Dr Thierry HERTOGHE
Abstract
Hertoghe TM, Lhermitte MC, Gadomski A, Dalle C, Résimont S, Hertoghe TAM, Duboé B, Claeys B, Poutet B, Truong P, Everard B, François M
JEAAM. 2006 Oct.; (4): 20-5
ABSTRACT
281 consecutive, ambulatory patients (181 females, 100 males) treated with anti-aging medical therapies for two years or more and followed up in 2005, were retrospectively analysed for overall and specific cancer incidences. Anti-aging therapies consisted of at least one hormone therapy. Possible therapies were in both sexes: thyroid, testosterone or one of its synthetic derivatives, DHEA, melatonin, a glucocorticoid, fludrocortisone, pregnenolone; in addition oestrogen was taken by the female patients, generally transdermal oestradiol gel, and progesterone. Average ages of female and male patients at the start of the treatment were 47.7 years and 50.3 years respectively. Average duration of treatment was 6.3 years (76 months) in females and 6.4 years (77 months) in males, totalling 1146 patient-years in women and 640 in men, i.e. 1786 patient-years of therapy for the whole group. Seven cases of new cancers occurred during the treatment period (4 among women: two breast cancers, one cervical cancer, one malignant kidney tumour); 3 among the men (two prostate cancers, one cancer of the pharynx ).
The average incidence of new cancers in the female patients was 2.2 % for 6.3 years, corresponding to an annual overall cancer incidence of 0.35 %, and 3 in the male patients% for 6.4 years, i.e. an annual incidence of 0.47 %. Compared to Belgian, French and USA populations, the overall cancer incidence was markedly lower in both sexes treated with anti-aging therapies (respectively -27 %, -28% and -31%). For male patients with anti-aging therapies, the overall cancer incidence was 3 % for 6.405 years, i.e. an annual incidence of 0.47 % of new cancers. It was lower in the treated male patients than in Belgian, French, and USA men (-27, -28 and -29 % respectively).
In women, the breast cancer incidence was considerably lower than the incidence in comparable age groups in Belgium, France and the USA (respectively -30.3 %, - 30.1 % and 22.2 %)..
In men, the overall incidence of prostate cancer was also considerably lower by -23 % in patients treated with anti-aging therapies in comparison with the Belgian male population, but not lower than the incidence of men living in France or the USA.
Conclusion: Marked decreases in overall, breast and prostate cancer rates were observed in both sexes treated with a combination of anti-aging therapies compared to the most comparable population group, namely the age-adjusted Belgian population. Thus, long-term anti-aging therapies with multiple hormone supplements that correct age-related deficiencies, and nutritional and dietary adjustments may reduce the risk of overall, breast and prostate cancer. More extensive studies should be undertaken to confirm the validity of these results before any definitive conclusions can be drawn.
INTRODUCTION
Concerns that anti-ageing and preventive therapies, and in particular hormone replacement therapies, may cause or accelerate cancer development in patients, have kept many physicians from specializing in such treatments. How grounded are these concerns? In several studies direct links between the use of oestroprogestogen therapies and breast cancer1-6 or endometrial cancer7-8 in women have been found. The Women’s Health Initiative, a randomized placebo-controlled study of more than 16.000 postmenopausal women, and the Million Women Study, the largest prospective observational study with more than one million women participating, are the most famous of these studies9-10. On the other hand, in other human studies, a reduction of the cancer risk or cancer progression has been reported with the use of therapies with growth hormone11-13, thyroid hormones14-15, female hormone therapies16-42 (including in breast cancer patients28-36), testosterone in men43-44 and women32,45, and, in cancer patients, melatonin46-58. DHEA treatments have been shown to decrease the cancer development in rodents in several studies59-68. In order to clarify the influence of associations of these hormones combined with dietary and nutritional supplements on the cancer risk, the authors reviewed retrospectively the files of 281 consecutive patients who were under anti-aging treatments including hormone therapies for correction of diagnosed endocrine deficiencies.
AIM OF THE STUDY: assess whether anti-ageing therapies containing hormone therapies increased or not the cancer incidence in a patient population.
STUDY DESIGN
Retrospective study of patients followed up in one clinic. Results were compared with the global cancer incidence of the general populations of Belgium, France and the USA.
STUDY SUBJECTS: the 281 consecutive, ambulatory patients (181 females, 100 males) who received preventive, anti-aging medicine and came in consultation during the year 2005. Patients responded to the following conditions:
- were 20 years old at least (adults, post-puber).
- were receiving at least one hormone replacement therapy
- were following a treatment for at least two years. A minimum of two years of treatment was considered essential for inclusion in the study as this period may correspond to the minimal time necessary for development and appearance of new cancers. The treatment period was considered to start at the first consultation when patients received a multitude of dietary, lifestyle and environmental advices to follow immediately, and, more rarely, nutritional supplementation.
TREATMENT
The anti-ageing therapies consisted of dietary advices in all patients (avoidance or minimizing of milk products and non-sprouted grains (bread, pasta’s), sugar and sweets, alcohol, soft drinks; increases in fruit and vegetables intakes, low temperature cooking, avoidance of the use of fat (oils, butter) in the cooking, consumption of a sufficient amount of proteins, increased drinking of (non-chlorinated) water, tips on how to make the patient’s environment healthier, various nutritional treatments (such as supplements of magnesium, potassium, iron, zinc, cupper, selenium, vitamin E, B12, B9, A, D, C, etc.) based on results of laboratory tests.
All patients received hormone replacement, taking two or more hormone therapies. Hormone therapies were prescribed only when a diagnosis of endocrine deficiency was made, based on clinical and laboratory investigations. Corrective hormone treatments included oestrogen (in women; mainly transdermal estradiol), progesterone (in general micronized progesterone) or one of its derivatives (mainly dydrogesterone – Duphaston®), testosterone (mainly in gel or intramuscular injections) or one of its derivatives (mesterolone or Proviron®, nandrolone or Decadurabolin®), thyroid hormones (synthetic T3-T4, desiccated thyroid or L-thyroxine), growth hormone, melatonin, pregnenolone, fludrocortisone, DHEA, hydrocortisone or one of its derivatives (prednisolone, methylprednisolone)..
Hormone replacement therapies were introduced at the second consultation, about one month later, when results of all laboratory tests (serum and 24-hour urine tests) were available.
RESULTS:
Initially sick or healthy?
Contrary to popular beliefs that people who seek anti-aging hormone therapies are mainly healthy, sport-oriented persons who come solely for prevention of aging and age-related diseases and to improve sport performances, most patients had a different profile. They considered themselves at the first consultation, before any treatment, as sick people, and their ill feelings or state was the dominant reason for consulting an anti-aging expert (figure 1). 
The perception of being unwell among most patients is important in the interpretation of the results as people who perceive themselves as sick are reported to have higher disease and mortality rates, including a higher cardiovascular disease incidence and mortality69-<wbr></wbr>73, and may be suspicious of having an increased cancer risk. All seven patients with new cancer found themselves to be unhealthy before any treatment, was taken. This gives credit to the idea that patients with a poor health perception may have an increased risk of cancer.
Hormone therapies that correct endocrine deficiencies
In men, androgen treatment was the most frequent hormone supplementation: 96 % of male patients took testosterone or one of its synthetic derivatives (testosterone liposomal gel 100 mg/g was the main androgen treatment in 61% of the male patients). 88 % men were under DHEA therapy for DHEA deficiency. The least used treatment was fludrocortisone (13/100 men).
In women, sexual hormone therapies wer frequently taken as well by postmenopausal as perimenopausal women. Only 3.3 % took a contraceptive pill (which is not recommended after 40 years of age). Estrogens were taken by 90.1% of women (including the pill). By far the main estrogen treatment was transdermal estradiol. Nearly all female patients took transdermal estradiol gel: 85.6% of female patients. A progestogen was taken by 84 % (including those who were taking a estroprogestative birth control pill). Micronized progesterone was taken by 66.3 %, while the rest took dydrogesterone, except for one person taking another progestogen deriviative. Testosterone or one of its derivatives was taken by 46.4 % of female patients. DHEA replacement was taken by 85.1 % of women. Pregnenolone was the treatment that the female patients took least (11.6 %).
Average age
The average age at the start of the treatment was 47.7 years for women (20-81 years), and 50.3 years for men (20-74 years).
The average duration of therapies was 6.3 years for women and 6.4 years for men, totalling 1146 patient-years in women and 640 in men, i.e. 1786 patient-years of therapy for the whole group.
Overall cancer incidence
At the first consultation, eight of the 181 female patients reported cancer (five with in situ or invasive cancers of the uterine cervix, one with breast cancer, one with craniopharyngoma, and one with thyroid cancer), while three of the 100 male patients had had cancer before treatment (one colon cancer, one with prostate cancer and one osteosarcoma).
During the treatment period, seven patients were found to develop new cancers: four women (two with breast cancer, one with malignant kidney tumour, one ), while cancer was discovered in three men (two with prostate cancer, one with cancer of the pharynx).
The average incidence of new cancers was 2.21 % for 6.3 years, i.e. an annual cancer incidence of 0.35 % in the female patients, which is markedly lower than the incidence of age-adjusted groups of Belgian (-27.1 %), French (-27.7%), and USA women (-31.3 %) from Globocan data74.
For male patients with anti-aging therapies, the overall cancer incidence was 3 % for 6.405 years, i.e. an annual incidence of 0.47 % of new cancers in the male population of the study. The overall cancer incidence was lower in the treated male patients than in Belgian (-26.6 %), French (-27.7%), and USA men (-29.3 %) based on Globocan data74 (see figure 2).
Breast and prostate cancer incidence
The breast cancer risk in women taking anti-aging hormone therapies was lower than in the age-adjusted Belgian, French and USA populations (respectively -30.3 %, - 30.1 % and 22.2 %). The incidence of breast cancer was 1.11 % for 6.3 years, i.e. an annual incidence of breast cancer of 0.18 %.
The incidence of prostate cancer in treated men is 2 % for 6.4 years, i.e. an annual incidence of prostate cancers of 0.31 % which is 23.1 % lower than the values found in Belgian citizens, but not significantly different than those in French or American men74 (see figure 3).
DISCUSSION:
Possible bias may have influenced the results.
One possible bias of the results may be that patients who got cancer with anti-<wbr></wbr>aging therapies did not come back for follow-<wbr></wbr>up. They chose to be followed by another doctor or died from cancer. Three such patients that had come in the last six years (200-<wbr></wbr>2005) could be traced back: one with new prostate cancer, two with breast cancer.
Nevertheless, this bias is not likely to change the statistics. If we had included these cases in the study, we should have included and added to the total number of patients a large group of very long-<wbr></wbr>term patients who did not develop cancer under anti-<wbr></wbr>aging treatment. These patients who are in treatment since a long time, didn’t come back in follow-<wbr></wbr>up in 2005, but in 2004 or 2006. In particular, we think of the long-<wbr></wbr>term patients who do not need to come back every year and patients from foreign countries who live just too far to come each year. Generally, these patients are also followed up by another physician who works in their neighbourhood or country, which reduced the necessity of frequent follow-<wbr></wbr>ups at the clinic.
Another bias may have influenced the results. Initially, a majority of patients perceived themselves as sick. Studies have linked people’s perception of poor health to a higher risk of disease, especially cardiovascular disease, and mortality69-<wbr></wbr>73, and possibly with a higher cancer incidence. In this study, the majority of patients found their health to be poor at the initial consultation, a frequency which is the triple of the rate reported in the general population (a Belgian large scale study published in 2006 showed that about one quarter of the Belgian population perceives itself as unhealthy)75. The high frequency of poor health perception in patients should have increased the risk of disease, but it did not. Cancers occurred only in patients who reported themselves as being unhealthy, not in the healthy groups. These data give credit to the possibility that the anti-<wbr></wbr>aging therapies that included corrective hormone therapies might partially have protected patients who perceive their health as bad (sick), against cancer.
CONCLUSION:
This study is, to our knowledge, the first of its kind to retrospectively review the cancer incidence in patients treated with a combination of corrective hormone therapies associated to nutritional supplements and dietary improvement. Considerable reductions of the overall, breast and prostate cancer incidence were observed in patients who were treated for an average of more than six years with anti-<wbr></wbr>aging therapies in comparison with the most comparable general population, namely the Belgian population. Compared to French and USA citizens, lower incidences of overall cancer were observed in male and female patients, and in breast cancer risk for the female patients. Large prospective studies should be undertaken before any definitive conclusions on the possible anti-<wbr></wbr>cancer effects of anti-<wbr></wbr>aging therapies can be drawn.
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