Sickle Cell and Cancer: New Studies Are Revealing Troubling Results
In 2016, a study was published in the Journal of the Royal Society of Medicine in the United Kingdom. This study showed that patients with sickle cell anemia are at an increased risk of skin cancer and colon cancer (amongst other malignancies). The study showed that black people with Sickle Cell Anemia had 4.4 times the risk for skin cancer than black people without sickle cell anemia (1). This same study found that there was 2.8 times the risk of colon cancer occurrences amongst this same group verses black people without sickle cell anemia. The control group being other black people without sickle cell anemia is notable. That is because black people in general are already determined to be at higher risk for colon cancer than other populations (2). In this inaugural article of the International Health Support Group Blog, we will endeavor to shed light on what may be the underlying reasons behind these shocking revelations. By providing you this information, we hope that you will be empowered to make wise decisions concerning your own health and well-being, so you will have improved quantity and quality of life.
Hydroxyurea & Sickle Cell
Numerous case studies have demonstrated the link between various skin cancers and Hydroxyurea. One such case report was published in 1998, by two physicians. In these case reports, the skin cancers that appeared were “multiple”and in one case “the tumors appeared more than 4 years after discontinuation of therapy.” This led the physician authors to conclude that even after discontinuation, there is an “apparent prolonged duration of the risk of skin cancers.”(3)
In 2009, a formal study was performed by four physicians in Detroit, Michigan, confirming these findings. 292 patients using the drug Hydroxyurea for various ailments were evaluated. The results showed 18 cases of skin cancer amongst these patients. When broken down between dark and light-skinned individuals there is an increased risk of 277 times among dark skinned individuals compared to the general population for hydroxyurea being linked to skin cancer. For light skinned individuals: the rate was 12.0968 per 100. This is statistically significant as the established rate is 0.23 per 100 people, meaning the risk was increased by 52.5 times in light skinned individuals.
These are exceptionally high increased risks! 277 times the risk and 52.5 times the risk of skin cancer amongst dark and light skinned people respectively, while using Hydroxyurea vs. those who did not, is what this study states.
Constipation & Sickle Cell
In regards to Colon (Colorectal) Cancer in Sickle Cell Patients, there are a number of risk factors to consider. These include factors that fall into three categories: Genetics, Lifestyle and General Characteristics. The genetics category includes family history of Colorectal Cancer, inherited syndromes, racial and ethnic background (Higher risk amongst Blacks and Jews). The lifestyle category includes diet (high in red and processed meats), inactive lifestyle, smoking and heavy alcohol use. The general category includes Age (increased risk over 45), history of polyps or cancer, inflammatory bowel disease, obesity, and type II diabetes (2).
While each of these risk factors are important, there is one that affects people with sickle cell anemia probably more than the general population. That risk factor is chronic constipation.Studies have found that chronic constipation is associated with an increased risk of colorectal cancer(5).
Chronic Constipation is quite prevalent in many people whether they have sickle cell or not. But, we have found it to be a major problem amongst people with sickle cell anemia. We know this as we have been working with Clients with Sickle Cell Anemia and their families for over 30 years. Why is this risk factor so prevalent in Sickle Cell Anemia Clients? There may be a number of reasons, but perhaps the biggest reason is the wide spread use of Narcotics or Opioids, for pain management. These drugs lead to what is called Opioid Induced Constipation or (OIC).
What Exactly is Opioid Induced Constipation (OIC)?
Serious Issues in The Stomach
Opioid Induced Constipation is constipation that arises from the disastrous effects of opioid pain medication on the gastrointestinal tract or the bowels. Opioids exert their effect on the bowels starting in the stomach. Opioids decrease the emptying of the stomach. They also increase the pyloric tone, meaning they make the outlet of the stomach more rigid, and not able to release food as well. All this can cause anorexia (loss of appetite for food), nausea, and vomiting (6).
Serious Issues in the Intestines
Next in the small and large intestines, opioids prevent propulsion, meaning they prevent the intestines from churning and digesting the food as the intestines are designed to do. Furthermore, opioids increase the amount of fluid absorbed from the digested material. All this leads to a delay of absorption of nutrients (like Dioscovite®) and medications, hard dry stools, constipation, straining, bloating, abdominal distension, and a sense of incomplete rectal evacuation (or the feeling that you didn’t get all the stool out). (7).
Serious Issues in the Rectum
Furthermore, opioids increase the tone of the anal sphincter. That means the area where stool should finally exit the body is not allowed to relax and release the stool. This leads to impaired ability to evacuate the bowel, as well as abdominal spasm, cramps, and pain.
Serious Issues with Secretions for Digestion
Finally, Opioids decrease the gastric (stomach), biliary (bile in intestines), pancreatic, and intestinal secretions that are needed for the bowels to properly digest its food.
So as can be seen above, there is not a single section of the Gastrointestinal tract where Digestion and basic functionality is not seriously affected by Opioid use. As you will see in the next section, Digestion is not the only thing affected by OIC.
The Gastrointestinal SystemNot one section of the GI Tract from the Stomach to the Rectum is left unaffected by opioids according to the medical literature.
What May Opioid Induced Constipation Lead To?
Low Quality of Life
All these effects of OIC are disastrous for the body. The most prominent problem is that it diminishes quality of life. People with OIC will have the same type of presentation as other types of constipation except opioid use precedes this particular version. People affected may have nausea, vomiting, GI reflux, straining, abdominal spasm, sense of incomplete rectal evacuation etc (6). Furthermore, beyond the effect that opioids have on the bowels, they can also cause Physical Dependency (More on this later), sedation, increased sensitivity to pain, and respiratory depression (meaning slowing down of breathing).
Malabsorption of Nutrients
A more insidious effect of constipation/OIC is it can lead to starvation in the midst of plenty, so to speak. What this means is that even if one’s intake of necessary nutrients is adequate, in the setting of constipation, those nutrients never make it out of the lumen (inner space) of the intestines into the blood. They never get absorbed, which is required for one to actually benefit from them.
This is a central problem we have had to contend with in Sickle Cell Anemia Clients when they first make the decision to take Dioscovite®. Many clients contact us while in the hospital, while their loved one is in the midst of crisis, when they are loaded up on these opiates. The effect is that their bowels have essentially been placed on lock down and they are constipated. This is the worst time to try to start Dioscovite! Dioscovite can indeed reverse sickling, but not if it is blocked from reaching the blood stream in the first place, because the bowels fail to absorb it. Constipation prevents the bowels from absorbing not just Dioscovite, but many other essential nutrients. This can lead to disastrous consequences for ones health, especially in setting of sickle cell anemia.
Increased Risk of Colon Cancer
The third potentially deadly effect is that chronic constipation, whether due to OIC or not, leads to an association with an increased risk for Colon Cancer, as we have already mentioned above (7). The proposed causal mechanism is that the longer the time it takes for bowel movement to occur, the longer any cancer-causing agents may remain in the lumen (inner space) of the intestines. The longer these agents remain the more the cells lining the colonic lumen (Colonic mucosa) interacts with these carcinogens hence increasing the risk of mutation within the cells which may progress to a tumor which is cancerous (5).
What Should I Do to Diminish My Risk of OIC and Colon Cancer?
You must decide whether or not to discontinue and detoxify from Opioids…
Given the information about OIC found in the literature, to attain normal bowel function, you need to speak with your doctor about stopping the use of opioids as the main source of your sickle cell pain control. This is evident in the fact that despite increasing fiber and water intake, many patients still experience OIC when they continue opioids, and must take a prescription medication to counteract the effect (6). Dioscovite is a nontoxic, non-addictive, non-cancer inducing solution for pain management to stop sickle cell pain and sickle cell crisis. However, in order for Dioscovite to work it must be absorbed in the bowel, which opioids help to prevent by inducing constipation. Therefore Dioscovite and Opioids are incompatible. A choice has to be made which way to go. If one is on a low dose of the opioids, then it should be relatively easy to come off them without suffering withdrawal. Some of our clients, though, are on much higher doses ie. on an opioid administration pump. Those clients may take longer to do a taper to avoid going into withdrawal if they have become physically dependent on these drugs (see our upcoming quarterly blog article for more information about opioid dependency, tolerance, addiction, and overdose). Please seek your doctor’s advice on how to discontinue the opioids when you make that decision.
Increase Fiber and Enzyme intake…
It is important to increase Fiber and Enzyme intake. The best way to do this is to increase fruit and vegetable intake. For example, broccoli is one of the most effective ways to increase fiber intake, and help alleviate a state of constipation. Other examples are carrots, apples, celery etc. If fruit and vegetables are not as feasible, then fiber supplements may be utilized. The goal is to have 10 mg of fiber at least per day. Be sure to ensure that at least some of the fiber intake occurs at dinner time.
Increase Water Intake…
Water is important for proper bowel function. Remember opioids cause excessive water removal from the stool leading to dry hard stools. Water intake is important especially when coming off opioids. (6) Water intake is also important for the proper hydration of the red blood cell especially in sickle cell anemia.
As you are taking the three steps above to get back into a state of proper bowel movements, you can begin to take Dioscovite®. Keep in mind the goal is to have at least three decent bowel movements every day first. A good holistic rule of thumb is that each time something goes in, there should be a time something comes out. That signifies a proper healthy functioning bowel.
Black people with Sickle Cell Anemia have now been found to have 4.4 times the risk of skin cancer and 2.8 times the risk of colon cancer as the general population (1). There is evidence to suggest that the use of Hydroxy Urea may be a major contributor to the increased risk of skin cancer (2) (3). There is also evidence to suggest that chronic constipation, induced by Opioids or otherwise, may be a contributor to the increased risk of Colon Cancer amongst people with Sickle Cell Anemia (5) (7).
It is important to recognize the problems with opioid use, and to make a decision of whether to continue or not. These problems include the many adverse effects opioids have on the gastrointestinal tract from decreased emptying of the stomach, excess water removal from stool, decreased secretions needed for digestion, the blockage of stool release from the rectum (6). The evidence clearly suggests that opioids should be stopped if your decision is to have a healthy, normal functioning bowel.
If you chose to go the natural healthy route and stop the opioids, you should make sure to also increase fiber/enzyme intake, increase water intake and start Dioscovite®. That way you will be on your way to effectively controlling the scourge sickle cell pain and crisis.
To your health.
Oji Agbai II, MD
International Health Support Group
- Seminog, Olena O; et al. “Risk of Individual malignant neoplasms in patients with sickle cell disease: English national record linkage study.” Journal of the Royal Society of Medicine 109.8 (2016): 303-309.
- American Cancer Society. “Colorectal Cancer Risk Factors.”https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html. American Cancer Society. Feb 2018
- Best, Patricia JM & Petitt, R. M. “Multiple Skin Cancers associated with Hydroxyurea Therapy.” Mayo Clinic Proceedings. Vol 73. No 10. Elsevier, 1998
- “Skin Malignancies Associated with HYDROXYUREA Use in MYELOPROLIFERATIVE DISORDERS and Sickle Cell Patients: Incidence and Significance.” (2009):4969
- Guerin, A., et al. “Risk of Developing Colorectal Cancer and Benign Colorectal Neoplasm in patients with chronic constipation.” Alimentary Pharmacology & Therapeutics. 40.1 (2014): 83-92 https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.12789
- Nelson, Alfred D and Camilleri, Michael. “Opioid-induced constipation: advances and clinical guidance.” Therapeutic Advances in Chronic Disease. 7.2 (2016): 121-134. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772344/pdf/10.1177_2040622315627801.pdf
- American College of Gastroenterology (ACG). “Chronic constipation linked to increased risk of colorectal cancer.” ScienceDaily. www.sciencedaily.com/releases/2012/10/121022081228.htm (accessed May 22, 2018).