Health News for Late March 2008

Cancer

Obesity & Breast Cancer

A paper published in the March 15 issue of Clinical Cancer Research has found that inflammatory breast cancer (IBC) is seen more frequently in obese patients (45%) than in overweight patients (30%) or normal weight patients (15%), and that the more obese a patient is, the more aggressive the disease. In a March 14 news release, the study's senior author said, "This is the first study to highlight the value of BMI at the time of diagnosis as a prognostic indicator in women with aggressive disease and at a high risk of recurrence and at the time of diagnosis in locally advanced disease, including its most aggressive form, inflammatory breast cancer. We embarked on this research because the vast majority of our newly-diagnosed inflammatory breast cancer patients were overweight or obese, and IBC is associated with a poor prognosis." Both overall survival and recurrence-free survival are significantly worse for overweight and obese patients, compared to those who were of normal weight or underweight. (IBC is extremely aggressive, yet rare, representing only 1% to 2% of breast cancer cases diagnosed in the USA.)

Breast Cancer & Radiation Therapy

An article published early online on March 19 in The Lancet and The Lancet Oncology reports that for women with early breast cancer, a lower total dose of radiation, delivered in fewer, larger treatments is as effective as the international standard of a higher total dose delivered over a longer time. Additionally, a March 19 news release said, "After an average follow-up of five to six years, the rate of recurrence in the breast remained very low for patients in each of the treatment groups studied. The rate of side-effects were low overall, and no higher in women receiving the revised treatment than those receiving the international standard of 25 treatments."

Lung Cancer Surgery Outcomes

A study published in the March issue of The Annals of Thoracic Surgery has found that people who are undergoing lung cancer surgery tend to do better in teaching hospitals. The study concluded: "In-hospital mortality is reduced for patients undergoing lung cancer resections at teaching hospitals, with results prominent at all but the highest volume institutions. Lower mortality rates persisted at [Accreditation Council for Graduate Medical Education-approved general surgery] and [Accreditation Council for Graduate Medical Education-approved thoracic surgery] residency programs." The findings were based on 46,951 lung resections occurring between 1998 and 2004.

Finding the Source of a CUP

An article published online on March 23 in Nature Biotechnology has shown the potential of microRNA to be used as biomarkers for diagnosing the primary tumor site in patients with cancer of unknown primary (CUP) origin. (CUP is the diagnosis when a metastatic cancer is found, but the primary site can't be determined; about 2% to 4% of patients have a CUP.) Researchers examined 400 samples of 22 different tumor tissues and metastases, and were able to identify the source in two-thirds of the cases. For more information, see the press release from Rosetta Genomics.

Hormone Replacement Therapy & Breast Cancer

For some time, people have known that HRT increases the risk of breast cancer, but now researchers have found that there's also a greater risk of recurrence of disease in breast cancer survivors. Research published online on March 25 in the Journal of the National Cancer Institute concluded that after extended follow-up, there was a clinically and statistically significant increased risk of a new breast cancer event in survivors who took HRT.

Obese Women & Cancer Screening

A review of 32 cancer studies (10 breast cancer studies, 14 cervical cancer studies, and eight colorectal cancer studies) has found that obese women are less likely to have some types of cancer screening. For breast cancer, obesity was associated with decreased screening among white women but not among black women. For cervical cancer, there was an inverse relation between decreased screening and increasing body size, and several studies reported that the association was more consistent among white women than among black women. The results on a relationship between screening and weight were mixed for colorectal screening. The researchers wrote, "Overall, the results indicated that obesity most likely is a barrier to screening for breast and cervical cancers, particularly among white women; the evidence for colorectal cancer screening was inconclusive. Thus, efforts to identify barriers and increase screening for breast and cervical cancers may be targeted toward obese women, whereas outreach to all women should remain the objective for colorectal cancer screening programs." The paper was published online on March 24 in Cancer.

Future Tactic for Chemo?

A special feature published online on March 31 in Proceedings of the National Academy of Sciences suggests that a few days of fasting may be a way to help patients tolerate chemo better. In tests on mice, one group was fasted for 48 hours and another group was fed normally, then both were given a high dose of chemo. The high dose of chemo killed 43% of the mice that had been fed normally, but only one of the mice that had fasted. The mice that had not eaten regained their lost weight within four days. Test tube experiments using human cells confirmed the differential resistance of normal and cancer cells to chemotherapy after a short period of starvation. As explained in a March 31 press release from the University of Southern California, "(S)tarved cells go into what Longo [the lead researcher] calls a maintenance mode characterized by extreme resistance to stresses. In essence, the cells are waiting out the lean period, much like hibernating animals. But tumors by definition disobey orders to stop growing because the same genetic pathways are stuck in an 'on' mode." The lab is preparing to test the strategy in humans, and in the meantime, researchers warn that fasting before chemotherapy has unknown risks and benefits for humans, so people should not try this themselves.

Genes & Lung Cancer

Three studies, two in Nature and one in Nature Genetics, which were published online between April 2 and 3, have found genetic variations that increase the risk of lung cancer in smokers and former smokers. By studying the DNA of more than 60,000 people, researchers found a genetic variant on chromosome 15 that can boost a person's chances of developing lung cancer – if they have one copy of the variant, the chances increase by about 30% and if they have two copies, chances increase by about 80%. The research suggested that about half of the general population has one copy. The studies are: A variant associated with nicotine dependence, lung cancer and peripheral arterial disease, A susceptibility locus for lung cancer maps to nicotinic acetylcholine receptor subunit genes on 15q25, and Genome-wide association scan of tag SNPs identifies a susceptibility locus for lung cancer at 15q25.1.

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Diet & Weight Issues

Overeating, Genes, & Disease

An article published online on March 16 in Nature suggests that overeating disrupts entire networks of genes in a person's body, which causes conditions such as obesity, heart disease, and diabetes. They concluded, "(C)omplex traits such as obesity are emergent properties of molecular networks that are modulated by complex genetic loci and environmental factors."

Big Belly at 40 Increases Risk of …

If you're like most people, you may have thought "risk of …" metabolic syndrome, or diabetes, or cardiovascular problems, but did you think "dementia"!? An article published online on March 26 in Neurology concludes that: "Central obesity in midlife increases risk of dementia independent of diabetes and cardiovascular comorbidities." The findings were based on 6,583 people in northern California, who were tracked for an average of 36 years, starting when they were ages 40 to 45.

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Heart Health

Heart Attack Risk News

Five studies were presented this week at the American College of Cardiology's 57th Annual Scientific Session. In one, researchers reported that patients with coronary artery disease who reduced their anxiety levels or kept them steady were up to 60% less likely to have a heart attack or die compared to those who had an increased anxiety level. A second found that young heart attack victims (i.e., those <35 years) who continue to smoke are three times more likely to have future heart problems (e.g., cardiac death, a repeat heart attack, revascularization due to clinical deterioration) than those who quit – the increased risk was independent of treatment, other CV risk factors, and even function of the left ventricle. A third study reported that the anniversary of the death of a close family member, particularly a parent, is a strong trigger for sudden death, especially in men. The fourth study reported that while men are at greater risk for cardiovascular problems than women, the difference disappears when victims are morbidly obese. The final study said that individuals with heart failure have lower immune responses to flu vaccines when compared to healthy individuals of similar age.

Diabetes & Heart Attack Risk

A paper published online on March 31 in Circulation has found that diabetics aged 30 or older who required glucose-lowering therapy, exhibited a cardiovascular risk comparable to non-diabetics with a prior MI, regardless of sex and diabetes type.

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Babies & Children

Hyperactive Girls

A paper published in the March issue of Archives of General Psychiatry looked at 881 females to age 21, who provided self-reports of substance use problems, criminal behaviors, aggression in intimate relationships, early pregnancy, educational attainment, and welfare assistance. Researchers found that girls with high hyperactivity were significantly more likely to report nicotine use problems, mutual psychological aggression in intimate relationships, and low educational attainment than other females. Those who were determined to have high hyperactivity and high physical aggression were significantly more likely to report physical aggression and psychological aggression in intimate relationships, early pregnancy, and welfare assistance than other females. As a result, the researchers recommended that elementary school girls with elevated levels of hyperactivity should be targeted for intensive prevention programs, which should take into account the presence or absence of physical aggression.

Preemies

A contribution published in the March 26 issue of The Journal of the American Medical Association, which looked at 1,167,506 people born in Norway between 1967 and 1988, concluded that preterm birth was associated with diminished long-term survival and reproduction. Preterm women were at increased risk of having preterm children. A March 26 news release about the research also said, "Preterm birth contributes to several long-term quality of health issues, including lower educational achievement, lower rates of reproduction, and an increase in the likelihood that future offspring will be born preterm and with complications." Lead author, Dr. Geeta Swamy, a maternal-fetal medicine specialist at Duke said, "Preterm survival is improving now because of interventions we have in pregnancy and neonatal care. However, it may be that we're improving survival while adversely affecting the overall health and quality of life in the long run."

Preemies & Autism Risk?

A paper published in the April issue of Pediatrics, which looked at a group of 91 preterm infants (≤1500g), has found that 26% had a positive result on the autism screening tool. The authors concluded: "Early autistic behaviors seem to be an under-recognized feature of very low birth weight infants. The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results."

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American Healthcare

Social Security Funding in the USA

The Social Security Board of Trustees released its annual report on the financial health of the Social Security Trust Funds on March 25. In a news release, they announced four major findings: the projected point at which tax revenues will fall below program costs comes in 2017 (the same as the estimate in last year's report); the projected point at which the Trust Funds will be exhausted comes in 2041 (the same as the estimate in last year's report); the projected actuarial deficit over the 75-year long-range period is 1.70% of taxable payroll (down from 1.95% in last year's report); over the 75-year period, the Trust Funds would require additional revenue equivalent to $4.3 trillion in today's dollars to pay all scheduled benefits.

Doctors & Universal Healthcare for Americans

An article entitled "Support for National Health Insurance among U.S. Physicians: 5 Years Later," which was published in the April 1 issue of Annals of Internal Medicine reports that of more than 2,000 doctors surveyed, 59% said they support legislation to establish a national health insurance program, while 32% said they opposed it. The last survey, in 2002, found that 49% were in favor and 40% opposed.

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Miscellaneous

"We Need Some New Blood Around Here …"

An article published in the March 20 issue of The New England Journal of Medicine has found that fresher blood makes for better survival in cardiac surgery patients. Researchers found that transfusion of red cells that had been stored for more than two weeks was associated with a significantly increased risk of postoperative complications as well as reduced short-term and long-term survival in cardiac surgery patients. The findings were based on 6,002 patients who had undergone CABG, heart-valve surgery, or both between June 30, 1998, and January 30, 2006 at the Cleveland Clinic Foundation.

Pain After Traumatic Injury

Research published in the March issue of Archives of Surgery looked at 3,047 patients between the ages of 18 to 84 years who were admitted to the hospital because of acute trauma and survived to 12 months after injury. Among these patients, 62.7% reported injury-related pain a year later, and most of these had pain in more than one area. Interestingly, the reported presence of pain varied with age and was more common in women and those who had untreated depression before injury, and lower pain severity was reported by patients with a college education and those with no previous functional limitations.

Cloning to Treat Parkinson's in Mice

A brief communication published online on March 23 in Nature Medicine reports that researchers have treated mice with Parkinson's using their own cloned cells, and that the mice showed significant signs of improvement after treatment. According to a March 23 news release, "The scientists used skin cells from the tail of the animal to generate customized or autologous dopamine neurons – the missing neurons in Parkinson's disease. The mice that received neurons derived from individually matched stem cell lines exhibited neurological improvement. But when these neurons were grafted into mice that did not genetically match the transplanted cells, the cells did not survive well and the mice did not recover."

Assessing the Safety of Singulair

The Food and Drug Administration announced on March 27 that they were working with the pharmaceutical company Merck to evaluate a possible link between the use of Singulair and behavior/mood changes, suicidality, and suicide. Singulair is used to treat asthma and the symptoms of allergic rhinitis (sneezing, stuffy nose, runny nose, itching of the nose), as well as to prevent exercise-induced asthma. Singular received FDA approval in 1998.

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