There are 2 types of diabetes mellitus – Type I and Type II. Type I diabetes occurs when the pancreatic islets, which produce insulin, are destroyed by an auto-immune process. It affects young children and they are dependent on insulin injections for life. Type II diabetes occurs when the body tissue becomes less sensitive to the action of insulin, thus, more insulin has to be produced by the body in order to keep the glucose level normal. Type II diabetes usually affects adults who are overweight / obese and older. As one gets fatter, one develops insulin resistance and this leads to an impaired glucose level. Eventually a proportion of overweight / obese people develop persistently elevated glucose levels and the condition is termed Type II diabetes.

Researcher in Umea University, Sweden, studied the association between blood glucose and cancer risk in 274,126 men and 275,818 women from Norway, Austria and Sweden (PLoS Med 2009; 6(12): e1000201). The study found that impaired glucose level was associated with increased incident and fatal cancer risk. In men, the risk per 1 mmol/L glucose increment for incident cancer and fatal cancer was increased by 5% and 15%, respectively. Significant increase in the risk of incident and fatal site-specific cancer was observed for cancer of the liver, gallbladder and the respiratory tract. Incident risk of cancer of the thyroid and multiple myeloma were increased. Men with the highest impaired glucose level also had significant increased risk of fatal colon cancer. In women, the risk for incident cancer and fatal cancer was increased by 11% and 21% respectively. Significant increase in the risk of incident and fatal site-specific cancer was observed for cancer of the pancreas and stomach. Incident risk of urinary bladder cancer was increased. Women with the most amount of impaired glucose level also had significant increased risk of incident endometrial cancer.

The result from this European study corroborates the findings of a Korean study published in 2005. Impaired glucose levels are associated with increased risk of cancer. For those who are overweight, this bit of information is another reason for you to lose weight. Achieving it depends on what you eat, how much exercise you do and how determined you are.

The most common presenting symptom for someone with pancreatic head cancer is painless progressive jaundice. The prognosis for inoperable pancreatic cancer is grave. Surgical resection is the only curative options. For those jaundiced patients with operable pancreatic cancer, some clinicians will insist on relieving the jaundice before surgery. This is achieved by placing a plastic stent into the common bile duct to re-establish bile flow into the duodenum. Usually this means a delay of 4 to 6 weeks before surgery can be performed. (The rationale for relieving the jaundice is to reduce the risk of developing hepato-renal syndrome.)  However, some surgeons will operate immediately without relieving the jaundice, believing that stenting before surgery increases the post-operative complications rate. The argument of ‘to drain or not to drain’ before surgery has been raging for more than 2 decades.

A multi-centre, randomised study on 202 patients with pancreatic head cancer was recently completed in the Netherlands (N Engl J Med 2010; 362: 129 – 137). The researchers compared pre-operative biliary drainage (for 4 – 6 weeks) with subsequent surgery against surgery alone in order to determine the rate of serious complications within 120 days after randomization in these 2 groups of patients. The rate of serious complications in the early surgery group was 39% while that in the biliary drainage group was 74%. The surgery-related complications rate was 37% in the early surgery group compared to 47% in the biliary drainage group. This study thus showed that routine pre-operative biliary drainage increases the rate of complications in patients with jaundice secondary to pancreatic head cancer.

Despite this study, there will still be clinicians who routinely perform pre-operative biliary drainage for these patients because they believe this will reduce the risks associated with surgery in the presence of jaundice. As it is very difficult to complete a study with very large number of patients with pancreatic head cancer, the controversy of ‘drainage’ versus ‘no drainage’ will unfortunately continue.

As a result of the recent event in US, many Western countries are contemplating the use of full-body scanners on passengers to improve airport security. These machines are used to see under clothes and to identify unusual objects. Many people have objected to their use because of privacy issues. For some there is the worry of health implications if one is scanned too often.

There are 2 types of machines being used: the millimetre wavelength imaging scanner which beams radio waves over the body to create a 3-dimensional image and the backscatter X-ray scanner which uses low dose radiation to create a 2-sided image. The backscatter scanner will expose individuals to ionizing radiation, similar to that found in medical X-rays. While the average chest X-ray delivers 100 microseverts of radiation, the typical backscatter scanner delivers 0.1 microsevert of radiation. Thus, it is logical to conclude that such low level of radiation exposure would not be of great concern.

Would repeated, regular low dose radiation exposure over a prolonged period of time have health implications? This may be relevant to frequent travellers in the course of their work. What about the security staff who are manning the machine on a regular basis? No one has an answer to this.

Some have advocated that all passengers should be scanned while others have suggested using the scanner on selected passengers. We will have to wait and see which policy will finally be adopted. I have no doubt that the use of scanners will be implemented.

Personally, I have adopted the policy of travelling only when necessary and I choose my destination with more care than before. This helps to give me peace of mind and the feeling of staying safe or safer.