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MRI Improves Prostate Cancer Biopsy Accuracy, Study Finds
January 27, 2015


TUESDAY, Jan. 27, 2015 (HealthDay News) -- Prostate biopsies that combine MRI technology with ultrasound appear to give men better information regarding the seriousness of their cancer, a new study suggests.

The new technology -- which uses MRI scans to help doctors biopsy very specific portions of the prostate -- diagnosed 30 percent more high-risk cancers than standard prostate biopsies in men suspected of prostate cancer, researchers reported.

These MRI-targeted biopsies also were better at weeding out low-risk prostate cancers that would not lead to a man's death, diagnosing 17 percent fewer low-grade tumors than standard biopsy, said senior author Dr. Peter Pinto. He is head of the prostate cancer section at the U.S. National Cancer Institute's Center for Cancer Research in Bethesda, Md.

These results indicate that MRI-targeted biopsy is "a better way of biopsy that finds the aggressive tumors that need to be treated but also not finding those small microscopic low-grade tumors that are not clinically important but lead to overtreatment," Pinto said.

Findings from the study are published in the Jan. 27 Journal of the American Medical Association.

Doctors performing a standard biopsy use ultrasound to guide needles into a man's prostate gland, generally taking 12 core samples from predetermined sections.

The problem is, this type of biopsy can be inaccurate, said study lead author Dr. Mohummad Minhaj Siddiqui, an assistant professor of surgery at the University of Maryland School of Medicine and director of urologic robotic surgery at the University of Maryland Marlene and Stewart Greenebaum Cancer Center in Baltimore.

"Occasionally you may miss the cancer or you may glance the cancer, just get an edge of it, and then you don't know the full extent of the problem," Siddiqui said.

In a targeted biopsy, MRIs of the suspected cancer are fused with real-time ultrasound images, creating a map of the prostate that enables doctors to pinpoint and test suspicious areas.

Prostate cancer testing has become somewhat controversial in recent years, with medical experts debating whether too many men are being diagnosed and treated for tumors that would not have led to their deaths. Removal of the prostate gland can cause miserable side effects, including impotence and incontinence, according to the U.S. National Cancer Institute. But, even if a tumor isn't life-threatening, it can be psychologically difficult not to treat the tumor.

To test the effectiveness of MRI-targeted biopsy, researchers examined just over 1,000 men who were suspected of prostate cancer because of an abnormal blood screening or rectal exam.

The researchers performed both an MRI-targeted and a standard biopsy on all of the men, and then compared results.

Both targeted and standard biopsy diagnosed a similar number of cancer cases, and 69 percent of the time both types of biopsy came to exact agreement regarding a patient's risk of death due to prostate cancer.

However, the two approaches differed in that targeted biopsy found 30 percent more high-risk cancers, and 17 percent fewer low-risk cancers.

"You're missing low-risk cancer. This is the type of cancer where this person certainly would have lived their whole life and died of something else," Siddiqui said.

An MRI is great for guiding doctors to serious cancers, but is not able to detect lesions smaller than 5 millimeters, said Dr. Art Rastinehad, director of focal therapy and interventional urological oncology and an associate professor of urology and radiology at Icahn School of Medicine at Mount Sinai in New York City.

"MRI's greatest weakness is also its greatest strength when it comes to prostate cancer," ignoring low-risk tumors while accurately directing a biopsy to potentially lethal cancers, Rastinehad said. "This study does lay the foundation for a possible paradigm shift in the way we screen men for prostate cancer," he added.

Clinical trials still are needed to show whether MRI-targeted biopsy will save lives or reduce future recurrence of cancer, JAMA Associate Editor Dr. Ethan Basch argued in an editorial accompanying the study. Basch is also director of cancer outcomes research at the University of North Carolina at Chapel Hill.

"A new test should not be widely adopted in the absence of direct evidence showing benefits on quality of life, life expectancy, or ideally both," wrote Basch.

Another open question also remains -- whether the new technology, which requires an MRI for each suspected case of prostate cancer and new equipment to fuse the MRI with an ultrasound scan, would be worth the extra expense.

Pinto believes the new technology might actually save money in the long run, by reducing overtreatment.

"We have to be very thoughtful, especially where health care dollars are scarce, to bring in technology that will not only help men but will be cost-efficient," he said. "That work has not been done completely, although some studies imply this technology may decrease considerably the number of unnecessary biopsies performed every year, and so could help control costs."

More information

For more on prostate cancer, visit the U.S. National Cancer Institute.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Peter Pinto, M.D., head, prostate cancer section, U.S. National Cancer Institute's Center for Cancer Research, Bethesda, Md.; Mohummad Minhaj Siddiqui, M.D., assistant professor of surgery, University of Maryland School of Medicine, and director ...

Prostate Cancer Patients Who Smoke Fare Worse, Study Finds
January 27, 2015


TUESDAY, Jan. 27, 2015 (HealthDay News) -- Smoking doubles the chances that a prostate cancer patient will see his disease spread and that he will eventually die from his illness, a new study finds.

"Basically we found that people who smoke had a higher risk of their tumor coming back, of it spreading and, ultimately, even dying of prostate cancer," said study co-author Dr. Michael Zelefsky. He is vice chair of clinical research in the department of radiation oncology at Memorial Sloan Kettering Cancer Center in New York City.

"But interestingly, this applied only to 'current smokers' who were smoking around the time they received external beam therapy," Zelefsky added, referring to the standard form of radiation treatment for prostate cancer. "Former smokers did not have the increased risk for disease spread and recurrence that current smokers did," he said.

"However, we also looked at how smoking affected treatment side effects," from the radiation treatment, which can include rectal bleeding and/or frequent and urgent urination, he noted. "And we saw that both patients who smoked and former smokers seemed to have a higher risk of urinary-related side effects after therapy."

Zelefsky and his colleagues reported the findings online Jan. 27 in the journal BJU International.

The research team pointed out that 19 percent of American adults smoke.

To explore the impact of smoking history on prostate cancer treatment and progression, the study authors focused on nearly 2,400 patients who underwent treatment for prostate cancer between 1988 and 2005.

Nearly 50 percent were identified as "former smokers," even if they had only kicked their habit shortly before beginning cancer treatment.

Disease progression, relapse, symptoms and deaths were all tracked for an average of eight years, as were all reactions to the radiation treatment.

The researchers determined that the likelihood of surviving prostate cancer for a decade without experiencing any disease recurrence was about 66 percent among patients who had never smoked. By comparison, that figure fell to 52 percent among patients who were current smokers.

Former smokers fared better than current smokers, with about 62 percent projected to hit the 10-year survival mark.

But compared with those who had never smoked, both current and former smokers faced a notably higher risk for the toxic urinary side effects that can occur with radiation treatment.

Zelefsky said the new study wasn't designed to highlight exactly how smoking worsens cancer prognosis. But he noted that one leading hypothesis is that smoking may reduce oxygen concentrations in the tumor region, perhaps making tumors less sensitive to radiation.

"We can't say for any certainty that this is the case," he said. "But what we can say, of course, is that smoking is not good for you. Clearly. We've long known that it increases the chances for developing lung cancer and cardiovascular disease. But this finding suggests that smoking may also undermine the battle against prostate cancer, and perhaps all cancers in general," Zelefsky said.

"So, at minimum this should make us more cognizant of the need to get a good smoking history on prostate cancer patients, and [to get] more proactive in terms of referring them for smoking cessation programs, rather than putting the issue on the backburner while undergoing treatment," he suggested.

Dr. Stephen Freedland, a professor of surgery at Cedars-Sinai Health System in Los Angeles, said the finding adds to growing evidence that smoking is associated with aggressive prostate cancer.

However, a cause-and-effect link was not proven in the new study.

"They clearly found that the risk of dying from prostate cancer goes up for smokers," Freedland said. "And, importantly, they controlled for the fact that smokers generally have other health problems in addition to cancer, and still found that smoking independently raises the risk of dying specifically from the cancer.

"So, I would say that quitting smoking is better than not quitting, and not starting in the first place is the best thing," he said. "But whichever is the case, it's not too late. If you're a smoker and you get prostate cancer, you should really consider that maybe it's time to stop."

More information

There's more on prostate cancer and radiation treatment at the American Cancer Society.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Michael Zelefsky, M.D., professor, radiation oncology, and vice chair, clinical research, department of radiation oncology, Memorial Sloan Kettering Cancer Center, New York City; Stephen Freedland, M.D., professor, surgery, Cedars-Sinai Health Sy...

Many Breast Cancer Patients Lack Info on Their Cancer
January 26, 2015


MONDAY, Jan. 26, 2015 (HealthDay News) -- Many women with breast cancer lack basic knowledge about their disease, such as their cancer stage and other characteristics, according to a new study.

The lack of knowledge was even more pronounced among minority women, the study authors found.

This finding is worrisome because knowing about a health condition can help people understand why treatment is important to follow, experts say.

"We certainly were surprised at the number of women who knew very little about their disease," said Dr. Rachel Freedman, assistant professor of medicine at Harvard Medical School and a medical oncologist specializing in breast cancer at the Dana-Farber Cancer Institute.

Although the study didn't specifically look at the reasons behind the lack of knowledge, Freedman suspects that women may be overwhelmed when they're initially diagnosed. In addition, she said, individual doctors vary in how much information they give and how well they explain the cancer characteristics.

The study is published online Jan. 26 in Cancer.

Kimlin Tam Ashing, a professor at the Beckman Research Institute at the City of Hope Cancer Center in Duarte, Calif., reviewed the study's findings, and said that quick appointments may also be to blame for the knowledge gap.

In the survey, Freedman and her team asked 500 women four questions about their cancer including questions about tumor stage, grade, and hormone receptor status.

Overall, 32 percent to 82 percent of women reported that they knew the answers to these questions. But only 20 percent to 58 percent were actually correct, depending on the characteristics, the investigators found.

Just 10 percent of white women and 6 percent of black and Hispanic women knew all of their cancer characteristics correctly, according to the study.

Cancer "stage" describes the extent of the cancer, whether it is invasive or not and if lymph nodes are involved (stages 0 through IV). Two-thirds of white women and about half of black and Hispanic women were able to correctly identify their cancer's stage, the researchers found.

Cancer "grade" describes how the cancer cells look under the microscope and can help predict its aggressiveness. Just 24 percent of white women, 15 percent of black women and 19 percent of Hispanic women knew what their cancer grade was, according to the study.

Two other questions asked about hormone receptor status. One asked about whether or not a cancer was HER2 positive. HER2-positive tumors test positive for a protein (human epidermal growth factor receptor 2) that promotes cancer cell growth. Almost two-thirds of white women, and just over half of black and Hispanic women were able to answer this question accurately, the researchers found.

The other question about hormone receptor status was whether or not the cancer was estrogen receptor-positive. Estrogen receptor-positive cancers need estrogen to grow. Other cancers are progesterone receptor-positive. Seventy percent of white women knew their estrogen receptor status, but fewer than half of the black and Hispanic women did, the study revealed.

Black and Hispanic women were less likely than white women to know and have correct responses in each measure. Even after the researchers took into account women's education and their health literacy, there were still racial and ethnic differences.

While the results were disappointing, Freedman added, hopefully, "this is a modifiable problem."

Doctors and other health care professionals can address the knowledge gap in clinics and in practices, she said. She recommends that breast cancer patients bring along a partner, friend or other family members. "When patients come with people, it always helps," she said, as they can take notes for the patient or think of questions that haven't occurred to the patient.

"I wasn't surprised, unfortunately," Ashing said of the current study.

The danger of not knowing information about your breast cancer, she said, is that it "might influence women's decision about treatment adherence." It might also affect how well they stick to schedules recommended for follow-up care and testing.

Along with having someone accompany you to a medical visit, she recommended that breast cancer patients ask if they can talk to another patient with the same diagnosis. She has studied this approach, known as "peer navigation," and found it to be helpful.

More information

To learn more about the characteristics of breast cancer, visit the American Cancer Society.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Rachel Freedman, M.D., M.P.H., assistant professor of medicine, Harvard Medical School, medical oncologist specializing in breast cancer, Dana-Farber Cancer Institute, Boston; Kimlin Tam Ashing, Ph.D., professor, Beckman Research Institute at Cit...

Use of 'the Pill' Tied to Higher Risk for Rare Brain Cancer
January 22, 2015


THURSDAY, Jan. 22, 2015 (HealthDay News) -- The risk for developing a rare form of brain cancer known as glioma appears to go up with long-term use of hormonal contraceptives such as the Pill, new Danish research suggests.

Women under 50 with a glioma "were 90 percent more likely to have been using hormonal contraceptives for five years or more, compared with women from the general population with no history of brain tumor," said study leader Dr. David Gaist.

However, the Danish study couldn't prove cause-and-effect, and Gaist stressed that the findings "need to be put in context" for women because "glioma is very rare."

How rare? Only five out of every 100,000 Danish women between the ages of 15 and 49 develop the condition each year, according to Gaist, a professor of neurology at Odense University Hospital. He said that figure includes women who take contraceptives such as the birth control pill.

So, "an overall risk-benefit evaluation favors continued use of hormonal contraceptives," Gaist said.

The findings were published online in the British Journal of Clinical Pharmacology.

In the study, Gaist's team looked at government data on all Danish women between the ages of 15 and 49 who had developed a glioma between 2000 and 2009.

In all, investigators identified 317 glioma cases, among whom nearly 60 percent had used a contraceptive at some point. They then compared them to more than 2,100 glioma-free women of similar ages, about half of whom had used contraceptives.

Use of the Pill or other hormonal contraceptive did appear to bump up the risk for glioma, the researchers reported, and the risk seemed to rise with the duration of use.

For example, women who had used any type of hormonal birth control for less than one year had a 40 percent greater risk for glioma compared with non-users. And those who had used the drug for five years or more saw their risk nearly double compared to non-users, the findings showed.

In addition, Gaist's team found that glioma risk seemed to go up most sharply for women who had used contraceptives containing the hormone progestogen, rather than estrogen.

Dr. Evan Myers is a professor of obstetrics and gynecology at Duke University Medical Center in Durham, N.C. He described the Danish study as "really well-done."

However, he stressed that the study couldn't prove a cause-and-effect relationship between hormonal contraception use and risk for glioma. Myers also suggested that future research focus on a number of indirect factors -- such as the progesterone found in some types of IUDs (intrauterine devices) -- that might also play a critical role in driving up glioma risk.

And in the end, "even if hormonal contraception does increase the relative risk of glioma, the absolute risk -- the actual increase in the chances of having a glioma diagnosed -- is quite small," Myers stressed.

According to his own statistical breakdown, Myers said that between 2000 and 2011, glioma affected less than two out of every 100,000 American women between the ages of 15 and 29.

"To put that in perspective," he said, "that's about one-tenth the risk of death from trauma in women aged 15 to 44, and a little over twice the risk of dying from a complication of pregnancy."

Myers said his number-crunching suggests an even lower risk profile when looking specifically at women who are taking the Pill or another form of hormonal contraception.

"Without going through the math, it's about 8.5 [cases of glioma] per million" for that subset of women, Myers said.

More information

There's more on gliomas at the American Brain Tumor Association.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: David Gaist, M.D., Ph.D., professor, department of neurology, Odense University Hospital, Odense, Denmark; Evan Myers, M.D., M.P.H., professor of obstetrics and gynecology, division of clinical and epidemiological research, department of obstetri...

Can Coffee Protect You From Melanoma?
January 20, 2015


TUESDAY, Jan. 20, 2015 (HealthDay News) -- Your morning coffee might do more than perk you up. Researchers suggest it also might help protect you against melanoma, the deadliest form of skin cancer.

Coffee drinkers are less likely to suffer from malignant melanoma, and their risk decreases somewhat with every cup they swallow, according to findings published Jan. 20 in the Journal of the National Cancer Institute.

"We found that four or more cups of coffee per day was associated with about a 20 percent reduced risk of malignant melanoma," said lead author Erikka Loftfield, a doctoral student at Yale University School of Public Health who is completing her dissertation work at the U.S. National Cancer Institute.

Previous research has shown that coffee drinking could protect against less deadly forms of skin cancer, apparently by mitigating the damage to skin cells caused by the sun's ultraviolet rays, the researchers said in background notes.

They decided to see if this protection extended to melanoma, the leading cause of skin cancer death in the United States and the fifth most common cancer. In 2013, there were an estimated 77,000 new cases of melanoma and about 9,500 deaths from the cancer, according to the study.

The researchers gathered data from a study run by the U.S. National Institutes of Health and AARP. A food questionnaire was sent to 3.5 million AARP members living in six states: California, Florida, Louisiana, New Jersey, North Carolina and Pennsylvania; as well as two cities, Atlanta and Detroit.

The questionnaire yielded coffee drinking info for nearly 447,400 white seniors in 1995 and 1996, and researchers followed up with the participants for about 10 years on average.

All participants were cancer-free when they filled out the questionnaire, and the researchers adjusted for other factors that could influence melanoma risk. These included ultraviolet radiation exposure, body mass index, age, sex, physical activity, alcohol intake and smoking history.

They found that people who drank the most coffee every day enjoyed a lower risk of melanoma, compared with those who drank little to no coffee.

There was also a trend toward more protection with higher intake. People who drank one to three cups a day had about a 10 percent decreased risk of melanoma compared with those who drank none at all, while those who drank four or more cups had a 20 percent decreased risk.

The study only uncovered an association between coffee consumption and melanoma risk; it didn't prove a cause-and-effect relationship.

Caffeine could be the reason for the apparent protection. The researchers found a significant decrease in melanoma risk only among those who drank caffeinated coffee, and previous studies have indicated that caffeine could protect skin cells against ultraviolet-B radiation, Loftfield said.

However, most of the people in the study drank caffeinated coffee, which made it difficult to fully analyze the health benefits of decaf. There could be other compounds in coffee besides caffeine that also protect against skin cancer, including antioxidants. "We certainly cannot rule that out as a possibility," Loftfield said.

This isn't the first study to look into the effect that coffee drinking might have on cancer risk, said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

"Coffee has been around the block several times in a variety of cancers, in terms of whether it increases or decreases risk," he said, noting that the findings have been very mixed.

Lichtenfeld said the researchers behind the new study made a good basic science case for the possibility that coffee might protect against skin cancer. However, because this study was not a clinical trial, it didn't prove cause and effect.

"As a result of that, one cannot conclude that in 'real life' coffee actually decreases the risk of melanoma," he said.

Even with these findings, Loftfield said people should not rely on coffee to protect them from melanoma. Sunscreen, long sleeves and a wide-brimmed hat will do more than a mug of java ever could.

"The main message really is that sun and [ultraviolet] radiation exposure are the major risk factors for melanoma," she said. "It is important to study other factors to better understand the cause of this disease, but we must keep these major risk factors in mind."

More information
For more on melanoma, visit the U.S. National Cancer Institute.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Erikka Loftfield, M.P.H., doctoral student, Yale School of Public Health and U.S. National Cancer Institute; Len Lichtenfeld, M.D., M.A.C.P., deputy chief medical officer, American Cancer Society; Jan. 20, 2015, Journal of the National Cancer ...

Pursuing Pancreatic Cancer's Deadly Secret
January 16, 2015


FRIDAY, Jan. 16, 2015 (HealthDay News) -- A new lab study might help explain why pancreatic cancer is so deadly.

"Patients with the earliest stage of pancreatic cancer have a survival rate of only 30 percent. This suggests that even in that very early stage of invasive cancer there are already cells that have spread to distant parts of the body," said study author Dr. Diane Simeone, director of the Pancreatic Cancer Center at the University of Michigan Comprehensive Cancer Center.

"This study sheds important light on what it is about pancreatic cancer that makes it so aggressive early in the game," she said in a university news release.

Using mice and tissue samples, researchers found that a gene known to be involved in nearly 90 percent of pancreatic cancers promotes cancer spread and growth.

The ATDC gene plays an important role in how a tumor progresses from the preinvasive stage to invasive cancer and then to metastatic cancer, which means it has spread to other areas of the body.

The findings were published Jan. 15 in the journal Genes and Development.

The ATDC gene offers a potential target for new drugs to treat pancreatic cancer, the researchers said. New treatments are crucial, as about 46,000 Americans will be diagnosed with pancreatic cancer this year and more than 39,000 will die of the disease, the researchers note in the news release.

By 2030, it's expected that pancreatic cancer will be the second leading cause of U.S. cancer deaths, they said.

The researchers also said preliminary data suggests the ATDC gene may play a role in other cancers, including those of the bladder, ovaries, colon and lungs, as well as the blood cancer multiple myeloma.

More information

The American Cancer Society has more about pancreatic cancer.
Copyright © 2015 HealthDay. All rights reserved.

SOURCE: University of Michigan Health System, news release, Jan. 15, 2015...

Children of Melanoma Survivors Often Get Sunburned: Study
January 16, 2015


FRIDAY, Jan. 16, 2015 (HealthDay News) -- Common wisdom holds that adults who've experienced the trauma of melanoma would go to greater lengths to shield their children from the sun's rays.

But a new study shows that nearly half of parents who were also melanoma survivors said their child had experienced a sunburn over the previous year.

"Sunburns were common among the children in our study despite their elevated risk for skin cancer," study author Dr. Beth Glenn, an associate professor of health policy and management at the University of California, Los Angeles, said in a university news release.

Sunburn is a major risk for the most deadly type of skin cancer, and children of survivors are at increased risk for developing the disease as adults, Glenn team noted.

They surveyed 300 white and Hispanic melanoma survivors with children aged 17 or younger. The parents were asked about their attitudes towards melanoma prevention, how they rated their children's risk for the disease, and the sun protection methods they used for their children.

Many parents said they relied on sunscreen to protect their children from the sun, with fewer saying their children wore hats or sunglasses, or tried to find shade.

The researchers also found that 43 percent of the parents said their child had a sunburn in the past year.

"Protecting kids against the sun's harmful rays at an early age is vitally important," Glenn said. "Our goal is to develop an intervention that will help parents protect their children today and help children develop sun-safe habits that will reduce their risk for skin cancer in the future.

Glenn is also associate director of the Healthy and At-Risk Populations Research Program at UCLA. She noted that, "children of Latino survivors were just as likely as children of non-Latino white survivors to have experienced a recent sunburn, which highlights the importance of including this group in our work."

According to Glenn, Hispanics have often been left out of skin cancer prevention research due to the common misconception that sun protection is not important for them.

The study was published online Jan. 13 in the journal Cancer Epidemiology, Biomarkers & Prevention.

More information

The American Cancer Society has more about melanoma.
Copyright © 2015 HealthDay. All rights reserved.

SOURCE: University of California, Los Angeles, news release, Jan. 13, 2015...

Gene-Based Spit Test Shows Promise in Lung Cancer Detection
January 15, 2015


THURSDAY, Jan. 15, 2015 (HealthDay News) -- Medicare indicated recently that it might soon cover CT scans to check longtime smokers for early lung cancer, and these types of scans are becoming more common.

Now, an experimental test may help determine whether lung nodules detected by those scans are malignant or not, researchers say.

The test, which checks sputum (respiratory mucus) for chemical signals of lung cancer, was able to distinguish early stage lung cancer from noncancerous nodules most of the time, according to findings published Jan. 15 in the journal Clinical Cancer Research.

"We are facing a tremendous rise in the number of lung nodules identified because of the increasing implementation of the low-dose CT lung cancer screening program," Dr. Feng Jiang, associate professor, department of pathology, University of Maryland School of Medicine, explained in a journal news release.

"However, this screening approach has been shown to have a high false-positive rate," he added. "Therefore, a major challenge is the lack of noninvasive and accurate approaches for preoperative diagnosis of malignant nodules."

Testing a patient's sputum for a group of three genetic signals -- called microRNA (miRNA) biomarkers -- may help overcome this problem, Jiang said.

Jiang and his colleagues first tried the test in 122 people who were found to have a lung nodule after they underwent a chest CT scan. The sputum test was nearly 83 percent accurate in identifying lung cancer, the study found, and nearly 88 percent in correctly identifying when a lung nodule was not cancerous.

In two other groups of patients tested, the rates were about 82 percent and 88 percent, and 80 percent and 86 percent, respectively.

However, those results are still not high enough for the panel to be used for diagnosing patients, so more work must be done to boost accuracy, the researchers said.

"We are now applying new technologies to identify additional miRNA sputum biomarkers of lung cancer with the goal of expanding our biomarker panel to generate a test with high efficiency that can be practically used in clinical settings for lung cancer early detection," Jiang said.

The study was funded by the U.S. National Cancer Institute, the U.S. Department of Veterans Affairs, and the LUNGevity Foundation.

Two experts in lung cancer agreed that the test shows promise.

"Invasive, unnecessary procedures may be avoided if this technology becomes available after more studies are completed," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City. "This is an exciting forefront in diagnostic medicine," he said.

Dr. Kevin Sullivan is a medical oncologist at North Shore-LIJ Cancer Institute in Lake Success, N.Y. He said that "with the rise in radiologic screening of heavy smokers for lung cancer using CT scans, a significant number of these patients will have solitary lung nodules for which the majority of these turn out to be benign."

Therefore, he added, "many patients go through further invasive and anxiety-provoking tests to find out they ultimately did not have cancer. If testing sputum can help determine which patients should undergo further invasive procedures, this improves our ability to personalize therapies for patients."

More information

The U.S. National Cancer Institute has more about lung cancer.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; Kevin M. Sullivan, M.D., medical oncologist, North Shore-LIJ Cancer Institute, Lake Success, N.Y.; Clinical Cancer Research, news release, Jan. 15, 2015...

Unhealthy Insulin Levels May Boost Breast Cancer Risk
January 15, 2015


THURSDAY, Jan. 15, 2014 (HealthDay News) -- After menopause, unhealthy insulin levels may predict breast cancer risk even more than excess weight, new research suggests.

The new findings suggest "that it is metabolic health, and not overweight per se, that is associated with increased risk of breast cancer in postmenopausal women," said study co-author Marc Gunter. He is an associate professor of cancer epidemiology and prevention at Imperial College London School of Public Health in England.

While high insulin levels often occur in overweight or obese women, some very heavy women have normal levels of the hormone, experts say. And some normal-weight females have metabolically unhealthy insulin levels.

The study was published Jan. 15 in the journal Cancer Research.

To assess insulin's role in breast cancer risk, Gunter studied more than 3,300 women without diabetes, 497 of whom developed breast cancer over eight years. He analyzed information on their weight, fasting insulin levels and insulin resistance, in which the body does not respond properly to insulin. Insulin helps the body use digested food for energy. A body's inability to produce insulin or use it properly leads to diabetes.

Overweight for the study was defined as a body mass index (BMI) of 25 or more. BMI is a calculation of body fat based on height and weight.

"The women who are overweight but who do not have metabolic abnormalities [as assessed by insulin resistance] are not at increased risk of breast cancer compared to [normal-weight] women," Gunter said.

"On the other hand, normal-weight women with metabolic abnormalities were at approximately the same elevated risk of breast cancer as overweight women with metabolic abnormalities," he added.

Gunter said this seemingly strong link between insulin and breast cancer is not a reason for women to ignore excess pounds. Being overweight or obese does increase the chances of developing insulin problems, he said.

In his study, high fasting insulin levels doubled the risk of breast cancer, both for overweight and normal-weight women.

In addition, women who were overweight and insulin-resistant had an 84 percent greater risk of breast cancer than overweight women who weren't insulin-resistant, he found.

Other research has found that up to 10 percent of women at a healthy weight may have insulin problems, he said.

Gunter said more research is needed to explain the findings. Insulin can cause cells, including cancer cells, to grow, so that could be a factor, he said. Other hormones related to insulin can also be higher in overweight women, and they could contribute to breast cancer risk, he said.

The overall findings are not surprising, said Dr. Courtney Vito, associate clinical professor of surgical oncology at City of Hope Cancer Center in Duarte, Calif.

"Fat is not inert," she said. "It is a metabolically active organ and we've known this from many other studies." There is much that experts still don't know about fat, she said.

The study is interesting, Vito said, although she agreed that more research is needed before the results can be considered conclusive. She played no role in the study.

Gunter's earlier research also found that higher insulin levels boost breast cancer risk in postmenopausal women. What may surprise some is the information about higher cancer risk in slender women with insulin problems, said Dr. Allison DiPasquale, a fellow at City of Hope, who wasn't involved in the study.

Future studies, DiPasquale said, should look more closely at four subgroups: overweight women with and without insulin problems and normal-weight women with and without insulin problems.

Meanwhile, all three experts agreed the take-home point for women is to eat a healthy diet and to exercise regularly, so weight and insulin levels are more likely to stay normal.

More information
To learn more about insulin resistance, visit the American Diabetes Association.

Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Marc Gunter, Ph.D., associate professor, cancer epidemiology and prevention, Imperial College London School of Public Health, London, England; Courtney Vito, M.D., associate clinical professor, breast and surgical oncology, City of Hope Cancer Ce...

Fewer Patients With Advanced Colon Cancer Getting Surgery, Report Finds
January 14, 2015


WEDNESDAY, Jan. 14, 2015 (HealthDay News) -- Fewer U.S. colon cancer patients who are diagnosed in the final stages of their disease are having what can often be unnecessary surgery to have the primary tumor removed, researchers report.

These patients are also living longer even as the surgery becomes less common, although their general prognosis is not good.

The findings reveal "increased recognition that the first-line treatment really is chemotherapy" for stage 4 colon cancer patients, said study co-author Dr. George Chang, chief of colon and rectal surgery at the University of Texas MD Anderson Cancer Center in Houston. While removing the primary tumor may be helpful for some reasons, he said, "surgery is not life-prolonging."

With the patients in question, their cancer has spread from the intestines to other organs such as the liver or lung, in a process called metastasis. In many cases, the prognosis is death, one expert not part of the study said.

"Cure is not possible for most patients with metastatic colorectal cancer," said Dr. Ankit Sarin, an assistant professor of surgery in the section of colon & rectal surgery at University of California, San Francisco.

Twenty percent of patients diagnosed with colon cancer have stage 4 disease, according to background information in the study. Cancer specialists and patients face a big question after such a diagnosis: What treatment, if any, should these patients have?

"The first instinct is 'I want it out,'" Chang said. But removing the tumor from the colon may not be helpful once cancer has spread, and "getting it out may delay their ability to get treatment that's life-prolonging," Chang added.

In the study, researchers examined a database on more than 64,000 patients diagnosed with stage 4 colon or rectal cancer between 1988 and 2010.
The study reports that about two-thirds of patients underwent removal of the primary tumor, but the procedure became less common over time, dropping from 75 percent of cases in 1988 to 57 percent of cases in 2010.

The study analyzed the "median relative survival rate" of the patients. This is a complicated statistical concept: The American Cancer Society defines relative survival as "the proportion of people with the cancer [who] have survived five years and compares it to the survival expected in a similar group of people without the cancer." The median refers to "the length of time it took for half the people in a certain group... to die."

According to the study, the median relative survival rate for the patients -- those who underwent the surgery and those who didn't -- increased from 9 percent in 1988 to 18 percent in 2009.

Chang added that the median survival time -- not the average -- has risen from fewer than 10 months to two years because of improvements in treatment. The researchers did note that the survival picture may also have brightened because new and better drugs have entered the treatment picture since 1988, including Avastin (bevacizumab), Erbitux (cetuximab) and Xeloda (capecitabine).

In the big picture, the study suggests that the tumor surgery "may still be overused," even though its use has fallen.

What should happen to patients with stage 4 cancer? Sarin, a colon and rectal surgeon, said, "Chemotherapy does not cure metastatic colorectal cancer, but it can improve symptoms and prolong life."

As for surgery, Chang said it may provide some benefit in terms of improving symptoms, but only in certain cases.

Why hasn't surgery become even more uncommon in these patients? "Practices vary considerably in different settings," Sarin said, "and recent research takes time to filter to community hospitals and to non-specialist surgeons."

As for patients who are wondering what to do, Sarin said they need to make sure they're being treated in a way that utilizes treatments like chemotherapy, surgery and radiation as needed "based on the specifics of their cancer and their individual circumstances."

The study is published online Jan. 14 in the journal JAMA Surgery.

More information

For more about colon cancer, try the American Cancer Society.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: George Chang, M.D., associate professor, departments of surgical oncology & health services research, chief, colon and rectal surgery, associate medical director, Colorectal Center, and director, clinical operations, Minimally Invasive and Ne...

Race, Ethnicity Affect Breast Cancer Survival, Study Shows
January 13, 2015


TUESDAY, Jan. 13, 2015 (HealthDay News) -- Your chances of being diagnosed with early breast cancer, as well as surviving it, vary greatly depending on your race and ethnicity, a new study indicates.

"It had been assumed lately that we could explain the differences in outcome by access to care," said lead researcher Dr. Steven Narod, Canada research chair in breast cancer and a professor of public health at the University of Toronto. In previous studies, experts have found that some ethnic groups have better access to care.

But that's not the whole story, Narod found. His team discovered that racially based biological differences, such as the spread of cancer to the lymph nodes or having an aggressive type of breast cancer known as triple-negative, explain much of the disparity.

"Ethnicity is just as likely to predict who will live and who will die from early breast cancer as other factors, like the cancer's appearance and treatment," Narod said.

In his study, nearly 374,000 women who were diagnosed with invasive breast cancer between 2004 and 2011 were followed for about three years.

The researchers divided the women into eight racial or ethnic groups and looked at the types of tumors, how aggressive the tumors were and whether they had spread.

During the study period, Japanese women were more likely to be diagnosed at stage 1 than white women were, with 56 percent of Japanese women finding out they had cancer early, compared to 51 percent of white women.

But only 37 percent of black women and 40 percent of South Asian women got an early diagnosis, the findings showed.

When the researchers calculated the seven-year risk of death, black women had the highest risk, with a 6 percent death rate. South Asian women (Asian Indian, Pakistani) had the lowest, at less than 2 percent.

And black women were nearly twice as likely as white women to die following the diagnosis of small tumors, according to the study published Jan. 13 in the Journal of the American Medical Association.

The new research "makes significant strides in explaining the well-known racial disparities in breast cancer," said Dr. Bobby Daly, a hematology-oncology fellow at the University of Chicago Medical Center. He co-authored an editorial that accompanied the study.

"It makes strides in showing how the difference in survival may reflect intrinsic differences in the biology of the tumor," he added.

However, there still needs to be improvements in access to care, treating women according to established guidelines and avoiding treatment delays, Daly noted.

Regardless of race or ethnicity, women should be aware of any family history of breast cancer, be aware of other risk factors they may have, and obtain appropriate screening with mammograms, he said.

Women in minority groups must also be included in greater numbers in future research, the authors of the editorial said.

More information

To learn more about disparities in cancer survival, visit the U.S. National Cancer Institute.

Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Steven Narod, Ph.D., M.D., Canada research chair, breast cancer, and professor, public health, University of Toronto; Bobby Daly, M.D., hematology-oncology fellow, University of Chicago Medical Center; Jan. 13, 2015, Journal of the Americ...

Gene Mutations Linked to Colon Cancer in Black Patients
January 13, 2015


TUESDAY, Jan. 13, 2015 (HealthDay News) -- Researchers who discovered new gene mutations linked to colon cancer in black Americans say their findings could lead to improved diagnosis and treatment.

In the United States, blacks are significantly more likely to develop colon cancer and to die from the disease than other racial groups.

For the study, the researchers said they used DNA sequencing to examined 50 million bits of data from 20,000 genes. They said that determining gene mutations has been the driving force behind all the new drugs created to treat cancer in the last decade.

"Many of the new cancer drugs on the market today were developed to target specific genes in which mutations were discovered to cause specific cancers," study corresponding author Dr. Sanford Markowitz, an expert in the genetics of cancer at Case Western Reserve University in Cleveland, said in a university news release.

The investigators compared 103 colon cancer samples from black patients and 129 samples from white patients treated at University Hospitals Case Medical Center in Cleveland. They found 20 previously unknown gene mutations in the colon samples from black patients.

About 40 percent of colon cancers in black patients had one or more of these gene mutations, which were three times more common in colon cancers among blacks than among whites.

The findings were published in this week's issue of the Proceedings of the National Academy of Sciences.

"This is the first study to perform a comprehensive gene mutation characterization and comparison of these colorectal cancer tumors in two ethnicities -- African-American and Caucasian," lead author Dr. Kishore Guda, an assistant professor in General Medical Sciences (Oncology) at Case Comprehensive Cancer Center, said in the news release.

"Our next step will be to collaborate with other centers in investigating African-American populations in different regions of the United States to determine whether they also share the unique gene signature found in the Cleveland African-American community," Guda added.

Further research is needed to learn more about the behavior and effects of these mutations, including whether they're linked with more aggressive colon cancer, the study authors said.

More information

The American Cancer Society has more about colon cancer.
Copyright © 2015 HealthDay. All rights reserved.

SOURCE: Case Western Reserve University, news release, Jan. 12, 2015...

As Altitude Rises, Lung Cancer Rates Seem to Fall
January 13, 2015


TUESDAY, Jan. 13, 2015 (HealthDay News) -- Americans who live in the mountains seem to have lower rates of lung cancer than those closer to the beach -- a pattern that suggests a role for oxygen intake, researchers speculate.

Their study of counties across the Western United States found that as elevation increased, lung cancer rates declined.

For every 3,300-foot rise in elevation, lung cancer incidence fell by more than seven cases per 100,000 people, researchers reported Jan. 13 in the online journal PeerJ.

No one is saying people should head to the mountains to avoid lung cancer -- or that those who already live there are in the clear.

"This doesn't mean that if you live in Denver, you can go ahead and smoke," said Dr. Norman Edelman, senior medical advisor to the American Lung Association.

It's not even certain that elevation, per se, is the reason for the differing lung cancer rates, said Edelman, who was not involved in the research.

"But this is a really interesting study," he said. "It gives us useful information for further research."

Kamen Simeonov, one of the researchers on the study, agreed. "Should everyone move to a higher elevation?" he said. "No. I wouldn't make any life decisions based on this."

But the findings do support the theory that inhaled oxygen could have a role in lung cancer, said Simeonov, a graduate student in the bioinformatics program at the University of California, San Francisco.

As elevation increases, air pressure dips, which means people inhale less oxygen, Simeonov explained. And while oxygen is obviously vital to life, the body's metabolism of oxygen can have some unwanted byproducts -- namely, reactive oxygen species.

Over time, those substances can damage body cells and contribute to disease, including cancer.

Some recent research on lab mice has found that lowering the animals' exposure to oxygen can delay tumor development. But no one knows whether taking in less oxygen would affect humans' cancer risk.

According to Edelman, the oxygen theory has some "biological plausibility." But for now, it's just a theory, he said.

Of course, it's not just oxygen that varies by elevation.

Simeonov said he and colleague Daniel Himmelstein, also an M.D./Ph.D. trainee at University of Pennsylvania, tried to account for other variables, such as county-by-county differences in sunlight exposure and air pollution -- neither of which explained the link between elevation and lung cancer.

Nor did rates of smoking or obesity, or differences in counties' demographics, including education and income levels, and racial makeup.

"We asked, can anything explain this better [than elevation]?" Simeonov said. "And nothing else even came close."

What's more, he said, there was no strong correlation between elevation and rates of several non-respiratory tumors: breast, prostate and colon cancers. That, said Simeonov, suggests an "inhaled" risk factor is at work.

He was quick to add, though, that no study can account for all the variables that sway cancer risk.

A next step, said Simeonov, could be a "cohort study," analyzing data from individual people, as opposed to this county-by-county look. But it would take lab research to figure out whether oxygen exposure, specifically, might affect lung cancer development.

For some, Edelman said, the current findings might raise another question: Could taking antioxidants help prevent lung cancer? Antioxidants include certain vitamins and other nutrients that help mop up reactive oxygen species in the body.

However, Edelman stressed, "You can't make a leap like that from this study."

There's some evidence, he noted, that a diet rich in antioxidants from fruits and vegetables may help curb lung cancer risk.

On the other hand, a recent study in mice found that antioxidant supplements sped up the progression of lung cancer.

According to the American Lung Association, the best ways to cut your lung cancer risk are to avoid tobacco smoke, including secondhand exposure; test your home for radon; and make sure you have the proper protection against any chemical exposures at work.

More information

The American Lung Association has more on lung cancer prevention.

SOURCES: Kamen Simeonov, graduate student, bioinformatics program, University of California, San Francisco; Norman Edelman, M.D., senior medical advisor, American Lung Association, New York City; Jan. 13, 2015, PeerJ, online...

Cluster of Heart Risk Factors Tied to Uterine Cancer Risk
January 13, 2015


TUESDAY, Jan. 13, 2015 (HealthDay News) -- A collection of health risk factors known as the "metabolic syndrome" may boost older women's risk of endometrial cancer, even if they're not overweight or obese, a new study suggests.

Metabolic syndrome refers to a group of health conditions occurring together that increase the risk of heart disease, stroke and diabetes. These conditions include high blood pressure, low levels of "good" HDL cholesterol, high levels of triglyceride fats, overweight and obesity, and high fasting blood sugar.

"We found that a diagnosis of metabolic syndrome was associated with higher risk of endometrial cancer, and that metabolic syndrome appeared to increase risk regardless of whether the woman was considered obese," Britton Trabert, an investigator in the division of cancer epidemiology and genetics at the U.S. National Cancer Institute, said in an American Association for Cancer Research news release.

The study's design only allowed the investigators to find an association between metabolic syndrome and endometrial cancer risk. The researchers couldn't prove whether or not metabolic syndrome directly causes this cancer of the uterine lining.

For the study, the researchers reviewed information on more than 16,300 American women diagnosed with endometrial cancer between 1993 and 2007. The study authors compared those women to more than 100,000 women without endometrial cancer.

Overall, metabolic syndrome was associated with a 39 percent to 103 percent increased risk of endometrial cancer in women 65 and older, according to the study. The reason for the variation in risk is that health groups have different definitions for metabolic syndrome.

Being overweight is a known risk factor for endometrial cancer. But, even after the researchers accounted for excess weight, metabolic syndrome was still linked to up to a 21 percent increased risk.

The authors also said that each condition that contributes to metabolic syndrome was independently associated with increased risk for endometrial cancer.

The study was published online Jan. 13 in Cancer Epidemiology, Biomarkers & Prevention.

"Although our study was not designed to evaluate the potential impact of preventing metabolic syndrome on endometrial cancer incidence, weight loss and exercise are the most effective steps a woman can take to prevent developing metabolic syndrome," Trabert added.

Nearly one-quarter of Americans without diabetes has metabolic syndrome, the researchers said.

More information

The U.S. National Cancer Institute has more about endometrial cancer.
Copyright © 2015 HealthDay. All rights reserved.

SOURCE: American Association for Cancer Research, news release, Jan. 13, 2015...

Health Highlights: Jan. 9, 2015
January 09, 2015


Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Two Ebola Vaccines Seem Safe: WHO
Two leading Ebola vaccines seem safe and clinical trials with healthy volunteers in West Africa will begin soon, according to the World Health Organization.
It says there is now enough data to show that the two most advanced Ebola vaccines have an "acceptable safety profile," the Associated Press reported.
One vaccine is made by GlaxoSmithKline and the other licensed by Merck and NewLink. Several other Ebola vaccines are being developed in the United States and elsewhere.
"(T)he cupboard (for Ebola vaccines) is filling up rapidly," Dr. Marie-Paule Kieny, who leads WHO's Ebola vaccine efforts, said at a media briefing Friday, the AP reported.


Teen's Rights Not Violated by Forced Chemotherapy: Court
A 17-year-old girl's rights are not being violated by forcing her to undergo cancer chemotherapy she says she doesn't want, the Connecticut Supreme Court ruled Thursday.
Jackie Fortin, the mother of the girl known in court documents only as Cassandra C., agreed with her daughter's decision to refuse chemotherapy for Hodgkin lymphoma. The teen will be able to make her own medical decisions when she turns 18 in September, the Associated Press reported.
Cassandra was diagnosed with cancer in September and doctors said chemotherapy would give her an 85 percent chance of survival. Without chemotherapy, she was almost certain to die within two years.
The girl is confined in a room at Connecticut Children's Medical Center in Hartford and being forced to undergo chemotherapy, the AP reported.
After the court's decision, Fortin and her lawyer said they are considering their next move. Fortin said she wouldn't allow her daughter to die, and just wants to see alternative treatment that doesn't include putting the "poison" of chemotherapy into her daughter's body.
After Cassandra's diagnosis in September, she missed several medical appointments. That led doctors to notify child welfare officials, who were granted temporary custody of the girl. She underwent two days of chemotherapy in November but ran away for a week. Her treatment resumed in mid-December, the AP reported.


Bird Flu Prompts Poultry Quarantine in Washington State
An emergency quarantine for domestic poultry and eggs in the southeast part of Washington state has been implemented to control highly contagious bird flu, state officials say.
The quarantine that took effect Wednesday covers an area within 20 miles of two Benton County locations where backyard flocks of turkeys, chickens and ducks were found to have the disease, the Associated Press reported.
No poultry can be moved out of the quarantine areas, officials said.
The disease isn't dangerous to people, but is deadly to birds. The quarantine was implemented in an attempt to protect commercial poultry operations, the AP reported.Copyright © 2015 HealthDay. All rights reserved.


Advisers Endorse HPV Test for Cervical Cancer Checks
January 09, 2015


THURSDAY, Jan. 8, 2015 (HealthDay News) -- An HPV test recently approved by U.S. health officials is an effective way to check for cervical cancer, two leading women's health organizations said Thursday.

The groups said the HPV test is an effective, one-test alternative to the current recommendation of screening with either a Pap test alone or a combination of the HPV test and a Pap test.

However, not all experts are in agreement with the move: the largest ob-gyn group in the United States, the American College of Obstetricians & Gynecologists (ACOG) is still recommending that women aged 30 to 65 be screened using either the Pap test alone, or "co-tested" with a combination of both the HPV test and a Pap test.

The new, so-called interim guidance report was issued by two other groups -- the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology. It followed U.S. Food and Drug Administration approval last year of the cobas HPV test as a primary test for cervical cancer screening.

The HPV test detects DNA from 14 types of HPV -- a sexually transmitted virus that includes types 16 and 18, which cause 70 percent of cervical cancers.

The two medical groups said the interim guidance report will help health care providers determine how best to include primary HPV testing in the care of their female patients until a number of medical societies update their guidelines for cervical cancer screening.

"Our review of the data indicates that primary HPV testing misses less pre-cancer and cancer than cytology [a Pap test] alone. The guidance panel felt that primary HPV screening can be considered as an option for women being screened for cervical cancer," interim guidance report lead author Dr. Warner Huh said in a news release from the Society of Gynecologic Oncology. Huh is director of the University of Alabama's Division of Gynecologic Oncology

The FDA approved the cobas HPV test last April as a first step in cervical cancer screening for women aged 25 and older. Roche Molecular Systems Inc., headquartered in Pleasanton, Calif., makes the test.

Thursday's interim report recommends that primary HPV testing should be considered starting at age 25. For women younger than 25, current guidelines recommending a Pap test alone beginning at age 21 should be followed.

The new recommendations also state that women with a negative result for a primary HPV test should not be tested again for three years, which is the same interval recommended for a normal Pap test result. An HPV test that is positive for HPV 16 and 18 should be followed with colposcopy, a procedure in which the cervix is examined under illumination and magnification.

"The introduction of cervical cytology screening [the Pap test] was truly one of the great breakthroughs in medicine, and has saved countless lives," Dr. Herschel Lawson, chief medical officer at the American Society for Colposcopy and Cervical Pathology, said in the news release.

"We are lucky that we have so many tools available now to improve cervical cancer prevention efforts and afford patients options depending on their individual situations. We'll continue to work to find the best way to combine screening tools with other prevention efforts like HPV vaccines, for the early detection and treatment of cervical cancer," he said.

"The most important message for providers and the community is that women should be screened for cervical cancer. Screening saves lives," Lawson added.

However, experts at ACOG said Thursday that it's too early to move to an HPV test-only screening model. They are standing by their recommendation for a combination of the HPV test and the Pap smear.

The reason? HPV infection is common among younger women, and often resolves on its own, so a positive test result might lead to too many invasive follow-up tests. While it's possible that the HPV test "can" replace the Pap smear altogether, there's not enough evidence at this time to say that it "should," ACOG said.

HPV is thought to cause the majority of cervical cancers. Certain strains, such as HPV 16 and 18, are most strongly tied to these tumors. The virus also causes genital warts in both men and women and certain head and neck cancers.

The American Cancer Society estimates that there will be about 12,900 new cases of invasive cervical cancer diagnosed in 2015, and about 4,100 women will die from the disease.

According to the cancer society, cervical cancer was once a leading cause of cancer death for American women. But in the last three decades the death rate has dropped more than 50 percent. The Pap test is the big reason cited for the decline.

The interim guidance report was published online Jan. 8 in the journals Gynecologic Oncology, the Journal of Lower Genital Tract Disease and Obstetrics and Gynecology.

More information

The U.S. National Cancer Institute has more about cervical cancer screening.

SOURCES: Society of Gynecologic Oncology, news release, Jan. 8, 2015; American College of Obstetricians and Gynecologists...

Health Highlights: Jan. 8, 2015
January 08, 2015


Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Teen's Rights Not Violated by Forced Chemotherapy: Court
A 17-year-old girl's rights are not being violated by forcing her to undergo cancer chemotherapy she says she doesn't want, the Connecticut Supreme Court ruled Thursday.
Jackie Fortin, the mother of the girl known in court documents only as Cassandra C., agreed with her daughter's decision to refuse chemotherapy for Hodgkin lymphoma. The teen will be able to make her own medical decisions when she turns 18 in September, the Associated Press reported.
Cassandra was diagnosed with cancer in September and doctors said chemotherapy would give her an 85 percent chance of survival. Without chemotherapy, she was almost certain to die within two years.
The girl is confined in a room at Connecticut Children's Medical Center in Hartford and being forced to undergo chemotherapy, the AP reported.
After the court's decision, Fortin and her lawyer said they are considering their next move. Fortin said she wouldn't allow her daughter to die, and just wants to see alternative treatment that doesn't include putting the "poison" of chemotherapy into her daughter's body.
After Cassandra's diagnosis in September, she missed several medical appointments. That led doctors to notify child welfare officials, who were granted temporary custody of the girl. She underwent two days of chemotherapy in November but ran away for a week. Her treatment resumed in mid-December, the AP reported.


Bird Flu Prompts Poultry Quarantine in Washington State
An emergency quarantine for domestic poultry and eggs in the southeast part of Washington state has been implemented to control highly contagious bird flu, state officials say.
The quarantine that took effect Wednesday covers an area within 20 miles of two Benton County locations where backyard flocks of turkeys, chickens and ducks were found to have the disease, the Associated Press reported.
No poultry can be moved out of the quarantine areas, officials said.
The disease isn't dangerous to people, but is deadly to birds. The quarantine was implemented in an attempt to protect commercial poultry operations, the AP reported.

Uninsured Rate Lowest in Years: Poll
The percentage of Americans without health insurance is at its lowest in years, a new Gallup poll finds.
In the last three months of 2014, 12.9 percent of adults did not have coverage, That's the lowest rate since Gallup started daily tracking of the uninsured in 2008, before President Barack Obama took office, the Associated Press reported.
A year ago, 17.1 percent of adults did not have health coverage. The 4.2 percent decrease since then works out to at least 10 million uninsured people getting coverage, some analysts estimate.
"The Affordable Care Act has accomplished one of its goals: increasing the percentage of Americans who have health insurance coverage," according to Gallup.
While some may credit the improving economy for the decreasing number of uninsured Americans, "it's hard to deny that the sharp reduction in the uninsured in 2014 was anything but the law," Gary Claxton, of the nonpartisan Kaiser Family Foundation, told the AP.
In related news, the Obama administration said Wednesday that nearly 103,000 people signed up for coverage last week in the 37 states where the federal government operates online health insurance markets.
That brings total enrollment for 2015 to 6.6 million in those states, according to the government. Other states are running their own health insurance exchanges.
The last day of open enrollment season in Feb. 15, and the Obama administration wants 9.1 million people signed up and paying premiums in 2015, the AP reported.
Measles Cases Linked to Disney Park Visits: California Officials
Seven people in California and two in Utah with confirmed cases of measles likely contracted the illness during visits to Disney theme parks in December, according to California health officials.
Another three other people in California are suspected to have the measles.
All of the people with confirmed or suspected measles visited Disneyland or Disney California Adventure in Orange County between Dec. 15 and Dec. 20. Officials believe a person with measles was at one of the theme parks at the time, CBS News/Associated Press reported.
The seven California residents with confirmed cases of measles range in age from 8 months to 21 years and are from five different parts of the state. Six of them had not been vaccinated against measles.


Herceptin May Benefit Some Women With Early Breast Cancer
January 07, 2015


WEDNESDAY, Jan. 7, 2015 (HealthDay News) -- For some women with early breast tumors, lower-dose chemotherapy and the drug Herceptin may help ward off a cancer recurrence, a new study suggests.

Experts said the findings, published in the Jan. 8 New England Journal of Medicine, could offer the first standard treatment approach for women in the early stages of HER2-positive breast cancer.

HER2 is a protein that helps breast cancer cells grow and spread, and about 15 to 20 percent of breast cancers are HER2-positive, according to the U.S. National Cancer Institute.

Herceptin (trastuzumab) -- one of the newer, so-called "targeted" cancer drugs -- inhibits HER2. But while Herceptin is a standard treatment for later-stage cancer, it wasn't clear whether it helps women with small, stage 1 breast tumors that have not spread to the lymph nodes.

Women with those cancers have a relatively low risk of recurrence after surgery and radiation -- but it's high enough that doctors often offer chemotherapy and Herceptin as an "adjuvant," or additional, therapy, explained Dr. Sara Tolaney, of the Dana-Farber Cancer Institute in Boston.

The challenge, Tolaney said, is balancing the potential benefits against the side effects. So for the new study, her team tested a low-intensity chemo regimen -- 12 weeks of a single drug, called paclitaxel -- plus Herceptin for one year.

The researchers found that women who received the drugs were highly unlikely to see their breast cancer come back over the next three years. Of the 406 study patients, less than 2 percent had a recurrence.

There was no control group that did not receive chemo and Herceptin for comparison. But the results are "better than expected," said Dr. Charles Shapiro, co-director of the Dubin Breast Center at Mount Sinai Hospital in New York City.

Shapiro, who was not involved in the study, said it's still not clear what the benefits could be in the longer term.

"Three years of follow-up is short," he said. "Time will tell if there are late recurrences."

In other studies of women with small breast tumors (up to 1 inch across), recurrence rates over five years have ranged widely -- from 5 to 30 percent, Tolaney said.

"With the regimen used in this study, there were very few recurrences and low toxicity," Tolaney said. "So it seems like a reasonable option."

Another oncologist not involved in the study agreed. "This is certainly an option for discussion," said Dr. Paula Klein, also of Mount Sinai.

But that discussion does need to cover the downsides, too, Klein added.

Herceptin is not an easy regimen. It's given by IV, usually once a week for a year, and the common side effects include fever, nausea, vomiting and infection.

There can also be more serious risks. Herceptin can damage the heart, sometimes leading to potentially life-threatening cardiomyopathy (an enlarged heart) or heart failure, where the muscle begins to lose its pumping ability.

In this study, two women developed heart failure. Their heart function normalized once they stopped Herceptin, Tolaney said.

Another issue is price. The one-year course of Herceptin costs roughly $64,000, according to Genentech, the company that makes the drug and funded the current study.

Still, Shapiro said, the shorter-term effects for women with stage 1 cancer appear "exceedingly favorable."

One question for future studies, he added, is whether those patients can benefit from Herceptin alone, and forgo the chemo.

More information

The American Cancer Society has more on treating HER2-positive breast cancer.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Sara Tolaney, M.D., M.P.H., attending physician, medical oncology, Dana-Farber Cancer Institute, Boston; Paula Klein, M.D., assistant professor, medicine, hematology and medical oncology, Mount Sinai Icahn School of Medicine, New York City; Charl...

Strategy Might Thwart Resistance to a Common Prostate Cancer Treatment
January 07, 2015


WEDNESDAY, Jan. 7, 2015 (HealthDay News) -- Conventional wisdom has it that high levels of testosterone help prostate cancers grow.

However, a new, small study suggests that a treatment strategy called bipolar androgen therapy -- where patients alternate between low and high levels of testosterone -- might make prostate tumors more responsive to standard hormonal therapy.

As the researchers explained, the primary treatment for advanced prostate cancer is hormonal therapy, which lowers levels of testosterone to prevent the tumor from growing. But there's a problem: Prostate cancer cells inevitably overcome the therapy by increasing their ability to suck up any remaining testosterone in the body.

The new strategy forces the tumor to respond again to higher testosterone levels, helping to reverse its resistance to standard therapy, the researchers say.

If confirmed in several ongoing larger trials, "this could lead to a new treatment approach" for prostate cancers that have grown resistant to hormonal therapy, said lead researcher Dr. Michael Schweizer, an assistant professor of oncology at the University of Washington School of Medicine in Seattle.

"It needs to be stressed that bipolar androgen therapy is not ready for adoption into routine clinical practice, since these studies have not been completed," he said.

The report was published Jan. 7 in the journal Science Translational Medicine.

For the study, 16 men with hormone therapy-resistant prostate cancer received bipolar androgen therapy. Of these patients, seven had their cancer go into remission. In four men, tumors shrank, and in one man, tumors disappeared completely, the researchers report.

Overall, "50 percent of patients had declines in their PSA [prostate specific antigen] and 50 percent had shrinkage of their cancer," Schweizer said. PSA levels are a standard signal of prostate cancer activity, as measured in a blood test.

Senior study author Dr. Samuel Denmeade is co-director of the prostate cancer program at Johns Hopkins University in Baltimore. He believes the new approach has benefits beyond its effect on cancer cells. That's because restoring a man's testosterone levels also reduced the side effects of hormone therapy, which include mood swings and not being able to have intercourse.

"For the most part, men said they felt great," Denmeade said. "Most of the men felt like they had more energy. Men on hormone treatment who couldn't have sex could have sex again, so they were very happy about that."

And although testosterone levels alternated between high and low, the men seemed to tolerate the treatment well, he added.

Denmeade stressed that this treatment is not a cure, but a way to make men feel better and extend the time standard hormonal therapy remains effective. "Maybe men will live longer, but we don't know that yet," he said.

According to Denmeade, men enrolled in the study didn't have any symptoms from their cancer, such as pain, and had been on standard hormonal therapy for an average of four years. They had also suffered a side effect of standard hormonal therapy -- impotence -- for at least one year.

Bipolar androgen therapy is probably not for "men who have not [yet] had any treatment for prostate cancer," he added.

Moreover, the long-term effects or dangers of the therapy aren't yet known, he said. Only longer, larger trials will help uncover any risks associated with the treatment.

And one expert worries that alternating testosterone levels could actually shorten men's lives.

"A cancer cell could escape and grow, as happened in breast cancer when this method was tried with estrogen, causing early death," said Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston.

D'Amico agreed with the study authors that bipolar androgen therapy is not ready to be used in clinical practice and doctors should wait for the results of ongoing trials before offering it to men.

More information

For more information on prostate cancer, visit the American Cancer Society.
Copyright © 2015 HealthDay. All rights reserved.

SOURCES: Michael Schweizer, M.D., assistant professor, oncology, University of Washington School of Medicine, Seattle; Samuel Denmeade, M.D., co-director, prostate cancer program, Johns Hopkins University, Baltimore; Anthony D'Amico, M.D., Ph.D., chief, r...

Study Finds Link Between Cancer Diagnosis, Stroke Risk
January 07, 2015


WEDNESDAY, Jan. 7, 2015 (HealthDay News) -- Newly diagnosed cancer patients are at increased risk for stroke in the months after they find out they have the disease. And the risk of stroke is higher among those with more aggressive cancer, a new study says.

The findings come from an analysis of Medicare claims submitted between 2001 and 2009 by patients aged 66 and older who had been diagnosed with breast, colorectal, lung, prostate and pancreatic cancer.

Compared to cancer-free seniors, those with cancer had a much higher risk of stroke. And the risk was highest in the first three months after cancer diagnosis, when the intensity of chemotherapy, radiation and other treatments is typically highest, the researchers at Weill Cornell Medical College in New York City said in a college news release.

The risk of stroke was highest among patients with lung, pancreatic and colorectal cancers, which are often diagnosed at advanced stages. Stroke risk was lowest among those with breast and prostate cancers, which are often diagnosed when patients have localized tumors, the researchers said.

Cancer increases the risk of stroke independently of other stroke risk factors, such as high blood pressure and diabetes, according to the study published Jan. 7 in the journal Annals of Neurology.

The researchers didn't examine why cancer patients are at increased risk for stroke, but it's believed that cancer and its treatments affect blood vessels and the body's clotting system, causing the blood to thicken.

"These findings are relevant to patients and their care because stroke often leads to death and disability, especially if it is not quickly diagnosed and treated with clot-busting medicines," study first author Dr. Babak Navi, an assistant professor of neurology and neuroscience at Weill Cornell and a neurologist at Memorial Sloan Kettering Cancer Center, said in the news release.

"Patients and their doctors should be vigilant for symptoms and signs of stroke and should immediately call 911 if they occur. In addition, stroke is particularly relevant to cancer patients because strokes often preclude or delay cancer treatments, resulting in reduced survival," Navi said.

The new study found an association between a cancer diagnosis and risk of stroke, but it didn't prove cause and effect.

More information

The U.S. National Heart, Lung, and Blood Institute has more about stroke.
Copyright © 2015 HealthDay. All rights reserved.

SOURCE: Weill Cornell Medical College, news release, Jan. 7, 2015...

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