplane, do what it
ations, and in people with certain types jection of low-molecular-weight hepa- takes to promote blood flow in your
of cancer, chronic leg swelling, or heart rin before they take off. veins. Be sure your doctor considers
failure. Other risk factors include obe- DVT prevention if you are hospitalized,
sity, smoking, and any condition that’s Moving on and cooperate fully with anticoagulant
led to prolonged immobility or bed rest The great actress Helen Hayes once therapy to prevent or treat DVTs.
within two weeks of the trip. People said that resting is rusting. She may not Most men spend much more time
with overactive blood clotting systems have known any more about deep-vein thinking about SUVs than DVTs. That’s
and those who have had previous epi- thrombosis than the average guy, but okay if you’re at low risk, but before you
sodes of deep-vein thrombosis face the she was clearly onto something. Men- fly across the country or check into a
highest risk of all. And the risk persists tal stimulation will help keep your body hospital, you should show your veins
even after you’ve landed; patients who (and brain) from “rusting.” And when the respect they deserve.
The 10 commandments of cancer prevention
A bout one of every three Americans
will develop some form of malig-
nancy during his or her lifetime. This
new breakthroughs, you can do a lot to
protect yourself right now.
Get regular check-ups, including the
Screening tests can help detect ma-
lignancies in their earliest stages, but
you should always be alert for symp-
year alone, about 1,437,000 new cases screening tests that can help detect can- toms of the disease. The American
will be diagnosed, and more than cer before it causes any symptoms. For Cancer Society developed this simple
565,000 people will die of the disease. men between 15 and 35, that means a reminder years ago:
Cancer is the second leading cause of periodic doctor’s testicular exam along C Change in bowel or bladder
death in America, and as deaths from with regular self-exams. All men older habits
heart disease decline, it’s poised to as- than 50 should have regular screening A A sore that does not heal
sume the dubious distinction of be- for colon cancer, and they should make
U Unusual bleeding or discharge
coming our leading killer. an informed decision about testing for
Despite these grim statistics, doctors prostate cancer (see Harvard Men’s T Thickening or lump in the breast
have made great progress in under- Health Watch, May 2008). Men with or elsewhere
standing the biology of cancer cells, risk factors should begin both process- I Indigestion or difficulty in
and they have already been able to im- es even earlier, and every man should swallowing
prove the diagnosis and treatment of routinely inspect himself for signs of O Obvious change in a wart or mole
cancer. But instead of just waiting for melanomas and other skin cancers. N Nagging cough or hoarseness
www.health.harvard.edu April 2009 | Harvard Men’s Health Watch |5
It’s a rough guide at best. The vast try to protect yourself and your family. of breast and possibly reproductive
majority of such symptoms are caused The 10 commandments of cancer pre- cancers. Exercise will help protect you
by nonmalignant disorders, and can- vention are: even if you don’t lose weight.
cers can produce symptoms that don’t
show up on the list, such as unexplained
weight loss or fatigue. But it is a useful
1 Avoid tobacco in all its forms, in-
cluding exposure to secondhand
4 Stay lean. Obesity increases the risk
of many forms of cancer. Calories
count; if you need to slim down, take
reminder to listen to your body and re-
Eat properly. Reduce your con- in fewer calories and burn more with
port sounds of distress to your doctor.
Early diagnosis is important, but can 2 sumption of saturated fat and red exercise (see HMHW, January 2006).
meat, which appears to increase the
you go one better? Can you reduce your
risk of getting cancer in the first place?
It sounds too good to be true, but it’s
risk of colon and prostate cancers 5 If you choose to drink, limit your-
self to one to two drinks a day.
(see HMHW, January 2008). Limit Excess alcohol increases the risk of
not. Scientists at the Harvard School your intake of charbroiled foods (es- cancers of the mouth, larynx (voice
of Public Health estimate that up to pecially meat), and avoid deep-fried box), esophagus (food pipe), liver, and
75% of American cancer deaths can be foods. Increase your consumption of colon; it also increases a woman’s risk
prevented; the table below summarizes fruits, vegetables, and whole grains. of breast cancer. Smoking further
their research on the causes of cancer in Although other reports are mixed, two increases the risk of many alcohol-
the United States. The American Can- large 2003 studies found that high- induced malignancies.
cer Society is only slightly less optimis- fiber diets may reduce the risk of colon
tic about prevention, estimating that
about 60% of America’s cancer deaths
cancer. And don’t forget to eat fish two
to three times a week; you’ll get protec- 6 Avoid unnecessary exposure to
radiation. Get medical imaging
can be avoided. And a 2005 study ar- tion from heart disease, and you may studies only when you need them.
reduce your risk of prostate cancer. Check your home for residential radon,
gues that over 2.4 million of the world’s which increases the risk of lung can-
7 million annual cancer deaths can be
blamed on nine potentially correctable
3 Exercise regularly. Physical activ- cer. Protect yourself from ultraviolet
ity has been linked to a reduced radiation in sunlight, which increases
risk of colon cancer, and it may even the risk of melanomas and other skin
You don’t have to be an internation- help prevent prostate cancer. Exercise cancers. But don’t worry about electro-
al scientist to understand how you can also appears to reduce a woman’s risk magnetic radiation from high-voltage
power lines or radiofrequency radia-
The causes of cancer tion from microwaves and cell phones.
Percentage of They do not cause cancer.
Smoking and tobacco use
Obesity and diet (red meat vs. fruits and vegetables)
7 Avoid exposure to industrial and
environmental toxins such as asbes-
tos fibers, benzene, aromatic amines,
Lack of exercise 5 and polychlorinated biphenyls (PCBs).
Carcinogens in the workplace
Viruses (hepatitis, human papillomavirus)
5 8 Avoid infections that contribute
to cancer, including hepatitis vi-
ruses, HIV, and the human papilloma-
Family history of cancer 5
Body size (taller, bigger people get more cancer) 5
virus. Many are transmitted sexually or
through contaminated needles.
Women’s reproductive factors (late or no childbearing,
late menopause, early periods)
Excessive alcohol consumption 3 9 Consider taking low-dose aspirin.
Men who take aspirin or other non-
steroidal anti-inflammatory drugs ap-
Poverty (aside from bad diet) 3
pear to have a lower risk of colon cancer
Environmental pollution 2
and possibly prostate cancer. It’s an un-
Excessive exposure to sun 2
proven benefit, and aspirin can produce
Medical procedures, drugs 1 gastric bleeding and other side effects,
Salt, food additives, contaminants 1 even in low doses. On the plus side,
Source: “Harvard Report on Cancer Prevention, Vol. I: Causes of Human Cancer” (1996), though, low-dose aspirin does protect
Vol. 7, pp. 53–55.
Continued on page 8
6 | Harvard Men’s Health Watch | April 2009 www.health.harvard.edu
10 Commandments of cancer (from page 6)
men from heart attacks and the most duce the risk of prostate cancer, colon These lifestyle changes will yield an-
common type of stroke; men at the cancer, and other malignancies (see other cancer-preventing benefit: if you
highest risk reap the greatest benefits.HMHW, February 2007). But don’t stay healthy, you won’t need cancer
Get enough vitamin D. Many count on other supplements. Careful treatments (chemotherapy, radiother-
10 experts now recommend 800 studies show that selenium, vitamins
to 1,000 IU a day, a goal that’s nearly C and E, beta carotene, folic acid, and
apy, drugs that suppress the immune
system) that have the ironic side ef-
impossible to attain without taking multivitamins are not protective, and fect of increasing the risk of additional
a supplement. Although protection that some may do more harm than cancers.
is far from proven, current evidence good (see HMHW, November 2007, As always, prevention is the best
suggests that vitamin D may help re- March 2008, and February 2009). medicine.
Proscar and osteoporosis
Q I am 76 years old, and I’ve had an enlarged
prostate for at least 10 years. I’ve been tak-
ing Proscar for about a year, and it seems to be
Testosterone is converted to DHT by an en-
zyme called 5-alpha reductase. Finasteride and
dutasteride inhibit the enzyme; they lower DHT
helping quite a bit. I have not noticed any side levels in the prostate and blood by 70% to 90%,
effects, but I’m worried that if the medicine but they do not reduce testosterone levels. As
ON CALL reduces testosterone levels enough to shrink a result, long-term use can shrink the prostate
my prostate, it will also give me osteoporosis. by about 25%, and it may stimulate some hair
Should I change medications, or take Fosamax follicles that are not too far gone, but it will not
like my wife? melt muscles or turn baritones into sopranos.
According to published reports, only 4% to 5%
A The prostate gland is stimulated by testoster-
one, the major male hormone; that’s a bad
thing for older gents at risk for benign prostatic
of men notice decreased sex drive or erectile
dysfunction while on the medications.
Bones are also spared. A randomized clini-
hyperplasia (BPH; an enlarged gland), or prostate cal trial of 117 men proved the point: after four
cancer. Testosterone also increases bone calcium years of therapy, men taking 5 mg of finasteride
content, a good thing. Finasteride (Proscar) and a day had the same bone mineral density as men
its newer rival, dutasteride (Avodart) block the taking a placebo.
action of testosterone in the prostate, but they On the other hand, men who need androgen-
will not interfere with bone mineralization. It deprivation therapy to control advanced pros-
sounds like a paradox, but it’s not. Here’s why. tate cancer are at risk for osteoporosis (“thin
Bones respond directly to testosterone, as do bones”) because treatment drastically lowers
many other male tissues: testosterone produces testosterone levels (see Harvard Men’s Health
the strong, large muscles, deep voice, facial and Watch, October 2008). Like your wife, they can
body hair, sex drive, and tendency toward ag- benefit from alendronate (Fosamax), a drug that
gressiveness that characterize the male gender increases bone calcium (see HMHW, December
by acting directly on a man’s organs and tissues. 2008). But men taking 5-alpha reductase inhib-
But the prostate and the scalp’s hair follicles are a itors for BPH don’t have to worry about their
bit different. To affect these organs, testosterone bones. Your wife’s Fosamax supply is safe.
must first be converted to dihydrotestosterone
(DHT). In turn, DHT stimulates the prostate
and stuns the scalp hair, producing unwelcome Harvey B. Simon, M.D.
changes in many men. Editor, Harvard Men’s Health Watch
Send us a By mail Dr. Harvey B. Simon By e-mail mens _ firstname.lastname@example.org Because of the volume of correspon-
Harvard Men’s Health Watch (Please write “On call” dence we receive, we can’t answer
question for 10 Shattuck St., 2nd Floor in the subject line.) every letter or message, nor can we
On call Boston, MA 02115 provide personal medical advice.
8 | Harvard Men’s Health Watch | April 2009 www.health.harvard.edu