Category: health

Adapted from BMJ 16 March 2023

One in four deaths are due to cancer between the ages of 35 and 69. The most common 23 cancers were investigated by Shelton and colleagues. Even though we have an aging population, cancer deaths over the last 25 or more years have declined.

Data from adults in the UK, aged 35 to 69, who had a diagnosis or death from cancer were analysed retrospectively covering between 1993 and 2018.

The incidence of cancer registrations increased in both both sexes by a substantial amount. 57% increase for men and 48% for women. At the same time cancer mortality declined by 37% for men and 31% for women.

In men, the cancers with the best improved mortality were for stomach, bladder and mesothelioma with some improvement in prostate cancer. In women, the best improvements were for stomach, cervical and non-Hodgkin’s Lymphoma with some improvement for breast cancer. In both genders lung and bowel cancer improved considerably.

In the UK the chances of dying from cancer before the age of 80 declined between 2002 and 2019 from one in six to one in eight for women and from one in five to one in six for men.

The results have been due to a reduction in smoking, less asbestos exposure at work, earlier detection due to screening and health education, improved diagnostic investigations and improved treatments.

France, the Netherlands and Sweden also show declining cancer deaths in the same age group.

Some types of cancer, are however increasing, mainly due to the increased weight of the general population.

Some cancers have become more common. Liver cancer incidence has been rising since 1980. This is due to increased alcohol consumption and body weight. These two factors account for 4.1% of cancers in men and 6.3% in women.

In adults under 50 the incidence and mortality rates for bowel cancer are rising. Various hypotheses for this are increased weight, less physical activity and antibiotic effects on the gut microbiome.

Adapted from Breast Cancer Now 17.3.25

Breast Cancer Now, a research and support charity for breast cancer, sent a very helpful educational leaflet to all UK General Practitioners via Pulse, the GP magazine. Mainly, this is to act as a reminder to them, to investigate and refer women who could be presenting with breast cancer that has spread. Nowadays more than 4 in 5 women who are diagnosed with breast cancer survive long term. Women who present with secondary breast cancer symptoms can sometimes still be cured, but sometimes they can’t. Information about possible secondary cancer symptoms is useful for the GP, but it is even more useful for women who have had breast cancer, so I’m sharing it with you today.

Secondary breast cancer occurs when breast cancer cells spread from the first cancer to other parts of the body. This is via the lymphatic or blood system. General symptoms can be tiredness, nausea, loss of appetite and weight loss. These can be caused by many other conditions such as infections, medications, immunological disorders and other illnesses, but if you have previously had breast cancer it is worth getting a diagnosis sooner rather than later.

Signs that cancer may have spread to the bones include: bone pain that doesn’t respond to simple pain killers and may be worse lying down or at night. Fractures with or without prior trauma. Unexplained back pain, difficulty walking, numbness or lack of bladder or bowel control. Feeling sick or being sick, fatigue, passing a lot of urine, confusion, and being thirsty. These may be due to a high level of calcium in the blood.

Signs that cancer may have spread to the lungs include: feeling out of breath on activity that you usually can do easily, or breathlessness at rest. A cough that doesn’t go away after three weeks. Pain or tightness in the chest that doesn’t go away with rest.

Signs that cancer may have spread to the liver include: pain in the abdomen or the right shoulder. Pain under the ribs on the right side. Nausea, loss of appetite and weight loss. Persistent hiccups, swelling of the abdomen, feeling unwell or tired. Itching of the skin or yellow discolouration of the skin or whites of eyes.

Signs that cancer may have spread to the brain include: persistent headache, nausea and vomiting especially in the mornings. Weakness or numbness down one side of the body. Dizziness, unsteadiness, loss of balance or co-ordination. Fits. Difficulty with speech. Problems with vision. Changes in behaviour, mood or personality. Confusion. Memory problems.

Signs that cancer has spread to the skin include: a change in colour of the skin. A persistent rash. A firm, painless lump or nodules or multiple lumps of different sizes. Swelling of the arm, hand or breast area. Pain. Bleeding. Infection. Smell.

Signs that cancer has spread to the lymph nodes include: a lump or swelling under your arm, breast bone or collar bone. Swelling in your arm or hand. Pain. Dry cough.

Signs that cancer has spread to the abdomen include: abdominal pain, swollen belly, feeling sick all the time, loss of appetite, feeling full quickly when eating, constipation, feeling bloated.

If you have NEW symptoms, that DON’T HAVE AN OBVIOUS CAUSE, or DON’T GO AWAY, you must report these to a doctor. If you first see or speak to a nurse or physician assistant it is worth asking for a doctor appointment.

The charity Breast Cancer Now has a phone line where you can discuss your worries: 0808 800 6000. They have dedicated nurses and can tailor information and support to you, not just at the point that you are worried about symptoms but if you are then diagnosed with secondary breast cancer.

Adapted from BMJ 28 September 2024

British birth cohort studies have looked at the future health of only children compared to those from larger families. Those born in 1946, 1958 and 1970, who were only children, had no differences in the risk of heart problems, hypertension, high triglycerides, high glycated haemoglobin, or high C-reactive protein compared to those who had siblings, by the time they reached middle age.

However, the risk of cancer and poor general health was higher in those with three or more siblings.

My comment: Given my hunch that richer families tend to have fewer children, I sought further information from AI. There are strong links between health and socio-economic status, and the wealth of the parents, does tend to affect the wealth of the adult child.

The highest quintile socio-economically in European families, do tend to have the fewest children, having on average 1.5 to 2.0 children. Group 2 has 1.8-2.24. Group 3 has 2.0-2.55. Group 4 has 2.3 -2.7 and the lowest quintile has 2.5-3.0 children.

The number of children are affected by education and career aspirations, family planning access, and lifestyle factors.

I do think that researchers could have looked at the health of large sized families from wealthy families compared to poorer families to tease out how marked these differences were.

Adapted from BMJ 28 Sept 2024

When I was at school, in a class of 42 pupils, there were a handful of children who wore spectacles. I was one of them. It wasn’t uncommon, but it wasn’t a third of the class.

A global review has found that from 1990 to 2023 the overall prevalence of myopia (shortsightedness) in children and teenagers has more than tripled. It was 24% between 1990 to 2000, but now it is 36% from 2020 -2023.

The review of 276 worldwide studies predicts that this will reach around 40% by 2050.

Factors that increase the chances of becoming myopic are living in east Asia, living in urban areas, being female and having a high school education.

Being myopic doesn’t just affect your ability to see the blackboard, or figure out who is waving to you across the street, your night vision is also adversely affected.

Adapted from BMJ 12 Oct 2024

When vaping started out, it was seen as a heathier way to help people stop harmful cigarette smoking. In addition, the cost was dramatically less. Since then, it has attracted a new population, the never smokers.

Now about a million adults in England alone use vapes despite never having regularly smoked cigarettes. There are also worrying reports about children and adolescents using them.

Vaping rates in non-smokers were pretty stable from 2016 to 2020, with around one person in 200 smoking them. But after disposable vapes came on the market this has increased seven fold, and now 1 in 28 non-smoking adults use them regularly.

To start with, vapes seem to have no real downside, but increasingly, severe addiction and lung problems are seen to develop.

Adapted from BMJ 12 Oct 2024

Almost 200,000 people in the UK Biobank Study were free of cardio-metabolic syndrome when they were recruited. Tea and coffee consumption was analysed.

Those who drank three or more cups of coffee a day, or the equivalent amount of other caffeine containing beverages, were 40-50% less likely to develop cardiometabolic multimorbidity. This means two of: type two diabetes, coronary heart disease, or stroke. This was in comparison to those who drank less than 100mg of caffeine a day.

Asking my computer AI system about what this means in real life consumption, it means drinking a fair bit of tea and coffee a day.

100mg of caffeine is found in 1.5 to 2 espressos. 1.5-2.5 cups of black tea. and two cans of diet coca cola.

Thus to gain the protective effects, you would need to consume around double this. I easily meet this amount but the downside is that my teeth get badly stained and I need to get them polished every three months.

What is less effective for metabolic syndrome is time restricted eating.

108 participants were randomised to limiting eating to 8-10 hours a day. This was at least a four hour reduction in their usual eating window. The other group received nutritional counselling alone.

After three months, time restricted eating improved HbA1c by 0.1% after three months.

Adapted from Which February 2025

Which recently surveyed their readers about their personal use of the Zoe app. As a reader, I contributed too, but was dissuaded from buying the App as I have wheat intolerance and irritable bowel syndrome, both of which make their food recommendations impractical. I was impressed with their integrity about this, as they could easily have taken my money, and then given me advice that wouldn’t have helped me.

Zoe is a self testing and nutrition plan, headed by Professor Tim Spector. Zoe has signed up more than 120,000 people so far. 241 Which members contributed to their survey about it.

67% said that they wanted to find out about their gut microbiome. 44% wanted dietary advice. 37% wanted to improve their health. 30% wanted to lose weight.

The top five changes that they made to their diets after using the app were:

They ate fewer carbohydrates, ate more protein, ate more nuts and seeds, ate more vegetables, and ate less red meat.

The response was generally very positive with most people getting out of the app what they wanted.

78% had a better idea of what to eat, 48% said their guts worked better, 42% said they felt healthier, and 41% had lost weight.

29% said it was good value for money. 46% said it was reasonable value for money and only 20% said it was poor value for money.

Subscriptions to Zoe costs between £400 for four months and £600 for a year.

When you join up, you have to eat various biscuits that they supply, and then send off faecal samples and blood samples. After this you get feedback on the variability of the bugs in your gut, and how well or not you handle fat and sugar in your body.

For the next stage, you log in all your meals, snacks and drinks. You are advised as to whether they are “green”- go ahead, “amber”- just now and then, or “red” -you really should avoid. One user was advised to eat more avocado, green lentils and olive oil, and to avoid canned chicken soup, rice, white bread and ice cream. She was also advised to add wholegrains, vegetables, nuts and seeds. Reading this, I could understand why I had been advised not to purchase it.

The app contains tutorials, information, recipes, and support groups. To increase meal “scores” you generally need to eat more plant food, less refined carbs, sugar, processed meat and processed food. Such advice is common to many healthy diets, so whether it is truly individualised, is difficult to ascertain.

Although the Zoe app also measures blood sugars, for most people who are not diabetic, this becomes unnecessary, when sugars and starches are restricted, as these are the culprits when it comes to blood sugar spikes.

In general, users are advised to increase the range of plant foods that they eat, such as lentils, pulses, legumes, nuts, wholegrains and seeds. Reduce ultra processed foods. Include fermented foods such as kefir, kimchi, kombucha, cheese, yoghurt, coffee and some teas.

Finally they also advise lifestyle improvements such as being active, managing stress, get enough sleep, and look after your mental health.

Adapted from BMJ 11-18 Jan 2025

Dementia is perhaps the disease we all most dread. It kills you slowly and gradually. You stop being able to learn new things, you forget a lot of your past and relationships, and your personality changes along with your physical abilities.

Bruck CC et al, searched for longitudinal studies on survival and admission to nursing homes, in people who had been diagnosed with dementia. Studies had to include at least 150 people and follow them up for at least a year.

Median survival from diagnosis seemed strongly dependent on age, ranging from 8.9 years, mean age 60 in women to 2.2 years at a mean age 85 for men.

Overall, women survived for fewer years than men, but this was due to them being diagnosed at later ages than men. The mean difference between the sexes was 4.1 years.

Median survival was 1.2 – 1.4 years longer in Asia, than in the US or Europe. My comment: I wonder if this is due to the tendency for older people to be looked after in extended families there.

Survival time with Alzheimer’s disease was 1.4 years longer than with other types of dementia.

One the whole, survival tends to be longer now than it was pre-2000.

The median time to nursing home admission was 3.3 years. 13% of people were admitted in the first year after diagnosis, increasing to 57% after five years. About a third of the time of remaining life expectancy was spent in a nursing home.

These figures are averages, and are potentially helpful when it comes to health and social care planning for governments, health boards and councils. The individual prognosis, however, is highly dependent on personal and clinical characteristics, offering potential for individualised prognostic information and care planning.

My comment: In my work as a GP, I often was consulted by worried relatives about suspected dementia. I would assess the patient, and particularly if I knew the patient well, I could be pretty sure that there had been a definite cognitive deficit, and I would refer to the memory clinic. More often than not, the patient would come back with no diagnosis. 18 months to two years later, I would refer again, and this time the dementia diagnosis would be made. It seems to me that the tests used for diagnosis are not that accurate in getting a diagnosis in the early stages. Dementia symptoms can have a lot in common with other problems such as depression. At the same time, there are still no good treatments for it. There has been a little success with ketogenic diets and ketone supplementation. Meanwhile, what tends to be good for your blood vessels, tends to be good for your brain.

Adapted from BMJ 7 Dec 2024

If given the choice, you will not experience more immunisation side effects if you decide to get a covid-19 vaccine at the same time as a flu shot.

Three hundred people were randomised to receive either vaccine plus a placebo injection or to have both together. The placebo or real vaccine was then given two weeks later. (That was very sporting of the participants!)

Adverse reactions were reported by a quarter of participants but were not more likely when vaccines were administered together or separated by two weeks.

My comment: In my health board area, the vaccines are offered together, probably to improve uptake. I was able to have them both in the same, non- dominant arm. I was given the option of different arms.