Health News for Late April 2008

Cancer

Location of Melanoma & Patient Outcome

A study published in the April issue of Archives of Dermatology has found that melanoma appearing on the neck or scalp is more deadly than melanoma appearing on other areas of the body, with patients experiencing scalp or neck melanomas dying at nearly twice the rate of those with melanoma elsewhere. Melanomas on the extremities, face, or ears had the best prognosis. In an April 21 news release, the study's senior author said, "Only six percent of melanoma patients present with the disease on the scalp or neck, but those patients account for 10 percent of melanoma deaths. That's why we need to take extra time to look at the scalp during full-skin examinations. … We think there's something different about scalp and neck melanomas. … This gives us directions for research to look at tumor cell types in those areas at the molecular level and to see if there are differences." The findings were based on 51,704 non-Hispanic white Americans who had been diagnosed with melanoma between 1992 and 2003.

Cancer Survivors & Physical Activity

An article published online on April 21 in Cancer looked at data from the Canadian Community Health Survey, which consisted of computer-assisted interviews of 114,355 individuals. In the survey, participants self-reported their cancer history, their height and body weight to calculate BMI, and their participation in various leisure activities. The findings indicate that fewer than 22% of Canadian cancer survivors were physically active (compared to 25% in the general population) and over 18% were obese (compared to 15% in the general population). As a result, authors concluded that, "…(C)ancer survivors have low levels of physical activity and a high prevalence of obesity that, although comparable to the general population, may place them at higher risk for poorer disease outcomes."

Bisphenol A Risk(s)

As Canada bans import and sale of baby products made with bisphenol A (or BPA, a compound found in polycarbonate plastic), and chain retailers like Wal-Mart, Toys "R" Us, and Babies "R" Us say they will phase out baby products made with BPA , and the NTP has released a document warning of BPA's possible effects on human reproduction and development, a priority report published this month in Cancer Research provides another warning about the compound. Researchers in California have found that BPA can alter the activity of genes in normal breast cells in ways that resemble those found in aggressive breast cancers. They wrote, "Our assays show a biological 'fingerprint' of probable prior exposure to endocrine-disrupting agents, and suggest a scenario in which their presence in the microenvironmental milieu of high-risk breast tissue could play a deterministic role in establishing and maintaining tumor aggressiveness and poor patient outcome."

Cancer Drug & Brain Damage

Research published online on April 22 in the Journal of Biology has found that in tests on mice, clinically relevant concentrations of 5-fluorouracil (5-FU), which is a widely used chemo agent, were toxic for CNS progenitor cells and oligodendrocytes. They also found, "Unlike that caused by local irradiation, the degeneration caused by 5-FU treatment did not correlate with either chronic inflammation or extensive vascular damage and appears to represent a new class of delayed degenerative damage in the CNS."

International Cancer Genome Consortium

On April 29, research organizations from around the world announced the launch of the International Cancer Genome Consortium (ICGC), a collaborative project whose goal is to generate high-quality genomic data on up to 50 types and subtypes of cancer, which will be prioritized by impact, including incidence and mortality rates, availability of therapies, and age of onset; scientific interest; and feasibility. The project, which is estimated to take up to a decade to complete, will make its data rapidly and freely available to the international research community. According to the news release, each ICGC member intends to conduct a comprehensive, high-resolution analysis of the full range of genomic changes in at least one specific type or subtype of cancer, and each project is expected to involve specimens from approximately 500 patients and cost an estimated US$20 million. One of the ICGC's roles will be to facility exchange of information, so work is not duplicated. ICGC's secretariat is headquartered in Toronto, and has participants in Australia, China, France, India, Japan, Singapore, the United Kingdom, and the United States. The news release states that the ICGC "…is one of the most ambitious biomedical research efforts since the Human Genome Project. The consortium will help to coordinate current and future large-scale projects to understand the genomic changes involved in cancer. This genomic information will accelerate efforts to develop better ways of diagnosing, treating and preventing many types of cancer."

Aspirin to Help Fight a Form of Breast Cancer

A study published on April 30 in BioMed Central's Breast Cancer Research has found that daily aspirin use was associated with a modest reduction in ER+ breast cancer risk.

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Cardiovascular Health

Mapping Metabolism for Cardiovascular Health

Researchers studied the urine samples of 4,630 people from population samples in the US, UK, Japan, and China, and are creating a map of metabolism throughout the world to gain insight about blood pressure. They've found that blood pressure patterns are not only about genetics, but about diet, lifestyle, and gut microorganisms. The findings were published online on April 20 in Nature.

Cardiac Stem Cells

A letter published on April 23 in Nature reports that a team of Canadian, American, and British scientists have used human embryonic stem cells to grow immature heart cells, known as progenitor cells, which can make the three major types of human heart cells – cardiomyocytes, endothelial cells, and vascular smooth muscle cells. In an April 23 news release from Toronto's McEwen Centre for Regenerative Medicine, researcher Dr. Gordon Keller said, "The immediate impact of this is significant as we now have an unlimited supply of these cells to study how they develop, how they function and how they respond to different drugs. In the future, these cells may also be very effective in developing new strategies for repairing damaged hearts, following a heart attack." (For an article on cardiac stem cells, see: Stem Cell Therapy in Thailand.)

Thyroid Function & Heart Disease in Women

Research published in the April 28 issue of Archives of Internal Medicine has found that low thyroid function that is within the clinical reference range was positively and linearly associated with coronary heart disease mortality in women. They stated, "The results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal CHD."

Physical Activity, BMI, & Heart Disease in Women

An investigation published in the April 28 issue of Archives of Internal Medicine warns that exercise is not enough to eliminate the risk of heart disease in overweight women – they must slim down as well. The authors concluded, "The risk of CHD associated with elevated body mass index is considerably reduced by increased physical activity levels. However, the risk is not completely eliminated, reinforcing the importance of being lean and physically active." The findings were based on 38,987 individuals participating in the Women's Health Study.

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Preemies & Pregnancies

Kangaroo Care & Preemies

A paper published online on April 24 in BioMed Central Pediatrics looked at 61 preemies (28 to 31 weeks) in Level III NICUs, and found that skin-to-skin maternal contact decreases their pain response with heel lance procedures, though not as powerfully as in older preterm neonates. The preemies also experienced significantly shorter recovery time after the procedures, which is important in maintaining homeostasis.

Pregnant Women with Diabetes

Research published in the May issue of Diabetes Care reports that the number of pregnant women with preexisting diabetes has more than doubled from 1999 to 2005. Additionally, the study found that the number of diabetic teens giving birth grew fivefold during the period. The findings were based on 175,249 women aged 13 to 58 years who gave birth at 11 Kaiser Permanente hospitals in Southern California. In an April 27 press release, lead author Jean M. Lawrence said, "More young women are entering their reproductive years with diabetes, in part due to the fact that our society has become more overweight and obese. … My advice to women who have type 1 or type 2 diabetes and are thinking about becoming pregnant is: work with your health care professional to get your blood sugar in good control. If you are pre-diabetic or have type 2 diabetes and are overweight, work on reducing your weight by a few pounds before becoming pregnant." Women with pre-existing diabetes are more likely to have miscarriages, stillbirths, and babies with birth defects because they may have elevated blood sugar during the critical first trimester of pregnancy when the infants' organs are developing.

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Drugs

Diabetes Drug Risk

A paper published in the April 28 issue of Archives of Internal Medicine has found further evidence of a possible association between long-term use of thiazolidinediones (e.g., Avandia) and fractures, particularly of the hip and wrist, in diabetic patients.

Osteoporosis Drug Risk

Also from the April 28 issue of Archives of Internal Medicine is the finding that the use of alendronate (Fosamax) is associated with an increased risk of incident atrial fibrillation (AF). The study compared 710 women who had AF and 966 who did not, and found that using alendronate meant an 86% higher risk of new AF compared with never having used the drug.

Sharing Prescriptions

A paper published online on April 29 in the American Journal of Public Health, which was based on one-on-one interviews with 700 people, has found that 22.9% of subjects reported having loaned their medications to someone else and 26.9% reported having borrowed someone else's prescription. The drugs most commonly shared were allergy meds (e.g., Allegra), pain meds (e.g., Darvoset, OxyContin), and antibiotics (e.g., amoxicillin).

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Miscellaneous

Improving Shift Work?

A review of 26 studies, which was published in the May issue of the American Journal of Preventive Medicine, looked at employers' attempts to improve workers' health and work-life balance. They found three techniques that had a beneficial effect: switching from slow to fast rotation of shifts (i.e., rather than have six or seven days of one shift before a change, have three days), changing from backward to forward rotation of shifts (i.e., moving from days to evenings to nights, not vice versa, and not changing randomly), and allowing self-scheduling. The writers admitted, however, that there were concerns about the generalizability of the evidence, and the studies did not report on the impact of health inequalities.

General Surgeons in the USA

A longitudinal analysis published in the April issue of Archives of Surgery has found that the overall number of general surgeons per 100,000 population in the USA has declined by 25.91% during the past 25 years. Although the decline has been most marked in urban areas, more remote and rural areas continue to have significantly fewer general surgeons per 100,000 population.

Treating Trauma

Research published on April 22 in the Canadian Medical Association Journal, which was based on data collected from the Ontario Pre-hospital Advanced Life Support (OPALS) major trauma study, has found that getting major trauma cases to a hospital as quickly as possible – without providing ALS measures at the scene – is the best way to improve their chance of survival. Researchers found that after implementation of ALS training in the province in the mid-1990s, survival for those with the most severe traumatic injuries dropped from 60% to 51%. The study is the largest of its kind in the world, and included 2,867 major trauma patients, with approximately 21% in the severe injury category. In an April 21 news release, the lead OPALS investigator, Dr. Ian Stiell said, "Taken together, our results show that the impact of Advanced Life Support depends on the type and severity of the injury. … This has been suggested by several smaller studies, and some paramedic services have already restricted the use of ALS in severely injured patients. With the definitive OPALS results now in, I would expect that all paramedic services will carefully examine ALS procedures to ensure that patients get the best possible care."

When the Brain Switches to Default …

Research published online on April 21 in Proceedings of the National Academy of Sciences started with the idea that "Humans engaged in monotonous tasks are susceptible to occasional errors that may lead to serious consequences, but little is known about brain activity patterns preceding errors." Using several techniques, including functional MRI, researchers found that maladaptive brain activity changes started about 30 seconds before the error as the brain begins to "economize" effort in light of repetitive, monotonous tasks. "In particular, a coincident decrease of deactivation in default mode regions of the brain, together with a decline of activation in regions associated with maintaining task effort, raised the probability of future errors." As a result, the researchers hope to develop monitoring methods to help avoid errors in real-world situation. An example of a real-life situation: Pilots flying planes!

Gene Therapy for Leber's Congenital Amaurosis

Two articles published online on April 27 in The New England Journal of Medicine report that gene therapy for a rare genetic type of blindness, Leber's Congenital Amaurosis (LCA), has improved the vision of four patients in two small trials (three in one trial in the United States, one in another trial in the UK). In the US trial, researchers developed their own virus to deliver the corrective gene, and in the UK trial, researchers used a virus created by the company Targeted Genetics Corporation. LCA damages light receptors in the retina, and usually causes total blindness by the time a person is 30.

Blood Substitute Testing

An early release review published online on April 28 in The Journal of the American Medical Association looked at the association between manufactured cell-free hemoglobin-based blood substitutes (HBBSs) and the risk of MI and death in trials in different clinical settings. Researchers found, based on data from randomized controlled trials of five different HBBSs conducted over the last decade in elective surgery, trauma, and stroke patients, there was an overall 30% statistically significant increase in mortality risk, as well as a statistically significant 2.7-fold increase in MI risk.

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