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Last year, we reported on two studies showing that African American men respond at least as well as white men to prostate cancer treatments given in clinical trials. Nationally, African Americans with prostate cancer are more than twice as likely to die of the disease as their white counterparts, and that has fueled speculation that genetic or biological factors put them at greater risk. But according to this new research, the survival difference disappears when men of either race get the same cutting-edge treatments.
Now scientists are reporting that African American and white men with prostate cancer live equally as long if they’re treated by the same care delivery system.
For this study, a team from the University of California at San Diego looked at survival data from 60,035 men who had been diagnosed and treated for prostate cancer by the US Veterans Administration (VA) Health Care System between 2000 and 2015. VA hospitals provide the same subsidized care to all eligible veterans, regardless of their socioeconomic standing. So, African American men cared for by that system don’t experience the delays in diagnosis or treatment that they can often face in the general population.
Of the men included in the study, 18,201 were African American and 41,834 were white. The African Americans tended to be diagnosed at younger ages, lived in areas with lower median incomes, and had less education and more additional health problems than the white men. Yet after adjusting for tumor grade, prostate-specific antigen levels, smoking habits, the types of treatment received, and other factors with an influence on prostate cancer survival, the investigators found that African Americans had slightly better of odds of not dying from the disease than the white men did.
Specifically, the 10-year prostate cancer-specific death rate was 4.4% among African Americans and 5.1% among white men. And among all men in the study who were still alive after 10 years, 81.8% were African Americans and 77.5% were white. According to the investigators, the results are consistent with evidence from other studies showing that racial disparities in prostate cancer survival diminish after men become eligible for Medicare or Medicaid, which also provide equal access care.
Taken together, the results suggest that high mortality from prostate cancer among African American men in the general population is driven less by genetics or biology than by delays in diagnosis and treatment, affirmed Dr. Marc Garnick, Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. Still, the study doesn’t address other mysteries, Dr. Garnick added, such as why more African American than white men develop prostate cancer, and at earlier ages. “More research into these important questions is still needed,” he said.
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Regular brushing and flossing are the cornerstones of good oral health. But what if you learned that your toothpaste was good for your teeth, but bad for your bones? That possibility has been raised by a recent study. The cause of this unprecedented finding may be triclosan, an antibacterial agent added to toothpaste to reduce gum infections and improve oral health. However, it may actually be causing more harm than good.
Triclosan is an antibacterial agent that’s been around for decades. Not only has it been used in soaps, hand sanitizers, and deodorants, but it’s found its way into cutting boards, credit cards, trash cans, and, yes, toothpaste.
Adding triclosan to all of these consumer products allowed marketers to slap “antibacterial” on the packaging and emphasize this feature of the product. Though unproven, the implication is that products containing triclosan (or other antibacterial agents) might prevent serious infections.
But for many years, studies done in animals or on human cells in the lab have raised concern about whether all this “cleanliness” might have some unintended — and negative — consequences, including:
If triclosan is bad for humans, the problems it causes could be widespread: one study found that more than 75% of the public have detectable amounts of triclosan in their urine. While we are still uncertain of the health impacts of this, if any, the FDA has taken action in recent years to curtail its use.
First, the FDA asked companies using triclosan in their cleaning products to produce research demonstrating that they were more effective than soap and water. In 2016, when no such proof had been offered, triclosan was banned from soaps sold to consumers. The following year, it was banned from healthcare cleansers. And, in 2019, the FDA announced that triclosan would be banned from consumer hand sanitizers as of April 2020.
In the study, researchers reviewed data from more than 1,800 women and found that
This is just the latest research to raise concerns about the safety of triclosan. My guess is that it won’t be long before the FDA bans its use in toothpaste, especially if no new studies find that it’s particularly beneficial. The impact of such a ban at this point may not be large; most toothpaste makers have stopped putting triclosan in their products.
To be fair, a previous review of research in 2013 concluded that there was less plaque, gum inflammation, and gum bleeding among users of a toothpaste containing triclosan compared with users of toothpaste without triclosan. However, the authors noted that “these reductions may or may not be clinically important.” There was also a small reduction in dental cavities among users of the triclosan-containing toothpaste, and no safety concerns were raised over a three-year period of use.
Still, the more recent studies may have tipped the balance. Triclosan’s days in consumer products may be numbered.
Check your toothpaste when you next brush. If you see triclosan listed among the ingredients, you may want to switch to a brand without it, at least until you can discuss it with your doctor or dentist.
Follow me on Twitter @RobShmerling
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