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CNN Sunday Morning
Weekend House Call: Breast Cancer, Prostate Cancer
Aired June 29, 2003 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
KELLI ARENA, CNN ANCHOR: And now it is time for "Weekend House Call." It begins right now.
KRIS OSBORN, CNN ANCHOR: Something for men and women today on "Weekend House Call." We're going to go in on two cancers, breast cancer and prostate cancer because there's big news on both.
I'm Kris Osborn here. I'm here with Dr. Sanjay Gupta.
Good morning, Doc.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. You're absolutely right, Kris. Thousands of women will be diagnosed with breast cancer this year. It's the cancer that women fear the most. And now there's news now that hormones may actually cause an aggressive form of breast cancer.
This week, in fact, researchers reported that the combination of estrogen-progestin pills, you've heard so much about that, can actually lead to larger tumors. Tumors that are more apt to spread and increase breast density making tumors harder to find.
This of course, caps months of bad news. We've been talking about this so much. Caps months of bad news about hormone replacement therapy, which is taken by millions of women after menopause. Many are reconsidering their HRT decision and asking good, new questions about their cancer risks. We want to get to those questions in just a moment.
But first, we also want to take a look at another cancer. That's the one that men may fear the most. It's prostate cancer. And the news looks more promising.
(BEGIN VIDEO CLIP)
GUPTA (voice-over): Dr. Peter Greeenwald, director of the National Cancer Institute's Office of Prevention, is well aware that he and every other man has a one in six chance of developing prostate cancer. That risk prompted Dr. Greenwald to become one of nearly 19,000 men nationwide who participated in a trial to determine if the drug finasteride, known as Propecia or Proscar and currently used to treat baldness and enlarged prostate could also reduce man's risk of prostate cancer.
The researchers stopped the study early because the findings were so promising; they had the first evidence now that prostate cancer could be prevented.
UNIDENTIFIED FEMALE: There was a 25 percent decrease in the number of prostate cancers in the men that took finasteride versus placebo.
GUPTA: But there are caveats. The patients taking finasteride who did develop prostate cancer had a potentially more aggressive form and the researchers aren't sure why.
UNIDENTIFIED FEMALE: It's very important that we continue to follow the men, who develop prostate cancer, to see if their tumors behave more aggressively or just happen to look different under the microscope.
(END VIDEO CLIP)
GUPTA: These new reports on prostate and breast cancer have huge implications. So many people affected by that. There will be more than 210,000 women diagnosed with breast cancer this year alone and more than 200,000 men diagnosed with prostate cancer.
We want to hear from you. If you have questions about either prostate or breast cancer, you've come to the right place this morning. We'll be taking your calls and your e-mails during the next half hour. You've got the e-mail address. You can also call us 1800- 807-2620. International charges may apply for our overseas caller. Our e-mail address again, us at housecall@cnn.com.
And joining me to answer your questions today, we're very delighted to have him. Dr. Otis Brawley, he's an oncologist at Emory University here in Atlanta. He's also been the assistant director of the National Cancer Institute.
So, first of all, thank you very much for joining us this morning.
DR. OTIS BRAWLEY, ONCOLOGIST, EMORY UNIV. & NCI: Thank you for having me.
GUPTA: Lots of questions about this. And you helped launch this prostate cancer trial back several years ago now.
BRAWLEY: Yes, it was 1991-1992 when we were helping to start write the trial.
GUPTA: People talking about this. And you know, people just watch the piece, talking about this new drug that may fix baldness as well as possibly prevent prostate cancer. Is this too good to be true? Is this something that men should start taking right away?
BRAWLEY: Well, you know the FDA is going to look at all the data. And there are some downsides to fanastaride. First off, fanasteride does cause decreased some sexual function. There's also a question that some of the prostate cancers that were found tend to be higher grade among men who got fanasteride but didn't get prevention of prostate cancer. So the jury is still out on whether someone should take it to prevent prostate cancer.
GUPTA: I don't mean to say it, this is pretty exciting stuff, though, that there's actually a medication that might prevent prostate cancer. And again, it's the same medication, Proscar, Propecia; it's the same active ingredients there.
BRAWLEY: Oh, absolutely. That's right. And it's very exciting that we finally learned that we can actually do something to prevent prostate cancer. So, this is definitely a scientific plus but I don't know if men ought to go out and start taking it yet. Maybe. But you know the FDA is going to vet this over the next six months. And this is actually going to be a good process, so we can find out the pluses and the minuses and men can make a good decision.
GUPTA: All right. We'll be looking to your expertise on that.
Lots of e-mail questions on this particular topic. We've had our e-mail open up for some time. Let's go ahead and get to our first one. It's from a viewer in Maryland. This is sort of a three-part question.
"What causes prostate cancer? What preventative things can one do if his father had prostate cancer and died because of it? And are there specific dietary changes recommended to minimize it?"
Sort of a long question there but what causes it?
BRAWLEY: We really don't know what causes prostate cancer. The epidemiologists will tell you that if you look at populations like in the United States or Western Europe that have a high fat diet, there's a higher amount of prostate cancer. If you look at people in Japan or China or even Eastern Europe where the diet has less fat, there's less prostate cancer.
If you look in countries that screen for prostate cancer, like the United States, you actually find that you find more prostate cancer than a country like England, which does not screen as a national policy. So we don't know exactly what causes it.
Does a vegetarian diet or a diet that's low in fat decreases one's risk of prostate cancer? Once you're 20 or 30 years old, we don't know. We know if someone is born into that sort of diet they do have a lower risk of prostate cancer.
GUPTA: Right. And we're going to take some phone calls.
Let me just ask you real quick. I've heard that all men, if they live long, are going to develop problems with their prostate. Is that true?
BRAWLEY: That is true. That is true.
GUPTA: Got some phone calls coming in, as well?
OSBORN: Yes. Yes. We do, Doc. And we're going to start answering some of them; either question for Dr. Brawley or Dr. Gupta. Our first caller is Lena, and she's calling in from Kentucky.
Hello. Good morning. Welcome.
LENA: Good morning.
OSBORN: Your question?
LENA: My question, is my life is basically unbearable physically and emotional without HRT, specifically Premphase. But what can I do to prevent breast cancer in light of this week's announcement? Or is Premphase results of use different from the Primpro?
BRAWLEY: Well, first off, I can't really comment about you specifically. I can tell you that Primerin and Provera for prevention of cancer is certainly not factor. For prevention of disease, it's probably something we should not be prescribing for. In individuals who have symptoms there still is, in my opinion, room for use of estrogen and progestin to get rid of menopausal symptoms. And some women have extreme menopausal symptoms and this is the only thing that can relieve them.
GUPTA: It's really remarkable. And let me just say you know eight million were taking the medication before a lot of these trials came out. Certainly, the number dropped. Less women are taking HRT now. But it's a risk you know, Chris. Women know it's a risk. But if their symptoms are so severe, they may take the hormone replacement therapies anyway.
OSBORN: Isn't that part of it, Doc, early prevention with breast cancer?
GUPTA: Absolutely.
OSBORN: And of course, that would be the case with most things.
GUPTA: It is and we're going to talk about that both with respect to breast cancer and prostate cancer in the next segment.
OSBORN: Well, I'm in a fortunate seat here. There are two experts here, Doctor Brawley and Doctor Gupta. You can be here, too, by calling in. So we'll continue to monitor this. So a drug that helps fight baldness already available may now help protect you against prostate cancer. We'll get more details as we continue "Weekend House Call."
GUPTA: And we'll answer more of your prostate and breast cancer questions. All that live here on CNN. Also, call us 1800-807-2620. Send an e-mail to housecall@cnn.com. We want to hear from you. We're coming right back. Don't touch that remote.
(COMMERCIAL BREAK)
OSBORN: We are answering your questions on breast cancer and prostate cancer today on "Weekend House Call." For more information on all types of cancer visit www.cancer.gov any time. This is the Web site of the National Cancer Institute. Or www.cancer.org, the American Cancer Society. That is on the Internet.
GUPTA: And we're answering your questions today on "Weekend House Call." Our number 1800-807-2620.
Before we go to the break, let's check our "Daily Dose Health" quiz. What is the lifetime probability that a woman will develop breast cancer and a man will develop prostate cancer? We'll have that answer in 30 seconds. Stay with us.
(COMMERCIAL BREAK)
OSBORN: Checking the "Daily Dose" quiz. We asked what is the lifetime probability that a woman will develop breast cancer and a man will develop prostate cancer? The answer is one...
GUPTA: One in every eight women will develop breast cancer. A woman's risk is greatly increased after age 40 with most breast cancers occurring in women over 50. And One in six men will develop prostate cancer. A man's risk increases as he get older.
We have Dr. Otis Brawley here to check us on all our facts, as well.
There are two tests commonly used to detect prostate cancer. One is a routine physical exam, the other is a blood test commonly called a PSA, prostate specific antigen test. Together these tests can detect many silent prostate cancers. Some that have not cause any symptoms.
Currently, the National Cancer Institute is supporting research to learn more about screening men for prostate cancer. This research will actually determine if these tests can help reduce the death rate from this disease and assess the risks and benefits of screenings and treatments.
Now, this is a little bit of a confusing point. And I want to make this point because most people think early detection, better survival.
BRAWLEY: That's right.
GUPTA: Is that the case always with prostate cancer?
BRAWLEY: That is not necessarily the case. Survival does not necessarily correlate with what we in epidemiology call mortality. That is, does the patient die or not. Simply stated the problem in prostate cancer, is that there clearly some prostate cancers that the worst thing you can do is tell a man he has it and then treat him for it because the cancer was never going to bother the man. Except we now have these new technologies to diagnose it.
The prostate cancer prevention trial actually suggested that it might be as many as one in four men who have prostate cancer. But yet in a country that doesn't screen, doesn't treat, only ability 3 percent of all men die from it. What we really need to do and what the science really needs to do is be able to come up with a test that's probably going to be genetic or proteomic based, that actually is able to tell us, sir, you have prostate cancer but it's the kind we need to watch. Sir, you have prostate cancer, it's the kind we need to treat.
Right now we have the ability to diagnose. And men in the United States are basically going to have to make a decision. Am I going to get screened and aggressively treated or am I going to walk away from screening? And actually, most people don't understand and don't appreciate; most of the professional organizations like the American Cancer Society; they don't say men should be screened. They say men should be offered the test. They should be informed of the potential risks and the potential benefits and they should be encouraged to make a decision.
It's a tough thing to talk about but...
GUPTA: Right. And we're going to make this point, I think, a couple of times.
We've got actually a phone caller from Memphis. Don from Memphis, I think, has a question about screening.
Go ahead Don with your question.
DON: yes, sir. First I'd like to say good morning, everybody.
GUPTA: Good morning.
BRAWLEY: Good morning.
DON: But I've got a two-part question I really want to ask. First of all, I think that microwave ovens caused a lot of this cancer and stuff. But I really can't prove it right now. But I just wanted to find out what you all think about this. And also about age, you know I'm very concerned. And a lot of men be talking about what age should you really get tested for prostate? And most doctors would tell you 40, 41 or 42. I just think you should get tested early as possible.
GUPTA: This is a good point. First of all, the microwave, anything to that?
BRAWLEY: I don't have any data that microwave energy causes prostate cancer.
GUPTA: All right. Age -- age. I think Don brings up a good point. Is there a set age, do you think?
BRAWLEY: Well, the professional organizations that have actually looked at this, most will say that men who choose to start screening should start screening at the age of 50; the exception being African American men who, are at a higher risk at a lower age. As well as men who have a family history of prostate cancer. Especially men who have a history of prostrate cancer at a lower age. That age usually most people would say between 40 and 45.
GUPTA: Let me just say really quick. Man comes in, let's says he's 50, has an elevated PSA, prostate specific antigen. What do you tell him to do?
BRAWLEY: OK, if a man has an elevated PSA. Number 1, it doesn't necessarily mean he has prostate cancer.
GUPTA: Important point. Yes.
BRAWLEY: Could be due to a number of other things: infection, benign prostatic enlargement. What the man actually needs is an ultrasound of the prostate and then he needs a series of biopsies of the prostate, usually six to eight biopsies of the prostate.
GUPTA: All right.
OSBORN: Very, very instructive. I was wondering what age you know men should start looking out for it.
We are going to go now to our next e-mail, which is, "What are your feelings towards nutraceuticals, Vitamin C, et cetera for the prevention/treatment of prostate and other types of cancer?" The question is from Dan in New Jersey.
GUPTA: And you know we get this a lot now because a lot of people are saying, let's go to other forms of therapy; maybe not the standard. What do you think about that?
BRAWLEY: Sure. Sure. Yes, there are some very important leads in science that suggest that both selenium as well as Vitamin E can prevent prostate cancer. And indeed, that's the subject of a large trial, called Select right now that's being done in the United States
And by the way, people who are interested in that trial can access the information through the National Cancer Institute Web site which is www.cancer.gov., G-O-V, or by calling 1-800-4-CANCER. Again, it leads that perhaps selenium and Vitamin E might prevent prostate cancer. It's not been proven yet. And that's important because you know for 40 years, we thought there was no problem with hormone replacement therapy, and then we finally ask the scientific question and we find lots of problems.
Now, lycopene in some epidemiological studies, actually a study of physicians, found Doctors who eat not tomato product, but cooked tomato products in high amounts tend to have a lower risk of prostate cancer. And it's thought that lycopene, which is a carotene in tomatoes and a number of other foods, might be the reason for that lower risk. Again, big might, has not been verified in good, definitive clinical trials.
GUPTA: Got it. All right. So we'll keep an -- we'll look to you to keep an eye on that for us. And we'll eat our tomatoes in the meantime.
Ladies, we haven't forgotten about you either. We haven't forgotten about breast cancer. That's something we want to talk about it. Those of you who have questions on hormone replacement therapy and breast cancer; we'll be answering your phone calls and e-mails. Stay with us on "Weekend House Call."
(COMMERCIAL BREAK)
GUPTA: All right. Although we know some of the risk factors linked to breast cancers; Doctors really don't know what causes most breast cancers. There's a study to suggest, though, that women may lower their risk by giving birth to several children. The more births, the less risk, and breast-feeding them for several months, not drinking alcohol, exercising regularly, and staying slim. Although I will say as well, that there are women out there who have none of those risk factors and still get breast cancer.
It is important to follow the recommended guidelines for screening, including mammograms, a very big topic as well.
Let's go straight to our next e-mail. It's from Angela in Ontario and she asks, "Would a person with a family history of breast cancer benefit from consuming soy milk at an early stage in life?"
And I told you, Dr. Brawley, a lot of people looking to alternative therapies, non-conventional therapies to reduce their risk and treat their cancers. What do you say to them?
BRAWLEY: Well, you know her question is actually very interesting and a actually very good one. We actually can look at populations that have a high soy diet, a low fat diet, a diet high in fruits and vegetables from birth on wards. And we can say that that population has a lower risk of both breast, prostate and colon cancer.
The issue, we don't know if a person who's 50 years old, who starts adapting that diet will benefit in terms of cancer. We actually know they will decrease their heart disease risk. So it can be advocated. The theory would be that a 20-year-old is more likely to benefit than a 50-year-old because we know that someone who starts that diet basically at birth has benefit. But the answer to her question, we don't know. But the theory sounds light. And if it's just drinking more soy, if it's eating a diet higher in vegetables, higher in fruits, lot more roughage, less fat, it's a reasonable thing to do.
GUPTA: Won't hurt, may help. Very interesting.
OSBORN: With that, we are going to bring in our next caller. We are going to say hello and welcome to Anne who's calling from New Jersey.
Good morning.
ANN: Good morning. Thank you for taking this call.
GUPTA: Thank you.
OSBORN: Pleasure is ours. ANN: My question is, does having mammographies early on throughout you 30s and 40s each year, increase your risk of developing breast cancer?
GUPTA: Hmm.
ANNE: And also does the radiation used during core biopsy or the clip that remains in the breast from core biopsy procedure increase your risk of breast cancer? And how is Paget's Disease usually associated with breast cancer.
GUPTA: A lot of questions there. Let me just say there as well, first of all, interesting points here. The radiation from mammography causing breast cancer, and let me just add on to that as well, mammography has been a bit controversial. Go back to screenings on that, as well.
BRAWLEY: OK. Well, I'm a great believer in telling people what we know, what we don't know and what we believe. Most of us do not believe that radiation from mammography causes breast cancer in high amounts. It may cause breast cancer in perhaps one out of every 100,000 cases. A very small -- your personal risk is going to be small.
Mammography is not a very good tool for women in their 30s. And it's actually a difficult thing to interpret a mammogram for a woman in her 40s. As women gets older and estrogen is removed from her body naturally, it's sort of like if one were looking at a television screen. The old black and white TV sets that had a contrast knob. You increase the contrast as a woman ages.
GUPTA: Hmm.
BRAWLEY: Indeed, one of the problems with hormone replacement therapy is the estrogen actually decreases the contrast. So when the mammographer is looking at the mammogram it's actually harder to see the image there.
Most organizations would recommend that a woman either start screening at the age of 50 or at the age of 40. Literally, no one recommends screening of normal risk of the below the age of 40. Now, if you are 25 years old and palpate mass or the doctor palpates a mass, one might get a mammogram in that instance. But that's different from a screening mammogram.
And by the way, the data for every year versus every one to two years, every two is probably good enough.
GUPTA: Good enough. And you and I probably both we all know women who have found their breast cancers threw routine mammography.
We're going to have some final thoughts on both of these cancers when we come back. Stay with us.
(COMMERCIAL BREAK) GUPTA: Lots of information today, both on prostate and breast cancer. Dr. Otis Brawley from Emory University, final thought today, sir?
BRAWLEY: Well, personally I believe that any woman over the age of 50 doesn't get a mammogram at least every two years, that is a tragedy. For women in their 40s they need to talk to their doctor and make an individualized decision.
In the case of prostate cancer, again, men need to know the risk, know the potential benefits and make an informed decision as to whether or not they want to be screened.
GUPTA: All right. And hormone replacement therapy, probably not the cure all that people thought it was going to be.
And this new medication, fanesteride, we're going to keep an eye on that. It may prevent prostate cancer, not quite ready for prime time yet.
We hope you feel a little bit smarter and a little bit healthier after today's show. We're here with our "Weekend House Call" every Saturday and Sunday morning at 8:30 East Coast Time.
And join me weekdays at 8:30 on "AMERICAN MORNING" for the latest health news as well. And Elizabeth Cohen brings you a daily dose of medical information every weekday morning at 11:30 Eastern. CNN is the place to get all your health questions answered.
Thanks for watching. CNN SUNDAY MORNING continues right now.
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Aired June 29, 2003 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
KELLI ARENA, CNN ANCHOR: And now it is time for "Weekend House Call." It begins right now.
KRIS OSBORN, CNN ANCHOR: Something for men and women today on "Weekend House Call." We're going to go in on two cancers, breast cancer and prostate cancer because there's big news on both.
I'm Kris Osborn here. I'm here with Dr. Sanjay Gupta.
Good morning, Doc.
SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning. You're absolutely right, Kris. Thousands of women will be diagnosed with breast cancer this year. It's the cancer that women fear the most. And now there's news now that hormones may actually cause an aggressive form of breast cancer.
This week, in fact, researchers reported that the combination of estrogen-progestin pills, you've heard so much about that, can actually lead to larger tumors. Tumors that are more apt to spread and increase breast density making tumors harder to find.
This of course, caps months of bad news. We've been talking about this so much. Caps months of bad news about hormone replacement therapy, which is taken by millions of women after menopause. Many are reconsidering their HRT decision and asking good, new questions about their cancer risks. We want to get to those questions in just a moment.
But first, we also want to take a look at another cancer. That's the one that men may fear the most. It's prostate cancer. And the news looks more promising.
(BEGIN VIDEO CLIP)
GUPTA (voice-over): Dr. Peter Greeenwald, director of the National Cancer Institute's Office of Prevention, is well aware that he and every other man has a one in six chance of developing prostate cancer. That risk prompted Dr. Greenwald to become one of nearly 19,000 men nationwide who participated in a trial to determine if the drug finasteride, known as Propecia or Proscar and currently used to treat baldness and enlarged prostate could also reduce man's risk of prostate cancer.
The researchers stopped the study early because the findings were so promising; they had the first evidence now that prostate cancer could be prevented.
UNIDENTIFIED FEMALE: There was a 25 percent decrease in the number of prostate cancers in the men that took finasteride versus placebo.
GUPTA: But there are caveats. The patients taking finasteride who did develop prostate cancer had a potentially more aggressive form and the researchers aren't sure why.
UNIDENTIFIED FEMALE: It's very important that we continue to follow the men, who develop prostate cancer, to see if their tumors behave more aggressively or just happen to look different under the microscope.
(END VIDEO CLIP)
GUPTA: These new reports on prostate and breast cancer have huge implications. So many people affected by that. There will be more than 210,000 women diagnosed with breast cancer this year alone and more than 200,000 men diagnosed with prostate cancer.
We want to hear from you. If you have questions about either prostate or breast cancer, you've come to the right place this morning. We'll be taking your calls and your e-mails during the next half hour. You've got the e-mail address. You can also call us 1800- 807-2620. International charges may apply for our overseas caller. Our e-mail address again, us at housecall@cnn.com.
And joining me to answer your questions today, we're very delighted to have him. Dr. Otis Brawley, he's an oncologist at Emory University here in Atlanta. He's also been the assistant director of the National Cancer Institute.
So, first of all, thank you very much for joining us this morning.
DR. OTIS BRAWLEY, ONCOLOGIST, EMORY UNIV. & NCI: Thank you for having me.
GUPTA: Lots of questions about this. And you helped launch this prostate cancer trial back several years ago now.
BRAWLEY: Yes, it was 1991-1992 when we were helping to start write the trial.
GUPTA: People talking about this. And you know, people just watch the piece, talking about this new drug that may fix baldness as well as possibly prevent prostate cancer. Is this too good to be true? Is this something that men should start taking right away?
BRAWLEY: Well, you know the FDA is going to look at all the data. And there are some downsides to fanastaride. First off, fanasteride does cause decreased some sexual function. There's also a question that some of the prostate cancers that were found tend to be higher grade among men who got fanasteride but didn't get prevention of prostate cancer. So the jury is still out on whether someone should take it to prevent prostate cancer.
GUPTA: I don't mean to say it, this is pretty exciting stuff, though, that there's actually a medication that might prevent prostate cancer. And again, it's the same medication, Proscar, Propecia; it's the same active ingredients there.
BRAWLEY: Oh, absolutely. That's right. And it's very exciting that we finally learned that we can actually do something to prevent prostate cancer. So, this is definitely a scientific plus but I don't know if men ought to go out and start taking it yet. Maybe. But you know the FDA is going to vet this over the next six months. And this is actually going to be a good process, so we can find out the pluses and the minuses and men can make a good decision.
GUPTA: All right. We'll be looking to your expertise on that.
Lots of e-mail questions on this particular topic. We've had our e-mail open up for some time. Let's go ahead and get to our first one. It's from a viewer in Maryland. This is sort of a three-part question.
"What causes prostate cancer? What preventative things can one do if his father had prostate cancer and died because of it? And are there specific dietary changes recommended to minimize it?"
Sort of a long question there but what causes it?
BRAWLEY: We really don't know what causes prostate cancer. The epidemiologists will tell you that if you look at populations like in the United States or Western Europe that have a high fat diet, there's a higher amount of prostate cancer. If you look at people in Japan or China or even Eastern Europe where the diet has less fat, there's less prostate cancer.
If you look in countries that screen for prostate cancer, like the United States, you actually find that you find more prostate cancer than a country like England, which does not screen as a national policy. So we don't know exactly what causes it.
Does a vegetarian diet or a diet that's low in fat decreases one's risk of prostate cancer? Once you're 20 or 30 years old, we don't know. We know if someone is born into that sort of diet they do have a lower risk of prostate cancer.
GUPTA: Right. And we're going to take some phone calls.
Let me just ask you real quick. I've heard that all men, if they live long, are going to develop problems with their prostate. Is that true?
BRAWLEY: That is true. That is true.
GUPTA: Got some phone calls coming in, as well?
OSBORN: Yes. Yes. We do, Doc. And we're going to start answering some of them; either question for Dr. Brawley or Dr. Gupta. Our first caller is Lena, and she's calling in from Kentucky.
Hello. Good morning. Welcome.
LENA: Good morning.
OSBORN: Your question?
LENA: My question, is my life is basically unbearable physically and emotional without HRT, specifically Premphase. But what can I do to prevent breast cancer in light of this week's announcement? Or is Premphase results of use different from the Primpro?
BRAWLEY: Well, first off, I can't really comment about you specifically. I can tell you that Primerin and Provera for prevention of cancer is certainly not factor. For prevention of disease, it's probably something we should not be prescribing for. In individuals who have symptoms there still is, in my opinion, room for use of estrogen and progestin to get rid of menopausal symptoms. And some women have extreme menopausal symptoms and this is the only thing that can relieve them.
GUPTA: It's really remarkable. And let me just say you know eight million were taking the medication before a lot of these trials came out. Certainly, the number dropped. Less women are taking HRT now. But it's a risk you know, Chris. Women know it's a risk. But if their symptoms are so severe, they may take the hormone replacement therapies anyway.
OSBORN: Isn't that part of it, Doc, early prevention with breast cancer?
GUPTA: Absolutely.
OSBORN: And of course, that would be the case with most things.
GUPTA: It is and we're going to talk about that both with respect to breast cancer and prostate cancer in the next segment.
OSBORN: Well, I'm in a fortunate seat here. There are two experts here, Doctor Brawley and Doctor Gupta. You can be here, too, by calling in. So we'll continue to monitor this. So a drug that helps fight baldness already available may now help protect you against prostate cancer. We'll get more details as we continue "Weekend House Call."
GUPTA: And we'll answer more of your prostate and breast cancer questions. All that live here on CNN. Also, call us 1800-807-2620. Send an e-mail to housecall@cnn.com. We want to hear from you. We're coming right back. Don't touch that remote.
(COMMERCIAL BREAK)
OSBORN: We are answering your questions on breast cancer and prostate cancer today on "Weekend House Call." For more information on all types of cancer visit www.cancer.gov any time. This is the Web site of the National Cancer Institute. Or www.cancer.org, the American Cancer Society. That is on the Internet.
GUPTA: And we're answering your questions today on "Weekend House Call." Our number 1800-807-2620.
Before we go to the break, let's check our "Daily Dose Health" quiz. What is the lifetime probability that a woman will develop breast cancer and a man will develop prostate cancer? We'll have that answer in 30 seconds. Stay with us.
(COMMERCIAL BREAK)
OSBORN: Checking the "Daily Dose" quiz. We asked what is the lifetime probability that a woman will develop breast cancer and a man will develop prostate cancer? The answer is one...
GUPTA: One in every eight women will develop breast cancer. A woman's risk is greatly increased after age 40 with most breast cancers occurring in women over 50. And One in six men will develop prostate cancer. A man's risk increases as he get older.
We have Dr. Otis Brawley here to check us on all our facts, as well.
There are two tests commonly used to detect prostate cancer. One is a routine physical exam, the other is a blood test commonly called a PSA, prostate specific antigen test. Together these tests can detect many silent prostate cancers. Some that have not cause any symptoms.
Currently, the National Cancer Institute is supporting research to learn more about screening men for prostate cancer. This research will actually determine if these tests can help reduce the death rate from this disease and assess the risks and benefits of screenings and treatments.
Now, this is a little bit of a confusing point. And I want to make this point because most people think early detection, better survival.
BRAWLEY: That's right.
GUPTA: Is that the case always with prostate cancer?
BRAWLEY: That is not necessarily the case. Survival does not necessarily correlate with what we in epidemiology call mortality. That is, does the patient die or not. Simply stated the problem in prostate cancer, is that there clearly some prostate cancers that the worst thing you can do is tell a man he has it and then treat him for it because the cancer was never going to bother the man. Except we now have these new technologies to diagnose it.
The prostate cancer prevention trial actually suggested that it might be as many as one in four men who have prostate cancer. But yet in a country that doesn't screen, doesn't treat, only ability 3 percent of all men die from it. What we really need to do and what the science really needs to do is be able to come up with a test that's probably going to be genetic or proteomic based, that actually is able to tell us, sir, you have prostate cancer but it's the kind we need to watch. Sir, you have prostate cancer, it's the kind we need to treat.
Right now we have the ability to diagnose. And men in the United States are basically going to have to make a decision. Am I going to get screened and aggressively treated or am I going to walk away from screening? And actually, most people don't understand and don't appreciate; most of the professional organizations like the American Cancer Society; they don't say men should be screened. They say men should be offered the test. They should be informed of the potential risks and the potential benefits and they should be encouraged to make a decision.
It's a tough thing to talk about but...
GUPTA: Right. And we're going to make this point, I think, a couple of times.
We've got actually a phone caller from Memphis. Don from Memphis, I think, has a question about screening.
Go ahead Don with your question.
DON: yes, sir. First I'd like to say good morning, everybody.
GUPTA: Good morning.
BRAWLEY: Good morning.
DON: But I've got a two-part question I really want to ask. First of all, I think that microwave ovens caused a lot of this cancer and stuff. But I really can't prove it right now. But I just wanted to find out what you all think about this. And also about age, you know I'm very concerned. And a lot of men be talking about what age should you really get tested for prostate? And most doctors would tell you 40, 41 or 42. I just think you should get tested early as possible.
GUPTA: This is a good point. First of all, the microwave, anything to that?
BRAWLEY: I don't have any data that microwave energy causes prostate cancer.
GUPTA: All right. Age -- age. I think Don brings up a good point. Is there a set age, do you think?
BRAWLEY: Well, the professional organizations that have actually looked at this, most will say that men who choose to start screening should start screening at the age of 50; the exception being African American men who, are at a higher risk at a lower age. As well as men who have a family history of prostate cancer. Especially men who have a history of prostrate cancer at a lower age. That age usually most people would say between 40 and 45.
GUPTA: Let me just say really quick. Man comes in, let's says he's 50, has an elevated PSA, prostate specific antigen. What do you tell him to do?
BRAWLEY: OK, if a man has an elevated PSA. Number 1, it doesn't necessarily mean he has prostate cancer.
GUPTA: Important point. Yes.
BRAWLEY: Could be due to a number of other things: infection, benign prostatic enlargement. What the man actually needs is an ultrasound of the prostate and then he needs a series of biopsies of the prostate, usually six to eight biopsies of the prostate.
GUPTA: All right.
OSBORN: Very, very instructive. I was wondering what age you know men should start looking out for it.
We are going to go now to our next e-mail, which is, "What are your feelings towards nutraceuticals, Vitamin C, et cetera for the prevention/treatment of prostate and other types of cancer?" The question is from Dan in New Jersey.
GUPTA: And you know we get this a lot now because a lot of people are saying, let's go to other forms of therapy; maybe not the standard. What do you think about that?
BRAWLEY: Sure. Sure. Yes, there are some very important leads in science that suggest that both selenium as well as Vitamin E can prevent prostate cancer. And indeed, that's the subject of a large trial, called Select right now that's being done in the United States
And by the way, people who are interested in that trial can access the information through the National Cancer Institute Web site which is www.cancer.gov., G-O-V, or by calling 1-800-4-CANCER. Again, it leads that perhaps selenium and Vitamin E might prevent prostate cancer. It's not been proven yet. And that's important because you know for 40 years, we thought there was no problem with hormone replacement therapy, and then we finally ask the scientific question and we find lots of problems.
Now, lycopene in some epidemiological studies, actually a study of physicians, found Doctors who eat not tomato product, but cooked tomato products in high amounts tend to have a lower risk of prostate cancer. And it's thought that lycopene, which is a carotene in tomatoes and a number of other foods, might be the reason for that lower risk. Again, big might, has not been verified in good, definitive clinical trials.
GUPTA: Got it. All right. So we'll keep an -- we'll look to you to keep an eye on that for us. And we'll eat our tomatoes in the meantime.
Ladies, we haven't forgotten about you either. We haven't forgotten about breast cancer. That's something we want to talk about it. Those of you who have questions on hormone replacement therapy and breast cancer; we'll be answering your phone calls and e-mails. Stay with us on "Weekend House Call."
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GUPTA: All right. Although we know some of the risk factors linked to breast cancers; Doctors really don't know what causes most breast cancers. There's a study to suggest, though, that women may lower their risk by giving birth to several children. The more births, the less risk, and breast-feeding them for several months, not drinking alcohol, exercising regularly, and staying slim. Although I will say as well, that there are women out there who have none of those risk factors and still get breast cancer.
It is important to follow the recommended guidelines for screening, including mammograms, a very big topic as well.
Let's go straight to our next e-mail. It's from Angela in Ontario and she asks, "Would a person with a family history of breast cancer benefit from consuming soy milk at an early stage in life?"
And I told you, Dr. Brawley, a lot of people looking to alternative therapies, non-conventional therapies to reduce their risk and treat their cancers. What do you say to them?
BRAWLEY: Well, you know her question is actually very interesting and a actually very good one. We actually can look at populations that have a high soy diet, a low fat diet, a diet high in fruits and vegetables from birth on wards. And we can say that that population has a lower risk of both breast, prostate and colon cancer.
The issue, we don't know if a person who's 50 years old, who starts adapting that diet will benefit in terms of cancer. We actually know they will decrease their heart disease risk. So it can be advocated. The theory would be that a 20-year-old is more likely to benefit than a 50-year-old because we know that someone who starts that diet basically at birth has benefit. But the answer to her question, we don't know. But the theory sounds light. And if it's just drinking more soy, if it's eating a diet higher in vegetables, higher in fruits, lot more roughage, less fat, it's a reasonable thing to do.
GUPTA: Won't hurt, may help. Very interesting.
OSBORN: With that, we are going to bring in our next caller. We are going to say hello and welcome to Anne who's calling from New Jersey.
Good morning.
ANN: Good morning. Thank you for taking this call.
GUPTA: Thank you.
OSBORN: Pleasure is ours. ANN: My question is, does having mammographies early on throughout you 30s and 40s each year, increase your risk of developing breast cancer?
GUPTA: Hmm.
ANNE: And also does the radiation used during core biopsy or the clip that remains in the breast from core biopsy procedure increase your risk of breast cancer? And how is Paget's Disease usually associated with breast cancer.
GUPTA: A lot of questions there. Let me just say there as well, first of all, interesting points here. The radiation from mammography causing breast cancer, and let me just add on to that as well, mammography has been a bit controversial. Go back to screenings on that, as well.
BRAWLEY: OK. Well, I'm a great believer in telling people what we know, what we don't know and what we believe. Most of us do not believe that radiation from mammography causes breast cancer in high amounts. It may cause breast cancer in perhaps one out of every 100,000 cases. A very small -- your personal risk is going to be small.
Mammography is not a very good tool for women in their 30s. And it's actually a difficult thing to interpret a mammogram for a woman in her 40s. As women gets older and estrogen is removed from her body naturally, it's sort of like if one were looking at a television screen. The old black and white TV sets that had a contrast knob. You increase the contrast as a woman ages.
GUPTA: Hmm.
BRAWLEY: Indeed, one of the problems with hormone replacement therapy is the estrogen actually decreases the contrast. So when the mammographer is looking at the mammogram it's actually harder to see the image there.
Most organizations would recommend that a woman either start screening at the age of 50 or at the age of 40. Literally, no one recommends screening of normal risk of the below the age of 40. Now, if you are 25 years old and palpate mass or the doctor palpates a mass, one might get a mammogram in that instance. But that's different from a screening mammogram.
And by the way, the data for every year versus every one to two years, every two is probably good enough.
GUPTA: Good enough. And you and I probably both we all know women who have found their breast cancers threw routine mammography.
We're going to have some final thoughts on both of these cancers when we come back. Stay with us.
(COMMERCIAL BREAK) GUPTA: Lots of information today, both on prostate and breast cancer. Dr. Otis Brawley from Emory University, final thought today, sir?
BRAWLEY: Well, personally I believe that any woman over the age of 50 doesn't get a mammogram at least every two years, that is a tragedy. For women in their 40s they need to talk to their doctor and make an individualized decision.
In the case of prostate cancer, again, men need to know the risk, know the potential benefits and make an informed decision as to whether or not they want to be screened.
GUPTA: All right. And hormone replacement therapy, probably not the cure all that people thought it was going to be.
And this new medication, fanesteride, we're going to keep an eye on that. It may prevent prostate cancer, not quite ready for prime time yet.
We hope you feel a little bit smarter and a little bit healthier after today's show. We're here with our "Weekend House Call" every Saturday and Sunday morning at 8:30 East Coast Time.
And join me weekdays at 8:30 on "AMERICAN MORNING" for the latest health news as well. And Elizabeth Cohen brings you a daily dose of medical information every weekday morning at 11:30 Eastern. CNN is the place to get all your health questions answered.
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