Melanoma Mortality Higher in African-Americans: Vitamin D Myths Revealed

[Ezliving_Jim]

Skin Cancer Update

Melanoma Mortality Higher in African-Americans

Melanoma is more often fatal in African-Americans than Caucasian patients. Susan C. Taylor, MD, outlined some of the main reasons melanoma is often more fatal in African-Americans than whites, and how educating patients can make a difference in the June 2004 issue of Dermatology Times.

Dr. Taylor, assistant clinical professor of dermatology, The College of Physicians and Surgeons, Columbia University, New York, included the widespread misconception that African-Americans never get melanoma, delayed diagnosis and treatment, and melanoma development on non-sun-exposed areas of the body as the potential causes for a higher mortality rate in African-Americans with melanoma. Melanoma screening campaigns and outreaches rarely emphasize the importance of these facts, but rather target people with traditional risk factors such as fair skin or dysplastic nevi.

Statistics from one study from the Washington Hospital Center (Washington, DC), show the 5-year survival rate for African- Americans with a melanoma diagnosis was about 60%, compared with 85% for whites. Other studies, including one from Duke University, have confirmed this discrepancy, demonstrating a 35% to 49% survival at 5 years for African-Americans versus 74% for white patients.

Strategies for a timely diagnosis lay in part on the dermatology clinicians. Dr. Taylor advised dermatology professionals to encourage African-American patients to seek regular examination, particularly on high-risk areas of the body that are not sun exposed, such as palms, the soles, fingers, toes, mucosal surfaces, and nails, and to maintain a high index of suspicion for melanoma in their African-American patients. She elaborated, "We as dermatologists must look at the palmar and plantar surfaces, the mucosal regions, the subungual areas, and the lower extremities. African-American patients must be informed these are areas they need to inspect on a regular basis, not forgetting the webbed spaces or areas between the toes and fingers." Dermatology clinicians should also assist African-American patients in obtaining medical treatment and surgery, particularly since African-Americans are often suspicious of the health care system, according to Dr. Taylor.

Public awareness campaigns can also help by focusing on melanoma in the African-American population, and encouraging the public to perform monthly exams with a particular focus on non-sun-exposed areas.

Updated Cancer Support Resources Available

The National Comprehensive Cancer Network (NCCN) and the American Cancer Society collaborated to update Nausea and Vomiting Treatment Guidelines for Patients with Cancer. This title is just one of a series, available in booklet form or online (www.nccn.org), that is dedicated to educating patients and their families about the treatment of cancer and associated side effects. "The nausea and vomiting which may be associated with cancer and its treatments can, at times, be overwhelming to patients," said William T McGivney, PhD, chief executive officer of NCCN. "Our goal in updating this booklet is to provide patients and their families with the most current information they need to work with their health care team to prevent and to treat nausea and vomiting."

Cancer treatment-related vomiting can be successfully treated or even prevented in most patients. By maintaining open communication between the patient and the physician, anti-vomiting medication can be adjusted to control this unpleasant symptom. Because some chemotherapy regimens may cause delayed vomiting, it is important that patients talk with their physicians about the specific regimens they are receiving and how long to take the anti-nausea medications.

NCCN Treatment Guidelines for Patients are the result of a collaborative effort between NCCN and the American Cancer Society and are derived directly from the Clinical Practice Guidelines in Oncology developed for physicians by the NCCN. The patient guidelines also provide background information on different types of cancers, their causes, various treatment options, and a glossary of terms. The guidelines provide the most upto-date information about treatment options and are written in easy to understand language.

Other available Treatment Guidelines for Patients include: breast cancer, colon and rectal cancer, prostate cancer, lung cancer, ovarian cancer, melanoma, nonHodgkin's lymphoma, bladder cancer, cancer pain management, fatigue and anemia, and fever and neutropenia. Most guidelines are also available in Spanish. The materials are available free of charge on NCCN's Web site at www.nccn.org and by calling NCCN toll-free at (888) 909-NCCN. Materials also are available on the American Cancer Society's Web site at www.cancer.org or by calling (800) ACS-2345.

Vitamin D Myths Revealed


Unsubstantiated reports in the media extolling the health benefits of vitamin D from unprotected sun exposure can confuse the public. Darrell Rigel, MD, debunked the vitamin D myths in the June 2004 issue of Dermatology Times.

Dr. Rigel, a clinical professor at New York University Medical Center, New York, explained, "We know the cause of most skin cancers and the way to lower the risk of developing them. It's important we try to lower UV exposure, and that should lead to fewer people developing skin cancer." His message was to practice proper sun protection to prevent skin cancer.

While UV rays do trigger vitamin D synthesis in the skin, not much exposure is required to provide enough of this nutrient. Dr. Rigel described the five common myths promoted in recent reports:

* Myth #1. Regular sunscreen use blocks UV exposure, which leads to decreased vitamin D levels. In a 1997 study in the Journal of the National Cancer Institute, patients with xeroderma pigmentosa were followed for several years, and had normal vitamin D levels despite almost no UV exposure.

* Myth #2. A significant amount of UV exposure is needed to maintain normal levels of vitamin D. Dr. Rigel said it is easy to maintain, because sun exposure is inevitable in our daily activities and a normal diet.

* Myth #3. Sunscreens block all UV rays, thus blocking vitamin D production. Because there is no such thing as a total UV block, adequate UV rays reach the skin allowing for enough vitamin D formation.

* Myth #4. Skin cancer isn't really dangerous, so sun protection is not important. In fact, one American dies every hour from melanoma.

* Myth # 5. Decreased vitamin D levels lead to increases in other cancers and diseases. This claim is based on a study showing overall cancer rates as higher in the northeast United States. Higher cancer rates were attributed to the region having lower sunlight levels. However, several other studies contradict this, showing that cancer rates are low in the northern Plains states, which have the lowest UV levels in the country.

MR Spectroscopy for Diagnosing Melanoma

Sentinel lymph node biopsy has long been the standard for diagnosing melanomas of 1 mm or more, but it is not without limitations. Magnetic resonance (MR) spectroscopy, however, has many advantages. Jon Stretch, MD, of the Sydney Melanoma Unit at the University of Sydney, Australia, discussed both procedures in an article in the June 2004 issue of Dermatology Times.

Melanoma researchers have been investigating minimally invasive diagnostic and treatment techniques. Although sentinel lymph node biopsy is an accurate procedure, it is open and invasive. Patients require anesthesia and hospital stay, and risk a complication rate of approximately 5% to 10%. MR spectroscopy of fineneedle aspiration biopsy specimens is being explored as an alternative to complete lymph-node dissection. In the short term, investigators hope that it can be used to evaluate melanomas of 1 mm or more. The ultimate goal, however, is to be able to perform a simple, percutaneous biopsy.

A Sydney, Australia group pioneered MR spectroscopy with fine- needle aspiration biopsy for melanoma. One study cut lymph nodes into 3-mm-thick slices and then analyzed them with MR spectroscopy. Proton magnetic resonance spectroscopy distinguished between benign and malignant lymph node tissue (p<0.001). In 77 patients, 56 nodes were malignant, and 62 were benign according to MR spectroscopy studies. Dr. Stretch said the overall accuracy of MR spectroscopy is 91.3%, and offers much more precise biochemical information about the signature of the tumor. In describing the benefits of this science, he said, "When you do an open biopsy on lymph nodes with a 1 mm or greater Breslow, 85% of them are going to be negative. If you can use a percutaneous technique and get the same accuracy, it would be more cost effective [and] offer a noninvasive, better- tolerated exam...It would be of great benefit."

Copyright Anthony J. Jannetti, Inc. Dec 2004

Source

[Ezliving_Jim]

PTAF Response to "Vitamin D Myths Revealed"



An Academic Rebuttal of "Vitamin D Myths Revealed"

(Copyright Anthony J. Jannetti, Inc. Dec 2004)


Rebuttal by: (December 19, 2004)

William B. Grant, Ph.D.,
Sunlight, Nutrition and Health Research Center (SUNARC)
2107 Van Ness Avenue, Suite 403B
San Francisco, CA 94109-2529, USA

wgrant@sunarc.org

http://www.sunarc.org

1-415-776-5274 - voice
1-415-776-5270 - fax


Rebuttal of 16 Dec., 2004 Rednova.com article from Jannetti, Inc. "Skin Cancer Update".

Source: http://www.rednova.com/news/display/?id=111696

"Unsubstantiated reports in the media extolling the health benefits of vitamin D from unprotected sun exposure can confuse the public. Darrell Rigel, MD, debunked the vitamin D myths in the June 2004 issue of Dermatology Times.

Dr. Rigel, a clinical professor at New York University Medical Center, New York, explained, "We know the cause of most skin cancers and the way to lower the risk of developing them. It's important we try to lower UV exposure, and that should lead to fewer people developing skin cancer." His message was to practice proper sun protection to prevent skin cancer.

While UV rays do trigger vitamin D synthesis in the skin, not much exposure is required to provide enough of this nutrient. Dr. Rigel described the five common myths promoted in recent reports:

* Myth #1. Regular sunscreen use blocks UV exposure, which leads to decreased vitamin D levels. In a 1997 study in the Journal of the National Cancer Institute, patients with xeroderma pigmentosa were followed for several years, and had normal vitamin D levels despite almost no UV exposure.¡¨

Rebuttal:

Sunscreen use has been found associated with reduced vitamin D production in solar UV radiation. Sunscreen blocks solar ultraviolet B (UVB) (290-315 nm) extremely well.

Supporting Study References available at http://www.sunarc.org/rednovarebut.pdf


* Myth #2. A significant amount of UV exposure is needed to maintain normal levels of vitamin D. Dr. Rigel said it is easy to maintain, because sun exposure is inevitable in our daily activities and a normal diet.

Rebuttal:

Vitamin D has been shown in numerous studies since 1980 to be very important in reducing the risk of cancer. The list now includes over a dozen types including breast, colon, ovarian, prostate, and stomach. Studies also indicate that over 600 I.U. of vitamin D per day affords reasonable protection, and it is likely that 1000 I.U./day would afford optimal protection. However, the average American consumes only about 260 I.U./day from diet and another 50-60 I.U./day from supplements, which is well short of optimal. Solar UVB is also a very important source of vitamin D through photoproduction in skin, but most Americans are not getting adequate UVB exposure. Those who live in urban settings spend most of their time indoors, and those living in the northeast cannot produce vitamin D for 4-5 months a year. One of the sad effects of dermatologists urging people to reduce their UV exposure is that they do not point out the importance of solar UVB in producing vitamin D and tell people that if they don¡¦t get vitamin D from the sun, they have to get it from diet or supplements. I checked the web sites for 14 major organizations urging reduced UV exposure and found very few recommendations regarding vitamin D.

Supporting Study References available at http://www.sunarc.org/rednovarebut.pdf

* Myth #3. Sunscreens block all UV rays, thus blocking vitamin D production. Because there is no such thing as a total UV block, adequate UV rays reach the skin allowing for enough vitamin D formation.

Rebuttal:

Sunscreen use has been found associated with reduced vitamin D production in solar UV radiation. Sunscreen blocks solar UVB extremely well. Australia, a country with very high UVB levels and plenty of sunscreen use, also has a high rate of people with vitamin D deficiency.

Supporting Study References available at http://www.sunarc.org/rednovarebut.pdf

* Myth #4. Skin cancer isn't really dangerous, so sun protection is not important. In fact, one American dies every hour from melanoma.

Rebuttal:

Melanoma is important. However, the 8000 deaths per year from melanoma in the U.S. should be balanced by the 45,000 or more deaths from internal cancers that could likely be prevented with adequate UVB and vitamin D as well as the increased risk of multiple sclerosis, osteoporotic fractures, muscle pain, poorer prognosis for osteo- and rheumatoid arthritis, etc.

Supporting Study References available at http://www.sunarc.org/rednovarebut.pdf

* Myth # 5. Decreased vitamin D levels lead to increases in other cancers and diseases. This claim is based on a study showing overall cancer rates as higher in the northeast United States. Higher cancer rates were attributed to the region having lower sunlight levels. However, several other studies contradict this, showing that cancer rates are low in the northern Plains states, which have the lowest UV levels in the country.

Rebuttal:

Geographic variations of cancer mortality rates linked to solar UVB radiation have been reported in Canada, Finland, Norway, the U.S., and the USSR.

The reader is referred to the Atlas of Cancer Mortality Rates for the United States, 1950-94, PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) and SUNARC (www.sunarc.org) for the data and interpretations. We are unaware of the studies showing lower cancer rates in the northern Plains states.

Supporting Study References available at http://www.sunarc.org/rednovarebut.pdf

Concluding comments.

If UVB and vitamin D were not thought to be so important in reducing the risk of cancer, then over 200 people would not have turned up at the Cancer Chemoprevention & Cancer Treatment: Is there a role for vitamin D, 1ƒÑ,25(OH)2-vitamin D3 or new analogs (deltanoids)? Natcher Auditorium, Bethesda, Maryland, Wednesday, November 17 ¡V Friday, November 19, 2004, Co-sponsored by The National Cancer Institute, NIH and the Vitamin D Workshop, (http://vitamind.ucr.edu/ScientificProgram.htm).

Dermatologists should be put on notice that they are contributing to the increased risk of internal cancers through advocating reduced UV exposure without at the same time pointing out that UVB is the primary source of vitamin D for many Americans and that high levels of vitamin D are required for optimal health. They should also be concerned that by advocating use of sunscreen, which preferentially blocks UVB but not UVA (315-400 nm), they are also putting people at higher risk for melanoma and are likely responsible for the global increase in melanoma incidence and mortality rates.

In addition to the obvious inaccuracies cited herein, the qualifications and motivations of the writer (unknown) at Jannetti are questionable, due to a lack of personal identification and other factors, such as the business relationship between Jannetti, a large, well-known health care industry management corporation, and the American Academy of Dermatology.

Supporting Study References available at http://www.sunarc.org/rednovarebut.pdf

Source (.pdf file)


_________________
Jim

"Entrepreneur Extraordinaire Since 1953"

Read "Sunlight Robbery"!

Support The PTAF
[ This Message was edited by: Ezliving_Jim on 2004-12-20 18:49 ]

[Neon Beach]

Bump

[sundude]

Neon
Good stuff you are digging up here