| ||What Your Doctor Is Reading || |
Update From the Medical Journals: November 2011
November 30, 2011
By Mary Pickett, M.D.
Harvard Medical School
What's the latest news in the medical journals this month? Find out what your doctor is reading.
Aspirin Lowers Risk for Colon Cancer in Highest Risk Families
People who have several relatives with colon cancer can reduce their own risk by taking aspirin, says an important worldwide study. The study, which was published online by the Lancet on October 27, was limited to people who had about ten times the normal risk for colon cancer. Their high cancer risk was due to an inherited cancer gene. The condition is called "Lynch Syndrome."
In the study, 861 patients were assigned to take either 600 milligrams of aspirin a day roughly double the dose that most people get if they take a daily aspirin or a placebo pill. The study lasted 10 years. Four out of five people assigned to take aspirin were able to stick with this treatment. But 1 out of 5 people had side effects that made them stop.
Doctors found a similar number of colon polyps (precancerous growths) in both groups of people. But most of the colon cancers discovered were in people who did not receive aspirin. People who took aspirin had a 63% lower rate of getting cancer.
Researchers are planning another study to see if 600 milligrams of aspirin is the best dose for preventing cancer in high-risk patients. A lower dose may have fewer side effects. But for now, it's reasonable that people who have a family history of Lynch Syndrome take aspirin to help prevent colon cancer.
Aspirin can cause bleeding from the stomach so it is not for everyone. It is not recommended for people without a high risk for cancer, nor for people who have ever had bleeding from the stomach or intestines. The best way to prevent colon cancer is to have periodic colonoscopy examinations. They can find polyps and remove them.
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Yaz, Yasmin and Similar Birth Control Pills Raise Risk for Blood Clots
One of the major side effects of birth control pills is an increased risk of blood clots. Some newer birth control pills may carry a higher risk of blood clots compared with older versions, a study finds. The study looked at pills that have the hormone drospirenone. It is found in Yaz, Yasmin and some other brands of pills.
Researchers reviewed medical records of 330,000 women and found more clots in women who took these newer pill brands. The Canadian Medical Association Journal published the study November 7. The U.S. Food and Drug Administration (FDA) wrote a drug safety alert about this risk. For every 10,000 women on birth control pills, the number of women who had a clot event was increased from 6 to 10 if these pill brands were used over a period of one year.
Blood clots in an artery can cause a heart attack or stroke. When a clot occurs in the vein, it causes a deep vein thrombosis (DVT). This usually affects a leg. Blood clots in veins can break off and travel to the lungs. This is called a pulmonary embolism, and it can be deadly. Smokers have a much higher risk for clots when they take birth control pills.
Some people say that these pill brands cause fewer side effects. There are many birth control pills to choose from, so pills with drospirenone should be avoided unless they are the only ones that a woman can take comfortably.
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Cancer Risk Doubles After Organ Transplant
People who have received a kidney, liver, heart or lung transplant have double the risk of cancer. Doctors have been aware of the higher risk, but no research study has documented the amount of increase in risk until now. The Journal of the American Medical Association (JAMA) published a study in the November 2 issue that looked at cancer events in nearly 200,000 people who had received transplants.
Cancer risk increased for 32 kinds of cancer. The most common cancers seen in the study were non-Hodgkin lymphoma, lung cancer, liver cancer and renal (kidney) cancer.
The immune system fights both infection and cancer. Many cancers never grow to a size that can be discovered because the immune system attacks cancer cells. There are also some cancers that are triggered by a virus infection. The immune system helps prevent those cancers by fighting viruses. After a transplant, to prevent rejection of the transplanted organ, a person has to take medication that suppresses the immune system. A suppressed immune system is the most likely reason that people with a transplant develop more cancers. Other possible factors (although these have not been proven to cause cancer) include side effects from transplant medications or proteins circulating in the body in reaction to the transplant.
More than 25,000 organ transplants are done each year. It will be important for doctors to find ways to reduce cancer risk and to find cancers at an early (treatable) stage among people who have had transplants.
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More News in Brief
- Parents Advised to Test Children's Cholesterol. All children ages 9 to 11 should have their cholesterol tested, according to a new recommendation from the American Academy of Pediatrics. Another cholesterol test should be done between ages 17 and 21. Before this recommendation, the earliest age at which cholesterol testing was advised was 20. The only exception was children with very strong family histories of cholesterol and heart troubles. The new recommendation was published November 14 in the journal Pediatrics. Doctors will treat most children who have high cholesterol with diet changes and exercise.
- More Elderly People Are Living Beyond Age 90. A report by the U.S. Census Bureau shows that for every 10 people who were 90 years old or older in 1980, today we have 26 people who are that old. Most of these "oldest old" are widowed white women who live in nursing homes. The number is expected to rise even more dramatically in the next several decades. Planners and policy makers are feeling the pressure to train more doctors in the care of geriatric patients, and to consider our increasing need for nursing services to care for this population.
- HPV Vaccine Is For Boys, Too. The human papilloma virus (HPV) vaccine (Gardasil), is now recommended for boys. Until now, the vaccination had only been recommended for girls at age 11 or 12. The U.S. Advisory Committee on Immunization Practices made the new recommendation on October 25. The U.S. Centers for Disease Control and Prevention usually follows the group's advice. Three shots of this vaccine helps to prevent infection by a virus that causes cancers. Cancers that can be caused by HPV include cervical cancer (in young women), anus cancer, cancer on the genitals and throat cancer. The vaccine also helps to prevent genital warts.
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Mary Pickett, M.D. is an Associate professor at Oregon Health & Science University where she is a primary care doctor for adults. She supervises and educates residents in the field of Internal Medicine, for outpatient and hospital care. She is a Lecturer for Harvard Medical School and a Senior Medical Editor for Harvard Health Publications.