Category Archives: Cancer Prevention & Treatment

What We Really Know About Sun Exposure

A foreword from Patty

Since I turn 50 this year I decided it’s probably time to start regular “mole patrol” appointments for identification and removal of any areas suspicious for skin cancer. I’d been hearing about Dr. Zirwas through shared patients over the last few months, and could tell that he seems to do a lot of “out of the box” thinking for chronic skin conditions – and just as important– that patients really like him.

During my visit, Dr. Zirwas discussed his views on sun exposure –  he is the only derm I’ve ever met who didn’t lecture me about my love of sunbathing. I’ve done a lot of my own research, and my long time views lined up with what Dr. Zirwas had to say – so it was nice to have validation and the peace of mind only a derm can give you.

I asked him right there on the spot if he would mind writing a guest blog for me so I could share this info with my patients.  He readily agreed, but asked that he be allowed to provide references to (hopefully) cut down on the blow-back he expects from other area derms.  So we’ve included those in his article below. First an introduction…

About Dr. Zirwas
Zirwas_Matt
Dr. Matthew Zirwas

Dr. Zirwas received his undergraduate and medical school degrees from the University of Pittsburgh. He completed his dermatology residency at the University of Pittsburgh as well, developing an interest in contact dermatitis, which led to additional training at Penn State University and the Cleveland Clinic.

One of the most important moments of Dr. Zirwas’ life happened while he was a young dermatologist and realized that so much of what he was being taught to tell patients didn’t have any proof to back it up. Even worse was that much of what he was supposed to tell them either didn’t work or was making their problems worse. At that moment he started looking for the actual causes for what he was seeing in his patients and for explanations that made sense, and he hasn’t stopped since.

Over the ensuing 15 years, he has developed innovative, effective treatment approaches that have helped hundreds, even thousands of patients. His approaches to treating these patients have garnered significant recognition in the dermatology world, with Dr. Zirwas publishing over 120 peer-reviewed medical articles and giving hundreds of lectures all over the country. Not all of the attention has been good, though, as much of what Dr. Zirwas says doesn’t fit with what the “conventional wisdom” is in dermatology.

The most frustrating things for him are that there are still so many things that we don’t have good explanations for, or, that we do have a good explanation for, but not a good way to fix. He is constantly listening to his patients and reading the medical journals, looking for clues to send him in new directions.

sun scribbleWhat We Really Know About the Sun

Matthew J. Zirwas, MD, Board Certified Dermatologist and author of  more than 100 peer-reviewed journal articles.

If you’ve ever asked your dermatologist what you should know about sun exposure, the answer has probably sounded something like this:

  • Sunlight contains ultraviolet radiation (UVR).
  • Ultraviolet radiation causes skin cancer and aging of the skin.
  • Therefore, people should avoid exposure to sunlight.

It’s simple, bite size, repeatable, easy… and totally wrong.

Well, maybe not TOTALLY wrong, but at a minimum, incomplete and misleading.  How do we change it to make it more accurate?  Let’s try adding a few more facts.  Every statement below is true.

A Few More Facts

  • Sunlight contains ultraviolet radiation.
  • Ultraviolet radiation is the main cause of certain types of skin cancer, specifically basal cell and squamous cell carcinoma.
  • Basal cell and squamous cell carcinoma are almost always easy to treat and very rarely kill anyone.
  • Ultraviolet radiation, especially sunburns, slightly increases the risk of getting melanoma, but it DOES NOT increase the risk of dying from melanoma. [1]
  • Compared to kids who go to schools with regular light fixtures, kids in schools that have low level ultraviolet radiation being released by the light fixtures are taller, have fewer cavities, miss fewer days of school, and do better academically.[2]
  • Your body produces endorphins when your skin is exposed to ultraviolet radiation and endorphins put you in a better mood.[6, 7] Being in a better mood benefits your cardiovascular, immune, and nervous systems.
  • Ultraviolet light reduced the risk of obesity in mice via a mechanism that is totally independent of vitamin D.[5]
  • Ultraviolet radiation reduces blood pressure and this very likely leads to a decreased risk of heart attacks, strokes, and other cardiovascular problems. This has nothing to do with vitamin D – it is because ultraviolet radiation increases nitric oxide levels.[3, 4]
  • People who get more sun exposure are less likely to get depression, rheumatoid arthritis[8-10], multiple sclerosis[9-11], and diabetes.[9, 10, 12, 13]
  • People who get more sun exposure have less risk of getting breast cancer[14, 15], lung cancer[16], and prostate cancer[17].
  • In studies in which people are given vitamin D supplements, the vitamin D doesn’t seem to reduce cancer risk.[18]
  • Women in Sweden who get the most ultraviolet exposure are the least likely to die.
  • All of the studies that show an association between sun exposure and decreased risk of health problems could be coincidences since sun exposure only happens outdoors. It could be that spending time outdoors while wearing sunscreen and sun protective clothing is just as good, or even better, than being outdoors without sunscreen.
  • The number of people who die from the diseases that sun exposure may benefit is so much bigger than the number who die from skin cancer that if avoiding sun eliminated 100% of skin cancer deaths but increased the number of deaths related to the other diseases by 0.1%, avoiding the sun would still increase your risk of dying.

My Conclusions Based on These Facts

This is a lot more complicated than what you usually hear from dermatologists. And it doesn’t necessarily lead to an easy recommendation. When I think about all the evidence and data I’ve read, here is what I think:

  • Sun exposure definitely increases your risk of basal cell carcinoma, cutaneous squamous cell carcinoma, and some types of melanoma. It doesn’t increase your risk of dying from melanoma. It does increase your risk of dying from cutaneous squamous cell carcinoma (cSCC), but cSCC is much less dangerous than melanoma and dying from it is easy to prevent by getting checked by a dermatologist regularly.
  • Sun exposure probably decreases your risk of numerous other health problems via skin production of vitamin D, nitric oxide, endorphins and other, as yet undiscovered, substances. We don’t know exactly how much it decreases them.
  • Taking vitamin D supplements doesn’t have ALL the same benefits as getting sun exposure.
  • We don’t know for sure which of the above is more important – in other words, we don’t know if the benefits of sun exposure overall outweigh the increased risk of skin cancer.
  • However, based on the number of people affected and the seriousness of the diseases that sun exposure probably affects positively vs the number of people affected and the seriousness of skin cancer, it is likely that sun exposure is an overall benefit to health. This is supported by the best study looking at the relationship between ultraviolet exposure and risk of death.

What I Do For Myself & My Family

  • I get as much unprotected sun exposure as I can (without getting a burn).
  • Sunburns are bad and I try to avoid them.
  • It makes sense to wear sunscreen on your face and neck, as this will prevent skin aging in these areas and these are the highest risk areas for skin cancer, so you get the most benefit in skin cancer reduction by protecting these areas.
  • If you’re over 50 and have gotten a lot of sun or if you have a lot of bumps on your skin, get checked by a dermatologist.

References

  1. Berwick, M., C. Pestak, and N. Thomas, Solar ultraviolet exposure and mortality from skin tumors. Adv Exp Med Biol, 2014. 810: p. 342-58.
  2. Hathaway, W., A Study Into the Effects of Types of Light on Children – A Case of Daylight Robbery, in IRC Internal Report No. 659. 1994, Institure for Research on Construction: Ottawa, Canada. p. 11-29.
  3. Liu, D., et al., UVA irradiation of human skin vasodilates arterial vasculature and lowers blood pressure independently of nitric oxide synthase. J Invest Dermatol, 2014. 134(7): p. 1839-46.
  4. Oplander, C., et al., Whole body UVA irradiation lowers systemic blood pressure by release of nitric oxide from intracutaneous photolabile nitric oxide derivates. Circ Res, 2009. 105(10): p. 1031-40.
  5. Geldenhuys, S., et al., Ultraviolet radiation suppresses obesity and symptoms of metabolic syndrome independently of vitamin D in mice fed a high-fat diet. Diabetes, 2014. 63(11): p. 3759-69.
  6. Jussila, A., et al., Narrow-band ultraviolet B radiation induces the expression of beta-endorphin in human skin in vivo. J Photochem Photobiol B, 2016. 155: p. 104-8.
  7. Levins, P.C., et al., Plasma beta-endorphin and beta-lipoprotein response to ultraviolet radiation. Lancet, 1983. 2(8342): p. 166.
  8. Arkema, E.V., et al., Exposure to ultraviolet-B and risk of developing rheumatoid arthritis among women in the Nurses' Health Study. Ann Rheum Dis, 2013. 72(4): p. 506-11.
  9. Ponsonby, A.L., A. McMichael, and I. van der Mei, Ultraviolet radiation and autoimmune disease: insights from epidemiological research. Toxicology, 2002. 181-182: p. 71-8.
  10. Artukovic, M., et al., Influence of UV radiation on immunological system and occurrence of autoimmune diseases. Coll Antropol, 2010. 34 Suppl 2: p. 175-8.
  11. van der Mei, I.A., et al., Regional variation in multiple sclerosis prevalence in Australia and its association with ambient ultraviolet radiation. Neuroepidemiology, 2001. 20(3): p. 168-74.
  12. Staples, J.A., et al., Ecologic analysis of some immune-related disorders, including type 1 diabetes, in Australia: latitude, regional ultraviolet radiation, and disease prevalence. Environ Health Perspect, 2003. 111(4): p. 518-23.
  13. Mohr, S.B., et al., The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide. Diabetologia, 2008. 51(8): p. 1391-8.
  14. Anderson, L.N., et al., Ultraviolet sunlight exposure during adolescence and adulthood and breast cancer risk: a population-based case-control study among Ontario women. Am J Epidemiol, 2011. 174(3): p. 293-304.
  15. Mohr, S.B., et al., Relationship between low ultraviolet B irradiance and higher breast cancer risk in 107 countries. Breast J, 2008. 14(3): p. 255-60.
  16. Mohr, S.B., et al., Could ultraviolet B irradiance and vitamin D be associated with lower incidence rates of lung cancer? J Epidemiol Community Health, 2008. 62(1): p. 69-74.
  17. Colli, J.L. and W.B. Grant, Solar ultraviolet B radiation compared with prostate cancer incidence and mortality rates in United States. Urology, 2008. 71(3): p. 531-5.
  18. Bjelakovic, G., et al., Vitamin D supplementation for prevention of cancer in adults. Cochrane Database Syst Rev, 2014(6): p. CD007469.

Supporting Breast Health Through Thermography

In whatever part of the body excess of heat or cold is felt, disease is there to be discovered.

– Hippocrates, 480 B.C.

My Take on Thermography

Many clients have asked for my opinion on mammograms and whether or not thermograms are a safer option. Unfortunately, there is no one answer I can give to everyone since family history, breast health history, age , and other risk factors (smoking, hormone use, environmental exposure, diet, lifestyle, etc) are all uniquely contributing factors.

What I can do is offer my perspective, provide some basic information. and point you to a list of things you can do to improve breast health and lower risk.

Ultimately, any screening decisions should be made with the help of your physician, but you can be a more proactive participant in this discussion with some education.

Mammography Has Its Place

mammogram
Mammogram of a healthy breast

Mammography is currently the gold standard for breast cancer screening. Unfortunately, it also exposes the breasts to harmful radiation and has limited efficacy in women who are on hormone replacement therapy, or who have enhanced, large, dense or fibrocystic breasts. In most cases it also cannot show areas near the chest wall.

These lifestyle and risk differences do not detract from the accuracy of thermography, so thermography may offer an advantage when combined with other screening methods to improve surveillance. Personally I have chosen to utilize mammography less often and do yearly thermograms because I have fibrocystic breasts.

Criticisms

The biggest criticism of mammograms is the radiation exposure. After all, radiation does cause cancer, so how does it make sense to irradiate breast tissue, as well as surrounding tissues (heart, coronary arteries, lungs, etc)? To put it into perspective, the amount of radiation exposure from a mammogram is approximately what you’d receive on a jet flight across the country. Still, there are genetic and other individual risk factors that can make this a very significant exposure, especially since the radiation exposure is concentrated in specific areas.

Another criticism is the number of cancers detected by mammogram that may have resolved on their own without costly treatments that carry their own risks.  We all make cancer cells every day.  Since most of us have never been diagnosed with cancer, this means our immune systems “cure” cancer every day.

Lastly, there is the controversy over the last several years as to how often and at what age mammograms should be done.

All of these are good talking points to include in a discussion with your healthcare provider as you make the individual decision of when and how often mammograms make sense for you.

What Is A Thermogram?

At a simple level, thermography has a wide application. It is performed using a highly sensitive infrared camera to detect subtle heat differentials. Think about the paranormal TV shows you may have seen when the camera crew is looking for a creature in the woods using a “heat sensor.” Or maybe an inspection you may have had before weather proofing your home. This is basic thermography at work.

thermo
An everyday example of thermography

The Argument for an Alternative

When it comes to breast health, the heat differentials detected by a thermograph allows us to pinpoint areas of increased blood circulation and metabolic activity. So why is that important?

Inflamm Cancer
Breast thermography at work

Because cancerous tumors are known to promote the growth of new vessels to “feed” themselves (angiogenesis),  they are associated with an ever-increasing pattern of rising local temperature. Digital infrared imaging (thermography) is extremely sensitive to these temperature variations and can therefore be a valuable tool in early cancer detection.

Adjunct to Mammography

Most thermography proponents consider it to be an adjunct to mammography and other forms of breast cancer detection, NOT a competitor. This complementary view arises from the basic differences in the technologies: structural imaging tools (mammography, ultrasound, MRI) capture anatomical images, and thermography captures metabolic images. Each of these types of detection tools have their advantages with different types of cancers and in different populations. For instance, not all tumors are visible on a mammogram, and not all tumors are associated with a high level of blood vessel activity.

Because tumors can take 8-10 years to grow to a size detectable by mammogram, thermograms may alert you to a need for preventive intervention.  It can be argued that regular thermography is one of the best ways to assess risk and maintain a proactive awareness of your level of breast health.

For more breast health recommendations, see our post on maintaining or regaining breast health.

Next Steps

As I said in my introduction to this post, all of your diagnostic decisions should be made together with a doctor you trust. If you decide that a thermogram is right for you, it’s important to establish a baseline thermogram to start. An initial thermogram should then be followed up with another in 3-6 months to determine if heat patterns are stable, or if there is a progressive increase in blood flow/heat to a particular area, suggestive of a growing tumor.

A Local, Trusted Practitioner

We are fortunate to have a trusted, experienced thermogram provider here in the Columbus area – Dena E. Johnston RN, MSN, CCT of Ohio Infrared Health, Breast & Body Thermography.

For more information on the services Dena provides, see descriptions, pricing, and FAQs on her website.

If you have concerns about paying for this imaging, Dena suggests checking out the assistance offered by The United Breast Cancer Foundation (UBCF). For a $5 application fee, the UBCF will assist with up to $150 of the cost of your imaging, depending on their current available funding.

 Bonus Time! Some Thermo-History

hipocrates
400 B.C. compared to present day

The FDA approved thermography as an adjunctive diagnostic breast cancer screening procedure in 1982. Interestingly enough, there’s a more natural history to this diagnostic tool. The first recorded use of thermobiological diagnostics can be found in the writings of Hippocrates around 480 BC. A mud slurry spread over the patient was observed for areas that would dry first and was thought to indicate underlying organ or tissue pathology.

Resources Mentioned in this Post

This was quite a bit of information to digest, so just to make sure that the valuable links and points of contact don’t get lost in the shuffle, here they are in one short list:

A Guide to Better Breast Health

Beyond The Mammogram

pink-ribbon3Years of marathons and ad campaigns have taught us all that regular mammograms are an essential tool in the early detection of breast cancer. But what do you know beyond the bumper stickers? Are you familiar with xenoestrogens? What about a thermogram as a non-irradiating, low risk mammogram alternative? What else should you be doing to ensure you’re on the right track when it comes to managing your breast health?

A Place to Start

We’ve put together a helpful guide to address that very question. As you’ll see, many of these strategies would make sense for anyone trying to live a healthier, less toxic lifestyle… while other suggestions are more focused on reducing or minimizing estrogen and other hormone exposure.

Reduce Your Hormone Exposure

  • Eat a diet of organic, whole, fresh foods. This will reduce your exposure to chemicals/xenoestrogens (xenoestrogens are chemicals that mimic estrogens and increase risk of hormone-fed cancers).
  • Drink clean, filtered water. This will help reduce exposure to xenoestrogens, drug residues and chemicals.
  • Limit or avoid hormonal contraceptive or synthetic hormone use.
  • Never take estrogen- , testosterone-, or DHEA-containing hormones without progesterone to balance them. Even in women who have had hysterectomies, breast tissue is still vulnerable to imbalance caused by “unopposed” estrogen or androgen use.

Upgrade Your Intake

  • Consume foods and spices rich in antioxidants (kale, berries, curcumin/turmeric, basil, etc).
  • Regularly consume dark, leafy greens. They are a rich source of antioxidants, chlorophyll and activated folate – all important in promoting optimal detoxification and lowering cancer risk.
  • Eat a single serving of cruciferous vegetables daily. This reduces your risk of many types of cancer, including breast cancer. Examples of cruciferous vegetables include broccoli, cauliflower, arugula, brussel sprouts, bok choy, cabbage, collard greens, daikon, kale, kohlrabi, mustard greens, radish, rutabaga, and watercress.
  • Make omega-3 fatty acids a regular part of your diet to lower/prevent inflammation. Good sources include salmon, mackerel, walnuts, flax, and fish oil.
  • Avoid vegetable oils (sunflower, safflower, soy or corn oil) as these are easily damaged by light, oxygen and heat, making them harmful and inflammatory in the body.
  • For cooking – ghee, coconut, grapeseed, and olive oils are best. Use olive oil liberally, but avoid heating to high temperatures (add at end of cook time or use in salad dressings, cold foods).
  • Avoid eating charred meat or fat. This is a source of heterocyclic amines (HCAs), which are known to promote breast tumor formation. Even without charring, high heat will produce HCAs.
  • Avoid refined carbohydrates and sugar. These compromise gastrointestinal health and hamper the ability to clear toxins and estrogen.
  • Avoid processed foods or items grown with chemicals/pesticides or GMOs. These contribute to overall toxicity, inflammation and cancer risk.
  • Choose pastured, free-range poultry and eggs, grass-fed beef/buffalo/bison and wild caught fish to avoid estrogenic compounds and other toxins.
  • Aim for 20-30 grams of fiber per day. Fiber binds toxins and hormones carrying them out of the body, and provides food for “friendly” bacteria in the gut that help metabolize estrogen.
  • Optimize vitamin D. A serum level of 60-70 is ideal, and in my practice, I find the average dose necessary for Ohio adults is 5000 IU per day, though be sure to check levels to avoid toxicity or under-dosing. There are small sub-sets of patients who need more or less than average.
  • Ensure optimal iodine and selenium levels (I utilize a dried urine iodine test with my patients that assesses iodine, selenium, mercury, bromine and arsenic levels, all key factors in thyroid, breast and total body wellness).
  • Limit alcohol intake as much as possible—alcohol competes with liver clearance of estrogens.

Kick Caffeine

  • Opt for green tea over black tea. Green tea contains approximately 4 times the amount of polyphenols and has less caffeine than black tea (caffeine content may vary).
  • Minimize caffeine – it competes for liver clearance of estrogen. Also, avoid conventionally grown (non-organic) coffee – it is often heavily sprayed with chemicals and pesticides that are estrogen mimics.

Lifestyle and Daily Practice

  • Exercise strenuous enough to cause perspiration for 20 minutes at least 5 times weekly has been shown to reduce the risk of breast cancer by 40% (exercise encourages healthy lymph flow/toxin removal and helps balance blood sugar and hormones, all factors in breast health).
  • If you have a sedentary job, make it a habit to move/walk/stretch for 2+ minutes every hour.
  • Maintain a healthy weight.
  • Pregnancy and breastfeeding both lower the risk of breast cancer.
  • Optimize your sleep and minimize light exposure at night, which decreases melatonin.
  • Melatonin has antioxidant properties and has been shown to be helpful in breast and hard tumor cancers. If you’ve been diagnosed w/breast cancer, consider 20mg of melatonin nightly.
  • Practice stress reduction (meditation, yoga, breathing, recreational activities, etc).
  • Consider daily breast massage with castor or sesame oil or dry skin brushing (always toward the heart) to help mobilize lymph and drain toxins, fats and excess hormones. Breast tissue is mainly composed of fat, so has less blood flow than other parts of the body.
  •  Address constipation if you are not having at least 2 bowel movements daily. The bowels are the most important channel of toxin and estrogen elimination.
  • Don’t smoke.
  • Avoid antiperspirants since sweating provides a channel for toxin elimination from the breast area, and instead opt for deodorants free of aluminum, parabens and xenoestrogens.
  • Optimize lymph flow (lymph flow removes toxins from the breast area) by wearing a comfortable and non-restrictive bra. Do not wear your bra to bed.

Resources

Check out the our lab testing menu for more information on the lab testing available through Leaves of Life.

See the Leaves of Life blog post on thermograms and breast health for more information on thermograms, including a local thermography provider plus a comparison of thermograms and mammograms.