Go ahead, have a cup.

As I sit down to write this, sipping my second cup of the day, I am delighting in the fact that I am enjoying something that may actually be good for me. Coffee.

More and more data is emerging about the benefits of these little aromatic beans. In fact, a simple Pubmed (database of medical literature) search of “coffee and cancer,” turns up 1400+ publications with 150+ related to breast cancer. Although the data remains a bit uncertain, there does seem to be an association of lower breast cancer risk with higher amounts of coffee intake, particularly in postmenopausal women and in BRCA1 mutation carriers. The most comprehensive study looking into the relationship of breast cancer risk and coffee intake was a meta-analysis published in 2013, a combined look of 37 different published articles on the topic. While there was no clear relationship between coffee and/or caffeine intake with breast cancer incidence in the population as a whole, there was definitely a suggestion of a benefit in the two groups mentioned above.

What is the mechanism, you ask? Well, a recent article published in Clinical Cancer Research suggests that caffeine may work to sensitize hormone receptor positive tumor cells to tamoxifen and may even reduce breast cancer cell growth, at least in a test tube. In addition, coffee is known to be a rich source of anti-oxidants, another cancer-fighting mechanism. More investigation is clearly needed to tease out which groups of individuals might benefit more or less from our favorite morning pick-me-up, but at the very least, I think it’s safe to say to go ahead and have another cup.

Along with this potential anti-breast cancer benefit, there are several other cancers with good data demonstrating the anti-tumor effect of coffee:

It should be noted that these studies show an association between caffeine and cancer reduction but do not necessarily imply causation. In fact, some associations determined from observational studies have subsequently been found to be incorrect when tested in a clinical trial.  Nevertheless, it is quite intriguing that these associations are found in multiple types of cancer.

Another interesting thing about these studies is that across the board, there does not seem to be any effect with decaf coffee, implicating the caffeine as the operative agent. In addition, it is the higher amounts of caffeine intake that seem to make a difference. So, does that mean you should go to your local coffee shop and chain yourself to a chair? No. Keep in mind, there are safe amounts of coffee to consume. This link is useful as a general guide to appropriate caffeine intake. Everyone has different sensitivities to caffeine, which need to be factored in as well.

The bottom line is, coffee is proving to be a lifestyle intervention that may offer some benefit to reduce the incidence of certain types of cancer. It will be interesting to watch the data as it becomes more mature and more specific to which groups are gaining the most benefit. I will likely be found reading that literature with a cup of joe in hand.

1. Loftfield E, Freedman ND, Graubard BI, et al. Coffee drinking and cutaneous melanoma risk in the NIH-AARP diet and health study. J Natl Cancer Inst. 2015 Jan 20. Epub ahead of print

2. Holick CN, Smith SG, Giovannucci E, Michaud DS. Coffee, Tea, Caffeine Intake, and Risk of Adult Glioma in Three Prospective Cohort Studies. Cancer Epidemiol Biomarkers Prev. 2010;19:39-47.

3. Merritt MA, Tzoulaki I, Tworoger SS, et al. Investigation of Dietary Factors and Endometrial Cancer Risk Using a Nutrient-wide Association Study Approach in the EPIC and Nurses' Health Study (NHS) and NHSII. Cancer Epidemiol Biomarkers Prev. 2015;24:466-71.

4. Geybels MS, Neuhouser ML, Wright JL, et al. Coffee and tea consumption in relation to prostate cancer prognosis. Cancer Causes Control. 2013;24:1947-54. NOTE: This study investigated the potential benefit of coffee in reducing the risk of recurrence or progression of prostate cancer.

 5. Setiawan VW, Wilkens LR, Hernandez BY, et al. Coffee intake reduces hepatocellular carcinoma risk: The Multiethnic Cohort. American Association for Cancer Research Annual Meeting 2014; April 5–9, 2014; San Diego. Abstr LB-281.

6. Galeone C, Tavani A, Pelucchi C, et al. Coffee and tea intake and risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium. Cancer Epidemiol Biomarkers Prev. 2010;19:1723-36.

The Science of Happy

One of the best gifts I ever received was from a colleague who sent me a link to this Shawn Achor  TED talk and a small “Gratitude Journal”. This talk, followed by subsequent observations in my own practice, really had me thinking about the impact of our mood on our health. Dr. Achor is a Harvard scientist whose research is focused on happiness. The basic premise of his research findings are two key points:

• Our brains work more successfully when we are positive.
• There are ways to train your brain to become more positive.
  • One way to do this is to write down three things you are grateful for, everyday; if you do this 2 minutes a day, for 21-days in a row, Achor reports that the “brain retains a pattern of scanning the world for the positive.”

I used to think that there were happy people in the world (optimists) and there were the others…you know who you are (me, before watching this TED talk).  Dr. Achor’s research flies in the face of this assumption and demonstrates that people are able to impact their level of happiness by focusing on positive things in their life.

I see the impact of mood on health play out on a daily basis in my breast cancer patients. Patients who come in “ready for the fight” tend to do fairly well throughout therapy and those with more fear, not infrequently, had a more complicated or difficult course. That’s not to say there are not genetic or other reasons why some people tolerate therapies better than others. There absolutely are. However, if you look at patients on treatment as a whole, I would say that the optimists tend to do a bit better.

Perhaps this is because the optimists see the chemotherapy as a challenge, something they can overcome rather than a barrier to their well-being. Perhaps the fear and anxiety frequently associated with the diagnosis of breast cancer actually contributes to increased side effects on therapy. There was an interesting study by Cimprich and colleagues reported at the San Antonio Breast Cancer Symposium in 2012  on the effects of mood, specifically anxiety, and fatigue on the development of “chemobrain” or cognitive dysfunction during and following a course of chemotherapy. The study essentially showed that women who were more anxious before starting therapy developed more fatigue and cognitive issues while on therapy. These changes were quantifiable on cognitive testing and on brain MRI. It was pretty impressive to see this direct impact of mood on actual physiologic changes in the brain. What we learned from this study is that really focusing on the psychological state before one embarks on a course of therapy for breast cancer is essential to one’s well-being during and following the course of therapy.

Let me be clear, what I am not saying is, “you were just diagnosed with breast cancer, now be happy!” What I am saying is that once the initial shock of the diagnosis has passed, having some positive thoughts might go a long way to improve your emotional and physical health while on therapy. Positivity can come from appreciating your support system, your care team, or most importantly, appreciating yourself and understanding that you are strong enough to do this.

Strength and positivity can also come from empowerment. Studies have demonstrated that women who are prepared for their consultations with medical specialists by having either a “prompt-sheet” (set of questions for their doctor) or a Consultation Planning session, much like we do here at Breast Cancer Consultants, have a better sense of satisfaction with their subsequent visits with specialists. Controlling some of the “fear of the unknown” with knowledge can be very powerful and may even lead to better well-being during and after breast cancer therapy.

So, if you’re ready to study the Science of Happy, here’s some homework you can do:

• If you haven’t already, watch Dr. Achor’s TED talk. I still do, frequently…
• Empower yourself by being prepared for your doctor’s visits.
• Get a gratitude journal and start writing. It may be one of the best things you can do for your health!