Can Measuring Your Body’s Inflammation Level Have Prognostic Value?

By Keith I. Block, MD

Chronic inflammation is well established as a factor that spurs on the development and progression of cancer.  For example, having ulcerative colitis more than doubles your risk of colon cancer, and patients with various chronic infections can develop very aggressive carcinomas and sarcomas.  About one in every four cases of cancer has been linked with chronic inflammation of either infectious or non-infectious causes, according to an excellent review of this topic in the 1 December 2007 issue of the International Journal of Cancer.  And if you include the more common situation of low-level chronic inflammation, the percentage is undoubtedly much higher.

Equally compelling is the potential impact of chronic inflammation after a diagnosis of cancer.  For example, if there is a high-grade inflammation in the area of a prostate tumor, then surgical removal of the prostate gland (prostatectomy) results in significantly more recurrences when compared to patients with low-grade inflammation.  Surgery is a biologically stressful event that generates both inflammation and growth factors.  It is thought that cancer survivors with chronic inflammation may have a heightened risk of recurrence due to the growth-stimulating effects of inflammatory chemicals -- those generated either by the surgery or by the cancer cells themselves.

One of the ways oncologists have come to appreciate the role of inflammation in cancer is by measuring a protein in the blood called C-reactive protein, or CRP. 

This is widely considered to be the most reliable indicator of systemic or whole-body inflammation.  Moreover, the recent introduction of a high-sensitivity CRP (hs CRP) enables physicians to identify patients with chronic inflammation that results in a small elevation of CRP, on the order of 3 to 10 mg/L.  Though such tiny increases in CRP were once thought to be clinically insignificant, a number of recent studies have demonstrated an association between these “minor” elevations and the risk of developing cardiovascular diseases, metabolic syndrome, and various cancers, as reported in the February 2006 American Journal of Medicine.

A substantial body of research now suggests that the higher your CRP level, the poorer your survival chances are for cancers of the breast, lung, colon, pancreas, liver, kidneys, bladder, ovaries, cervix, stomach, esophagus and prostate.  The results have been somewhat mixed, however, possibly due to differences in the CRP measuring techniques, including the timing of the measurements.

In the largest cohort study (1,183 breast cancer patients) to date focusing on the connection between systemic inflammation and breast cancer survival, researchers found that an elevated CRP was linked with both poorer survival and more frequent recurrences.  CRPs were measured approximately 31 months after the diagnosis.  Though results from smaller studies had suggested that an association between CRP and survival may be present only in groups of patients with metastatic breast cancer, this study found that the association held true even for patients with less advanced or non-metastatic disease, as reported in the 20 July 2009 Journal of Clinical Oncology.

More recently, however, a study of 59 breast cancer patients found that CRP levels correlated with lymph node metastasis and tumor stage, but not with distant metastases and overall survival.  Reporting in the 6 February 2011 issue of World Journal of Surgical Oncology, the researchers state that another inflammatory marker, called interleukin-6 or IL-6, correlated well with the extent of tumor invasion, lymph node metastasis, distant metastasis and TNM tumor staging—thus encompassing all aspects of breast cancer.  In this study, serum levels of both CRP and IL-6 were estimated every three months for two years.  It is possible that a larger study is needed (such as the 2009 cohort mentioned above) to more clearly determine the value of CRP.

Two final points about the CRP are worth mentioning.  First, a high CRP level before surgery strongly indicates a degree of immune incompetence, thus potentially boosting the risk of infections and recurrences after surgery.  Second, being overweight has been significantly associated with higher levels of CRP, an indication that body fat itself is a source of inflammation.  This is consistent with the finding that obese cancer patients generally have a poorer prognosis than their leaner counterparts.  Getting rid of excess body fat is bound to lower your CRP, reflecting a healthier inflammatory balance overall.

The good news is that having a high CRP is not a death sentence, but rather a call to be more proactive about tending to your biochemical terrain.  Your CRP is highly responsive to targeted changes in diet, supplementation and other lifestyle habits.  If you have an elevated CRP—and remember that readings in the range of 3 to 15 mg/L are still clinically significant —- I recommend adopting an anti-inflammatory nutritional and herbal regimen, as described in Life Over Cancer.

Lastly, the measurement of serum CRP is simple, cheap, and readily available—so don’t hesitate to request such a test when you see your physician.  Such measurements can serve as a primary motivator for helping you make the changes you need to lower your inflammatory burden and create the strongest possible tumor-fighting terrain.

Comments

[Breathe]

So, maybe Mom was on to something astute when she said, "Don't pick at that scab; you'll give yourself cancer!"

Could or would external inflammation, such as irritating certain scabs (for years) and/or almost constant picking and biting of fingernails and surrounding skin contribute to damaging inflammatory terrain, not just locally but perhaps elsewhere in the body?