Month: January 2018

Does Chinese Herbal Medicine Works

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Dr. Ting Hung-Leung, Hong Kong’s deputy director for Traditional Chinese Medicine, commented: “The problem in 1997 was we had over 7,000 practitioners of herbal and Traditional Chinese Medicine and anyone could call themselves TCM practitioners.” Now rigid licensing and educational standards have made the study more acceptable to Western standards.

As a result, Chinese herbal medicine and clinics offering acupuncture treatment are opening up in many American medical schools and the ancient treatments are being tested in laboratories for effectiveness. Researchers and patients alike are surprised at the results.

Did you know that emphysema can even be treated by Chinese herbal therapy? First, patients should consider what their diets include. Do’s include: protein (fish, eggs, lean meats), nuts, seeds, legumes, fiber-rich vegetables and soy. Don’ts include: complex carbohydrates, caffeine, nicotine, alcohol, simple sugars and things ending in “-ose.”

Never skip meals, but rather eat small meals throughout the day and have a small snack before bed. The most important Chinese herbal remedy is brewer’s yeast, which stabilizes blood sugar levels.

Chromium picolinate is also necessary for optimal insulin activity. Pacreatin and proteolytic enzymes aid in digestion. Zinc helps control appropriate insulin release. Glutamine will reduce sugar cravings. Many people with hypoglycemia are found to be lacking certain essentials: manganese and vitamin C with bioflavonoids.

Doctors also recommend herbal teas with burdock, dandelion or licorice to stabilize blood sugar levels. Ohiopogon is a powerful tonic that strengthens the lungs and heart and should be taken twice daily, 6 grams at a time. Check with a specialist to see what options are best for you.

“I think acceptance by the mainstream medicine is getting better and better,”said Che Chun Tao, professor and director of the School of Chinese Medicine at Chinese University. “I can tell you, before 1997 there were no doctors in hospitals who were willing to touch any herbal materials in clinical trials, but now there’s quite a number of clinical trials going on and there’s better acceptance from medical doctors.

I believe a combination of traditional Chinese medicine together with western medicine is needed for treating serious diseases and it’s important to offer a choice for patients and the general public,” he said. Currently, clinical trials for Chinese herbal extracts are being tested all around the world to cure some of the world’s most serious diseases.

“If you are taking herbs without experiencing any results after a week or two, then perhaps your formula needs to be changed, unhealthy foods eliminated from your diet, or other changes made,” says Jiang Wind Xiao, one Chinese herbal exhibitor.

“If you are being told to take herbs for long periods of time without seeing any benefits, or are experiencing side effects, then perhaps you need to see another practitioner.” Pharmaceuticals should still be used for emergencies, but for long term care Chinese herbal remedies work best.

A whole world of information about chinese herbal medicine eagerly awaits you from Mike Selvon portal. We appreciate your feedback at our oriental medicine blog.

The Truth You Should Know About Heart Disease

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There’s a heap of vital info concerning heart disease that you must be familiar with, therefore you’ll be able to take the essential steps so as to defend yourself from receiving this condition in the longer term as best as you can. 1st important info is about what it extremely is. Truly it’s a large, all-encompassing term and it’s not one form or disorder however rather a collection of diverse diseases and conditions. During this case, the term ‘heart disease’ refers to any drawback in any of the different components of your cardiovascular system, which include your heart furthermore because the blood vessels all through your body.

There are a vital variety of people who are at danger from heart disease and the bulk will be those that have a family lineage of the condition. So, if inherited or hereditary heart conditions are normal in your family lineage, then it might be prudent to make bound that you discuss this heredity together with your doctor and to ensure that you simply maintain regular annual check up to seem for any latent problems. If you are doing this, then you’ll evade serious issues down the road.

Heart disease remains one of the key reasons of early death in the planet today. Whereas this news would possibly sound depressing on the surface, the actuality is that the sheer volume of early deaths led to by it has declined considerably in recent years. The reason for this can be that remarkable steps have been achieved in terms of the treatment. The event of drugs designed to stop heart attacks with surgeries supposed to eradicate issues and reinstate proper heart functioning became quite intensive and the amount of dead caused by heart disease are spectacularly reduced.

Another vital data on heart disease is regarding how it’s caused, and there are in fact a variety of numerous things that are believed as being accountable for causing the condition. Though you’re possible to listen to a heap concerning preventing cardiovascular disease the truth is that typically no matter what you do you just cannot stop it.

When all, there are several types of heart disease that are inherited, which means that you’re born with them. In addition, there are more forms which are obtained, and normally during this regards you tend to develop them over the course of your life. The difference between these obtained forms and therefore the inherited forms, is that you’ll typically stop the obtained forms whereas the inherited forms you cannot.

Heart disease prevention

Maybe the most vital and valuable data related to the condition is how to stop it from happening. There are a variety of accessible preventive measures that may significantly lessen the problems. The awareness of the public has been raised to a great extent in terms of teaching folks with regard to the advantages of appropriate diet, keeping faraway from smoking and drugs, and investing time during a robust cardiovascular exercise program meant to create the center abundant stronger.

A regular check up along with your physician may not prevent all varieties of heart disease from going down, but it undeniably will have a serious result on catching a heart downside before it turns into a heavy matter. Like any downside or condition, catching the problem too soon will provide the momentum for obtaining treatment when possible. When treatment is dole out rapidly, the ability to avoid or successfully treat the matter before it becomes life threatening could be a high likelihood.

Many other preventive measures that you’ll do are: keep a healthy weight, get at least thirty minutes of see every day, maintain your cholesterol levels among healthy ranges, control your blood sugar if you’ve got diabetes, management your blood pressure, and build certain that you simply eat a various diet that’s wealthy in fruits and vegetables.

Heart disease research

Research is critical when it comes to learn concerning what heart disease is and also the causes of it, along with solutions that can be utilized to help treat and even prevent the condition. There are a number of unbelievable organizations out there that perform analysis to realize this purpose.

One in every of well-known organizations in explicit is The Research Center for Stroke and Heart Disease, which may be a non-profit organization that was founded in order to boost understanding and stop stroke and heart disease worldwide. It styles, puts into observe, and evaluates a variety of projects so as to teach individuals and along with inspire them to adopt sure practices which are shown to decrease risk factors.

Another heart disease research organization is that the British Heart Foundation, which is a corporation that is deemed as being the state’s heart charity, and that concentrates on three terribly necessary things in explicit: investing in revolutionary research, supporting and caring for heart patients, and providing basic info to assist people decrease their own risk of dying prematurely from a heart or circulatory related sickness.

Harvard Medical Faculty is another center that focuses a great part of their concentration on heart disease analysis, and they need truly been doing this for some decades now. They advocate an unlimited quantity of knowledge, like what it’s, what causes it, new analysis findings and statistics, and therefore on.

This kind of analysis is after all the only factor that can facilitate the grim scenario involving this condition in the world nowadays, and hopefully sometime within the near future this analysis can show the method to search out how heart disease can be totally avoided altogether.

Home Remedies Acne Treatment For Chin And Forehead Acne

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Looking for ways to get rid of chin acne and forehead acne? Searching for home remedies acne treatments online to solve your skin problems? It is true that acne can be a big pain especially if you can’t hide it.

People of all ages can generally get facial acne. Acne commonly develops in the T-Zone area. The T-Zone consists of the middle and sides of the forehead, the nasal area and down to the chin. This zone is very susceptible to acne lesions and where the most acne breakouts occur.

Reasons Why the T-Zone Is A Hot Spot For Acne Breakouts

Yes, the T-Zone is the area of the face where acne commonly appears. Why?

– T-Zone is the area that is being touched the most. The culprit here is our hands. We sometimes forget to wash our hands after touching a soiled rag or anything that is dirty.

– The T-Zone collects the most oil in the facial area, and we all know that one the main cause of acne is the clogging of pores and follicles.

– In this area of the face, there is a combination of oily, dry or normal skin.

– Stress can cause acne breakouts especially in the T-zone.

How to Control Acne In The T-Zone (Forehead, Nose, Chin)

There are several ways to control acne in the T-zone area. Here are some of them:

– Wash your face at least twice a day with an antibacterial facial wash. Remember not to use ordinary bar soap since it will just dry your skin. Use lukewarm water to open up your pores, usually done before washing. On the other hand, use cold water to rinse. Cold water closes the pores.

– Be gentle when you’re drying your face. Do not rub your skin because this will only irritate your facial skin. In addition, rubbing your skin with a towel will spread infection and will also remove the skin’s natural moisture.

– Use facial wipes sold in local stores and supermarkets to remove excess oil in the face. – Make sure that you keep your hands off your face. Wash your hands after using hair products so that when you need to apply makeup on you will not transfer germs, dandruff and bacteria from your hair to the skin of your face.

Home Remedies Acne Treatment

Did you know that you can actually find excellent remedies for acne in your kitchen? To get rid of your forehead acne, nose and chin acne you should try some of these home remedies:

– Rub fresh garlic on and around pimples. Garlic has antibacterial properties and with regular use, your pimples will disappear without a mark.

– To get rid of pimples, blackheads, and cracked skin use fresh lime juice mixed to a glass of boiled milk as a facial wash.

– Mix baking soda and water and use it as a mask. After application, you’ll notice your skin has greatly improved.

– Create a paste with ground orange peel and water then apply it on the affected area of your face. Use lukewarm water when rinsing of the mixture.

– Drink a glass of wheat grass juice to get rid of acne.

Summary

If you want to treat mild acne in your T-zone area, you can find your kitchen very helpful. The kitchen is where you can find simple home ingredients that are effective to treat acne. On the other hand, it is best to contact your dermatologist for severe cases of acne.

Tips for good health and beauty in Hindi

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Our daily life starts with morning newspapers or through news channels. These days, Hindi news media industry is making a good name in our society and people are accepting this new form and variation in a great way. This industry has a great future aspect in terms of delivering news and style. Hindi being our national language is famous in every section. From young generation to older generation everybody nowadays loves to read and watch Hindi newspapers and news channels respectively. Be it Hindi jokes or health news in Hindi, every news have their own demand and need to the society.

Health is an important sector in our society. Health news in Hindi newspapers and news channels has their own position. It generally gives us the detail information about the health system of our country. It acts as a mediator to the common people and the higher authority. They help the common people to come and share their views on our health system. Hindi news channels and newspapers provide the detail information about the happenings and incidents that are taking place in the health sectors. Sometimes they arrange special section where the people come in direct contact with the doctors and share their problems to get suggestions.

Jokes are the part of our entertainment and presenting Hindi jokes is really a challenge. It is loved by every section of our society. Jokes are crack among the children and among the family members when everyone wants to be in jovial mood. These jokes are also available online so that people can take relax from their work and read it and burst out in laugh. It is also a good exercise for one to remain fit and fine in terms of health.

The writing style and approaching to the people is unique for Hindi news media industry. People are accepting this change with open arms. Their positive and unbiased approach has really made it famous among the people. In recent years, the demand of entertainment news in Hindi, sports news in Hindi and health news in Hindi are in great demand. People from all over India demand for more news in every sector so that they can update themselves in every fields. Online facility has received a lot of response with the recent updates of variety of news according to your choice. Even Hindi jokes are also available online in maximum numbers to give them laugh for full time.

Pooja Rajput is a well known author who writes articles for Newspaper website that covers Hindi News ,Entertainment News, Hindi Jokes,and State News in Hindi etc visit Jagran.com for more details.

Improve Hair Quality and Health by Washing in Hair in Filtered Water

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When we shower or bathe every day, we do not often think about the way in which the additives in our water might effect our bodies or specifically our hair. Often it’s just a matter of turning on the shower, waiting for it to be warm enough, then getting under the water and doing what we need to do. Yet if we stopped to think for a moment what was actually inside the water we bathe and how those additives actually effect our hair, we might take a second thought before getting under that stream of shower water.

The water we use and is supplied to our homes varies greatly. Not all water is the same. There are regions of the country where water is drawn from underground sources, so the water is far more full of minerals and other things which might be in the soil, such as metals. Other regions might draw most of their water from over ground sources, so the water would have far less minerals but because of the exposure to the open, it may contain more organic material. Water companies also need to put chemicals (such as Chlorine or Chloramine) in our water supplies to kill that any bacteria and germs that are in the water or may be picked up in the pipes along the way to our homes. So depending upon where we live, we might live in an area where our water supplies are harder (more full of minerals) but has less chlorine, or we might live in an area where the water is softer, but has more anti-bacterial chemicals. Either way – the water we bathe and shower in is not as straight forward as we might superficially think.

When it comes to the health of our hair, hardness and added chemicals can play a major factor in the health and vibrancy of our hair. Below we will discuss various hair types and how unfiltered showering and bathing water can adversely effect our hair.

Oily Hair

Those of us with oily scalp and oily hair would benefit greatly from showering in filtered water. The chemicals that are put into our water supplies to kill bacteria are solvents (such as Chlorine) and can be found in many cleaning products. This means that even if we do not wash our hair every day, simply by immersing our hair in unfiltered water we are running a powerful oil stripping chemical through it. When our hair and scalps are stripped of oil every day in this manner, our bodies naturally react by producing more natural oils to protect our scalp and hair. In some cases the body will produce too much oil to overcompensate and this can actually be the cause of over oily hair.

Curly and Nappy Hair

Curly and nappy hair (such as hair of Afro-Caribbean decent individuals) are notoriously difficult to manage and to keep healthy. One reason for this is that those with this type of hair can often put their hair through a lot of chemical treatments to straighten the hair. These chemical treatments will always contribute to hair damage. There is no way curly or nappy hair can be straightened without actually damaging the hair. When hair is damaged in this way and it encounters further chemicals found in unfiltered shower or bathing water, the hair will get further damaged and split ends and hair will begin to actually look damaged.

It is recommended that curly and nappy hair is not shampooed every day, therefore bathing in a water supply which is very hard (high in mineral contents) these minerals can easily lodge themselves within the dense fibers of the hair and produce an effect on hair shafts that is similar to the white hardness marks and stains that can be seen on glass shower doors.

Long Hair

One of the hardest parts of maintaining long beautiful hair is split ends. Split ends are a sure sign of hair damage. Shower water which is unfiltered will strip away natural oils from hair, which will lead to dry hair and eventually lead to split ends. It is extra hard for those who have long hair to maintain a good balance of natural oils because the hair shafts are so long and more oils need to be produced to keep the hair healthy and long. Therefore it is vital for anyone who wants to maintain healthy long hair to ensure that natural levels oils in the hair and the scalp are produced.

Coloured Treated Hair

Coloured treated hair is highly susceptible to the negative effects of unfiltered water. Chlorine and other additives in our water supplies are specifically produced as a solvent. Any colour treatment on hair, be it a wild colour or even blonde highlights will wash away at a much higher rate if washed in unfiltered water than those washed in filtered water.

In conclusion the natural oils in our hair and scalps is a major factor in the health and well being of our hair. If we want to maintain the utmost level of health in our hair or if we want to maintain the perfect healthy hair for our particular hair type, we need to stop washing and bathing our hair in unfiltered water. Instead to protect our hair we should install a shower, bath or tap filter to remove solvents and hardness which contribute to the degradation of the natural oils in our hair.

Sinus Infections And Secondhand Smoke – Nurse’s Guide

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A new report is out revealing that the risk of having chronic rhino sinusitis (sinusitis) and therefore sinus infections is much greater for those who are exposed to second hand smoke, whether in the home or in the workplace, or any other public place. It’s long been accepted that second hand smoke is not good for the sinuses but it wasn’t known to what extent.

Now it appears that even moderate levels of exposure to secondhand smoke or cigarette smoke can carry a lot of risk. Of course what the study means is that the more secondhand smoke you’re exposed to the more damage will be done to the sinuses. This exposure can cause a chronic condition called chronic rhino sinusitis.

Secondhand smoke is not harmless. It contains more than 4000 substances or chemicals that are harmful to our health. About 50 of them can actually cause cancer.

Many non-smokers are exposed to secondhand smoke– as much as 60% in the U.S. alone. And of course smokers are exposed to firsthand smoke. So it goes without saying that most people are exposed to smoke in one way or the other.

This chronic exposure not only causes serious sinus problems, including sinusitis, acute and chronic sinus infections and sinus cancer, but acute respiratory infections, middle ear problems, asthma coronary heart disease and lung cancer.

Most people haven’t heard about sinus cancer but it’s certainly one of the dreaded cancers to get and preventable too.

The non-smokers in the study, who were exposed to secondhand smoke in more than one place, were much more susceptible to sinusitis and other sinus problems.

The way it works it’s thought is that the secondhand smoke may inhibit immune responses and increase the susceptibility to respiratory infections including sinus infections or worsen respiratory or sinus infections. The cells that line the respiratory tract may have increased permeability thus be more fragile and susceptible to infection.

Although the report says that more evidence is needed the preliminary studies should be a good reason to avoid secondhand smoke at all costs to prevent chronic and acute sinus infections and sinus problems and to stop smoking if you smoke to protect yourself and others around you at home and in your workplace.

If you suffer from chronic sinus infections or sinus problems now. Avoid secondhand smoke at all costs and use natural home sinus treatment to stop or cure your sinus infections once and for all. There is much you can do to prevent them from taking hold and curing them fast if they do, without medications.

Precisely How Mental Attitude And Digestion Affect Acne

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Mental outlook

Pimples is an expression of harmful toxins in our bodies that arent being released via normal channels of eradication, so they come out via your skin. Since mental mindset and thoughts cant be separate from your body, thoughts and feelings are also being expressed as pimples.

Bad thoughts and feelings produce chemicals that are toxic acids. Just like toxic acids created in the colon, the toxic thoughts need to have to be eliminated through the 5 eradication routes

Pimples can be an expression suppressed past traumatic historical experiences. As a child, when you were exposed to historical experiences that overwhelm you constant mental, physical, or sexually abuse, you suppress them. So now as an adult, as your defense system weakens, youre not able to completely suppress this information, so it becomes expressed as acne pimples or other skin disorders. Of course, these suppressed experiences can be expressed as other issues.

Acne pimples might also be related to the emotion of fear or stress and anxiety. It can also be an expression of holding onto old junkie or unpleasant thoughts. Its a way of holding on to and burying the junkie or toxic memory into your facial area. It is these memories that are trying to surface and, in an usual way, asking you to face them. several times, you and other people may not intend to remember them or deal with them.

To deal with them requires a lot of strength and help from a psychotherapist.

Stomach Acid

Your stomach uses Hydrochloric acid (hcl) to break down protein. It also has many other functions,

* will kill pathogens and microbes and inhibits them from acquiring into the colon and blood
* Controls the adsorption of B12
* Controls the adsorption of iron calcium zinc, copper, magnesium and most B-intricate vitamins
* Controls the adsorption of vitamin C
* developed indigestion
* prevents bowel obstruction

When you have low levels of hcl chances are that youll be prone to getting acne. Hcl may be elevated by utilizing a digestive enzyme consisting of hcl.

Pancreatic Digestive Enzymes

When the food you eat passes the stomach and enters the small intestine, the pancreas releases digestive enzymes and bicarbonate to support complete the digestive procedure.

The bicarbonate helps to reduce the acid strength in the food coming from the stomach. The digestive enzymes digest carbohydrates, fats, and protein.

When the pancreas loses its efficiency and will start to release less digestive enzymes, less food is properly digested. This results in more undigested food reaching the colon. When this happens, the undigested food, if it stays to long in the colon, becomes a source for rotting matter and toxic material. This toxic material may get into your blood and cause skin disruption such as acne.

A balanced pancreas, which offers the appropriate digestive juices to digest the food you eat, is needed for healthy epidermis and for eliminating acne and other epidermis sores and eruptions.

When youve got acne or other epidermis conditions, they are produced when there is an in-balance in the body and that includes countless different organs and body processes and systems your thoughts, digestion, liver, kidney, lymphatic system, lungs, and pancreas.

If you are looking for the best acne products make sure you check out the webpage. We have a large review of all the most effective products on the market. The reviews include rosacea treatment, natural acne treatment, blue light therapy, cure for pimples, and acne treatments that work!

Hitting The Snow Enraged My Son’s Eczema

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My husband and I grew up in the snow but sadly had to move to the big smoke in the lowlands for work. It is for this reason we take as many trips to the mountains as we can in order to reconnect, however the first time we took our son, a sufferer of eczema, it ended in disaster. Thankfully, we found a way to counteract the enraging effects the thin, dry, air has on his skin.
WHAT IS ECZEMA?
Eczema is a common skin condition that instigates due to an allergic reaction. It is regularly labeled as dermatitis, a catch-all term for inflammation of the skin, although some specialists use the term ‘eczema’ for specific types of dermatitis, such as atopic dermatitis in children.
Even though there are an array of instigators of eczema and dermatitis the effect is usually the same: when the skin is inflamed it gets red, swollen or blistered, and intensely itchy, leaving those with the condition in an unrelenting degree of irritation.
HOW DOES ALTITUDE AFFECT ECZEMA
As a rule of thumb, the higher the altitude the more extreme the climate and the greater effect it has on your skin, as was the case with our vacation to Aspen. Due to the high altitude the air was considerably thinner , stripping it of all of its moisture. To throw further salt into the wound, the elevated climate’s temperatures shifted drastically from warmer days with high UV levels to bitterly cold nights compensated for by hot, dry air in the mountain lodge.
As you can likely assume, this had a considerably negative effect on my son’s sensitive skin. The considerably drier air sucked all of the moisture out of his skin leaving it extremely dry, irritated, and red, essentially inflaming his eczema to unbearably high levels.
NATURAL SKIN CARE BALMS
Because this was our first experience of such inflated eczema we had no idea how to counteract it so we eventually cut our trip short in order to provide him with relief. Not wanting to allow eczema to limit my son’s enjoyment of the slopes we came ready on our next trip.
Thanks to a medical friend of ours, we were advised to pack a natural nourishing lotion that could replenish the moisture extracted from his skin. To my son’s delight, the simple remedy was extremely effective as his skin stayed hydrated, his eczema was kept at bay, and he could ski comfortably for the full two weeks.

Fiery Dragon

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elcome t the lost world of Atlantis. Dark destiny looms n th horizon s the fou tribes are at war t save lots f themseles. Harness the knowledge ad mysterious powers of the Historical Oes to construct n expansive empire n conquer yur enemies. It woul take te utmost braveness nd intellect to prevail. part of the battle n unleash the dragons t te moment in one of th thrilling dragon games n the market! In te midst f prepping subsequent months ig Moonlighters infrmation, we took a bit break t make a bit game tat ou may play nw SAFARI RESCUE free n te App Retailer !

Dragonplays Twister 8 s an exciting social card game rimarily based o the traditional Loopy Eights game (AKA Crazy8, UO or Taki). he goal of eah participant s to e the get rid of all his cards, whil the winner s the one who is rid of all hs cards and declared Twister! Feel free t visit m webpage :: http://bit.ly/1kdVwzi As you venture fort in Dragon Eternity, ou’ll com aross opportunities t complete quests. t is a great option to earn expertise and rewards which an aid you level. The upper stage ou bcome, t more highly effective ou’ll b an t ill unlock new skills.

Dragons ae massive, dragon city breeding guide alpine dragon reptiles hich can breathe fireplace onto ther enemies, rumored to hae a strong connection to magic. Dragons possess awesome nd horrible energy, capable f laying waste t armies ad burning complete cities t ashes. Mn who were capable f tame and journey dragons s beasts f battle sed tem to burn ther enemies an forge vast empires cross the continents f Essos d Westeros his is imprtant in each dragon city. Meals levels ur dragons, maing them stronger t combat and in addition earning extra gold er minute. T obtain meals, you’ll be able t build farms to grow meals.

he actual content f this blog, onetheless, s created y me. Please do not copy it n entire or art with no link back. You dont ned my permission to paraphrase, share hyperlinks, r borrow ny of m content. After all, its dedicated to Dragon Age. u can borrow t word per word or proper off the web pae if you happen t give m credit score y linking bck to my blog. It solely takes secnd, ts appreciated, d thats all ask. References to Billy and Jimmy Lee appar in mny arious games, straight or not. hee may e also crossover game, titled Battletoads & Double Dragon, launched fr numerous platforms.

How To Calculate Your Risk For Breast Cancer

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Using known risk factors for breast cancer, mathematical models can be developed to help answer important questions. These mathematical models are useful tools for researchers and for patients as follows:

1.Research on risk factors The Claus risk assessment model was used to discover the subpopulation of people who had an autosomal dominant genetic allele that increased their risk from 10% to 92%. This led to the discovery of the BRCA genes associated with breast, ovarian, and prostate cancer.
2.Clinical trial eligibility The Gail risk assessment model was developed to help researchers determine who to enroll in the NSAPB Breast Cancer Prevention Trials
where chemoprevention was shown to reduce breast cancer risk.
3.Guidelines for doing BRCA testing BRCA testing is very expensive and practically worthless if done on everyone (because it is so rare to be homozygous for BRCA1 or BRCA2). Mathematical models such as the BRCAPRO, BOADICEA, and Tyrer-Cuzick models can help determine what patients should undergo BRCA testing. The decision for testing is usually made when one of these models predicts a 10% or greater chance that there is a mutation of the BRCA1, BRCA2, or both genes.
4.Guidelines for doing MRI screening for breast cancer – MRI screening for breast cancer is not a cost effective screening test for the general population, but in specific groups, there are clear cut reasons to do so. In general, screening MRI is recommended for women with 20-25% or greater lifetime risk of breast cancer. The BRCAPRO and Tyrer-Cuzick models have been used to help make clinical decisions about ordering MRIs for breast cancer screening.
5.Guidelines for breast cancer therapy The Gail model is used clinically to help
determine who should be put on tamoxifen or raloxifene for chemoprevention. Other models have been used to help make decisions about breast cancer risk reduction with prophylactic mastectomy.

For these reasons, it is important to understand these models. These models are collectively refered to as risk assessment tools. The following paragraphs summarize the most popular and most widely used risk assessment tools. Keep in mind that none of these risk assessment tools apply to breast cancer survivors. No mathematical model has been widely accepted to determine cancer risk in cancer survivors.

General Risk Assessment Tools

Gail Model: The Gail model is a validated risk-assessment model that focuses primarily on nonhereditary risk factors, with limited information on family history. It was developed by scientists at the National Cancer Institute and the National Surgical Adjuvant Breast and Bowel Project (NSABP) to assist health care providers in discussing breast cancer risk to determine their eligibility for the Breast Cancer Prevention Trial. The tool allows one to project a woman’s individual estimate of breast cancer risk over a five-year period of time and over her lifetime. It also compares the woman’s risk calculation with the average risk for a woman of the same age. The Gail Model is an on-line quiz that has 13 questions and is interactive. This calculator is based on published risk statistics and methods gathered from peer-reviewed journals, and has been extensively tested for its validity.

The major limitation of the Gail model is the inclusion of only first-degree relatives, which results in underestimating risk in the 50% of families with cancer in the paternal lineage and also takes no account of the age of onset of breast cancer. It may underestimate risk in certain groups, such as obese patients.

National Cancer Institute Model: The NCI risk assessment tool is essentially a simplified Gail Model that also factors in race. Race is a factor in determining breast cancer risk but is excluded when determining eligibility for clinical trials. This tool is probably the most popular risk assessment tool available to the public as an on-line, interactive risk calculator. The on-line quiz is a shorter, nine-point questionnaire that includes multiple factors, giving a woman her future five-year risk of breast cancer and her lifetime risk of breast cancer.

The NCI tool does not account for a lot of risk factors that can be modified. For this reason, it is difficult to use this test as a motivation tool to show people how lifestyle can alter their risk of breast cancer. It also cannot be used in breast cancer survivors, in patients with DCIS, LCIS, or people who carry one of the BRCA genes.

BRCAPRO model: This is a statistical model available as a computer program that uses two different algorithms to evaluate family history and helps a doctor determine the likelihood of finding either a BRCA1 mutation or a BRCA2 mutation in a family. The results of this can be used to determine if BRCA testing is indicated. This is very useful in light of the high cost of BRCA testing ($3,000). None of the nonhereditary risk factors can yet be incorporated into the model, however. In a comparison of four different methods for estimating breast cancer risk in patients with a family history of breast cancer, the BRCAPRO model was the least accurate. It predicted only 49% of the breast cancers that actually occurred in the screened group of patients with a family history of breast cancer.
Harvard Center for Cancer Prevention Risk Assessment Tool: This is another breast cancer risk assessment tool that includes more lifestyle factors than the NCI or Gail Model tools. It has not been studied as extensively as the Gail Model or the simplified NCI model, but it is promising in that it includes many lifestyle factors that people can do to modify their risk of developing cancer. It is also an on-line questionnaire that can be used by both women and men to estimate their breast cancer risk.

Making all this practical

Now after a thorough and confusing discussion of all these statistical models, its time to make all this information practical. What is the best way to help a patient accurately assess her risk of breast cancer and if possible, show her what positive factors are reducing her risk and what negative factors can be changed to reduce her risk? If possible, it would also be great to show the patient the value and indications for testing, imaging, chemoprevention, and in some cases surgery. A discussion of the practical aspect of each of these is addressed in a Q & A format below:

Q: What (free) online programs can be used to help a patient assess their risk of breast cancer?

A: Several of the risk assessment tools mentioned above can be accessed for free by the public. Here are the tests and their websites:

1.Your Disease Risk English version: http://www.diseaseriskindex.harvard.edu
Spanish version: http://www.diseaseriskindex.harvard.edu/spanish
This is a great interactive questionnaire that calculates five-year and lifetime risk of breast cancer developed by the Harvard Center for Cancer Prevention and made public online in 2000. In 2005, they launched the Spanish version of the site, Cuidar de su Salud. The risk calculator includes lifestyle factors such as weight, dietary vegetables, alcohol intake, as well as Jewish ethnicity. It does not include other ethnicities, however, and is not accurate for BRCA mutation carriers or breast cancer survivors. Despite these issues, this is by far the best free online risk calculator since it is very interactive and gives you a personalized description of your risk in the form of a colored bar graph, which they can electronically manipulate to experience “virtual” risk reduction. The bar graph is a seven-level scale that compares users to a typical man or woman your age. Users learn where to focus their prevention efforts and how to make lifestyle changes by “clicking on” personalized strategies. With each click, the bar graph shrinks, and the user watches his/her predicted risk drop. This is a great concept to motivate people to participate and comply with lifestyle modification measures.

2.The NCI Risk Assessment Tool regular web: http://www.cancer.gov/bcrisktool
Mobile web: http://www.cancer.gov/bcrisktoolmobile
This is the easy to use, on-line questionnaire based on a modified Gail model that also includes ethnicity. It does not factor in a personal history of breast cancer, DCIS, or LCIS. It does not account for other factors such as BRCA status, hormonal replacement therapy, lifestyle factors, breast feeding, menopause, or mammographic density. Despite these issues, it is a very useful tool that gives a woman her five-year and lifetime risk of breast cancer. It is the only risk assessment tool that can be used via mobile handheld devices (any type). A version of this can be downloaded for PDAs with Windows Pocket PC operating system as well.

Q: What programs can be used to help a doctor make decisions about ordering a breast MRI?

A: The American Cancer Society has developed some very good guidelines for breast cancer screening with MRI. It should be emphasized that MRI is an adjunct to mammography, not a replacement. Four programs can be used to help in clinical decision making. They are as follows:

1.A Cancer Journal for Clinicians http://caonline.amcancersoc.org/cgi/content/full/57/2/75

2.BRCPRO ver.4.3 available @ http://www4.utsouthwestern.edu/breasthealth/cagene/default.asp

3.Claus Model available as a palm based software product version 1.0 at
http://www.palmgear.com/index.cfm?fuseaction=software.showsoftware&prodID=29820

4.IBIS – Breast Cancer Risk Evaluation Tool, RiskFileCalc version 1.0. This is the Tyrer-Cuzick model that includes hereditary and nonhereditary risk factors. Contact:

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