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  1. 1. 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 April 2009 | Harvard Men’s Health Watch |5
  2. 2. 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 smoke. 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 risk factors. 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. Risk factor cancer deaths Smoking and tobacco use Obesity and diet (red meat vs. fruits and vegetables) 30 30 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 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, 3 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
  3. 3. 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 _ 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