I remember a patient who went to Tijuana for treatment.
He got loaded up on IVs and colonics in a place that I once visited out of interest. The colonics involved enemas with gallons of water, causing risks of perforation, infection and water intoxication.
His wife assured me they were careful. They hurried back across the border after the treatment and didn’t stop to eat in Mexico.
Some cancer treatments and preventions are easy to dismiss. Others require more complicated explanations.
The idea of cleaning out toxins dates to ancient times. Colonics were popular in the 19th century and had a revival in the 20th. Seems intuitive that we don’t want yucky-toxic stuff inside us.
Some practitioners add freshly brewed coffee to the enema, with the explanation that it purges the bile. In fact, it adds the buzz and convinces sufferers that it must be doing something important.
Proponents defend the practice as a form of natural therapy. Imagine believing that definition of what God and nature have designed for us. Imagine being gullible enough to pay for it. There is no evidence beyond anecdotes that this method rids the body of the toxic agents that cause cancer. There is evidence that it could kill you.
I continue to hope that there are a couple of students in Walla Walla who will someday publish breakthrough concepts in the New England Journal or Lancet. For the rest of us, let’s begin with an oversimplified model and build on it.
The common forms of colon cancer arise in cells that come in contact with the things we swallow, as well as chemicals that reach them through the blood stream. Some of these chemical agents damage the normal processes that regulate cell death. Those injuries can initiate cancer development — oncogenesis or carcinogenesis.
Things that may decrease cancer risks include aspirin, other anti-inflammatory drugs, physical activity, certain hormones and some vitamins.
Things that seem to increase the risk include age, genetics, alcohol and obesity. These lists are not complete and we don’t have the same level of evidence for each. The data aren’t easy to sort out.
We’ll begin with aspirin. I’ll start with my conclusions. The chemistry and probable mechanisms will follow. If you want to know the basis for the conclusions, check back in two weeks.
Regarding aspirin as a tool to prevent cancer:
1) A baby aspirin a day reduces the risk of colon cancer. It warrants a recommendation for many, not all patients. It is also recommended for other conditions, including vascular disease.
2) Larger aspirin doses may decrease the favorable effect.
3) Aspirin increases the risk of bleeding in the brain and intestinal tract.
4) Aspirin may be useful in patients who also have adequate screening, but the issue is not fully resolved.
5) Three years ago, a research paper showed hat aspirin reduced the death rate from recurrence, after patients were treated for colon cancer.
6) In October 2012, a report in the New England Journal of Medicine showed the reduction in death from recurrence was only seen in patients with a specific variety of colon cancer (mutation of a chemical, PIK3CA, associated with apoptosis. That process of programmed cell death was described in an earlier column.)
This finding suggests that we may be able to narrow the number of patients who will benefit from aspirin therapy. Realizing that there are tens of thousands of genes in the human body, the ability to pin down the specific site and mode of action is a sign that we have moved beyond the days of snake oil and simple answers for complex issues.
What category best describes the use of vitamins, non-aspirin NSAIDS, exercise and others? Those are next on my list.
Error report: Sorry. In a recent column, I misstated the year that an estimated 70,000 women were overdiagnosed was 1978. The year was actually 2008.
Dr. Larry Mulkerin is a retired clinical professor. He can be reached at firstname.lastname@example.org.